Journal of clinical and diagnostic research

Efficacy of Pulmonary Rehabilitation in Pulmonary Tuberculosis Sequelae with Cystic Bronchiectasis and Pulmonary Hypertension

Pooja Ramesh Tiwari, Vishnu Diwakar Vardhan, Vishakha Tayade, Moli Jain

Cystic bronchiectasis, also known as saccular bronchiectasis (a severe type of bronchiectasis), is a condition that occurs as a complication and sequelae after pulmonary Tuberculosis (TB). There is chronic permanent dilation of bronchi that occurs after destructive changes in elastic and muscular layers of bronchial walls which further leads to the ballooning of bronchi and difficulty in clearing secretions with recurrent infection of the respiratory tract. Pulmonary hypertension is another major complication after bronchiectasis which affects pulmonary circulation. A 44-year-old female reported to the physiotherapy department with cystic bronchiectasis and pulmonary hypertension. The positive symptoms were chronic cough with mucoid sputum, low-grade fever, chest pain, breathlessness (modified Medical Research Council (mMRC) grade III), and easy fatiguability. The goals were set and inpatient Pulmonary Rehabilitation (PR) started with the aim of reducing burdening of symptoms and promoting the Quality of Life (QoL). The therapeutic interventions were splinted coughing techniques, deep breathing exercises, thoracic expansions, postural correction exercises, dyspnoea relieving positions, strength training, and pacing techniques. After rehabilitation the ventilation along with strength improved, dyspnoea was reduced, and exercise tolerance was increased.

Management of Accidental Chin Staining following Silver Diamine Fluoride Application in a 24-month-old Girl: A Case Report

Vipul Chandraprakash Lodha, Laresh N Mistry

Silver Diamine Fluoride (SDF) is a clear liquid that combines the remineralising effects of fluoride with the antibacterial effects of silver. It is a promising therapeutic agent for managing carious lesions in young children and those with special care needs. However, a major complication of SDF is black staining of the skin, mucosa, lips, tongue, and cheeks if improperly applied. This case report presents a complication following SDF application and its management. A 24-month-old girl presented with decayed teeth in the upper back tooth region of the jaw, and SDF application was performed on tooth no. 54 and 64. However, due to the child’s extremely negative behavior and movement during the application of SDF, staining occurred on the chin and lower lip a few hours later. Watchful observation, patient reassurance, and follow-up led to adequate patient management.

Primary (Idiopathic) Non-pancreatic Retroperitoneal Pseudocyst in a Young Female: A Rare Case Report

Abhay M Philip, Leo F Tauro

Retroperitoneal Cysts (RPC) are uncommon, with an estimated incidence of 1 in 5,750 to 1 in 250,000. A 26-year-old woman presented with dull aching, non-radiating pain in the upper abdomen for the past two months, with no aggravating or relieving factors. On clinical examination of the abdomen, a grossly visible mass measuring approximately 10×10 cm with a smooth surface, firm consistency, and well-defined borders was observed in the left lumbar and iliac region. Contrast-Enhanced Computed Tomography (CECT) of the abdomen and pelvis revealed a well-circumscribed cystic lesion measuring 9.3×9.5×5.5 cm in the left lumbar region near the tail of the pancreas. The pancreas appeared normal with no surrounding fat stranding or inflammatory changes. Peripheral enhancement and peripheral wall calcification were observed. The patient underwent laparotomy and cyst excision. Intraoperatively, the cyst was found to arise from the retroperitoneum located in the lesser sac. It was dissected out from the tail of the pancreas, and no obvious communication with the pancreas was observed. The cyst was excised completely. Histopathological examination revealed a cyst with absent endothelium, suggestive of a pseudocyst. Previous literature reports indicate that RPCs are very rare and are often discovered incidentally. Patients may be asymptomatic or present with vague symptoms. Imaging can help diagnose these lesions, but surgery is crucial in confirming the diagnosis.

Endovascular Management of Ruptured Renal Angiomyolipoma: A Case Report

Sambhaji Pawal, Rahul Arkar

Renal angiomyolipoma is classified as a benign tumour comprising fat, smooth muscle cells, and vascular tissue. Renal giant angiomyolipoma with rupture is a relatively rare clinical emergency condition. Here, the authors present a case of a 37-year-old female patient who presented with complaints of right flank pain for six hours. The patient was anaemic and did not have haematuria. On non contrast Computed Tomography (CT) imaging, there was a right perirenal haematoma with a mixed-density, fat-containing tumour in the upper interpolar region of the right kidney. On Contrast-Enhanced Computed Tomography (CECT) imaging, the right renal tumour showed multiple abnormal tortuous vessels with moderate to intense enhancement, consistent with a large angiomyolipoma. She was managed with primary therapeutic endovascular embolisation for a ruptured right renal angiomyolipoma under local anaesthesia via a right transfemoral artery approach. The procedure was uneventful, and postembolisation syndrome was managed with medications. The patient was discharged in a stable condition. During the one-month follow-up, the patient’s symptoms improved, and the need for major surgery like nephrectomy was avoided. Super selective embolisation to devascularise the tumour and preserve renal parenchyma was done under local anaesthesia via a right transfemoral approach without any complications. Postembolisation syndrome was managed medically.

Endometrial Stromal Sarcoma in a Young, Nulliparous Woman: A Case Report

S Subhasri, K Nivedita, N Noorul Nasheeha, K Rajkumar, V Sriram

Endometrial stromal tumours are tumours of endometrial stromal origin and are classified into Endometrial Stromal Nodule (ESN), Low-Grade Endometrial Stromal Sarcoma (LG-ESS), and High-Grade Endometrial Stromal Sarcoma (HG-ESS). LG-ESS and HG-ESS are rare tumours, accounting for 1% of uterine malignancies and 10% of uterine sarcomas. These tumours commonly occur in perimenopausal women between the ages of 45 and 50 years. Their incidence is rare in younger women. Endometrial stromal tumours are usually confused with leiomyoma, uterine Leiomyosarcoma (LMS), or other sarcomas. The authors here present a case report of a 28-year-old nulligravid patient who presented with a history of heavy menstrual bleeding and dysmenorrhea for a duration of six months. Ultrasonography of the abdomen and pelvis suggested fibroid with degenerative changes, and Magnetic Resonance Imaging (MRI) indicated leiomyoma variants such as: i) Stromal Tumours of Uncertain Malignant Potential (STUMP)/atypical/cellular leiomyoma; ii) myxoid degeneration of leiomyoma. To arrive at a definitive diagnosis, myomectomy was performed considering the woman’s young age and nulliparity. Histopathology allowed for a differential diagnosis of LG-ESS, LMS, and cellular leiomyoma. Consequently, the patient underwent total abdominal hysterectomy with left salphingo opherectomy, right salpingectomy, and preservation of the right ovary. The definitive diagnosis is made by histopathological examination coupled with immunohistochemistry of the hysterectomy specimen. Hysterectomy is the definitive treatment of LG-ESS considering their ability to infiltrate and become malignant.

A Rare Case of Tuberculosis in the Lumbar Facet Joint

Vijayanand Balasubramanian, Parth Mehta, Rajavel Kalirajan

Tuberculosis of the posterior elements is a rare and destructive form characterised by the destruction of the lamina, pedicle, or facet joints. Delay in clinical diagnosis and presentation is common because of poor visualisation of facet joints in X-rays. A 55-year-old male presented with back and left leg pain lasting for six months, accompanied by weakness in dorsiflexion of the left foot and ankle. Magnetic Resonance Imaging (MRI) revealed features suggestive of L4-L5 facetal arthritis on the left side, including marrow oedema, bone erosions, a posterior paraspinal abscess, and nerve root compression. The patient underwent posterior decompression and stabilisation, along with abscess drainage. The specimen was sent for histopathological examination, confirming the diagnosis of facetal joint tuberculosis. Antituberculous treatment was given for 12 months, that showed improved neurological status. This case is presented due to its rarity, highlighting the importance of considering facetal joint tuberculosis as a potential cause in cases of progressively increasing lower back pain, even in the absence of constitutional symptoms.

Reversible Cerebral Vasoconstriction Syndrome along with Posterior Reversible Encephalopathy Syndrome in a Postnatal Eclamptic Patient: A Case Report

Nainita Patel, Kamlesh Chaudhari, Apoorva Dave

Reversible Cerebral Vasoconstriction Syndrome (RCVS) and Posterior Reversible Encephalopathy Syndrome (PRES) are rare neurological disorders. Although rare, the diagnosis of these conditions is now possible due to increased clinical awareness and the availability of newer generation diagnostic methods such as Magnetic Resonance Imaging (MRI). The rarity of their occurrence can sometimes lead to misleading diagnoses, as both illnesses rarely coexist and share certain clinical and radiological characteristics. RCVS progresses rapidly and can result in chronic impairment or even in-hospital mortality in 5-10% of cases. On the other hand, PRES is a monophasic and reversible illness, although there have been instances of recurrence. In this case report, the authors present the case of a 22-year-old female who presented with post-natal seizures and severe headaches, suspected to have RCVS along with PRES. Since RCVS and PRES share some overlapping pathophysiological conditions, the findings of MRI, including Fluid-Attenuated Inversion Recovery (FLAIR), CR-Magnetic Resonance Angiography (MRA), Apparent Diffusion Coefficient (ADC), and Diffusion-Weighted Imaging (DWI), along with their correlation with clinical features, can help in differentiation. Vasoconstriction has been reported as the main cause; hence vasodilators are primarily suggested for controlling seizures. The patient survived and showed improvement. Initially, the patient was monitored every 15 days for one month, followed by monthly follow-ups up to 8 months after discharge. The purpose of presenting this case is to enhance understanding of RCVS with PRES, including associated risk factors, which can lead to better outcomes through timely diagnosis. Improved outcomes can be achieved through early recognition and improved clinical management.

Primary Breast Carcinoma in Accessory Axillary Breast Tissue: A Case Report

Vikas Goyal, Paras Kumar Pandove, Ramandeep, Parveen Kumar

Accessory axillary breast carcinoma is unusual, with an incidence of 0.2 to 0.6%. It is commonly located in the axilla; however, it may be seen anywhere along the milk line. Development is hormone-dependent, similar to normal breast tissue. Here, a 65-year-old postmenopausal multiparous woman presented at the Surgery Outpatient Department (OPD) with a complaint of a lump in her left axilla with multiple overlying skin ulcers for the past four months. A routine bilateral mammogram was performed, which showed a well-defined hypoechoic area measuring 1.2×1.0 cm with no lymph nodes and calcification over the left accessory breast tissue. A wedge biopsy of the lesion revealed Invasive Ductal Carcinoma (IDC). She underwent a left modified radical mastectomy with an extended incision to the left axilla. She also received neoadjuvant chemotherapy with close follow-up. Recent studies suggest that there is no additional advantage with mastectomy over total excision of accessory breast tissue. Axillary clearance is performed if preoperative lymph node biopsy is positive. Early diagnosis and differentiation of accessory breast cancer are the keys to the effective management of the cancer.

Diagnosis of Hepatocellular Carcinoma through Telehealth: A Unique Case Report

Mubasheer Ali, Ayesha Nazneen, Prashant Janjal

Hepatocellular Carcinoma (HCC) is common among individuals with cirrhosis, regardless of the cause, but rare in those without cirrhosis. While HCC typically spreads to lymph nodes in the abdomen, lungs, and bones, metastasis to the cardiac region is relatively uncommon. Early screening and diagnosis are crucial for determining the feasibility and prognosis of HCC treatment. In addition to well-known causes such as alcohol consumption and viral hepatitis B and C, Non alcoholic Fatty Liver Disease (NAFLD) is emerging as a significant risk factor for cirrhosis, steatosis, and advanced liver fibrosis, contributing to the rise in HCC cases due to the increasing prevalence of metabolic syndrome. The present case report highlights a 71-year-old patient with HCC who was able to receive a timely diagnosis through telemedicine and initiate treatment with an oncologist. The patient underwent Intensity Modified Stereotactic Radiotherapy (IMSR) followed by bridge therapy with chemotherapy drugs. The treatment plan was implemented in July 2022, and the patient tolerated it well, remaining haemodynamically stable with no complaints.

Gastropancreatic Fistula in Acute Necrotising Pancreatitis with Septicaemia: A Case Report

Acute Pancreatitis (AP) is an inflammatory condition with cumbersome side effects. Gastrointestinal (GI) fistula is a rare complication seen in cases with infected pancreatic or peripancreatic necrosis. GI fistulas can result in severe haemorrhage and septicemia. Hereby, the authors present a case of 36-year-old male with a chief complaint of abdominal pain associated with abdominal distension and non bilious vomiting after binge consumption of alcohol for the past 10 days. Computed Tomography (CT) scan showed the presence of free gas in the abdomen. Contrast-Enhanced CT (CECT) imaging revealed diffuse enlargement affecting the head, uncinate process, body, and tail of the pancreas. There were also a few necrotic peripancreatic fluid collections with extensive peripancreatic fat stranding. Based on these findings, the diagnosis of acute necrotising pancreatitis was suggested. Despite treatment with antibiotics and necrosectomy with drainage of the abscess collection, the patient showed no improvement. A repeat CECT examination was performed due to the deterioration of the patient’s clinical condition, which showed a complete non enhancing pancreas. Additionally, a large defect measuring approximately 16 mm was observed in the posteroinferior wall of the stomach at the middle third of the body, with extravasation of contrast material into the pancreatic collection, suggestive of fistula formation. Subsequently, the patient underwent pancreatic necrosectomy with closure of the gastric perforation using feeding jejunostomy. A follow-up CT examination was performed four days later due to the deteriorating status of the patient, as well as new onset haematemesis and bloody discharge from the surgical drain. The CT scan revealed a few peripancreatic soft tissue infiltrates adjacent to the pancreatic head. Persistent collections were noted along the anterolateral surface of the right psoas, extending to the adjoining right anterior pararenal space and the left anterolateral abdominal wall in the left hypochondriac region. Thickening of the bilateral lateroconal fascia and anterior and posterior renal fascia was observed, likely due to inflammation. Following this, the patient underwent another surgery, and percutaneous drainage was performed with antibiotic coverage. The patient showed a significant reduction in the collection and improved clinical condition after 10 days. Imaging plays a crucial role in diagnosing such complications, enabling early detection and reducing mortality in these patients.

Levofloxacin-induced Fatal Hypoglycaemia in a Non-diabetic Patient: A Case Report

Yash N Panchal, Bhavesh M Vyas

Levofloxacin, a broad-spectrum, third-generation fluoroquinolone antibiotic, is rarely reported to cause life-threatening adverse effects, such as severe hypoglycaemia resulting in a coma. This case concerns hypoglycaemia in an elderly, non-diabetic patient induced by levofloxacin. A 61-year-old male patient was admitted with severe hypoglycaemia. Past medical history revealed treatment with levofloxacin for pneumonia. During the hospital stay, the patient was treated with multiple doses of 25 g dextrose 50% (D50), 2 doses of 1 mg glucagon, and a continuous infusion of dextrose 10% (D10). The patient was discharged on the sixth day of admission in a stable condition with no clinical symptoms. Clinicians must be aware of this lesser-known adverse effect to ensure quick recognition and treatment with the proper adjuncts.

Tube-within-Tube Technique during Emergency Intubation for the Unanticipated Difficult Airway in Low-resource Settings: A Case Report

Nidhi Panu

Emergency intubation can pose numerous difficulties for an anaesthesiologist, especially in unpredictable situations. A crucial aspect in trauma cases with a low Glascow Coma Scale (GCS) is to promptly and safely secure the airway. Patient and environmental factors further complicate the intubation process. The survival rate of patients is closely linked to successfully establishing a patent airway. Factors that hinder intubation include limited ability to assess the airway, inadequate equipment and positioning, lack of backup, challenging or insufficient preoxygenation, presence of other life-threatening conditions, and the risk of aspiration. Familiarity with alternative techniques and utilisation of all available aids can significantly reduce morbidity and mortality in settings with limited resources. The author presents a case report of a 26-year-old male patient with polytrauma and a head injury, presenting with a low GCS score, who required emergency intubation. This situation occurred unexpectedly in the triage area of the hospital. The ‘tube within tube’ intubation technique was effectively employed to achieve early and successful airway control in this resource-limited setting.

Aggressive Pilomatrixoma of the Scalp in a Geriatric Patient: A Rare Occurrence

Rakesh Rajiv Patkar, Vicky Jain, Shilpa Mishra

Pilomatrixoma is a benign cutaneous adnexal neoplasm that arises from the hair matrix. This lesion is typically observed in the first two decades of life, with most cases occurring before the age of 20. However, it is rare in the elderly. While aggressive and malignant variants of pilomatrixoma exist, they are rarely reported compared to their benign counterparts. In this case, we present an instance of aggressive pilomatrixoma in a 90-year-old female. The patient exhibited a large ulceroproliferative growth on the scalp. A preliminary biopsy was performed, followed by wide local excision. Both the biopsy and excision specimens exhibited characteristics of pilomatrixoma, with a focal infiltrative growth pattern and moderate nuclear atypia. Features indicative of malignancy, such as geographic necrosis, brisk mitosis, atypical mitosis, vascular invasion, and perineural invasion, were not observed. Therefore, the diagnosis of aggressive pilomatrixoma was made. Wide local excision and subsequent skin grafting were conducted, with no involvement of deeper subcutaneous tissue and intact pericranium. The patient is currently faring well during follow-up. This case underscores the importance of meticulous histopathological examination for distinguishing aggressive variants, as they carry a higher risk of recurrence and aid in distinguishing aggressive pilomatrixoma from carcinoma. Failure to recognise the aggressive variant may result in inadequate management.

Congenital Pulmonary Airway Malformation in a Two-month Old Infant: A Case Report

Sanket Bhadra, Ritu Rakholia, Ankit Kumar

Congenital Pulmonary Airway Malformations (CPAM) are rare clinical conditions that affect the lungs. They are characterised by the formation of large, multiloculated, cystic structures due to the overgrowth of the terminal bronchioles. This report presents the case of a two-month-old female infant who was referred to the pediatric emergency ward with a diagnosis of aspiration with collapse of the left lung. The patient exhibited progressively worsening respiratory distress accompanied by fever. The infant had a history of breast milk aspiration and had been admitted to the hospital multiple times due to respiratory distress since birth. Even after discharge, she required moist oxygen therapy at home. Upon presentation, a chest X-ray showed left lung collapse, and her respiratory rate was measured at 70 breaths/min. Other vital parameters and laboratory examinations were within normal limits. A high-resolution Computed Tomography (CT) scan of the thorax confirmed the diagnosis of CPAM. The patient was placed on ventilator support and received antibiotic treatment. Once stabilised, she underwent right postero-lateral thoracotomy with right middle and lower lobectomy under general anesthesia. Following surgery, she was discharged in stable condition on the seventh postoperative day, with her respiratory distress resolved. The child continues to receive regular follow-up care, including immunisations and appropriate nutritional support.

An Unusual Case of Post-traumatic Intramuscular Organised Haematoma of the Left Hand

Anji Reddy Kallam

An organised haematoma is a benign cystic lesion in which the haematoma is enclosed by a superficial fibrotic capsule. It is also referred to as chronic expanding haematoma or hematic cyst. Organised haematoma can be observed in various sites, but it is extremely rare to find it in an intramuscular location. This is a rare case of organised haematoma in the palm of the left hand of a 75-year-old female, which occurred after an accidental injury from broken bangles fifteen years ago. The swelling gradually increased in size and became painful over the years. A pre-operative Magnetic Resonance Image (MRI) revealed a well-defined, large soft tissue density lesion located in the subcutaneous plane of the interdigital space between the left thumb and index finger, extending into the volar and dorsal aspects of the hand. An incision was made on the skin over the swelling, followed by excision. The patient was discharged with a good post-operative outcome.

An Unusual Case Report of Adult Cervical Cystic Hygroma

Cystic Lymphangioma (CL) is a rare condition that is typically observed as a congenital malformation in the head and neck. These congenital lesions usually appear before the age of two. Adult occurrences are extremely unusual, and only a few cases have been mentioned in the literature. CL is characterised by the collection of an epithelial lining of lymphatic fluid, which can be caused by lymphatic abnormalities, trauma, or surgery. In the present case report, the authors present the findings of a 49-year-old adult female who had painless, gradually increasing left-sided neck swelling for three years, with no other relevant medical history. The initial ultrasound revealed a large cystic lesion extending from the left sternocleidomastoid muscle to the left submandibular gland. The lesion measured 8×7×3 cm and exhibited narrow septae and loculation at the periphery. Avascularity was noted within the cyst wall and interlobular septae. The diagnosis favoured macrocytic lymphangioma/Congenital Lymphangioma (CH). During the surgical procedure, the cyst was dissected, and it was found to be located over the internal jugular vein, carotid artery, and spinal accessory nerve. The cyst was completely removed, and a surgical drain was left in place. The wound was sutured in two layers, and a sterile dressing was applied. The drain was removed on the third postoperative day, and the dressing with sutures was removed on the seventh postoperative day, revealing a healthy wound. The diagnosis was confirmed by histopathological examination {Haematoxylin and Eosin (H&E)} of the tissue specimen, which showed flattened epithelium lining the inside of the cyst. The cyst contained dilated gaps in a fibrocollagenous stroma infiltrated by lymphocytes. Therefore, CH can be considered as a differential diagnosis for head and neck masses in adults.

Multidisciplinary Approach in the Management of Maxillary Anterior Region Dental Trauma: A Case Report

Deepshikha Mehrotra, Rajmohan Y Shetty, Amarshree A Shetty

Traumatic Dental Injuries (TDIs) to the maxillary anterior teeth occur frequently in paediatric and adolescent populations. Prompt diagnosis, correct treatment planning, and a multidisciplinary approach are pertinent aspects of successfully managing multiple TDIs in a patient. The present case report of a 13-year-old female patient describes a multidisciplinary approach necessary to successfully manage dental trauma of an avulsed maxillary central incisor and a complicated crown fracture involving the maxillary left lateral incisor in an adolescent. The complicated crown-root fracture was treated with endodontic therapy, followed by the placement of a fibre-reinforced post, core build-up, and the cementing of a porcelain-fused-to-metal crown. Bone grafting with a mandibular symphysis block autograft, followed by prosthetic rehabilitation with transitional implants, was performed to restore the aesthetics, form, and function of the avulsed maxillary central incisors. The use of osseointegrated implants has gained wide acceptance in the adult population. However, due to concerns regarding growth, their use in the paediatric population is not as common. This accounts for a scarcity of clinical cases reported in the literature. There are no established guidelines for the placement of implants in growing patients. Thus, authors believe that the present case report contributes to the literature on this subject. The treatment of this complex, multi-dental injury in the maxillary anterior region of a young female required a holistic approach with a step-wise progressive, long-term treatment plan. Traumatic injuries in adolescent patients can adversely impact their oral health-related quality of life if not treated correctly.

Air Leak Conundrum following Oesophagectomy: A Case Report and Review of Literature

Varun Kumar Agarwal, Amiy Arnav, Rohit Sharma, Ramakrishnan Shankaran

Oesophagectomy is an established technique for treating oesophageal cancer. Pulmonary complications during the postoperative period can arise from intraoperative manipulation, thoracic structure injury, or anastomotic leaks. At our institution, it is standard practice to place a soft corrugated drain around the anastomosis in the neck to facilitate the drainage of any anastomotic leakage towards the skin. In this case report, a 55-year-old female underwent video-assisted oesophagectomy in the prone position after neoadjuvant chemoradiation. A corrugated drain was subsequently placed near the anastomosis site in the neck. On the third day postoperatively (POD 3), she developed a sudden pneumothorax and an air leak in the chest tube. Despite the placement of a second intercostal tube and normal findings on fibreoptic bronchoscopy, the air leak persisted. Unexpectedly, the air leak spontaneously ceased, and the lungs re-inflated after 24 hours. Upon analysis, it was discovered that the dressing over the neck drain, which had been changed on POD 3, did not completely cover the wound. This, combined with malpositioning, created a one-way valve effect, leading to pneumothorax. Therefore, the use of a corrugated neck drain following oesophagectomy may result in life-threatening pneumothorax and should either be airtight sealed with dressing or avoided.

Verrucous Haemangioma with Histoid Leprosy: A Case Report

Verrucous Haemangioma (VH) is a rare, congenital vascular malformation of cutaneous and subcutaneous tissue. It usually presents as macular lesion at birth which progresses with age, and may become bluish papules, nodules, and warty plaques. Linear presentation of this disease is even rarer. Here the present case report presents a case of a 30-year-old male patient with multiple raised erythematous hyperkeratotic papules and plaques over right forearm since birth which was arranged in a linear pattern.The patient also had asymptomatic papules on right thigh and lower back region, associated with sensory loss and peripheral nerve thickening. Dermoscopy of forearm showed reddish-blue lacunae, alveolar pattern, and whitish veils. Colour Doppler showed intradermal dilated venous channels with thrombosis which was suggestive of haemangioma. Histopathological examination confirmed the diagnosis of linear VH on forearm and slit skin Ziehl-Neelsen staining was suggestive of histoid leprosy. Linear VH is a rare congenital venous malformation, progresses proportionately with age. Dermoscopy can help in early diagnosis of vascular lesions. Complete surgical excision is the treatment of choice.

Dorsal Lingual Lipoma (Yellow Epulis): A Case Report

Jignesh Gandhi, Pravin Shinde, Tarun Shetty, Aarsh Gajjar

Lipoma is a common soft tissue tumour. Its occurrence in the oral mucosa is rare, accounting for 1% to 5% of all benign oral tumours. Typically, it presents as an asymptomatic yellowish mass. The overlying epithelium remains intact, and superficial blood vessels are often visible on the tumour’s surface. The present report presents a case of tongue lipoma in a 50-year-old man who was referred to the department due to a tongue mass. The duration of the mass’s presence was unknown. Clinical examination revealed a yellowish nodular lesion. Histological examination confirmed the diagnosis of classic lipoma, showing mature adipocytes and vessels of varying sizes within the adipocyte lobules. The lesion was surgically excised, and no recurrence was observed during the one-year follow-up period.

Treatment Dilemma in an Unusual Case of Dengue Fever with Cardiomyopathy and Nephropathy: A Case Report

Somnath Maitra, Ratul Seal, Koushik Ray

Dengue is a viral illness in humans caused by the bite of infected Aedes mosquitoes, mostly Aedes aegypti and also Aedes albopictus. There are four serotypes of the Dengue virus that cause infection in humans and may lead to a variety of complications. Myocarditis and cardiomyopathy can occur in several viral and non viral infections, increasing morbidity and mortality. Nephropathy may also arise in dengue fever, causing complications. The case presented here involved both complications, nephropathy and cardiomyopathy, posing treatment challenges in terms of altering fluid and electrolyte status, which hindered fluid therapy as fluid overload would be detrimental. However, the complications were reversible with the normalisation of echocardiography and urea and creatinine levels. Long-term follow-up is necessary to monitor cardiac and renal function, as some patients may progress to Chronic Kidney Disease (CKD). The patient presented with fever, headache, vomiting, and haematuria, along with signs of fluid overload. There was a past history of fever, and since both Immunoglobulin G (IgG) and IgM Dengue antibodies were positive, this may be a case of a second episode of dengue fever causing complications. This case report emphasises the diagnostic and treatment challenges in a dengue patient with cardiomyopathy and nephropathy, where excessive fluid replacement may increase morbidity and mortality. Additionally, long-term follow-up of these patients is necessary.

Anaesthetic Considerations for General Anaesthesia in an Adult Patient with Wolf-Hirschhorn Syndrome and Kyphoscoliosis: A Case Report

Manju Bala, Rashmi, Rishmeet Kaur, Ajithkumar, Vinay Jangra

Wolf-Hirschhorn Syndrome (WHS), also known as Chromosome 4 deletion syndrome, is a rare hereditary disease with a prevalence of 1 in 50,000. It occurs due to the microdeletion of the short arm of chromosome 4, specifically the 4p16.3 domain. Patients with WHS exhibit diverse phenotypes, including growth retardation, developmental delay, congenital heart disease, and convulsions, depending on the amount of deleted genetic material. This case report focuses on a 25-year-old male who was admitted for cataract extraction and posterior chamber intraocular lens implantation. Through gene analysis, the patient was diagnosed with WHS. He exhibited micrognathia, a short neck, kyphoscoliosis, seizure disorder, and mental retardation. Additionally, he had severe kyphoscoliosis, which resulted in restrictive lung disease. These abnormalities posed significant challenges for anaesthetic management. To ensure a successful general anaesthesia, adequate preparedness for difficult airway management was crucial. A thorough cardiovascular and neuromuscular examination was conducted preoperatively to rule out associated anomalies and minimise complications. The patient’s perioperative antiepileptic cover was continued. Extubation proved challenging due to the patient’s mental retardation and restrictive lung disease. This case underscores the importance of effective anaesthetic management for patients with this rare condition undergoing cataract surgery under general anaesthesia.

Excessive Immunoglobulin Lambda (λ) Light Chain Production with Thrombocytopenia and Anaemia in a Patient with Smoldering Multiple Myeloma: A Case Report

Smoldering Multiple Myeloma (SMM) is defined as focal premalignant plasma cell proliferation in the bone marrow, along with the presence of monoclonal or biclonal protein bands in the patient’s serum. The current patient complained of severe weakness six months after knee arthroplasty. The patient exhibited a monoclonal (M-1) band on Serum Protein Electrophoresis (SPEP), which was observed in the γ-globulin region in combination with γ-heavy chains. Another protein band (M-2) was identified in the β-globulin region. These paraproteins were later confirmed by Immunofixation Electrophoresis (IFE), and both proteins reacted with anti-λ antibody. The concentration of the M-1 band was 32% (2.82 gm/dL), while the concentration of the M-2 protein band was 7.9% (0.7 gm/dL). Additionally, the total serum proteins measured 8.84 gm/dL. The plasma cell count in the Bone Marrow (BMPC) was approximately 20%. Provisionally, the patient was diagnosed as a case of gammopathy, with non-IgM Monoclonal Gammopathy of Undetermined Significance (MGUS), light chain MGUS, SMM, and MM considered in the differential diagnosis. However, the final diagnosis for the current patient was SMM. The patient responded well to treatment with cyclophosphamide and prednisone.

Gingival Giant Cell Fibroma in Three-year-old Patient: A Case Report with Review of Literature

Deepak Pandiar, Reshma Poothakulath Krishnan, Suvarna K Nair

Gingival diseases are commonly observed in children and young adults. However, Giant Cell Fibroma (GCF) is a rare occurrence in children, accounting for only 2.2-7.3% of oral fibrous tumour cases. Clinically, these lesions often resemble squamous papillomas, and a definitive diagnosis can only be confirmed through histopathological {Haematoxylin and Eosin (H&E)} examination. Hereby, the authors present a rare case of gingival GCF in a three-year-old boy who presented with a pebbly growth on the mandibular gingiva. Initially, the lesion was clinically diagnosed as a papilloma and subsequently excised. The final diagnosis of GCF was established through histological examination. It is crucial for paediatric dentists to consider GCF as a differential diagnosis for lesions, particularly those with a papillary surface. Additionally, submitting all excised specimens for histopathological examination is recommended.

Infective Endocarditis Caused by Multi-drug Resistant Corynebacterium Species: A Case Report

G Vaishnava Devi

Corynebacteria species are anaerobic, facultative, non-sporing, gram-positive bacilli that can cause infective endocarditis. In recent years, non-diphtherial Corynebacterium (diphtheroids) has increasingly been recognised as a cause of both localised and systemic infections. Determining the exact species of Corynebacteria is challenging due to their similar characteristics. Infective Endocarditis (IE) caused by Corynebacteria species is uncommon because positive blood cultures might be considered contaminants, leading to missed diagnoses. However, they can indeed cause IE, which is a severe condition. Antibiotic resistance among Corynebacteria species is common and has been increasing, making treatment challenging. In-vitro resistance to vancomycin cannot be detected reliably. Literature on IE caused by Corynebacteria species is limited, and more comprehensive information is needed. In cases of IE caused by Corynebacteria species, prosthetic valves are mainly affected, especially in elderly patients, and surgery is often required. Within the Corynebacterium genus, Corynebacterium striatum is a major causative agent of IE. Although Corynebacteria species in blood cultures are often considered contaminants from skin flora, they can also cause invasive infections such as sepsis and IE. The present case report describes the isolation of Corynebacteria species from the blood specimen of a 50-year-old male who presented with fever, headache, decreased appetite, and fatigue.

Anaesthetic Management of a Down’s Syndrome Patient Acyanotic Congenital Cardiac Anomalies and Hypothyroidism: A Case Report

Shyamolima Bhuyan, Deepjit Bhuyan

Down Syndrome (DS) is a common chromosomal disorder that is associated with multiple anomalies in different organ systems. Cardiac anomalies are frequently observed in individuals with DS, and as patients with Congenital Heart Disease (CHD) are at an increased risk of developing complications related to anaesthesia during the perioperative and postoperative periods, it is crucial to pay attention to the anaesthetic management of DS patients undergoing corrective surgery for cardiac anomalies. Complete Atrioventricular Septal Defects (CAVSD) are the most prevalent cardiac defects in DS patients, followed by isolated ventricular septal defects, atrial septal defects, patent ductus arteriosus, and tetralogy of Fallot. This case report focuses on the anaesthetic management of a one-year-old female with DS who was diagnosed with a combination of Atrioventricular Septal Defects (AVSDs) and patent ductus arteriosus. Due to the concurrent diagnosis of hypothyroidism, the case required a thorough preanaesthetic examination and meticulous attention to perioperative anaesthetic management, considering factors such as airway difficulty, cervical spine instability, ligament laxity, and susceptibility to infections. The patient underwent cardiac surgery following a standard anaesthetic protocol, and the procedure was well tolerated. After the surgery, she was transferred to the Intensive Care Unit (ICU). The postoperative period was uneventful, and the patient was discharged on the eighth postoperative day.

A Rare Case of Synchronous Cervical Squamous Cell Carcinoma and Ovarian Brenner Tumour in a Postmenopausal Female: A Histological Surprise

Riddhi Jaiswal, Deval Brajesh Dubey, Prashant Verma

Synchronous Tumours (ST) are defined as two or more neoplasms originating within six months of diagnosing the first neoplasm. Due to the rarity of synchronous cervical Squamous Cell Carcinoma (SCC) and ovarian Brenner tumours, their pathology has been poorly understood. These patients usually present with symptoms related to cervical cancer and are often diagnosed early. Since many synchronous tumours are incidentally discovered postoperatively, it is important to conduct thorough grossing and histopathological examinations. The primary differential diagnosis for synchronous tumours is multiple metastases from a single primary tumour. The management of multiple tumours is not well-defined and depends on various factors. In the present case, authors present a rare occurrence of synchronous neoplasms: cervical SCC and preoperatively undiagnosed benign Brenner tumour of the left ovary in a 52-year-old postmenopausal female. Immunohistochemistry helped rule out metastasis from a single primary and metastasis from cervical cancer to the ovary. The ovarian tumour showed immunoreactivity for GATA Binding Protein 3 (GATA) but was negative for Carcinoembryonic Antigen (CEA). The cervical SCC was immunopositive for CEA and p40, while no immunoreactivity was observed with GATA 3.

Co-existence of Nodular Hyperplasia and Papillary Carcinoma Thyroid in a Case of Struma Ovarii: A Rare Occurrence

Shivam Chakraborty, Chhanda Das, Joyita Sinha, Mamata Guha Mallick Sinha

Struma ovarii is a monodermal ovarian teratoma. This is an ovarian germ cell tumour with more than 50% ovarian tissue. It is a rare tumour, accounting for only 3-5% of all ovarian teratomas. Malignant transformation occurs very rarely, only in about 0.3% cases. The authors report a case of struma ovarii with a malignant transformation to papillary carcinoma thyroid. Not much information is present in the literature about this rare entity. Due to the rarity of this condition, there is a lack of uniformity of histological criteria of malignancy and its management is not universally accepted by physicians. Here, the authors present a rare case of struma ovarii with malignant transformation to papillary carcinoma thyroid. A 62-year-old female presented with a left ovarian mass. On histopathological examination of the surgical specimen of hysterectomy it was found that the ovary had a neoplastic growth with morphological features of papillary carcinoma thyroid. The final diagnosis was struma ovarii with papillary thyroid carcinoma. Postoperative period was uneventful for the patient. However, follow-up was not done.

Ischaemic Supraventricular Tachycardia: A Rare Case Report

VE Dhandapani, R Aravindan, D Anjani, S Prasanna, M Abhilasha

The incidence of supraventricular arrhythmias other than Atrial Fibrillation (AF) and atrial flutter in postmyocardial Infarction (MI) patients is usually rare. The incidence of in-hospital AF after MI ranges from 5%-18%. Paroxysmal Supraventricular Tachycardia (PSVT) occurs in less than 10% of patients after an acute MI. Herein, the authors presented a case of a 47-year-old male presented to the Casualty Department with chief complaints of palpitations for the past six hours. The Electrocardiogram (ECG) revealed Supraventricular Tachycardia (SVT), and immediate pharmacological cardioversion was performed. Coronary Angiogram (CAG) was conducted, which revealed double vessel disease with critical lesions in the proximal Right Coronary Artery (RCA) and mid Left Circumflex (LCX). Percutaneous coronary intervention was performed for both lesions. The patient was discharged in a stable condition. Prompt and immediate diagnosis of arrhythmias is crucial, especially in patients with MI, to reduce mortality and morbidity.

Intraluminal Submucosal Lipoma as a Lead Point Causing Colo-colic Intussusception: A Case Report

Adult colo-colic intussusception is very rare and it poses a diagnostic challenge in the geriatric population. The clinical diagnosis can be difficult due to non specific presenting complaints. However, it is a surgical emergency with high morbidity and mortality rates. Surgical exploration is the recommended treatment as most cases involve a pathological lead point. In this case report, the authors present the case of a 50-year-old female patient who complained of pain in the left lumbar region, loose stools, and loss of appetite for one month. Ultrasound (US) revealed an echogenic mass with a typical bowel within-bowel appearance. Contrast-enhanced Computed Tomography (CECT) of the abdomen showed telescoping of the proximal descending colon into the distal descending colon. Additionally, a fat density rounded lesion was observed on CT. The wall of the descending colon exhibited enhancement, indicating viable large bowel loops. Colonoscopy revealed a polypoid growth. The patient subsequently underwent surgery, confirming all imaging findings. Resection and anastomosis of the colon were performed, with an intraluminal lipoma identified as the primary cause of the colo-colic intussusception. The postoperative period of up to three months was uneventful. US and CT play a crucial role in the early diagnosis and prevention of serious complications.

Deep Subfascial Approach in the Management of Zygomatic Arch Fracture: A Case Report

Nayla Khan, Amod Patankar, Swapna Patankar, Rachel Changrani, Pranjali Kulkarni

Even for the most skilled maxillofacial surgeon, gaining access to the zygomatic arch for surgical procedures can be difficult due to the potential obstruction caused by a depressed zygomatic arch fracture, leading to restricted mouth opening. There are various treatment options available for zygomatic arch fractures. This article discusses the deep subfascial technique as a means to access the Temporomandibular Joint (TMJ) and zygomatic arch. This surgical procedure ensures a secure operative field while minimising the risk to facial nerve branches. Here, the authors present the case of a 62-year-old male patient who sustained a right zygomatic arch fracture in a road traffic accident. The fractured segments were treated surgically through open reduction and internal fixation using the deep subfascial approach. The procedure resulted in minimal post-operative discomfort, no functional impairment, successful reduction of the fracture, and restoration of function.

Case Report: Organophosphorus Poisoning-induced Intermediate Extrapyramidal Syndrome

Puneeth M Reddy, Karthik CH Reddy

Organophosphate (OP) compounds are one of the most common agents used for deliberate self-harm in developing countries, including India. OP compounds inhibit the enzyme acetylcholinesterase, which is responsible for hydrolysing the neurotransmitter acetylcholine in both the central and Peripheral Nervous Systems (PNS). Acute cholinergic crises are the most common clinical presentation of OP poisoning. While physicians mostly encounter acute and delayed complications, there have been rare documented cases in the litreature of an intermediate syndrome presenting with extrapyramidal symptoms such as tremors, rigidity, and dystonia. In this report, the authors present a case of a 64-year-old male patient who presented to the Emergency Department (ED) with a history of consuming an unknown quantity of OP-Phorate (11.2%). The initial manifestations included vomiting, sweating, difficulty in breathing, and a low level of consciousness. The patient was managed with atropine, pralidoxime, and mechanical ventilation. He was extubated but later reintubated due to respiratory failure. Eventually, a neurological examination revealed rigidity in all four limbs. The patient was diagnosed with an extrapyramidal type of intermediate syndrome and treated with oral amantadine and trihexyphenidyl. After further hospital monitoring, the patient was extubated and discharged with intact neurological function.

Prefabricated Acrylic Cap Splint: A Minimally Invasive and Conservative Intervention for Paediatric Mandibular Fractures: A Case Report

Nishima, Anil Gupta, Shalini Garg, Vishal Sharma, Sugandha Sharma

Dental traumatic injuries in paediatric patients result in a painful experience for both the parents and the child. Although children may exhibit similar fracture patterns as seen in adult traumatic injuries, there are various factors to consider when treating fractures in paediatric patients, which pose challenges for paediatric dentists. There are numerous treatment options available for managing maxillofacial fractures, such as open reduction, closed reduction, immobilisation with open or closed cap splint, with or without circummandibular wiring, and the use of mini plates, among others. In this present case report, a five-year-old child presented with multiple step deformities in the mandible. Since the patient had deciduous dentition, the main concerns were the high possibility of disruption to the periosteal envelope, which could affect the growth of the mandibular processes, and damage to developing permanent tooth buds. These were key considerations when planning the appropriate treatment. Taking into account these potential complications associated with other invasive procedures, a minimally invasive conservative management approach was chosen for the child, which proved to be highly successful and cost-effective. Undisplaced fractures in paediatric patients should always be treated or stabilised using the closed reduction method.

Case of Impacted Foreign Body in Zygomatic Region- A Missed Diagnosis

K Santhosh Kumar, Vishal Ramachandran, Jawahar Babu

Foreign body impaction in the soft tissues is not uncommon following maxillofacial trauma. Traumatic injuries in this region often cause penetrative injury of the soft tissues. Immediate closure of the soft tissue wound becomes the primary management strategy for control of haemorrhage. Foreign bodies may sometimes remain unnoticed in these wounds. Here, the authors present a case of retained metallic foreign body in the left zygomatic region in a 21-year-old male patient with history of simple slip and fall from staircase at home. Clinical evaluation and primary management of the facial wounds were done in a nearby healthcare centre by a general physician where the facial wounds were closed primarily using cyanoacrylate tissue glue to control the bleeding. Further, on clinical and radiographic examination by an oral maxillofacial surgeon, a 2×1 cm metallic foreign body was noted in the left zygomatic region. Immediate surgical removal under local anaesthesia was planned and performed. The purpose of reporting this case is to highlight the importance of thorough clinical and radiographic assessment as well as the need for an oral maxillofacial surgeon for prompt assessment, diagnosis, and management of these facial injuries.

Varied Aetiologies and Outcome of Neonatal Cholestasis: A Series of Four Cases

S Sivanandam, R Prabhu Vikash, R Balakrishnan, K Rajendren, TM Karthikeyan

Neonatal cholestasis is a significant cause of chronic liver disease in infants. However, lack of awareness among parents and primary care physicians often leads to delayed diagnosis and management of these children. In this series, the authors discussed four cases of neonatal cholestasis (48 days term female, 3 months term male, 73 days old female, 33 days old term male) that presented in the outpatient department with the chief complaint of yellowish discolouration of the eyes and pale-coloured stools. Clinical and histochemical findings in all cases were suggestive of neonatal cholestasis. The neonates were treated with Ursodeoxycholic Acid (UDCA), vitamin ADEK, and followed-up. Fortunately, in all the babies, symptoms resolved after management, except for a three-month-old male baby who unfortunately succumbed to liver failure after two weeks of hospitalisation. Early identification of Progressive Familial Intrahepatic Cholestasis (PFIC) disorders is crucial as it enables effective management and potential definitive therapy. Additionally, prompt implementation of a galactose-free diet is critical for preventing acute toxicity and minimising tissue damage in galactosemia. Late presentation of biliary atresia can lead to increased morbidity and mortality. Therefore, it is crucial to include stool and urine charts in the discharge summary of every newborn and provide parental education on recognising the signs of cholestasis in the Paediatric Outpatient department.

Revisiting Vertical Flap Pyeloplasty in Pelviureteric Junction Obstruction: A Case Series

Pelviureteric Junction Obstruction (PUJO) can cause recurrent Urinary Tract Infections (UTIs), pain, and loss of renal unit function. Surgical intervention is often required, and numerous treatment strategies have been employed. Vertical flap pyeloplasty was initially described as the technique of choice in PUJO patients with the large box-shaped extra-renal pelvis and longer segment strictures (usually >2 cm). In the present case series, 11 patients underwent vertical flap pyeloplasty for PUJO with a large extra-renal box-shaped pelvis. Demographic, perioperative, and follow-up data were recorded. Success was defined as symptomatic improvement and an improvement in early Diethylenetriamine Pentaacetate (DTPA) renogram at six months. In the present series, all 11 patients showed an improvement in Glomerular Filtration Rate (GFR) with an average improvement of 11.9 mL. The procedure was technically easier, less time-consuming, and produced acceptable results. Vertical flap pyeloplasty could be considered as a practical, technically easier, and effective treatment option in PUJO with a large extrarenal pelvis and long segment strictures.

Renal Cell Carcinoma Grossly Presenting as Cystic Lesions: A Series of Four Cases

Kidney cancer currently ranks as the seventh most common cancer in men and the tenth most common in women. Clear-Cell Renal Cell Carcinoma (CCRCC) represents the most common malignancy of the kidney, accounting for 80% of renal carcinomas. Most CCRCC develops in patients aged over 60 years, and the incidence is slightly higher in men than in women. Partial or total nephrectomy cures the majority of patients with CCRCC. In the present discussion, the authors present cases of 4 males with RCC radiographically identified as Space Occupying Lesions (SOL) to warn clinicians that these seemingly solid lesions have a cystic component as well and may harbour underlying malignancy. Grossly, upon cutting the kidney, all four cases showed solid and cystic components, two of which were multiloculated. Histopathological Examination (HPE) revealed three cases of CCRCC and one case of cystic CCRCC. It is difficult to determine preoperatively whether a cyst is malignant based solely on imaging examinations. Regarding disease prognosis, RCC with predominantly cystic components is considered less aggressive than solid RCC. Cystic RCC (CRCC) carries an excellent prognosis following surgical treatment. Partial nephrectomy should be regarded as the preferred surgical technique in the management of CRCC. In conclusion, authors would like to highlight the fact that histopathologists need to be familiar with the different types of RCC presenting with a cystic component, as these have prognostic significance. Clinicians also need to be aware that there are certain caveats in the radiological diagnosis of cystic renal neoplasms, and histopathology may often present a different picture from the radiological diagnosis.

A Combination of Ultrasound-guided Popliteal Sciatic Nerve Block and Adductor Canal Block as a Sole Anaesthetic Technique for below Knee Amputation in High-risk Patients: A Case Series

MK Sandhya, Sambhram Shenoy, Sudham Ramesh Shetty, Adiraju Chanakya

Below-knee amputation in high-risk patients is associated with significant mortality and morbidity. Spinal anaesthesia is linked to an increased incidence of hypotension and bradycardia, and it is relatively contraindicated in patients with coagulation abnormalities. General anaesthesia is used as an alternative when spinal anaesthesia is contraindicated, but it is associated with a considerable increase in perioperative morbidity and the need for postoperative ventilatory support and Intensive Care Unit (ICU) care. A combination of sciatic nerve block and femoral block has been employed for below-knee surgeries as it provides complete anaesthesia below the knee. Adductor canal block, compared to femoral nerve block, is motor-sparing and, when combined with popliteal sciatic nerve block, offers complete anaesthesia below the knee. Below-knee amputation requires complete motor and sensory blockage, making regional block for below-knee amputation more challenging for the anaesthesiologist. Present case series is of five cases of below-knee amputation performed under a combination of ultrasound-guided popliteal sciatic nerve block and adductor canal block. Ultrasound-guided popliteal sciatic nerve block was administered with a combination of 10 mL of bupivacaine 0.5% and 5 mL of lignocaine 2% with adrenaline (1:200,000) diluted with 5 mL of distilled water to a total volume of 20 mL. Ultrasound-guided adductor canal block was performed with 8 mL of bupivacaine 0.5% and 4 mL of lignocaine 2% with adrenaline (1:200,000), diluted with 4 mL of distilled water to a total volume of 16 mL. All patients achieved adequate surgical anaesthesia, and none experienced any anaesthesia-related complications.

Primary Aldosteronism: A Series of 11 Cases

Primary Aldosteronism (PA) should be suspected in patients with resistant hypertension, early-onset hypertension, hypertension with hypokalaemia, and metabolic alkalosis. The diagnosis is often missed due to a lack of awareness and cumbersome investigations. Eleven cases of PA who attended the Endocrinology Outpatient Department (OPD) and were also admitted to the hospital over the last three years (January 2020 to January 2023) were studied, and data were collected and analysed. All 11 patients had hypertension, and five out of 11 had resistant hypertension and 36.36% (four patients) had a family history of hypertension. In this cohort, nine out of 11 patients presented with hypokalaemia (81.81%), and five of them had hypokalaemic paralysis at presentation. In 54.54% of patients, plasma aldosterone was in the range of 20-40 ng/dL, with a mean plasma Aldosterone conc. of 31.7 ng/dL. Plasma Renin Activity (PRA) was suppressed in all eight patients. In nine out of 11 patients, PAC/PRA was >20. A left-sided adrenal adenoma was observed in 54.54% of cases. Six patients (54.54%) received surgical management (laparoscopic adrenalectomy), and the remaining five patients were doing well with medical management (antihypertensives and spironolactone). This case series illustrates the need for screening of PA in patients with resistant hypertension, specifically those with hypokalaemia. Elevated PAC is diagnostic, especially in the context of suppressed PRA. Computed Tomography (CT) is the modality of choice for localising the adenoma in most cases. Clinicians can make decisions regarding the choice of treatment based on these two investigations.

Role of Early Mitral Valve Surgery in Acute Infective Endocarditis: A Case Series and Review of Literature

Gunavathy Nagesh Jakaraddi, Nagesh D Jakaraddi

Infective Endocarditis (IE) is a serious cardiac infection diagnosed with syndromic approach based on clinical, immunological, sonographic, and microbiological findings. It is highly suspected in patients with pre-existing heart disease who have bacteremia in absence of other obvious source. Due to its non-specific symptoms and delayed diagnosis causes severe septicemia, multiple organ failure, and high mortality. This case series describes three critically ill patients who were diagnosed with active IE upon admission to the Intensive Care Unit (ICU). All three patients were admitted in critical condition and were newly diagnosed with IE. They were initially stabilised with appropriate antibiotics. However, during their ICU stay, after two weeks, they experienced recurrent arrhythmias and severe Mitral Regurgitation (MR), complicating recurrent pulmonary oedema that hindered weaning from mechanical ventilation. Therefore, it was decided to perform Mitral Valve (MV) correction surgery during the acute phase of endocarditis (2 weeks after starting antibiotics). Unfortunately, all patients had in-hospital mortality. Intraoperative findings revealed extensive vegetation on the Anterior and Posterior Mitral Leaflet (AML and PML) with extension to the chordae. The high mortality was attributed to their critical pre-operative condition, septic shock, and cerebral embolism. Guidelines and task force management clearly state that early surgery plays a definitive role in acute endocarditis with complications. However, identifying the appropriate candidates for early surgery is challenging due to the associated high mortality. A database search on MV surgery in acute IE, comparing repair and replacement, has concluded that repair is safe and associated with better survival than replacement.

Case Series of Three Cases of Madura’s Foot with a Characteristic ‘Dot in Circle’ Sign: A Radiologist Perspective

Sadaf Sultana, Mehtab Ahmad, Sana Sultana, Mohammad Arif, Inam Ullah Khan

Madura’s foot is a rare infectious granulomatous disease affecting the foot. The incidence of this disease has decreased in recent years due to improved living conditions. However, it can still be misdiagnosed by inexperienced surgeons as other similar conditions. Early and accurate diagnosis is crucial for optimal treatment and limb preservation. In this study, the authors present three unusual cases of Madura’s foot. A 23-year-old woman presented with swelling and draining sinuses in her left foot for six years. Imaging tests including Ultrasonography (USG), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) revealed the characteristic ‘dot in circle’ sign of Madura’s foot. However, her USG-guided biopsy did not confirm the diagnosis, and it was only through an excisional biopsy that actinomycetoma was confirmed. Another case involved a 60-year-old male with multiple soft tissue swellings on his right foot for 10 years, resulting in foot deformity. Radiographs showed multiple punched-out lytic lesions in the bones, while USG and MRI exhibited the typical ‘dot in a circle’ sign. Histopathological examination confirmed actinomycetoma. The third case involved a 36-year-old male with a chronic sinus discharging yellow pus and black granules on the volar side of his right foot. USG and MRI revealed the classic signs of Madura’s foot, and these findings were correlated with histopathological examination. The present cases confirm the specificity of the ‘dot-in-circle’ sign on MRI and USG, supported by histopathological correlation.

A Case Series of Amicrobial Pustulosis of Folds: An Eye-opener for the Diagnosis of Autoimmune Disorders

Amicrobial Pustulosis of Folds (APF) is a rare, chronic, relapsing cutaneous disease seen exclusively in younger women with a history of autoimmune disease, most commonly Systemic Lupus Erythematosus (SLE), or who simply have circulating autoantibodies. This case series highlights the occurrence of an unusual manifestation of APF as a marker of autoimmune disorders and emphasises the importance of double-stranded Deoxyribose Nucleic Acid (dsDNA) positivity in such cases. A total of five female patients with APF were included in this case series. All five cases presented with pustular lesions lasting 10-12 weeks, involving conchal bowls, eyes, perineal, and perianal regions, either as an initial presentation or as a flare-up of pre-existing autoimmune disease. All patients underwent screening for autoimmune disorders, which revealed dsDNA positivity and met the diagnostic criteria for APF. Therefore, a diagnosis of APF with SLE was made. All patients showed significant improvement with oral steroids. Although SLE is a complex multisystem disorder where patients may not always present with malar rash, photosensitivity, arthritis, and arthralgia, APF could serve as an eye-opener for diagnosing underlying autoimmune diseases.

Giant Papilloma OR Nevus Lipomatosus Superficialis: An Incidental Finding in a Patient with Chronic Obstructive Pulmonary Disease

Puja Upadhyay, Babaji Ghewade, Ulhas Jadhav, Pankaj Wagh

A 65-year-old female presented to the Department of Respiratory Medicine with chief complaints of breathlessness {modified Medical Research Council (mMRC) Dyspnoea Scale Grade 2} (1) for seven days and cough with mucoid expectoration for 15 days. She was a known case of Chronic Obstructive Pulmonary Disease (COPD) and was on regular medication for the same. On general examination, a mass-like structure was seen protruding from her middle back. Upon further inspection, it was identified as a cauliflower-like mass, approximately 10x15 cm in size, with a stalk (Table/Fig 1). The mass had a smooth surface and was skin-coloured, painless, and non tender. No foreign body was present. The patient first noticed the mass two years ago, while bathing. Initially, it was a small non tender swelling the size of a pea, which gradually grew to its present size. The mass did not cause any pain or disruption in daily activities, except for minimal discomfort , while lying on her back due to its size. As a result, the patient did not seek medical attention for it. Surgery and dermatology opinions were obtained, and a working diagnosis of squamous cell papilloma vs nevus lipomatosus cutaneous superficialis was made. The patient declined surgical intervention, and thus, a confirmed histopathological diagnosis could not be established. A papilloma is a benign non cancerous tumour that originates from an epithelial surface and typically grows outward (2). Squamous cell papillomas, which appear as frond-like tumours, can develop on various parts of the body with squamous epithelium. Most of these lesions are caused by the Human Papillomavirus (HPV) and are contagious upon contact, except for cutaneous papillomas. In immunocompetent patients, papillomas are usually self-limiting (3). Nevus lipomatosus cutaneous superficialis is a benign hamartoma of the skin. It is a rare tumour with an unknown cause and is a cosmetic defect that produces no symptoms or discomfort. There are two major types: multiple or classic type with segmentally distributed multiple lesions, and solitary type presenting as a solitary papule or nodule (4),(5). It is characterised by the presence of mature adipocytes in the reticular dermis without involvement of the underlying subcutaneous tissue. Both squamous cell papilloma and nevus lipomatosus cutaneous superficialis are mostly asymptomatic conditions that do not cause discomfort to the patient. If treatment is required or desired, surgical excision is performed, and confirmation of diagnosis is done through histopathological examination. In a case report by Mehdiratta S et al., a similar lesion was discussed on the gluteal region in a 69-year-old male. The lesion was a single, soft, well-defined, skin-coloured, cerebriform pedunculated mass measuring 4.5×3.5×2 cm. The lesion grew slowly and gradually, was painless, and not associated with inflammation or discomfort, which is similar to the findings in the present case. Mehdiratta S et al., made a working diagnosis of papilloma and an excisional biopsy was performed (6). The histopathological examination revealed the diagnosis of nevus lipomatosus cutaneous superficialis.

Sickle Cell Anaemia with Antiglobulin Positive Autoimmune Haemolytic Crisis

Saniya Khan, Sourya acharya, Samarth Shukla, Sunil Kumar

Dear Editor, Immune-mediated haemolytic crises can worsen congenital anemias, and although autoantibodies have been identified, they are not frequently associated with overt Autoimmune Haemolytic Anaemia (AIHA) (1). Sickle Cell Disease (SCD) is characterised by the presence of haemoglobin S (HbS), an abnormal type of haemoglobin that can form polymers in erythrocytes and distort the structure of Red Blood Cells (RBC). This can lead to intravascular sickling, haemolytic anaemia, and vaso-occlusive crisis caused by persistent narrowing of the tiny blood arteries. Autoimmune disease can result from various mechanisms, including the alteration of RBC membrane antigens, molecular mimicry, the propagation of hidden epitopes, and the destruction of innocent bystanders (2). This letter describes the case of a 25-year-old female who presented with fever, breathlessness, and severe myalgia and bone pain for ten days. She had been diagnosed with sickle cell SS pattern 15 years earlier and was taking tablet Hydroxyurea 500 mg once daily, tablet folic acid 5 mg per day, and tablet zinc 50 mg per day. The patient had a history of recurrent crises and had been hospitalised four times in the previous year. Upon examination, the patient had a pulse of 110/min, blood pressure of 130/90 mm/Hg, respiratory rate of 22/min, raised jugular venous pressure to 11 cm of H2O, pallor, and mild icterus. Abdominal examination revealed tender hepatomegaly, but the spleen was not palpable. Respiratory system examination showed reduced bilateral air entry at the base. Severe anemia was detected (haemoglobin of 4.5 gm/dL) upon investigation, along with sepsis, raised serum Lactate dehydrogenase and total bilirubin [Table/Fig-1,2]. Chest radiography revealed bilateral minimal pleural effusion. The patient was diagnosed with SCD with vaso-occlusive crisis and treated with three units of blood transfusions, intravenous antibiotics, fluids, and supplemental oxygen. By the third day of admission, the patient’s condition had slightly improved as her haemoglobin levels increased to 6.5 gm/dL (Table/Fig 1). On the fourth day, the patient complained of breathlessness and palpitations, and blood parameters were repeated, showing further derangement and haemolysis (Table/Fig 1). As three blood transfusions had been performed, an antiglobulin test was done to rule out the possibility of a transfusion reaction. The test was positive, and further transfusions were withheld. The patient was started on methylprednisolone 40 mg twice daily, and serial monitoring of haemogram, liver function, serum lactate dehydrogenase, and other parameters was done. The patient’s condition clinically improved over the next few days. Her haemoglobin levels stabilised, and her total serum bilirubin and serum LDH declined (Table/Fig 1). The patient was discharged on day 10 in stable condition, with oral prednisone in tapering doses, zinc 50 mg per day, and tablet hydroxyurea 500 mg once a day. Patients with underlying haemoglobinopathies are susceptible to a condition known as autoimmune haemolysis. One of the most popular hypotheses for the cause of this condition is “bystander haemolysis”, which occurs when both native and donated RBCs go through haemolysis caused by complement activation [3,4]. Other hypotheses include the reduction of erythropoiesis, increased expression of phosphatidylserine, and an increase in haemolysis by activated macrophages following transfusion (5). To help stop further haemolysis and aid in the patient’s recovery, corticosteroids and Intravenous Immune Globulin (IVIG) can be used (6). Additionally, Rituximab and Eculizumab are C-5 convertase inhibitors that inhibit complement activity, which can help stop complement-mediated destruction (7). Red cell transfusion is usually the first step in treating these patients, but it can be challenging due to red cell incompatibility. The transfused red cells will be destroyed no less- but no more- than the patient’s own red cells. This approach is frequently used in such situations and requires close communication and comprehension between the clinical unit caring for the patient and the serology lab.

Comparison of Synergistic Action of Alpha Blockers and Tadalafil in the Management of Lower Ureteric Stones as Medical Expulsive Therapy: A Prospective Cohort Study

Introduction: Medical Expulsive Therapy (MET) involves the utilisation of different drugs that act on the ureter through various mechanisms. Alpha-1 adrenoceptor and Phosphodiesterase (PDE) regulate ureteric motility thus combination of these drugs can increase the ureteric stone expulsion rate by complementing each other’s actions. Aim: To assess the synergistic role of alpha-blocker and Tadalafil therapy in facilitating the spontaneous expulsion of distal ureteral stones. Materials and Methods: A prospective cohort study was conducted in the Department of Urology at a Tertiary Care Centre (NSCB Medical College) from April 2020 to January 2022. A total of 281 patients diagnosed with lower ureteric stones (5-10 mm) were divided into five study groups: Group A was treated with tamsulosin, group B with silodosin, group C with tadalafil alone, group D with tamsulosin and tadalafil, and group E treated with a combination of silodosin and tadalafil. Corticosteroid (deflazacort 6 mg) was also included in every group. All patients were reassessed after three weeks of treatment for stone expulsion rate, expulsion time, the number of hospital visits for pain, and adverse effects of drugs. The statistical data was analysed using Statistical Package for Social Sciences (SPSS) software (version 21.0, IBM Corp, USA). The Chi-square test and Analysis of Variance (ANOVA) test were used to determine the effect on stone expulsion rate and expulsion time. The confidence interval was 95%, and the significance level of the p-value was set <0.05. Results: The stone expulsion rates in group A, B, C, D, and E were 70.91%, 79.63%, 52.63%, 84.21%, and 86.20%, respectively, which was significant (p=0.00194). The mean time taken for stone expulsion in group A, B, C, D, and E were 8.95±1.73, 8.43±1.57, 9.86±1.90, 7.96±2.03, and 7.75±1.84 days (p=0.0001). Minor side effects were not significant, except for retrograde ejaculation in group B and E, and 22.8% of patients needed hospitalisation in group C (tadalafil alone). Conclusion: Combination therapy is safe, efficacious, and well-tolerated as MET for distal ureteric calculi in the 5-10 mm range, thereby avoiding surgical procedures and providing faster relief for the patients.

Assessment of Treatment Patterns in Patients with Alcohol Withdrawal Syndrome during Hospitalisation and Post-discharge: A Retrospective Cohort Study

Introduction: Alcohol dependence is an increasing and pervasive problem. Alcohol Withdrawal Syndrome (AWS) is a cluster of symptoms that occur in alcohol-dependent individuals after cessation or reduction of alcohol consumption. However, studies on the clinicoepidemiological profile of patients with AWS and treatment patterns in India are scarce. Aim: To assess the treatment patterns during hospitalisation and after discharge in Indian patients with AWS. Materials and Methods: A retrospective observational study was conducted using data from 1000 patients with AWS who were admitted to nine addiction centres across India. Data from medical charts from the previous five years were collected over six months, from January to June 2022. The study included patients of either sex, aged ≥18 years at the time of data collection, who had been hospitalised for AWS symptoms and had ≥3 months of documented follow-ups. The primary endpoints of the study were the most commonly used medications and their dose titrations in the treatment of AWS, as well as the duration of treatment in the hospital and post-discharge. Key secondary endpoints included the socio-demographic profile of patients, common co-morbidities, common signs and symptoms, the association between prescription patterns of Benzodiazepines (BZDs) and liver enzyme levels, and the average duration of hospital stay. Continuous variables were summarised as mean and Standard Deviation (SD), while categorical variables were summarised as frequency and percentages. Levels of serum Aspartate Aminotransferase (AST), Alanine Transaminase (ALT), γ-Glutamyl Transferase (GGT), and bilirubin were recorded from the source data, if available, and the association with the use of chlordiazepoxide and lorazepam was analysed using the Chi-square test. Results: The mean±SD age of the 1000 enrolled patients was 41.4±9.6 years, with the majority (n=997; 99.7%) being males. BZDs were the mainstay pharmacotherapy, with lorazepam (n=686; 68.6%) and chlordiazepoxide (n=482; 48.2%) being the two most commonly prescribed BZDs during hospitalisation. During post-discharge treatment, 57.0% (n/N=74/130) of patients received lorazepam, while 52.0% (n/N=67/130) received chlordiazepoxide. Frequently used drug regimens during hospitalisation included fixed doses of chlordiazepoxide {25 mg twice a day (BID:143/482; 29.7%), 20 mg thrice a day (TID:103/482; 21.4%), or 25mg TID (87/482; 18.0%)}, or lorazepam {2 mg TID (188/686; 27.4%), 2 mg BID (183/686; 26.7%), or 2 mg once a day (OD;175/686; 25.5%)}. Commonly observed signs and symptoms included tremors (n=567; 56.7%), irritability (n=539; 53.9%), and agitation (n=500; 50.0%). Depression (n=182; 18.2%) and anxiety (n=136; 13.6%) were the most commonly reported co-morbidities. Among the patients, only 13.4% (86/641) had an AST/ALT ratio >2, and 12.9% (44/340) had AST and GGT levels >2× Upper Limit of Normal (ULN). There was no significant difference in these patients between those receiving and not receiving chlordiazepoxide (p>0.05). The mean±SD duration of hospitalisation was 23.1±18.97 days, while the mean±SD duration of treatment during hospitalisation and post-discharge was 22.3±16.36 days and 71.6±52.3 days, respectively. Conclusion: The two most commonly prescribed drugs during hospitalisation and post-discharge were the BZDs, lorazepam and chlordiazepoxide. Fixed-dose regimens of chlordiazepoxide at 25 mg BID or TID, or 20 mg TID, and lorazepam at 2 mg TID, BID, or OD were frequently used during hospitalisation.

Thromboprophylaxis in Proximal Femur Fracture: A Pilot Survey among Practicing Orthopaedic Surgeons in India

Nayantara Srikanth, Naveen Sathiyaseelan, Jagadeesh Bhaskaran, S Natarajan

Introduction: Venous Thromboembolism (VTE) and Pulmonary Embolism (PE) are more common following orthopaedic surgeries around the hip than other surgeries. However, there is still a dilemma among orthopaedic surgeons regarding whether routine thromboprophylaxis is justified in patients. Aim: To describe current practices among orthopaedic surgeons regarding routine thromboprophylaxis among patients with proximal femur fractures. Materials and Methods: A cross-sectional exploratory study was conducted at Department of Orthopaedics, Saveetha Medical College, Chennai, Tamil Nadu, India between March 2022 and May 2022 among orthopaedic surgeons. A Google survey form, containing 10 prevalidated multiple-choice questions, was shared on social media and medical groups. Descriptive analysis was undertaken, and statistical analysis was done with International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software version 28.0. Results: Among the 141 respondents, 72% were from private sector institutions/hospitals. Over 90.78% of the respondents indicated that there was a role for anticoagulation therapy in proximal femur fractures, and 92% used low molecular weight heparin. The responses varied slightly depending on whether anticoagulant treatment was used preoperatively (51%) or postoperatively (48%), and if there was a waiting time of less than 24 hours to 3-5 days before surgery. Most orthopaedic surgeons opted for anticoagulation therapy in the presence of a previous history of Deep Vein Thrombosis (DVT)/PE (79%), age greater than 70 years (61%), and use of hormone replacement therapy (64%), or if the surgery lasted more than two hours (61%). Conclusion: The present study concludes that 9.2% of orthopaedic surgeons do not use anticoagulation therapy and nearly half (48%) do not administer anticoagulation therapy preoperatively. As the proportion of elderly patients increases, consensus building will enable the formulation of practice guidelines based on evidence generated through such surveys.

Survival Analysis and Factors Affecting Treatment Outcome in Glioblastoma Multiforme: A Cohort Study

Treesa Thomas, Shehna A Khader, K Suresh Kumar

Introduction: High-grade gliomas, especially Glioblastoma Multiforme (GBM), are the most prevalent primary brain tumours in adults. Treating GBM is challenging due to resistant tumour cells, resulting in a dismal prognosis. While GBM often develops spontaneously, familial gliomas have also been identified in 1% of cases. Primary and secondary glioblastoma are the subtypes that affect patients of varying ages and develop via different paths. Aim: To estimate the two year survival and to assess factors affecting survival in patients diagnosed with GBM and to evaluate the “ability for self-care” following treatment. Materials and Methods: The cohort study investigated treatment outcomes in GBM using a sample of 65 patients from the Department of Radiation Oncology at Government Medical College Thrissur, a tertiary care centre in Kerala, India. The patients were diagnosed between January 2018 and December 2019. Survival and the factors determining survival were explored through case records and telephonic interviews with primary caregivers. Median survival and two year survival rates were calculated. The study examined possible associations of survival with patient-related, tumour-related, and treatment-related factors. Patient-related factors assessed were age, gender, and Eastern Cooperative Oncology Group (ECOG) performance status at diagnosis. Tumour-related factors assessed included tumour location, laterality, and volume based on pretreatment Magnetic Resonance Imaging (MRI). Treatment-related factors such as extent of surgery, postoperative radiotherapy, and chemotherapy were also assessed. Data analysis was performed using the Statistical Package for Social Sciences (SPSS version 21.0). Qualitative variables were expressed in percentage and compared using the Chi-square test or Fisher’s-exact test. Quantitative variables were expressed as mean and standard deviation and compared using unpaired t-tests. Telephonic interviews with primary caregivers were conducted to assess the “ability for self-care” following treatment. Results: The study included a total of 65 cases, with a mean patient age of 54 years. Out of the patients, 45 (68%) patients were male, while 20 (32%) patients were female. The median survival for GBM was found to be eight months. The one year and two year survival rates were 18.46% (12 patients) and 10.8% (7 patients), respectively. The survivors had a mean age of 48 years. There were no statistically significant differences in survival based on sex (p-value=0.527), tumour location (p-value=0.765), and laterality (p-value=0.596). Survival was found to be related to ECOG performance status at diagnosis (p-value=0.001) and tumour volume (p-value=0.002). Among the patients, 37 (58%) patients were able to perform self-care after treatment, while 28 (42%) patients were unable to do so. Conclusion: The survival of patients with GBM is related to ECOG performance status at diagnosis and the pretreatment volume of the tumour. The evidence was insufficient to establish a relationship between survival and the administration of postoperative radiotherapy and chemotherapy. Despite multimodality treatment protocols, the survival of patients with GBM remains dismal. A tailored treatment protocol that weighing morbidity of treatment and cost effectiveness on one side and survival on the other side is the need of the hour.

Association of Serum Vitamin D₃ Levels with the Severity of Acne Vulgaris in Adolescents: A Cross-sectional Study from Western Odisha, India

Kuldip Das, Sanghamitra Bhoi, Sumitra Bhoi, Mamata Pandey

Introduction: Vitamin D₃ plays an important role in the immune system, and its deficiency has been implicated in various skin diseases, including atopic dermatitis and psoriasis. Acne is a common inflammatory skin disease of adolescence and young adulthood that affects the face and upper trunk. The scarring caused by acne can have a significant psychological impact on patients and greatly affect their quality of life. However, the association between the severity of acne and vitamin D₃ levels remains unclear. Aim: To assess the role of vitamin D₃ in the severity of acne vulgaris in adolescents. Materials and Methods: This prospective cross-sectional study was conducted at the Department of Dermatology and Biochemistry, VIMSAR, Burla, Sambalpur, Odisha, India, from August 2022 to November 2022. Adolescents between the ages of 10 and 19 years, of either sex, with acne were clinically examined, and the severity of acne was evaluated using the Global Acne Grading System (GAGS) score. Serum vitamin D₃ levels were measured using a Chemiluminescence Immunoassay (CLIA) analyser (Electra FA). Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software version 21.0 (SPSS IBM Corporation, Armonk, New York), and a p-value <0.05 was considered statistically significant. Results: A total of 150 clinically diagnosed cases of acne vulgaris patients were evaluated. The study included 73 males and 77 females. The mean age of males was 19.1±2.3 years, and for females, it was 18.2±2.4 years. Serum vitamin D₃ levels were lower in patients with severe acne (18.03 ng/mL) compared to those with moderate acne (23.57 ng/mL) and mild acne (28.02 ng/mL). The association between serum vitamin D₃ concentration and the different degrees of acne vulgaris was statistically significant (p<0.05). There was a strong negative correlation between severe acne and serum vitamin D₃ levels (r=-0.042, p-value=0.002). Conclusion: Vitamin D₃ deficiency was more prevalent in patients with severe acne, and serum vitamin D₃ levels were inversely correlated with the severity of acne vulgaris.

Role of Pulp Volume Method in Assessment of Age and Gender: An Observational Study from Lucknow, India

Introduction: In forensics, age and gender determination are required for victim identification. Secondary dentine deposition occurs throughout life, resulting in decreased pulp volume and size. Evaluation of pulp volume using Cone Beam Computed Tomography (CBCT) is a non invasive method used to evaluate age and gender. Aim: To evaluate the efficacy of the pulp volume method in determining age and gender. Materials and Methods: An observational study was conducted in the Oral Medicine and Radiology Department of King George’s Medical University, Lucknow, Uttar Pradesh, India from July 2019 to August 2020. Pulp volume measurements were obtained from CBCT data of randomly selected individuals (n=90) aged 18-70 years, focusing on maxillary Central Incisors (CI) and maxillary Canine (C). Statistical analyses, including Chi-square test, Pearson’s correlation, linear regression, and logistic regression, were performed on the data. Results: The CBCT data from 90 individuals, aged 18-70 years, were evaluated for pulp volume of maxillary CI and C. The Pearson correlation coefficient indicated a decrease in pulp volume with age. The validation of the equations for sex determination revealed higher prediction accuracy for CI (56.70%) compared to C (53.30%). Conclusion: Pulp volume obtained from CBCT can serve as a reliable indicator for age estimation and gender prediction.

Effect of Two Different Doses of Intravenous Phenylephrine on the Prevention of Oxytocin Induced Hypotension in Lower Segment Caesarean Section Under Subarachnoid Block: A Randomised Controlled Study

Introduction: Postpartum haemorrhage with an atonic uterus is one of the leading causes of maternal mortality during Lower Segment Caesarean Section (LSCS) in nearly 50% of cases. Oxytocin is the most commonly administered drug for achieving post-delivery adequate uterine contractions and placenta expulsion, thereby preventing postpartum haemorrhage. Co-administration of phenylephrine during LSCS under spinal anaesthesia inhibits Oxytocin-induced hypotension. Aim: To compare the effectiveness of co-administration of two different doses of phenylephrine with oxytocin in preventing the incidence of Oxytocin-induced hypotension. Materials and Methods: A randomised, double-blinded controlled trial was in the Department of Anaesthesiology, SMS Medical College and Attached Group of Hospitals, Jaipur, Rajasthan, India from August 2021 to July 2022, involving 120 parturients with American Society of Anaesthelsiologists (ASA) grade second undergoing LSCS under subarachnoid block. They were randomised into three groups: Group A received oxytocin 3U with normal saline, Group B received Oxytocin 3U with Phenylephrine 50 mcg, and Group C received Oxytocin 3U with Phenylephrine 75 mcg administered intravenously over five minutes after the baby’s extraction. The incidence of hypotension, requirement for the total rescue dose of Phenylephrine, and side effects were recorded. Statistical analysis was performed using Analysis of Variance (ANOVA) and Chi-square test. Results: Demographic parameters such as age, height, weight, gestational age, and duration of surgery were comparable in all groups. The incidence of hypotension (Group A (Control): 77.5%, Group B (PE50): 47.5%, Group C (PE75): 22.5%, p<0.001), lowest Mean Arterial Pressure (MAP) after Oxytocin infusion (Group A: 67.80±6.16 mmHg, Group B: 68.23±3.96 mmHg, Group C: 72.50±5.87 mmHg, p<0.001), dose of rescue vasopressor requirements (Group A: 75.5±56.61, Group B: 40±50.89, Group C: 17.50±34.99, p<0.001), and incidence of side effects were significantly lower in Group C compared to Group B and Group A. Conclusion: Compared to Phenylephrine 50 mcg, the co-administration of Phenylephrine 75 mcg with Oxytocin 3U reduces the incidence of Oxytocin-induced hypotension and the need for rescue vasopressors during LSCS under subarachnoid block.

Association of Maternal Factors with Hyperbilirubinaemia in Newborns at a Tertiary Care Hospital in Navi Mumbai, India: A Cross-sectional Study

Vijay Baburao Sonawane, Veeranna Kotrashetti, Samarth Gupta, Saili Bunde

Introduction: Hyperbilirubinaemia in newborns is a common and serious condition, and it is also one of the most common causes of neonatal readmission to the hospital. It is challenging to diagnose or predict the onset of hyperbilirubinaemia in newborns. Therefore, identifying neonates with maternal risk factors is useful for early prediction of hyperbilirubinaemia, enabling effective management and prevention of complications such as acute bilirubin encephalopathy or kernicterus. Aim: To estimate the prevalence of neonatal hyperbilirubinaemia and its association with various maternal risk factors such as parity, maternal diseases, blood group incompatibility, mode of delivery, etc. Materials and Methods: This hospital-based descriptive, cross-sectional study was conducted at Dr. D.Y. Patil Hospital in Navi Mumbai, Maharashtra, India, from December 2021 to December 2022. A total of 500 healthy full-term neonates and their mothers were screened. Neonates with hyperbilirubinaemia during follow-up were evaluated. Data on maternal factors (e.g., parity, maternal diseases, polyhydramnios, premature rupture of membranes, ABO and Rh incompatibility) were collected, and their association with neonatal hyperbilirubinaemia was assessed. Statistical analysis of the data was performed using the Chi-square test to determine prevalence and significance. Results: Out of the 500 babies studied, 95 had serum total bilirubin levels beyond the acceptable normal level of 13 mg/dL at 72 hours of life. The prevalence of hyperbilirubinaemia was 19%. Among the 95 babies, 40 (42.1%) were born to primigravida mothers, while 55 (57.9%) were born to multigravida mothers. In the present study, the authors observed that out of the 26 mothers suffering from hypothyroidism, 14 babies developed hyperbilirubinaemia. Similarly, out of the 24 mothers with preeclampsia, eight babies developed hyperbilirubinaemia. Furthermore, out of the 15 mothers with diabetes mellitus, six babies developed hyperbilirubinaemia. Additionally, out of the 11 mothers with polyhydramnios, two babies developed hyperbilirubinaemia, and out of the 10 mothers with Premature Rupture of Membranes (PROM), one baby developed hyperbilirubinaemia. Among the 208 male neonates, 58 developed hyperbilirubinaemia, while among the 292 female neonates, 37 developed hyperbilirubinaemia. ABO incompatibility was seen in 23 (24.2%) neonates, and Rh incompatibility was seen in 3 (3.2%) neonates, both of which were identified as important risk factors. A higher incidence of hyperbilirubinaemia was observed in neonates born via Lower Segment Caesarean Section (LSCS) compared to normal vaginal delivery. Conclusion: In the present study, the prevalence of neonatal hyperbilirubinaemia was 19%. Male babies, babies born via LSCS, those with ABO incompatibility, and mothers with hypothyroidism were significantly more prone to develop hyperbilirubinaemia in neonates.

Parental Knowledge, Attitudes, and Practices towards Self-medication for Various Oral Health-related Problems in Children: A Cross-sectional Study

Harsha Veena Kakollu, SVSG Nirmala, Sivakumar Nuvvula, Dhigvijay Arepogu

Introduction: Over the years, there has been an increase in the practice of Self-medication (SM) with over-the-counter drugs for dental conditions. Regarding paediatric patients, it is important for parents to have proper Knowledge, Attitude, and Practice (KAP) regarding SM for their children. Aim: To assess the parental KAP towards SM for various oral health-related problems of children below 15 years of age. Materials and Methods: A cross-sectional study was conducted at schools in Nellore, Andhra Pradesh, India, between March 2021 and January 2022. A total of 323 parents of children aged up to 15 years were included in the study. Data were collected from parents through a prevalidated questionnaire to record their demographic details and KAP of SM. Fisher’s exact test was used to compare KAP of SM with the age, gender, education, and Socioeconomic Status (SES) of parents. Results: The most common medicine and reason for which SM was practiced were pain relievers (85%) and expensive dental treatment (39.8%), respectively. The pharmacist was the most common source of information for SM (46.9%) and drug dosage (46%). There was a significant association (p=<0.001) between children age groups and the presentation form of medicine. Additionally, statistically significant differences were found when comparing parents’ educational level and SES with dosage difference (p=0.01, p=<0.001), route of administration of medicine (p=0.04, p=<0.002), preference for expensive medicine (p=<0.001, p=<0.001), and reasons for not visiting the dentist (p=<0.01, p=<0.001), respectively. Furthermore, when SES was compared with course completion, a statistically significant difference was found (p=<0.05). Conclusion: Knowledge regarding SM practice was lower in the low educational and low SES groups.

Trends of Animal Bite Cases and Comparison of Cases Reported during Pre-COVID-19 and COVID-19 Period in a Dedicated Anti-Rabies Clinic from a Tertiary Care Hospital, Hassan, Karnataka, India: A Retrospective Cohort Study

G Praveen, KJ Subhashini, KJ Shashank, M Ashik

Introduction: Rabies causes 100% case fatality in animal bite victims if left untreated, and it ranks as the 10th leading cause of death due to infectious diseases worldwide. India alone reports 20,000 human rabies deaths annually, accounting for one-third of global mortalities related to the disease. However, rabies is 100% preventable. The nationwide lockdown imposed from March 25, 2020, to curb the spread of the Coronavirus Disease-2019 (COVID-19) disrupted various essential health services, including Post-Exposure Prophylaxis (PEP) for rabies. Aim: To describe the socio-demographic profile of animal bite cases and assess the burden of animal bites during the pre and post COVID-19 Pandemic, specifically in patients reporting to the dedicated Anti-Rabies Clinic (ARC) of a tertiary care hospital in Hassan, Karnataka, India. Materials and Methods: A retrospective record-based study was conducted from January 2019 to November 2021 among animal bite cases reporting to the ARC at Hassan Institute of Medical Sciences, Hassan, Karnataka, India. Data on age, gender, locality, and socio-economic status were collected from the records maintained at the ARC. All subjects with complete data in the records were included in the study. All animal bite cases were managed according to the World Health Organisation (WHO) guidelines, with necessary COVID-19 precautions taken. A total of 3,706, 3,303, and 2,144 subjects were considered for the years 2019, 2020, and 2021, respectively. Results: There was a decreasing trend in the reported cases during the pandemic. The proportion of animal bite cases among those less than 19 years old was 1,146 (30.9%), 1,124 (34.1%), and 711 (33.1%) in the years 2019, 2020, and 2021, respectively. The majority of animal bite victims were males: 2,489 (67.2%), 2,240 (67.8%), and 1,173 (54.7%) in the years 2019, 2020, and 2021, respectively. The majority belonged to the rural population, with 2,668 (72.0%), 1,057 (32%), and 1,586 (74%) in the years 2019, 2020, and 2021, respectively. However, there was an increase in the number of victims from the urban population in the year 2020, with nearly 2,246 (68%). Most of them, 2,299 (62%), 2,114 (64%), and 1,441 (67.2%) in the years 2019, 2020, and 2021, respectively, belonged to a lower socio-economic status. Category-III bites made up the majority representation in all the years 2019, 2020, and 2021. Conclusion: The number of animal bite cases reported during the pandemic was lower compared to the pre-pandemic phase. This highlights either missed reporting of cases or a reduction in exposure to animals, which decreased the risk of animal bites.

Survival in Patients with Post-myocardial Infarction Ventricular Septal Rupture: A Retrospective Observational Study

Shilpa Suresh, Srujan Singanamala, Raghavendra Murthy, Ravikalyani Nagashetty

Introduction: Post-myocardial infarction ventricular septal rupture (post-MI-VSR) is a dreaded complication with high mortality. There is a varied survival pattern among patients who have undergone surgical repair. Aim: To assess the survival rates in patients who underwent surgical repair for post-MI-VSR in a single centre. Materials and Methods: A retrospective observational study was conducted in the Department of Cardiothoracic Surgery at Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India. The patient records from January 2005 to December 2020, who underwent surgical repair of post-MI-VSR, were reviewed. The perioperative variables, mortality, and survival data were analysed. Kaplan-Meier analysis was performed to assess the survival time. Results: The mean age of the studied patients was 58.4±7.5 years. A total of 73 patients underwent surgery for post-MI-VSR. A total of 40 (55.80%) were males and 33 (45.20%) were females. Overall, 36 (49.32%) patients had diabetes, and 27 (36.99%) had hypertension. Anterior Myocardial Infarction (MI) (n=56, 76.71%) was the most common location of MI. The mean Cardiopulmonary Bypass (CPB) and clamp times were 144.05±59.09 and 105.38±38.34 minutes, respectively. The mean survival time was 2619.564 days {95% Confidence Interval (CI) 2105.936 to 3133.192}. Conclusion: As revascularisation confers a significant survival advantage, VSR repair with concomitant Coronary Artery Bypass Graft (CABG) appears beneficial.

Analysis of Postoperative Complications of Minimally Invasive Surgery for Carcinoma of Oesophagus: A Single Centre Retrospective Cohort Study

Sonai Datta Kakati, Dokne Chintey, Gaurav Das, Marie Ninu

Introduction: Traditional transthoracic oesophagectomy is associated with high perioperative morbidity. Minimally Invasive Oesophagectomy (MIE) techniques have been shown to have a decreased incidence of respiratory complications and an improvement in perioperative outcomes, such as length of hospital stay and wound infection rates. Aim: To evaluate the incidence of postoperative respiratory complications, 30-day mortality, and length of hospital stay among patients with carcinoma of the oesophagus undergoing, Video-Assisted Thoracoscopic Surgery (VATS) oesophagectomy. Materials and Methods: A cross-sectional study was conducted in the Department of Anaesthesiology in a new thoracic oncology unit at a Tertiary Cancer care centre, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India. A total of 67 patients with resectable oesophageal cancer who underwent VATS oesophagectomy from September 2019 to December 2021 were included. Patients who had surgery by open thoracotomy and inoperable cases were excluded. The patients’ clinicodemographic profile, intra-and postoperative variables, and complications were studied. Descriptive statistics were used for analysis. A p-value ≤0.05 was considered statistically significant at a 5% level of significance. Results: Out of 67 patients, 45 (67.2%) were male, and 22 (32.8%) were female. The age ranged from 33 to 78 years with a median age of 55 years (IQR 47-61). The median body weight was 45 kg (IQR 42-53). Nineteen (28.4%) patients developed postoperative complications, including respiratory distress in 7 (10.4%) and anastomotic leakage in 5 (7.5%) patients. Other complications included symptomatic Coronavirus Disease 2019 (COVID-19) infection, pneumonia, mediastinitis, Multiorgan Dysfunction Syndrome (MODS) with sepsis, seizure and cardiac arrest, and surgical re-exploration. The 30-day mortality was 2.98%. The median length of hospital stay was 19 days (Interquantile Range (IQR) 16-22), which was higher in those with complications (p<0.001). One-lung ventilation was associated with a higher risk of postoperative respiratory complications (p=0.077). Conclusion: VATS oesophagectomy, even in a new thoracic oncology unit, was associated with lower perioperative complications, a shorter hospital length of stay, and decreased mortality compared to historical controls.

Preoperative Clonidine with Perioperative Dexmedetomidine for Attenuating Haemodynamic Responses and Blood Loss in Patients Undergoing Elective Transnasal Transsphenoidal Resection of Pituitary Tumours: A Randomised Clinical Study

Introduction: Transsphenoidal resection of pituitary tumours presents challenges for an anaesthesiologist due to haemodynamic fluctuations caused by intense nociceptive stimuli during different surgical stages. This relatively short procedure requires a smooth and rapid emergence for spontaneous airway control and assessment of surgical outcomes. Therefore, the chosen anaesthetic agent should provide effective haemodynamic control and facilitate rapid recovery. Alpha-2 agonists such as dexmedetomidine and clonidine are known to centrally decrease noradrenaline release, thus reducing sympathetic outflow. This could be particularly beneficial in minimising haemodynamic fluctuations during such surgeries. Aim: To compare the effects of preoperative clonidine and perioperative dexmedetomidine in attenuating haemodynamic responses and blood loss in patients undergoing elective Transnasal Transsphenoidal (TNTS) resection of pituitary tumours. Materials and Methods: A randomised, double-blinded study was conducted in the Department of Neuroanesthesiology at Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India, over a period of one year, from February 2022 to January 2023. Sixty patients of either sex, aged 18-65 years with ASA I or II, scheduled for elective TNTS pituitary surgery, were enrolled and divided into group A and group B. Group A received clonidine tablets (3 mcg/kg) 180 minutes prior to surgery, while group B received intravenous (i.v.) infusion of dexmedetomidine (1 mcg/kg/min) over 10 minutes before induction, followed by 0.5-0.7 mcg/kg/hr. Group A received a placebo of 0.9% Normal Saline (NS) (50 mL). Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Arterial Pressure (MAP) were recorded at baseline, intubation, nasal pack insertion, endoscope insertion, and at various time intervals. Data obtained were analysed using unpaired sample t-test for independent groups, and Chi-square test was used for categorical data. A probability value of 0.05 was considered significant for both statistical tests. Results: The mean age of participants was 42±11 years for group A and 43±12 years for group B, with a male: female ratio of 66.6% to 33.3% in group A and 70% to 30% in group B, respectively. The mean Body Mass Index (BMI) was 26.4±3.2 in group A and 25.2±1.7 in group B. HR, SBP, and MAP decreased at various stages in group B compared to group A, and these differences were statistically significant (p-value <0.05). The study also found that the total consumption of propofol was significantly less in group B (220±38) compared to group A (282±140). Similarly, total fentanyl consumption was significantly lower in group B (5.83±1.60) than in group A (16.6±23.9). Although not statistically significant, total blood loss was also lower in group B (115±63) compared to group A (156±108). Conclusion: Intraoperative infusion of i.v. dexmedetomidine provides a reasonable choice compared to orally administered clonidine for transsphenoidal pituitary tumour resection, considering its favorable effects on haemodynamic stability and anaesthetic requirements.

Perception of First Year Medical Students towards a New Histology Module in a Medical College in Eastern India: A Quasi-experimental Study

Rituparna Basu, Tapati Roy

Introduction: The post-COVID (Coronavirus) era, the transition of our country towards a competency-based curriculum, and our fundamental goal to improve students’ learning experience and academic performance expedite the need to introduce new strategies to the existing teaching-learning method based on principles of medical education in the form of a structured module. Among all subdivisions of anatomy, this is especially relevant for histology because microscopic anatomy poses a basic difficulty associated with the comprehension of microscopic details of human tissues through the novice, untrained eyes of the freshly-admitted first-year medical students. Aim: To study the perception of first year medical students towards the new histology teaching module. Materials and Methods: This quasi-experimental study was conducted among 85 first year medical students of Medical College, Kolkata, from May 2022 to October 2022, on histology teaching methods, comparing new histology modules versus traditional histology methods. A student survey was conducted to study their perception regarding the difficulties faced by them during their first-semester histology practical examination. After conducting a literature search, a new learner-centered histology module was designed and implemented among students to address these difficulties. Forty-eight histology sessions were conducted using the new module over a total duration of six months. Students’ feedback regarding the new module was recorded at the end of the sixth month. The collected data was analysed using Statistical Package for the Social Science (SPSS) software version 22.0 (trial version). Results: A total of 84 (98.8%) of students strongly agreed that because of the preliminary self-study time followed by discussions, quizzes, and brainstorming during the histology sessions, they had an improved understanding of the assigned learning areas. Additionally, 81 (95.3%) of students strongly agreed that their drawing skills of histology diagrams had improved due to drawing practice during the sessions. Furthermore, 83 (97.6%) of students reported an improvement in focusing and correctly identifying slides. Moreover, 82 (96.4%) of students felt that the regular formative assessments and immediate feedback improved their readiness for histology examinations. All of them agreed to the continued practice of the new module in future histology sessions. Conclusion: The students’ response towards the module was found to be positive. Addressing the students’ recommendations in the future would increase the chances of generating more support for it and enhancing their motivation towards improved academic performance in histology examinations.

Treatment Outcome of Tuberculosis in Patients with Diabetes under RNTCP in a Tertiary Care Centre, Chengalpattu, India: A Prospective Cohort Study

P Parameshwari, Sanjai, Niveditha, Preetha, H Gladius Jennifer, Latha Durai

Introduction: Diabetes increases the risk of Tuberculosis (TB) by three times, and this bidirectional association is currently one of the major concerns. A stronger evidence base is required to clarify the impact of Diabetes Mellitus (DM) on the treatment outcome of TB. Aim: To compare the treatment outcome among diabetic and non diabetic patients on Category-I TB treatment based on the Revised National Tuberculosis Control Program (RNTCP). Also, to assess the various factors influencing the treatment outcome of TB among diabetic patients. Materials and Methods: A prospective cohort study was conducted on 75 newly diagnosed TB patients enrolled for Category-I treatment Department of Pulmonary Medicine, Chengalpattu Medical College, Chengalpattu, Tamil Nadu, India, between October 2018 to November 2019. All patients with TB underwent blood glucose screening at treatment initiation and were categorised into two groups: with diabetes and without diabetes. Demographic details, family history of DM, smoking, alcohol consumption, and clinical profile were collected using a semi-structured questionnaire and followed-up for six months to assess their treatment outcome. The treatment outcome was compared statistically based on diabetes status using the Chi-square test. Results: The mean age of the study population was 49.9±0.5 years, with the majority being male 56 (74.7%). More than half of the study population belonged to a low socio-economic status. Among the study population, 42 (56%) were diabetic, with a mean blood glucose level of 242.7±80.5 mg/dL. Eighty-two percent had Pulmonary TB, with a 68% smear positivity rate among diabetic patients. In terms of treatment outcome, 44 (58.7%) were cured, 15 (20%) completed treatment, 10 (13.3%) were lost to follow-up, and 6 (8%) expired during the treatment course. Conclusion: Smear positivity and pulmonary TB were predominant among patients with diabetes. Treatment completion was lower, and mortality was higher among diabetic patients with TB.

Treatment Outcome of Cervical Cancer Patients in the Elderly Population Aged 80 Years and Above: A Single Institution Study

Introduction: Age-related deficits such as malnutrition, functional reliance, and cognitive decline also occur in older women, as they are typically weaker and have many co-morbid conditions like diabetes or cardiac illness. These prognostic factors might predict overall survival and progression-free survival. Aim: To analyse the management outcomes of elderly patients with cervical carcinoma treated with radiotherapy and brachytherapy. Materials and Methods: A retrospective observational study was conducted in the Department of Radiation Oncology at Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India. Medical records were collected from 876 patients with cervical cancer who had been treated with radiotherapy or combined radiotherapy and chemotherapy from January 2009 to December 2021. A total of 876 patients presented with cervical cancer in the Outpatient Department (OPD), and 20 patients meeting the inclusion criteria were selected. Patients diagnosed with cervical cancer, Federation International Federation of Gynaecology and Obstetrics (FIGO) stage IB to IVA, aged equal to or greater than 80 years old, and Eastern Cooperative Oncology Group (ECOG) performance status I to III were considered for inclusion. Categorical variables were expressed as counts and percentages. The following clinicopathological characteristics of the study population were examined: FIGO staging, including stage IB to stage IVA, histopathological features of adenocarcinoma, squamous carcinoma, or adenosquamous carcinoma, doses of radiotherapy and brachytherapy, overall survival, disease-free survival, and the patient’s current status (alive or dead) was determined. If death occurred, the cause of death was determined. The Kaplan-Meier approach was used to analyse overall survival and disease-free survival in the study population using XLSTAT statistical software. Results: The study population was age standardised, with 18 patients (90%) falling between the ages of 80 and 85, and 2 patients (10%) falling between the ages of 86 and 90. A total of 12 patients (60%) belonged to ECOG PS II. A total of 19 (95%) patients had histologically confirmed squamous cell carcinoma. 75% of the population was in a locally advanced stage (stage III-IVA). The overall survival (in months) was 65.58 months, which was statistically significant (p<0.0083). Similarly, the average disease-free interval was 38.73 months, which was also significant (p<0.0062). Conclusion: According to the findings of the study, age may not be an independent risk factor for determining the outcome of cervical cancer patients in the Indian scenario. Even though elderly females may present with multiple co-morbidities, the standard treatment protocol must be radical.

Surgical Transversus Abdominis Plane Block for Postoperative Analgesia in Lower Abdominal Surgeries: A Prospective Interventional Study

Introduction: Pain from lower abdominal surgeries originates from the abdominal wall incision. The Transversus Abdominis Plane (TAP) is a fascial plane between the internal oblique and the transversus abdominis muscle, which contains the nerve bundles. TAP block involves infiltrating this plane with anaesthetic drugs that block the somatic component of postoperative pain. Traditionally, the TAP block is given by anaesthesiologists as a blind procedure or under Ultrasound (US) guidance. In 2010, an innovative surgical TAP block method was developed, where the surgeon gives TAP block under direct vision before closing the abdomen during abdominal surgery. Many studies have recommended surgical TAP block as an intervention for achieving postoperative pain relief. Aim: To evaluate the efficacy of the surgical TAP block technique for postoperative analgesia following lower abdominal surgeries using Visual Analogue Scale (VAS) scores and by comparing the need for rescue analgesia and the total amount of analgesic drugs utilised within the first 24 hours of surgery. Materials and Methods: This hospital-based prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at The Oxford Medical College Hospital and Research Centre, Bengaluru, Karnataka, India, from January 2022 to December 2022. The study participants included 108 women undergoing lower abdominal surgeries under spinal or epidural or combined regional anaesthesia and belonging to the American Society of Anaesthesiologists (ASA) physical status classification system ASA I or ASA II or ASA IIE. The study group included 54 women who received surgical TAP block with 20 mL 0.25% bupivacaine and 4 mg of dexamethasone, intraoperatively on either side before closure of the abdomen. Postoperative pain was assessed using VAS at regular intervals within 24 hours of surgery. VAS was also recorded whenever the participants demanded rescue analgesia. The control group included 54 women who received intravenous tramadol 50 mg eight hourly for postoperative pain relief, while the study group received rescue analgesia on demand or if the VAS score was recorded as three or more. The time for the first request for rescue analgesia and the total dose of rescue analgesic required in the first 24 hours after surgery were also recorded. Data were analysed using Statistical Package for Social Sciences (SPSS) version 25.0. For inferential statistics, numerical data were analysed by Chi-square test, and for continuous data, the Student’s t-test was used. A p-value <0.05 was considered statistically significant. Results: The study group had significantly lower postoperative pain VAS scores when compared to the control group at four hours and beyond time intervals. The mean VAS scores at six hours were 1.85 in the study group and 2.35 in the control group (p-value=0.01), at 24 hours it was 2.04 in the study group and 2.24 in the control group (p-value=0.04). The mean time for the first rescue analgesia in the study group and control group was 11 hours 25 minutes and 2 hours 43 minutes, respectively, and the total tramadol consumption was 77.78±46.24 mg and 117.59±36.55 mg, respectively. Both results were statistically significant (p-value <0.001). Conclusion: Surgical TAP block significantly delays the need for rescue analgesia and decreases the total analgesia required in the first 24 hours after surgery. It is an effective, safe, and simple technique for achieving postoperative pain relief.

Association of D-dimer Level with Renal Parameters and Cardiovascular Events in Type 2 Diabetes Mellitus: A Retrospective Cohort Study

Kinjal P Patel, Nishant B Patel, Silky A Patel

Introduction: D-dimer is a biomarker that can detect early stages of renal and cardiovascular dysfunction in Type 2 Diabetes Mellitus (T2DM). It serves as a key indicator and is readily available in laboratory settings, along with other risk factors. Aim: To investigate the association between D-dimer levels and renal parameters, as well as cardiovascular events, among T2DM subjects. Materials and Methods: This retrospective cohort study was conducted at Visnagar’s Nootan Medical College and Research Centre, Visnagar, Gujarat, India, involving subjects who visited the centre for health checks between September 2021 and December 2022. Screening was performed on all adult individuals with T2DM. Clinical records of 550 consecutive T2DM patients, aged between 18 and 80 years, receiving care at the centre were analysed. After applying exclusion criteria, 155 patients with T2DM diagnosis were enrolled. Parameters such as cystatin C, D-dimer, serum creatinine, urea, estimated Glomerular Filtration Rate (eGFR), and albuminuria were evaluated in all subjects. Bivariate logistic regression analysis was conducted to determine whether renal indicators are associated with high D-dimer levels, generating an odds ratio. Multivariate logistic regression analysis was then performed, correcting for sex and age, to determine which kidney indicators are linked to high D-dimer levels. Results: A total of 155 participants were included in this study, and were divided into high and low D-dimer groups. The mean ages of the low and high D-dimer groups were 40±13 years and 55±10 years, respectively. Compared to the low D-dimer group, the high D-dimer group had a higher frequency of males (p-value <0.001). Patients with high D-dimer levels exhibited significantly increased levels of HbA1c, creatinine, urea, cystatin C, and UAE compared to patients with low D-dimer levels (p-value=0.001, p-value=0.001, p-value <0.001, p-value <0.001, and p-value=0.001, respectively). Conclusion: D-dimer may be beneficial in identifying patients with early-stage diabetic kidney disease, thereby promoting the early adoption of renal and cardioprotective therapy. Additionally, elevated D-dimer levels are associated with an increased risk of cardiovascular disease.

Efficacy and Safety of Naproxen Gel in Musculoskeletal Pain Management: A Prospective Cohort Study

Introduction: Naproxen is effective for various musculoskeletal conditions and has a longer half-life, making it a favourable choice for sustained relief. Additionally, there is a potential unmet need for guidelines on the usage of topical Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in the Asia-Pacific region. A study on naproxen 10% gel aims to address this need and increase awareness of its therapeutic potential in the region. Aim: To assess the efficacy and safety of naproxen 10% gel in relieving pain associated with lower back, knee, cervical, synovitis, bursitis, muscle sprain, and tendinitis. Materials and Methods: This prospective, cohort, observational, open-label, single-arm, multicentric study was conducted at 458 centres in India, including Ahmedabad, Bengaluru, Chandigarh, Chennai, Delhi, Guwahati, Hyderabad, Indore, Jaipur, Kolkata, Lucknow, Meerut, Mumbai, Patna, and Pune, between February 2023 and May 2023. The data was collected from outpatient settings/clinics of orthopaedicians and clinicians who have been prescribing topical naproxen 10% gel to their patients. The study included patients aged 18 to 60 years of either sex who were suffering from back pain, muscle pain, sprains, frozen shoulder, arthritis, acute low back ache (non-specific), or pain. The data was captured during the scheduled follow-up visits planned by the treating clinician, with data recorded at 3, 5, 10, and 15 days. At the baseline visit, demographic details (age, sex, weight, height, body mass index, and symptoms), Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain subscale score, pain intensity on movement score, Visual Analogue Scale (VAS), and overall pain score were obtained. Results: Out of 10,587 patients, 10,265 completed the present study. The majority of patients had lower back pain (n=3386, 32.99%) and knee pain (n=3184, 31.02%). The average pain intensity on movement score of patients with bursitis significantly decreased from the baseline to 15 days {mean change {95% Confidence Interval (CI)}: 6.04 (5.89, 6.20); p<0.001}. Post-naproxen treatment, the average pain intensity, WOMAC pain score, VAS, and overall pain score significantly decreased from baseline to day 15 in patients with knee pain and lower back pain. A significant improvement in WOMAC, WOMAC pain (5.42 vs 17.98), WOMAC stiffness (1.49 vs 5.75), and WOMAC physical function score (18.93 vs 56.21) at day 15 was observed in patients with a muscle sprain. Adverse Events (AE) were reported in 173 (1.69%) patients overall, with dryness (n=125) being the most common, followed by erythema (n=20) and pruritus (n=17). Conclusion: Naproxen 10% gel is an effective topical treatment for lower back pain, knee pain, cervical pain, synovitis, bursitis, muscle sprain, and tendinitis. It could prove helpful in patients where the side-effects of oral NSAIDs are to be avoided.

Reliability of the Kannada Version of the Knee Injury and Osteoarthritis Outcome Score: A Cross-sectional Study

K Deekshith, Nityal Kumar Alagingi

Introduction: The Knee Injury and Osteoarthritis Outcome Score (KOOS) is a valid and reliable tool for assessing knee injury and osteoarthritis (OA). It has been cross-culturally adapted into several Indian languages. However, the reliability of the Kannada translation of the KOOS scale has not been established. Aim: The aim of this study was to confirm the reliability of the Kannada translation of the KOOS scale and to assess the inter-rater and test-retest reliability of the culturally adapted KOOS outcome measure. Materials and Methods: A cross-sectional study was conducted involving 74 patients diagnosed with OA. All patients were asked to complete the KOOS questionnaire. To test inter-rater reliability, two raters completed the questionnaire, while for test-retest reliability, one rater was involved. The procedure was repeated after a week. The scores of both questionnaires were then compared to check the inter-rater and test-retest reliability of the cross-culturally adapted KOOS outcome measure. Cronbach’s Alpha and the Intraclass Correlation Coefficient (ICC) were utilised to determine the scale’s reliability. Results: The entire scale demonstrated high reliability, with an ICC ranging from 0.96 to 0.98 for all subscales. The domain-wise and overall Cronbach’s Alpha values were >0.70. There was agreement between the raters (p<0.01) and test-retest data (p<0.01) for pain and activities of daily living items. Highly significant correlations were also observed between test-retest data for all items related to sport and recreation function and knee-related quality of life (p<0.001). Conclusion: The Cronbach’s Alpha values obtained for all domains of the scale were >0.70, indicating the scale’s reliability. Additionally, the scale demonstrated consistency as the ICC was determined to be substantial.

Analysis of Hormonal Profile in Women with Benign Breast Diseases and Women without Breast Pathology at a Tertiary Care Hospital in Lucknow, India: A Cross-sectional Study

Tulika Singh, Nisar Ahmad Ansari, Manish Kumar, Nirupma Lal, Sachin Khanduri

Introduction: Disruptions in normal hormonal pathways contribute to the development of various benign breast conditions. Having a general understanding of specific hormonal interactions, such as estradiol, progesterone, and prolactin, among breast tissue, the hypothalamus, the pituitary, and the gonads, can enhance understanding of the causes and manifestations of benign breast conditions such as fibroadenoma, fibroadenosis, breast cyst, abscess, mastitis, galactocele, and phyllodestumour. However, there is limited available information regarding the hormonal environment associated with Benign Breast Disease (BBD). Aim: To compare serum levels of estradiol, progesterone, and prolactin between women with BBD and those without breast pathology. Materials and Methods: This cross-sectional study was conducted in the Department of General Surgery, Era Lucknow Medical College and Hospital (ELMC and H), Lucknow, Uttar Pradesh, India, from January 2021 to January 2023. A total of 80 female subjects were enrolled and divided into two groups: Group A (40 subjects diagnosed with BBD by triple assessment) and Group B (40 subjects with no breast pathology). Serum levels of estradiol, progesterone, and prolactin were tested during the follicular phase and compared between the two groups. Student t-test and Spearman’s correlation with a 95% confidence interval were used for mean comparison between the groups. Receiver Operating Characteristic (ROC) analysis was performed to determine cut-off values, sensitivity, and specificity for the hormones. A p-value of <0.05 was considered as significant. Results: The mean age showed no statistical differences between Group A (26.5 years) and Group B (28.8 years). The mean levels of estradiol and progesterone hormones were significantly higher in Group A (188.38±96.06 pg/mL; 4.34±5.05 ng/mL) than in Group B (103.21±39.52 pg/mL; 0.38±0.30 ng/mL) with a p-value of 0.001. The sensitivity of estradiol was found to be 80% with a specificity of 75% based on ROC analysis when the cut-off was set to <139.5. Furthermore, progesterone showed a sensitivity of 92.50% and specificity of 80% at a cut-off <0.8560. Prolactin showed a sensitivity of 52.50% and specificity of 62.50% at a cut-off <18.96. Conclusion: Authors concluded that steroidal harmones have a significant effect on the development of BBD. The present study had demonstrated that women with BBD exhibit higher levels of estradiol and progesterone compared to women without breast pathology.

Frequency and Patterns of Bacteraemia in Children with Sickle Cell Disease: A Prospective Cohort Study

Introduction: Sickle Cell Disease (SCD) is one of the most common inherited haemoglobinopathies and is associated with high morbidity and mortality, particularly in early childhood among the affected population. Infection is a significant contributor to morbidity and mortality in SCD. Aim: To investigate the frequency and pattern of bacteraemia in children with SCD. Materials and Methods: This prospective cohort study was conducted in the Department of Paediatricss at Acharya Vinoba Bhave Hospital, Sawangi (M), Wardha, Maharashtra, India, a tertiary care hospital attached to Jawaharlal Nehru Medical College from October 2019 to September 2021. A total of 70 patients with SCD, aged upto 18 years, who presented with fever on two separate occasions and were admitted to the hospital, were included in the study. Blood culture, complete blood counts, and C-reactive Protein (CRP) tests were conducted to detect bacteraemia immediately after admission and when required. Quantitative data was analysed using mean, median, and standard deviation. Results: In the present study, out of 70 patients, 40 (57.14%) were male and 30 (42.86%) were female. A total of 54 (77.14%) were homozygous and 16 (22.86%) were heterozygous for SCD. A total of 30 (42.86%) patients belonged to the 6-10 years age group. Fever and pallor were the most common clinical findings. The rate of bacteraemia was found to be 15.71%. Gram-negative organisms were more frequently isolated compared to gram-positive isolates. The most common organism isolated in sickle cell patients was Klebsiella species (36.36%). Conclusion: Bacteraemia was observed in only approximately 15.71% of the patients. Gram-negative bacteraemia was more prevalent in patients with SCD. Patients with acute chest syndrome were more susceptible to bacterial infections. Mortality was higher in sickle cell patients from whom organisms were isolated in blood cultures.

Microbiological Profile and Visual Recovery in Various Clinical Types of Endophthalmitis at a Tertiary Eye Care Hospital of Tamil Nadu, India: A Retrospective Cohort Study

Introduction: Endophthalmitis is a serious, sight-threatening purulent inflammation of the intraocular cavities of the eyeball. It greatly affects vision and can lead to severe complications such as panophthalmitis. The prevalence of endophthalmitis varies from one place to another. Aim: To identify the various aetiological and predisposing factors that contribute to endophthalmitis and to assess the visual outcomes following medical intervention (intravitreal antibiotics only) and surgical intervention (both intravitreal antibiotics and pars plana vitrectomy). Materials and Methods: The present study was conducted in the Department of Ophthalmology at Trichy SRM Medical College Hospital and Research Centre, Trichy, Tamil Nadu, India between January 2023 and February 2023. Demographic and clinical data of patients diagnosed with endophthalmitis over a two year period from October 2020 to September 2022 were collected from the Medical Records Department of the Institution for analysis. A total of 50 case records were selected using convenience sampling. Demographic details such as age, gender, predisposing risk factors, visual acuity, microbiological profiles, treatment modalities, and final visual acuity were collected from the present study. Quantitative data was presented as Mean and Standard Deviation (SD), while qualitative data was presented as frequencies and percentages. Summary statistics were analysed using Microsoft Excel version 2018. Results: In present study, 29 (58%) were males and 21 (42%) were females, with the majority falling within the age group of 50-70 years. The mean age of the sample was 53.8±16.1 years. Postoperative causes accounted for 39 (78%) of the cases, with phacoemulsification surgery with foldable intraocular lens implantation being the leading cause in 23 (58.7%) cases. Culture positivity was observed in only 22 (44%) cases, with Staphylococcus (Staph) epidermidis as the major causative organism. The best visual acuity achieved was 6/12 for two patients. Conclusion: Postoperative endophthalmitis remains the most common cause of endophthalmitis. Additionally, patients who presented with better visual acuity had a better visual outcome after treatment. Therefore, patients should be educated about the early signs of endophthalmitis to ensure prompt medical attention and improve visual recovery.

Mothers’ Knowledge, Attitudes and Practices Regarding Antibiotic Use in Paediatric Dentistry: A Cross-sectional Survey

Mainak Das, Nupur Saha, Dipanjan Debnath, Piyali Datta, Shabnam Zahir

Introduction: Odontogenic infections in children are commonly addressed through prescriptions that frequently include antibiotics for both preventive and therapeutic purposes. Mothers, being the primary caregivers, play a vital role in ensuring their children receive antibiotics as prescribed. Insufficient awareness among mothers regarding the prudent utilisation of antibiotics can contribute to misuse and the development of antibiotic resistance. Aim: To explore the Knowledge, Attitudes, and Practices (KAP) of mothers regarding the use of antibiotics in children for the management of odontogenic infections in the city of Kolkata, West Bengal. Materials and Methods: A cross-sectional survey was conducted using a multi-lingual, close-ended, knowledge-attitudes-practices-based offline questionnaire with 23 questions. The survey included 203 mothers with children between six months and 13 years old, attending the Outpatient Department (OPD) of Paediatric and Preventive Dentistry, Guru Nanak Institute of Dental Sciences and Research, Panihati, between October 2022 and January 2023, in the city of Kolkata, India. The data collected were subjected to statistical analysis. Results: A majority of mothers, 104 (51.2%) belonged to group ≤35 in the present study. A total of 85.7% of the mothers had knowledge that antibiotics are used against bacterial infections leading to toothache or facial swelling. Approximately 44.9% of the mothers demonstrated a lack of awareness regarding the global issue of antibiotic resistance, while 89.6% of mothers believed that antibiotics should be continued until the full course of prescribed antibiotics is completed. A total of 63.1% of mothers have administered antibiotics prescribed by pharmacists or medical shopkeepers to their children. The study revealed a significant association between the educational level of mothers and their awareness regarding the issue of antibiotic resistance, as well as between the parents’ monthly income and their attitude towards the use of expensive antibiotics (p<0.05). Conclusion: The present study highlights that in the city of Kolkata, the education level of mothers significantly affects their knowledge of antibiotic use in paediatric dentistry.

Comparing Conventional Cytology Smear and Cell Block Techniques for Ovarian Cancer Diagnosis: A Prospective Observational Study

Naina Saluja, Jayant Makarande, Sunita Vagha

Introduction: The cytological examination of ascitic fluid is widely recognised and well-documented for its importance in staging and prognosis of malignancy, and for providing information about inflammatory lesions. The Cell Block (CB) method offers improved architectural patterns and morphological features, aiding in the differentiation between reactive mesothelial cells and malignant cells, thus enhancing the efficacy of cyst diagnosis. Additionally, the CB technique finds applications in molecular biology and immunocytochemistry, making it advantageous for targeted therapy due to its ability to preserve cytological material. Aim: To compare the accuracy of conventional cytology smear technique and CB from ascitic fluid with histopathology for diagnosing ovarian tumours. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology at Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India. A total of 45 patients with suspected ovarian tumours or presence of ascites were included. Biopsy samples were sent to the pathology laboratory for histological evaluation, while study samples were collected from the Department of Pathology between January 2021 and December 2022. Sample processing techniques, such as conventional cytology {including cytocentrifugation before Giemsa, Pap, and Haematoxylin and Eosin (H&E) staining} and thromboplastin-plasma technique for CB preparation, were employed. Evaluation parameters included comparing morphological features of frequently stained cytology smears and CB technique of ascitic fluid, along with their concordance with histopathological diagnosis. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) program for Windows, version 28.0. Results: Among 45 patients, majority 24 (53.40%) of them belonged to 41-60 years of age group. It was noted that 24 (53.40%) patients had ascites, 11 patients (24.40%) had abdominal pain with ascites, and 10 (22.20%) had ovarian mass with ascites. Conventional cytology smear diagnoses revealed that 22 (48.9%) patients had infiltrates of serous cystadenocarcinoma. A significant correlation was found between the findings of the CB and Conventional Smear (CS) (p=0.0001), with a sensitivity of 94.12%, specificity of 100%, Positive Predictive Value (PPV) of 100%, Negative Predictive Value (NPV) of 85.71%, and a diagnostic accuracy of 95.65% for CB correlating with CS. Conclusion: A combined strategy utilising stained cytology smears and the CB technique of ascitic fluid could be considered in the diagnostic approach for malignant ovarian tumours.

Ischaemia-modified Albumin Estimation and Usefulness of Different Albumin Adjustment as a Marker to Predict Kidney Damage in Diabetes Mellitus

Afzal Ahmad, Ashish Agarwal, Charu Yadav, Nadia AZ Zahra

Introduction: Urine Albumin Creatinine Ratio (UACR) has been the standard for detecting albuminuria in diabetes mellitus, but the presence of “non albuminuric renal impairment” has encouraged the search for novel markers. Recently, increased serum Ischaemia Modified Albumin (IMA) levels have been implicated in cases of Diabetic Nephropathy (DN). However, its estimation by conventional albumin cobalt assay is confounded by serum albumin levels. Aim: To estimate IMA and albumin-adjusted IMA levels to assess their utility in diagnosing early renal damage in diabetes mellitus. Materials and Methods: This hospital-based cross-sectional study was conducted from March 2014 to January 2015 at Kasturba Medical College, Mangaluru, Karnataka, India. The study included 30 healthy individuals and 60 patients with diabetes mellitus, which were further divided equally into three groups based on UACR. The groups were as follows: normoalbuminuria group (UACR <30 mg/g of creatinine), microalbuminuria group, and macroalbuminuria group (UACR 30-300 and >300 mg/g of creatinine, respectively). Serum IMA levels were estimated using Enzyme-linked Immunosorbent Assay (ELISA), while Glycated Haemoglobin (HbA1c), serum creatinine, urine albumin, and urine creatinine were measured using auto-analysers. Albumin-adjusted IMA values were measured, and correlation assays between IMA and serum albumin concentration were analysed in each group using one-way Analysis of Variance (ANOVA) and Pearson’s correlation. Results: In the present study, out of the 60 diabetes mellitus patients, 27 were females and 33 were males, with a mean age of 53±17 years. Among the 30 controls, 14 were females and 16 were males, with a mean age of 51±17.5 years. Serum albumin had a significant negative correlation with IMA in the microalbuminuria (r=-0.4, p<0.01) and macroalbuminuria (r=-0.58, p<0.001) groups. A significant mean difference was found in serum IMA, albumin-adjusted IMA, IMA index, and IMA ratio between the normoalbuminuria group and the other groups. Receiver operating characteristic analysis was used to predict the early stage of nephropathy (albuminuria). High sensitivity and specificity were measured for IMA (97.5% and 78%, respectively) and IMA ratio (97.5% and 76%, respectively) at cut-off percentages of 99 and 24.5, respectively. Conclusion: The IMA ratio has greater diagnostic importance compared to other adjusted IMA values in discriminating diabetic patients with micro- and normoalbuminuria.

Calcium and Magnesium Levels in Subclinical and Overt Hypothyroidism: A Cross-sectional Study

Suman Chatterjee, Phalguni Chakrabarti, V Lokanathan

Introduction: Hypothyroidism, one of the most common thyroid gland disorders, can cause electrolyte disturbances in the body. Hypothyroidism can alter mineral metabolism by changing the levels of serum calcium and magnesium. Therefore, it is essential to study any abnormalities in calcium and magnesium metabolism in patients with hypothyroidism. Aim: The aim of this study was to assess the levels of calcium and magnesium in patients with hypothyroidism and to study the correlation between Thyroid Stimulating Hormone (TSH), fT3, and fT4 with calcium and magnesium in subclinical and Overt Hypothyroidism (OH). Materials and Methods: This cross-sectional study was held from August 2019 to January 2020 in the Department of Biochemistry, BS Medical College, Bankura. A total of 150 subjects were included in the study, distributed equally among three groups: euthyroidism, subclinical hypothyroidism, and OH. Serum TSH, fT3, fT4, calcium, and magnesium levels were determined in the laboratory, and the data obtained were statistically analysed using ANOVA test and Pearson’s correlation test. Results: Out of a total of 150 subjects, 61 were female, among whom 23 had subclinical hypothyroidism and 21 had OH. There were significant differences in the mean levels of TSH, fT3, fT4, calcium, and magnesium between the SCH, OH, and euthyroid groups. The study showed that the mean serum calcium level was significantly lower in SCH and OH compared to euthyroids, while the level of serum magnesium was significantly increased in SCH and OH compared to euthyroid. There was a statistically significant negative correlation between TSH and serum calcium in both OH and SCH, while a statistically significant positive correlation was observed between TSH and serum magnesium levels in both groups. Conclusion: The present study revealed that serum magnesium levels were high while serum calcium levels were low in both subclinical hypothyroidism and OH when compared to euthyroid subjects. Additionally, calcium levels negatively correlated with TSH, while magnesium levels positively correlated with TSH levels.

A Cross-sectional Study of Third to Seventh Cervical Vertebral Bodies, Pedicles, and its Relevance to Screw Size used in Clinical Practice

Kishore Chandra Thakur, Sunder Lal Jethani

Introduction: To provide stability to the unstable cervical spine, the usage of transpedicular screws is very common due to their success in providing good results in terms of fixation, stability, and strength. The size of the transpedicular screw used must be in accordance with the morphology of the pedicle of the vertebra in a particular region or group of the population. This helps avoid pedicle wall damage along with nearby neurovascular structures. Aim: The aim of the present study was to measure the body and pedicle of cervical vertebrae (third to the seventh) and to understand their morphology in relation to the need for a uniform screw size. Materials and Methods: A cross-sectional study was conducted from May 2019 to March 2023, using a total sample of 102 adult human dry cervical vertebrae collected from the bone bank of the Anatomy Department at the Himalayan Institute of Medical Sciences, SRHU, Dehradun. Only cervical vertebrae from the third to the seventh were included. Digital vernier calipers were used to measure the parameters, including the Transverse Diameter (TD), Anteroposterior Diameter (APD), and Vertical Height (VH) of the vertebral body, as well as the Pedicle Width (PW), Pedicle Height (PH), and Pedicle Length (PL) of the pedicle. Statistical analysis was performed using Microsoft® Excel® 2019 MSO (Version 2209 Build 16.0.15629.20200) 64-bit software (Microsoft Office Home and Student 2019, Washington, USA). The parameters of the right and left sides of the pedicle (PW, PH, PL) were compared using the student’s t-test, and Pearson correlation test was used to find correlations among them. A p-value of 0.05 or lower was considered statistically significant. Results: For the vertebral body, the mean APD was 16.6 mm, VH was 11.6 mm, and TD was 25.6 mm. For the pedicle, the mean PW was 5.1 mm, PH was 6.5 mm, PL was 8 mm, and Axial Length (AXL) was 30.4 mm. No significant difference was found between the right and left sides of PW (p=0.7), PH (p=0.2), PL (p=0.7), and AXL (p=0.2). A weak correlation (0.31-0.40) was observed among the parameters of the vertebral body (APD, TD, VH), whereas a moderate to strong correlation (0.60-0.89) was noticed among the parameters of the cervical vertebrae pedicle (PW, PH, PL, and AXL). Conclusion: The size of the screw used for spinal fixation in one region of the Indian population may not always be compatible with other regions. This morphological study of the cervical vertebral body and pedicle suggests its clinical relevance in the use of a cervical transpedicular screw with a diameter of less than 4 mm and a length of less than 30 mm. Additionally, using a screw along the sagittal plane of the vertebral body with a length of less than 16 mm may reduce bone breach and prevent neurovascular damage.

Diffusion Tensor Imaging Parameters in Patients with Meningitis: A Case-control Study

Introduction: Neuroimaging plays an important role in the assessment of meningitis, but conventional Magnetic Resonance Imaging (MRI) is insensitive for early and specific diagnosis. Diffusion Tensor Imaging (DTI) can illustrate disturbances in white matter integrity before they become obvious on conventional MRI. Aim: To determine DTI parameters, specifically Fractional Anisotropy (FA) and Apparent Diffusion Coefficient (ADC), in patients with meningitis and compare them with controls. Materials and Methods: This case-control study was conducted over a period of 18 months at Teerthanker Mahaveer Medical College and Research Centre in Moradabad, Uttar Pradesh, India. The study included a total of 61 clinically diagnosed meningitis patients, aged 18 years and above, who were referred to the Department of Radiodiagnosis for an MRI Brain. Additionally, 61 controls were included. Conventional MRI images were obtained followed by DTI. FA and ADC values were calculated by placing Regions Of Interest (ROI) at different levels for both groups. DTI parameters for different causative organisms (bacterial, viral, tubercular, and fungal) were compared. Data was analysed using Statistical Package for the Social Sciences (SPSS) software version 24.0, and Analysis of Variance (ANOVA) test was used to identify significant differences. The p-value <0.05 was considered as statistically significant. Results: FA values were significantly lower in cases compared to controls at all levels in the brain (mean whole brain FA value of 0.30±0.036 in cases vs 0.43±0.030 in controls). ADC values were significantly higher in cases at the cerebellum, brainstem, and whole brain levels compared to controls (mean whole brain ADC value of 0.812±0.095 in cases vs 0.758±0.026 in controls) (p-value <0.05 considered statistically significant). These differences were evident in patients with clinically proven meningitis who had a normal appearance on conventional MRI, demonstrating the superiority of DTI over conventional MRI for the diagnosis of meningitis. Statistically significant differences were also found among different aetiological agents, highlighting the potential utility of DTI in the differential diagnosis of meningitis cases (mean whole brain FA of 0.31±0.038 in bacterial cases, 0.029±0.037 in viral cases, 0.299±0.034 in tubercular cases, and 0.27±0.00 in fungal cases vs. 0.43±0.030 in controls (p-value <0.01) and mean whole brain ADC values of 0.80±0.051 in bacterial, 0.85±0.14 in viral, 0.79±0.058 in tubercular, 1.03±0.00 in fungal cases vs. 0.758±0.026 in controls (p-value <0.01)). Conclusion: DTI is more sensitive than conventional MRI and is a useful early indicator of inflammatory process in patients with meningitis.

Knowledge and Perception Regarding Sexual Health among College Students in Malappuram District, Kerala, India: A Cross-sectional Study

Nandini Gopalamenon, Remya Ramachandran, Aiswarya K Venugopal

Introduction: Good Sexual and Reproductive Health (SRH) encompasses complete physical, mental, and social well-being in all matters related to the reproductive system. Access to accurate information is crucial for maintaining SRH. Adequate knowledge and perception regarding sexual health play a vital role in reducing Sexually Transmitted Infections (STIs), teenage or unwanted pregnancies, and empowering individuals against sexual violence. Aim: To evaluate the knowledge and perception of sexual health and associated factors among college students in Perinthalmanna, Malappuram District, Kerala. Materials and Methods: A cross-sectional study was conducted among 540 students from January to April 2022 among 540 students attending MES Arts and Science College in Perinthalmanna, Malappuram District, Kerala, India. A semi-structured questionnaire was used to assess their demographic details, knowledge, and perception regarding sexual health. The Chi-square test and Independent t-test were employed, and multivariate logistic regression was performed to identify independent predictors, including the students’ academic qualification, educational status of their mothers, and prior information on sexual health. Results: The respondents were predominantly male (60.4%), with a mean age of 19.32±1.262 years. The majority (95.4%) were undergraduate students, while 4.6% were postgraduate students. Muslims accounted for the majority of respondents (83%), followed by Hindus (14.6%). More than 90% of the participants were unmarried. Approximately 60% of the respondents’ mothers and 51% of the fathers had a high school education. Out of 540 respondents, 487 (90.2%) reported having obtained information on sexual health. Friends (41.7%) were the most preferred sources of information. The mean score for respondents’ knowledge was 3.79±1.3, and the mean score for perception was 31.26±4.5. Being a postgraduate student (p=0.035), having a higher educational status of the mother (p=0.034), and prior information on sexual health (p<0.001) were significantly associated with higher knowledge. Being a postgraduate student (p=0.02) and having a higher educational status of the mother (p=0.03) were significantly associated with higher perception. A total of 21% of the respondents stated that sex education should be provided according to age appropriateness. Gender-wise differences were observed in the respondents’ opinions regarding the timing of sex education (p=0.024). Conclusion: Good knowledge and positive perception levels were significantly associated with the academic qualification of the study subjects and the educational status of their mothers. However, the respondents’ knowledge regarding fertilisation, pregnancy, and contraceptives was deficient. Therefore, implementing a comprehensive sexual and reproductive health education program in schools and colleges, along with behavioural change communication materials, is urgently needed.

Evaluating the Dietary Gaps and Anthropometric Parameters of the Government School Children Aged 11-14 Years in Accordance with ICMR Standards

K Silambu Selvi, J Sai laavanya, G Nandhini, P Shanthini Priya, I Vanthi Ekal

Introduction: Malnutrition is a major global health crisis that needs immediate attention. Adolescence is a crucial stage where nutrition plays a major role on account of their growth and development. There is a need to assess the nutritional status of Government school children in Tamil nadu to take appropriate policy decisions and implement nutritional interventions. Aim: To assess the dietary gaps of Government school children and compare their anthropometric parameters with Indian Council of Medical Reasearch (ICMR) standards. Also, to associate their daily intake of five food groups with their weight status. Materials and Methods: This cross-sectional study was conducted by the Department of Clinical Nutrition and Dietetics, SRM Medical College Hospital and Research Centre (SRMIST), Kattankulathur, Chengalpattu District, Chennai,Tamil Nadu, India as a part of a nutritional awareness camp in month of March 2022 to examine the eating pattern of school-going children aged 11-14 years, in a Government school of Kalivanthapattu village, Chengalpattu, Tamil Nadu. Data was collected randomly among 73 school children during a nutritional awareness camp conducted by study Institute. A validated tool was used to identify the dietary gaps in food group intake and the anthropometric parameters were assessed using standard measures and were compared with ICMR and World Health Organisation (WHO) standards to analyse their nutritional status. The acquired data was analysed using Statistical Package for Social Sciences (SPSS) software. Results: Out of the 73 children, there were 52 girls and 21 boys and the mean age of the children was 12.09±0.80 years. The dietary gap assessment tool indicated the gross deficiency in the intake of different food groups by the children. The majority of the samples 52 (71.2%) had an average dietary pattern, 9 (12.3%) students were found to have poor dietary habits and only 12 (16.4%) students had a good dietary pattern. Body Mass Index (BMI) assessment indicated that 39 students (53.4%) were normal (-2SD to +1SD) and others were found to be malnourished. A substantial variation in the mean weight of 12-year-old-male students (p-value=0.025) as well as female students (p-value=0.003) was observed when compared to ICMR standards. There was high significant difference between mean height of 13-year-old female students and the mean height as per ICMR standards (p-value=0.004). Conclusion: The dietary intake of Government school children was average and the anthropemetric assessment indicated that many of them were malnourished.

Surgical Site Infections in Clean and Clean-contaminated Surgeries at a Tertiary Care Centre: A Longitudinal Study

Dwaipayan Samaddar, Sourav Kumar Ghosh, Jaya Bagchi Samaddar, Gautam Das

Introduction: Surgical Site Infections (SSIs) are very common and the most frequently studied Hospital-Acquired Infection (HAI) in developing countries. Up to 5% of patients undergoing surgery develop SSIs, which can cause significant morbidity and, in some cases, be fatal. Aim: To determine the prevalence of SSI and compare the factors related to its development between clean and clean-contaminated surgeries. Materials and Methods: This longitudinal study was conducted at a rural tertiary care centre in the Department of General Surgery from May 2020 to April 2021. A total of 1,020 patients who underwent clean and clean-contaminated surgeries were clinically examined, investigated, and provided standard treatment modalities. Dirty and contaminated cases were excluded from the study. Clean and clean-contaminated surgeries were defined according to the guidelines provided by the Centres for Disease Control and Prevention (CDC). Demographic and risk factors, such as sex, age, nature of surgery, wound irrigation, American Society of Anaesthesiologists (ASA) score, smoking, preoperative stay, duration of surgery, hair removal, drains, immunosuppression, Diabetes Mellitus (DM), and Haemoglobin (Hb) levels, were observed and compared between the two groups. The development of SSI was diagnosed based on CDC guidelines. SSI cases were followed-up longitudinally in both groups. Continuous variables were analysed using an unpaired t-test, while categorical variables were analysed using a chi-square test. A p-value of <0.05 was considered statistically significant. Results: Out of the 1,020 patients, a total of 93 (9.11%) developed SSI. Among the males (573, 56.17%), 39 (6.8%) developed SSI, while among the females (447, 43.83%), 54 (12.08%) developed SSI. The study found that 24 (3.46%) clean operations and 69 (21.1%) clean-contaminated surgeries developed SSI (p-value <0.0001). There was a significant association between SSI and risk factors such as ASA <2 (p-value <0.01), smoking (p-value <0.01), DM (p-value <0.01), Hb <8 gm% (p-value <0.01), shorter preoperative stay (p-value <0.01), prolonged surgery (p-value <0.01), use of drains (p-value <0.01), and immunosuppression (p-value <0.01). The majority of SSIs were caused by Staphylococcus aureus (24 cases, 25.8%), followed by Pseudomonas aeruginosa (18 cases, 19.3%) and Escherichia coli (12 cases, 12.9%). Patients who developed SSI had a mean postoperative stay of 32.35 days, compared to 7.19 days for those who did not develop SSI. Conclusion: The study concluded that SSI was significantly more common in clean-contaminated surgeries compared to clean surgeries. Proper surveillance can help document SSI even after hospital discharge. Prompt identification of organisms can facilitate clinical recovery.

Association of HbE Haemoglobinopathy in Patients with Systemic Lupus Erythematosus: A Cross-sectional Study

Introduction: Systemic Lupus Erythematosus (SLE) is a chronic inflammatory disease of autoimmune origin that affects multiple systems, with the haematologic system being commonly involved. However, the co-existence of haemoglobinopathies and connective tissue disorders has rarely been investigated, and the available data on this matter are primarily anecdotal. Aim: To determine the prevalence of Haemoglobin E (HbE) haemoglobinopathy in adult SLE patients and to assess the association of HbE haemoglobinopathy and SLE with disease activity. Materials and Methods: A hospital-based cross-sectional study was conducted at the Department of General Medicine, Regional Institute of Medical Sciences (RIMS) Hospital, Imphal, Manipur, India, from April 2021 to July 2022. The study included SLE patients diagnosed during the study period who attended the rheumatology Outpatient Department (OPD). The independent variables were age, gender, occupation, religion, and family history, while HbE haemoglobinopathy, Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), Red Blood Cell (RBC) count, and Systemic Lupus Activity Measure Revised Index (SLAM-R index) score were the dependent variables. Data were analysed using Statistical Package for Social Sciences (SPSS) version 21.0, with proportions analysed using the Chi-square test and Fisher’s-exact test, and means compared using Analysis of Variance (ANOVA) and independent t-test. A p-value of <0.05 was considered significant. Results: Of the 105 SLE patients included in the study, 93% were females. The majority of participants (36.2%) were in the age group of 21-30 years. Twenty-five patients (23.8%) had HbE haemoglobinopathy. Anaemia and MCV were significantly associated with HbE patients. Among the 25 HbE patients, 24 (96%) had active SLE disease. Among the HbE negative patients, 55 (68.7%) had active disease, while 25 (31.3%) did not have any active disease. Active SLE disease was significantly associated with HbE haemoglobinopathy (p-value=0.002). Conclusion: The overall prevalence of HbE haemoglobinopathy in SLE patients was found to be 24%. Hb levels and MCV levels were significantly lower in HbE patients. There was a significant association between active SLE disease and HbE haemoglobinopathy.

Usefulness of Endoscopic Ultrasound for the Detection of Asymptomatic Pancreatic Morphological Changes in Patients with Alcoholic Liver Disease: A Cross-sectional Study

Pankaj Gupta, Dinesh Agarwal, Anurag Govil, Harsh Udawat

Introduction: Although alcoholism is a common aetiological link between liver and pancreatic disorders, the frequency of coinciding pancreatic disease in patients with alcohol-related liver disease is not well understood. The present study mentions about the use of Endoscopic Ultrasound (EUS) with standardised criteria to assess asymptomatic or overt pancreatic pathology in patients with alcoholic liver disease. Aim: To determine the prevalence of asymptomatic Alcoholic Chronic Pancreatitis (ACP) in Indian patients affected by Alcoholic Liver Cirrhosis (ALC) using EUS. Materials and Methods: The present observational cross-sectional study was conducted on patients attending the Outpatient Department of Gastroenterology at Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, Jaipur, Rajasthan, India. A total of 35 patients were screened with alcoholic liver disease for pancreatic abnormalities using EUS. The patients were recruited for the study over a period of 12 months, from September 2013 to August 2014. The prevalence of chronic pancreatitis (CP) was determined, and abnormalities were graded according to the Rosemont criteria. The severity of alcoholic liver disease, as indexed by Child Pugh Scoring (CPS) and Model for End-stage Liver Disease (MELD), was evaluated for any association with endosonographic findings of CP. The influence of various clinico-demographic factors on alcoholic liver and pancreatic diseases was analysed using the PSS Inc. Chicago, IL program. Results: A total of 35 male patients, aged 28 to 65 years with a mean age of 46.97 years, fulfilled the inclusion criteria. EUS revealed a prevalence of CP in 20% of patients. Three patients showed changes suggestive of CP, of which two had ALC and one had Alcoholic Hepatitis (AH). Four patients were prioritised in categorised as indeterminate for CP, with three having cirrhosis and one having Alcoholic Fatty Liver (ALF). No significant influence of clinico-demographic profiles on the final outcome parameters was observed. The patient with endoscopic changes had a MELD score of 12.85±5.11 compared to patients without changes of ACP (19.1±5.71) (p=0.013). ALC was found to be inversely related to EUS changes of ACP. Conclusion: The EUS is an effective screening tool for evaluating pancreatic abnormalities in patients with alcoholic liver disease. The present study provides a comprehensive review of previous findings in light of the varying facts and figures. As there is still a lack of experimental animal models for ALC and ACP, studies of this kind may shed light on hidden links in disease pathology.

Psychosocial Impact, Perceived Stress Levels and their Learning Effect among the Undergraduate Dental Students during the Transition from Preclinicals to Clinicals: A Questionnaire-based Cross-sectional Study

Introduction: Dentistry is known as the most challenging and stressful profession. Dental education enhances students’ ability to provide high-caliber work in the clinical field. To fulfill this criterion, students are required to develop professional conduct, competencies, and psychological and cognitive abilities in due course of time. The shift from preclinical to clinical is considered one of the most crucial stages for dental undergraduates. During this period, individuals often experience unique emotional and social challenges, leading to stress, anxiety, and depression. Aim: The aim of this study is to assess the perceived stress levels, psychosocial impacts, as well as depression and anxiety levels among dental undergraduates during their transition from preclinical (2nd year) to clinical (3rd year) practice. Materials and Methods: A cross-sectional questionnaire-based study was conducted among second and third-year dental undergraduates from different dental colleges in South India from February 2022 to June 2022. Two questionnaires, the Dental Environmental Stress (DES) scale (25 items) and the Depression Anxiety Stress Scale (DASS) (21 items), were utilised to measure stress, depression, and anxiety levels. The questionnaire was designed using Google Forms and distributed via WhatsApp. The snowball sampling technique was used, and data from 489 self-selected participants were collected and sent for statistical analysis. Descriptive statistics (mean, 95% Confidence Interval [CI]) were used to identify major stressors and their perceived magnitude. The responses were recorded on a 4-point Likert scale. Results: This study included a total population of 489 participants, with 360 (73.6%) females and 129 (26.3%) males, respectively. According to the DES results, the educational environment and clinical domain were the most stressed domains, with mean values of 1.7859±0.47929 and 1.7639±0.43729, respectively. The top five stressors identified were lack of relaxation time, fear of failure, financial burden, assigned work, and examinations/grades. The DASS results revealed the highest prevalence of stress (15.22±5.92), followed by anxiety (13.39±6.01) and depression (12.60±8.66). Conclusion: The results of this study indicate that dental undergraduates experience higher levels of perceived stress, psychosocial effects, depression, and anxiety during the transition from preclinical (2nd year) to clinical (3rd year) practice. Structured student support systems, such as counselling programmes and effective communication skills, can help create an environment that reduces stress and enhances student well-being.

Association of Clinicopathological Profile and Immunohistochemical Expression of KRAS and BRAF in Colorectal Carcinoma: A Cross-sectional Study

Mandira Mitra, Suman Ghosh, Niladri Sarkar, Anadi Roy Chowdhury

Introduction: Colorectal Carcinoma (CRC) is a multi-step process that occurs due to the accumulation of several genetic alterations. The most important alterations are related to the rat sarcoma viral oncogene homolog (RAS) and Rapidly Accelerated Fibrosarcoma (RAF), which have been implicated as key intermediates in the RAS-mediated signalling cascade. However, the levels of Kristen Rat Sarcoma Virus (KRAS) and v-raf Murine Sarcoma Viral Oncogene Homolog (BRAF) protein expression and their prognostic evaluation in CRC patients remain unknown. Aim: To investigate the immunohistochemical expression of KRAS and BRAF proteins in CRC. Materials and Methods: The present institutional-based cross-sectional observational study was conducted in a tertiary care centre in West Bengal, specifically in the Department of Pathology in collaboration with the Department of Surgery at Murshidabad Medical College and Hospital, Berhampore, West Bengal, India. A total of 26 CRC cases were enrolled in the present study, received over a period of one and a half years from January 2021 to June 2022. The parameters studied included demographic and clinical information of the patients, histopathological findings, pathological grade and stage of carcinoma, and immunohistochemical findings for KRAS and BRAF. For statistical analysis, data were entered into Microsoft (MS) Excel. Descriptive measures such as mean±Standard Deviation (SD), range, and percentage were used. The Chi-square test was used to determine the significance of the study. Results: A total of biopsy-proven CRC specimens were studied, consisting of 17 male patients (65.38%) with a male-to-female ratio of 1.9:1. The most common age group involved was 51-60 years (38%). Conventional adenocarcinoma accounted for the majority of cases (85%), with mucinous carcinoma comprising the remaining 15%. Among the 26 cases, 15 (58%) showed KRAS positivity, which was significantly associated with tumour grade and stage. Most of the cases were BRAF-negative. Out of the 21 cases where either KRAS or BRAF or both were positive, 20 cases showed high T stage (T3 and T4) and/or metastatic lesions (p-value 0.001). All four cases that were negative for both BRAF and KRAS belonged to the low T stage. Conclusion: A significant correlation was observed between the expression of KRAS and high-grade, high pathological Tumour, Node, Metastasis (TNM) T stage (T3 and T4) CRC. Therefore, KRAS Immunohistochemistry (IHC) biomarkers should be included in the standard diagnostic protocol for colorectal cancer, as they help identify KRAS-positive CRC cases that are resistant to targeted immunotherapy.

Effect of Palonosetron in the Prevention of Spinal Anaesthesia-induced Hypotension and Bradycardia: A Randomised Controlled Trial

Introduction: Spinal Anaesthesia (SA) is frequently associated with hypotension, which is due to sympathectomy causing vasodilation, leading to relative hypovolemia. This decrease in venous return to the heart causes a decrease in left ventricular filling pressure, leading to the activation of the Bezold-Jarisch Reflex (BJR), which causes bradycardia. This response is mediated by mechanoreceptors and chemoreceptors present on the heart walls. These chemoreceptors are mediated through serotonin (5-HT). Therefore, the activation of 5-HT3 receptors at sensory vagal nerve endings in the heart causes hypotension and bradycardia. Aim: To assess the efficacy of Palonosetron in attenuating spinal anaesthesia-induced hypotension and bradycardia. Materials and Methods: The trial was a parallel-design, randomised, double-blind controlled trial conducted over two years, from February 2021 to August 2022 in the Department of Anaesthesiology, Kalinga Institution of Medical Sciences (KIMS), Bhubaneswar, Odisha, India, among patients undergoing spinal anaesthesia for various surgeries. The patients were divided into two groups based on the type of medication received: Group A- Palonosetron group and Group B- the saline group. Computer-generated random number generator software was used for randomisation. At a 1:1 ratio, 150 patients were chosen (75 in each group). Baseline assessment of haemodynamic parameters was performed, followed by continuous monitoring. The drug was administered 10 minutes prior to spinal anaesthesia, and the haemodynamic parameters (Heart Rate [HR], Systolic Blood Pressure [SBP], Diastolic Blood Pressure [DBP], and Mean Arterial Pressure [MAP]) were monitored. Continuous variables are expressed as mean±Standard Deviation (SD). The Student’s t-test was used to compare the difference between the two groups, and categorical variables are expressed as frequency and percentage, with comparisons done using the Chi-square test. A p-value of <0.05 was considered statistically significant. Results: The mean age of Group A and Group B was 40.88 and 42.14, respectively. Significant haemodynamic changes (hypotension) were observed following induction in Group B (28 [37.3%]) compared to Group A (9 [12%]). Consumption of vasopressors and intravenous (i.v.) fluids was significantly higher in Group B compared to Group A. The incidence of bradycardia in Group A and Group B was 15 (20%) and 18 (24%), respectively. Postoperative Nausea and Vomiting (PONV) in Group A and Group B were 3 (4%) and 8 (10.7%), respectively. Conclusion: Based on the present study, the prophylactic administration of 0.075 mg Palonosetron 10 minutes before subarachnoid block is effective in attenuating the incidence of spinal anaesthesia-induced hypotension and bradycardia. There is also decreased consumption of vasopressors and a lower incidence of PONV.

Red Cell Distribution Width and Platelet Indices in Women with Pre-eclampsia: A Cross-sectional Study

Manuja Naik, HS Ashok Kumar, Greeshma

Introduction: To determine the prognosis and fetomaternal outcome in eclampsia and pre-eclampsia, a simple and cost-effective approach is to assess the Red cell Distribution Width (RDW) and platelet count. RDW, Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and platelet markers such as Mean Platelet Volume (MPV) have been the subject of research. Aim: To compare the variation of RDW, NLR, PLR, and platelet indices between women with pre-eclampsia and gestational age-matched healthy controls. Materials and Methods: A cross-sectional study was conducted among 208 pregnant women (104 with pre-eclampsia and 104 controls) at the Department of Obstetrics and Gynaecology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India, from January 2020 to June 2021. RDW, NLR, PLR, and platelet indices were analysed after obtaining detailed history, conducting clinical examinations, and relevant investigations. An Independent t-test was used as a test of significance to identify the mean difference between the two quantitative variables. Results: The RDW among cases was 17.05±4.01, whereas among controls, it was 15.09±1.86. The mean age of subjects among case group was 25.72±4.741 years, while in the control group it was 23.25±3.803 years. There was a significant difference in mean Red cell Distribution Width- Coefficient of Variation (RDW-CV) between the two groups. The MPV among cases was 9.86±1.14, while among controls, it was 8.92±1.40 (p-value=0.001). The PDW among cases was 11.30±2.20, and among controls, it was 12.72±3.50. The mean NLR among cases was 5.92±4.94, whereas among controls, it was 4.59±2.22. There was a significant difference in mean platelet count, MPV, PDW, and NLR between the two groups. Conclusion: According to the findings of the current study, RDW, NLR, and MPV were all shown to be higher in women with pre-eclampsia. Additionally, pre-eclamptic women consistently exhibited decreased PDW and platelet counts.

Clinical Profile and Risk Factors of Exudative Age-related Macular Degeneration: A Hospital Based Case-control Study

Aparna Ravi, Simon George

Introduction: Age-Related Macular Degeneration (ARMD) is one of the leading causes of vision loss in the elderly population. ARMD is characterised by progressive degeneration of the retinal pigment epithelial complex and photoreceptors primarily in the macular region of the retina. The prevalence of ARMD in India ranges from 39.5% to 0.3%, as reported in population-based studies. Numerous risk factors, both modifiable and non-modifiable, have been identified for this condition. Aim: To determine the clinical profile and risk factors associated with exudative ARMD. Materials and Methods: This is a case-control study conducted in a tertiary eye care hospital in South Kerala from June 2011 to June 2012. The cases were patients attending the Outpatient Department (OPD) and Retina clinic who were diagnosed with wet ARMD. The corresponding control is the next patient seen after the case who is of the same sex and comparable age. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 17.0. Chi-square test was used to elucidate the association between the presence of ARMD and diet, educational status, occupation, smoking, alcoholism, hypertension, diabetes mellitus, cardiovascular disease, obesity, hyperlipidemia, history of cataract surgery, and cataract. Multivariate logistic regression analysis was used to assess these risk factors for cases and controls. Results: A total of 130 subjects consisting of 65 cases and 65 controls participated in the study. The majority of patients were in the age group of 60-69 years. History of hyperlipidemia (Odds Ratio [OR]: 1.649, Confidence Interval [CI]: 0.524-5.191, p=0.042) was significantly associated with the development of exudative ARMD. Hypertension (OR: 1.398, CI: 0.694-2.815, p=0.051), cardiovascular disease (OR: 1.770, CI: 0.274-5.064, p=0.188), Body Mass Index (BMI) >25 (OR: 0.537, CI: 0.254-1.133, p=0.075), dietary factors (OR: 1.351, CI: 0.461-3.961, p=0.609), smoking (OR: 1.400, CI: 0.484-4.051, p=0.593), alcoholism (OR: 1.400, CI: 0.484-4.051, p=0.593), history of cataract surgery (OR: 1.160, CI: 0.411-3.279, p=0.456), cataract (OR: 1.618, CI: 0.692-3.782, p=0.149) were not found to be significant. The results may vary in the present scenario due to changes that have occurred over the years, especially in the case of smoking and alcoholism, as the prevalence of which has increased. The majority (88.75%) of study subjects have classic Choroidal Neovascular Membrane (CNVM). Conclusion: ARMD was found to have a significant association with hyperlipidemia. Those with hypertension, cardiovascular disease, cataract, smokers, and alcoholics have a higher risk of developing exudative ARMD. By controlling modifiable risk factors like hyperlipidemia and by avoiding smoking and alcoholism, the authors can prevent this potentially blinding condition to some extent.

Clinical Profile and Visual Outcome of Traumatic Glaucoma Patients Following Closed Globe Injury in the Rural Part of Eastern Uttar Pradesh at a Tertiary Eye Care Centre: A Retrospective Cohort Study

Introduction: Glaucoma is a significant cause of ocular morbidity following ocular trauma, particularly Closed Globe Injury (CGI), which frequently leads to elevated Intraocular Pressure (IOP). This type of trauma can result in various tissue damages such as radial sphincter tears, iridodialysis, angle recession, cyclodialysis, trabecular meshwork tears, zonule separation, or peripheral retinal dialysis. Damage in these areas can lead to early or delayed onset glaucoma. Aim: To evaluate the clinical profile, assess visual outcomes, and analyse management strategies in post-traumatic glaucoma with CGI. Materials and Methods: The retrospective cohort study was conducted at a tertiary eye care centre in Department of Ophthalmology, Regional Institute of Ophthalmology (RIO), Sitapur, Uttar Pradesh, India. from January 2020 to December 2022. Retrospective data of patients presenting with CGI and developing elevated IOP (>21 mmHg) were collected. Only patients with a minimum follow-up of three months were included. Various parameters, including demographics, IOP, Best-Corrected Visual Acuity (BCVA), and the effects of medical and surgical treatments on IOP and BCVA, were analysed. The Ocular Trauma Score (OTS) was also calculated. Statistical analysis was performed using Microsoft excel and Statistical Package for Social Sciences software version 21.0, with a significance level of 5%. Continuous variables were described as mean±Standard Deviation (SD), and an unpaired t-test was used for comparisons between pre- and postmanagement visual acuity and IOP. Results: Out of 259 eyes with ocular trauma, 93 (35.90%) were diagnosed with CGI and developed elevated IOP. The most common causes of elevated IOP were hyphema (37.63%) and angle recession mechanisms (32.25%). The median IOP at presentation was 35 mmHg (range: 12 to 71 mmHg) and decreased to 16.5 mmHg (range: 4 to 52 mmHg) at the last follow-up (p-value <0.001). Surgical management was required in 30 (32.25%) eyes, with 13 (13.97%) eyes undergoing trabeculectomy. Conclusion: Post-traumatic IOP elevation occurred in 93 (35.90%) eyes with CGI, and 13.97% of these eyes required glaucoma filtering surgery for IOP control. Overall, medical management was necessary in 67.74% of eyes, while 32.25% required surgical intervention. Eyes with posterior segment involvement had poor visual acuity. Poor baseline vision and vitreo-retinal involvement increased the risk of a poor visual outcome.

Immunohistochemical Expression of p16 and p53 as Prognostic Indicator in Oral Squamous Cell Carcinoma: A Cross-sectional Study

Introduction: Head and Neck Squamous Cell Carcinoma (HNSCC) is the sixth most common cancer globally and the seventh most common cause of cancer-related mortality. Tobacco use, alcohol consumption, and Human Papillomavirus (HPV) infection are prominent risk factors for HNSCC. HPV-positive Oral Squamous Cell Carcinoma (OSCC) differs from HPV-negative OSCC in terms of risk factors, preferential site of origin, age, histomorphological features, molecular genetic alterations, and prognosis. The prominent basaloid morphology and lobular growth of OSCCs are associated with p16 positivity and p53 negativity, respectively. Aim: To establish the immunohistochemical expression of p16 (p16INK4a) and p53 in OSCC and to assess their relationship with specific histomorphological features, in the form of solid growth of cells in a lobular configuration, small crowded cells with scant cytoplasm, dark hyperchromatic nuclei without nucleoli. Materials and Methods: The cross-sectional study involved fifty cases of OSCC over a two-year period from January 2017 to January 2019 at Army Hospital (R and R) Delhi Cantt. The intensity of p16 and p53 protein expression was graded as follows: no staining (0), weak staining (1), moderate staining (2), and strong staining (3). The proportion/percentage of staining for p16 and p53 protein expression was calculated as follows: 1-4% (1), 5-19% (2), 20-39% (3), 40-59% (4), 60-79% (5), and 80-100% (6) cells stained. A quick score of 0-1 (negative), 2-3 (weak positive), 4-5 (moderate positive), and >6 (strong positive) was assessed. Cross tables were generated and the Chi-square test was used for testing associations. The Statistical Software for Data Science (STATA)-14 was used for statistical analysis. Results: A total of 50 cases of OSCC were analysed for histomorphological features and immunohistochemical patterns of p16 and p53. The age distribution showed that 8 (16%), 9 (18%), 18 (36%), 13 (26%), and 2 (4%) of the patients were in the age groups of 31-40 years, 41-50 years, 51-60 years, 61-70 years, and above 70 years, respectively. The gender distribution noted 42 (84%) males and 8 (16%) females. Genital and non-genital mucosa are usually involved by HPV subtypes 6, 11, 16, 18, and 16, 18, 11, 13, 2, respectively. HPV-16 has been demonstrated in 90-95% of all HPV-positive HNSCC cases, followed by HPV-18, HPV-31, and HPV-33. p53 is considered the guardian of the genome and controls the expression and activity of proteins involved in cell cycle regulation, DNA repair, cellular senescence, and apoptosis. More than 50% of all primary HNSCC exhibit p53 mutation. Conclusion: A significant correlation was observed between age, dysplasia, keratinisation, basaloid morphology versus p16 expression, and lobular growth, histological grade versus p53. An inverse relationship between p16 and p53 expressions was observed. The immunohistochemical expression of p16 as an immunohistochemical marker of HPV, along with p53, is recommended. Due to the constraint of the study period, the survival of the patients could not be assessed in correlation with p16 and p53 expression.

MALDI-TOF-MS for Rapid Detection of Fungi causing Mucormycosis during COVID-19 Pandemic from a Tertiary Care Hospital in Southern India: A Retrospective Cohort Study

R Someshwaran, B Appalaraju

Introduction: Mucormycosis is an opportunistic fungal infection that became a public health emergency during the second wave of Coronavirus Disease-2019 (COVID-19). It is an acute, angioinvasive, opportunistic, and emerging mycosis caused by mucormycetes, resulting in a significantly fatal fungal infection among immunocompromised and/or immunosuppressed individuals. Mucormycosis has a specific predilection for blood vessels (angioinvasive) and tissues, leading to extensive necrosis and thromboembolic events. Globally, the incidence rate of mucormycosis varies from 0.005 to 1.7 per million people. Early diagnosis and appropriate therapy are crucial for clinical outcomes. Aim: To evaluate the mycological profile of mucormycosis during the COVID-19 pandemic using automated Matrix Assisted Laser Desorption Ionisation Time of Flight Mass Spectroscopy (MALDI-ToF-MS) in comparison with conventional fungal identification methods. Materials and Methods: A retrospective cohort study was conducted, collecting data from July 2020 to June 2022, involving 1,176 patients from various clinical departments who attended PSG Hospitals affiliated with PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India. Data analysis was performed from July 2022 to August 2022. Clinical specimens, including Bronchoalveolar Lavage (BAL), Sputum, Cerebrospinal Fluid (CSF), nasal swabs, tracheal aspirates, pus, blood, corneal scraping, eye discharge, and necrotised tissues, were subjected to Potassium Hydroxide (KOH) mount, conventional culture coupled with micrometry-aided microscopy, and MALDI-ToF-MS among suspected mucormycosis cases. The results were collected in Microsoft Excel, and data analysis was conducted using the International Business Machines Statistical Package for the Social Sciences statistical software (IBM SPSS) version 24.0. The study variables were expressed as descriptive statistics: frequency (N) and percentage (%). The incidence of mucormycosis, mycological profile, and diagnostic utility of conventional micrometry-aided microscopy-assisted culture were compared with the automated MALDI-ToF-MS protein signature method of testing. Results: Fungal elements were positive in 130 (11.05%) out of a total of 1,176 clinical samples, such as necrotised tissue, biopsy, and sputum, in the KOH mount. Fungal culture was positive in 258 (21.94%) out of 1176 samples, with mucormycosis detected in 73 (28.29%) of the culture-positive samples. The incidence of mucormycosis in this study was 73 (6.21%) out of 1176. A total of 101 (8.59%) samples showed positive results for mucormycetes through KOH, culture, and MALDI-ToF-MS. MALDI-ToF-MS could rapidly and specifically identify and confirm the causative agents of mucormycosis at their genus and species levels compared to KOH or culture. Conclusion: Simple, low-cost, and less laborious conventional culture coupled with micrometry-aided microscopy can detect Mucorales at the species level, where KOH microscopy could not differentiate between species. MALDI-ToF-MS can be employed for the rapid detection and confirmation of mucormycosis agents at the genus or species level.

Trichoscopic Patterns of Scalp Dermatoses: An Observational Cross-sectional Study

G Sukanya, NR Vignesh, C Geo Danny, Sane Roja Renuka

Introduction: Trichoscopy is a well-acclaimed diagnostic tool for numerous dermatoses. Scalp disorders contribute to a significant percentage of daily visits to the outpatient dermatology department, and a multitude of trichoscopic signs have been documented in the literature. The consistency and repeatability of these signs add weight to their diagnostic value. Aim: To determine the various trichoscopic patterns observed in classical cases of scalp dermatoses and to differentiate between different scalp disorders. Materials and Methods: The present observational cross-sectional study included 100 newly diagnosed cases of scalp dermatoses attending the Dermatology Outpatient Department at Sree Balaji Medical College and Hospital, Chennai, India. The study was conducted over a period of six months (180 days) from December 2021 to May 2022. After obtaining a thorough history and conducting clinical examinations, patients underwent trichoscopy. Photographs were taken, and the data obtained were systematically tabulated. The scalp disorders studied included Androgenetic Alopecia (AGA), Alopecia Areata (AA), Telogen Effluvium, Tinea Capitis, Trichotillomania (TTM), Seborrhoeic Dermatitis, Scalp Psoriasis, Discoid Lupus Erythematosus (DLE), Lichen Plano-Pilaris (LPP), and scalp verruca. All data were entered into Microsoft excel and analysed using Statistical Package for Social Sciences software. Results: Trichoscopic findings from the 100 cases were categorised and tabulated according to pattern and condition for better understanding and comparison. Trichoscopic patterns observed were categorised as dots, vessels, shaft patterns, and changes in the inter and perifollicular areas. Out of the 100 patients, 67 presented primarily with alopecia, of which 56 patients (83.5%) had non scarring alopecia and 11 patients (16.4%) had scarring alopecia. The highest number of cases was observed in alopecia areata (n=20), where exclamation mark hairs were seen in all individuals, followed by coudability sign, yellow dots, and black dots. Among the androgenetic alopecia cases (n=18), anisotrichosis, pearly white dots, yellow dots, and an increased vellus-to-terminal hair ratio were observed in 100% of cases. Conclusion: While certain signs/findings are specific, most trichoscopic patterns overlap in various skin conditions. Therefore, dermatologists should be aware of the patterns observed in trichoscopy and the need to stay updated with the latest findings.

Efficacy of Apnoeic Oxygenation by Nasal Prongs in Preventing Desaturation during Airway Management in Infants Undergoing General Anaesthesia: A Randomised Controlled Study

Introduction: Neonates and infants are more prone to desaturation during the apnoeic period of laryngoscopy and intubation. Various options exist to reduce this risk beyond conventional preoxygenation. Aim: To assess whether continuous apnoeic oxygenation via nasal prongs during intubation can extend the safe apnoea period compared to standard management with preoxygenation alone. Materials and Methods: A randomised controlled, two-group parallel clinical study was conducted at the Department of Anaesthesiology, Vijayanagar Institute of Medical Sciences, Ballari, Karnataka, India, from July 2019 to November 2020. The study involved 63 infants aged one day to six months undergoing elective or emergency surgeries under general anaesthesia. Preoxygenation via a mask was followed by sevoflurane induction and vecuronium-induced muscle relaxation. Conventional laryngoscopy and intubation were performed in 32 infants in Group-C (Control group), while 31 infants in Group-O (Apnoeic Oxygenation group) also received oxygen (O2) via nasal prongs at 4 L/min in addition to preoxygenation. The primary outcome parameter was the time taken for desaturation by 1%. The time taken to desaturate by 2%, 3%, 4%, and 5%, as well as their incidences, lowest observed saturation, safe apnoea period, and Heart Rate (HR) trends, were also noted. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20.0 and OpenEpi version 3.01. Results: Demographic and clinical parameters were comparable between the groups. The mean time for 1% desaturation was 18.33±4.3 seconds in Group-C, while all Group-O cases maintained 100% saturation during the study period. No significant difference was found in the safe apnoea period between the groups (p=0.503). The average lowest O2 saturation observed in Group-C was 98.81±1.28%, while it was 100% in Group-O. Only one infant in Group-C showed desaturation down to 95%. Both groups exhibited similar HR trends. Conclusion: Apnoeic oxygenation by nasal prongs in healthy infants helps prolong the time to desaturation and can be beneficial for those at risk of desaturation and hypoxia.

Minimal Unified Wilson’s Disease Rating Scale (M-UWDRS) Score Compared to UWDRS Neurological Subscore in Wilson’s Disease: A Cross-sectional Study

S Mishra, SD Nayak, AK Mallick, BD More, G Mohanty, M Samanta, AK Sahu

Introduction: Wilson’s Disease (WD) is a copper metabolic disorder that affects the nervous system and liver. The Unified Wilson’s Disease Rating Scale (UWDRS) is used for diagnosing WD, but it is time-consuming. Therefore, a less exhaustive scale is needed as a screening tool, such as the minimal Unified Wilson’s Disease Rating Scale (M-UWDRS). Aim: To evaluate the utility of M-UWDRS in assessing signs and symptoms associated with WD and compare it with the UWDRS (Neurological) subscore. Materials and Methods: This prospective, observational, non interventional, cross-sectional study was conducted in the Department of Neurology, Srirama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India from November 2017 to October 2020. A total of 42 patients with WD, based on the European Association for the Study of the Liver (EASL) guidelines, were enrolled. They were assessed using both M-UWDRS and UWDRS (Neurological) scoring before treatment and at a three-month follow-up. Results: A total of 42 cases were enrolled, of which 28 were males and 14 were females. The mean age of presentation was 15.4±5.1 years. Both the neurological subscore of UWDRS and M-UWDRS were used pre and post-treatment, revealing a significant improvement in the majority of subjects. Both scores fared similarly in predicting disease severity, treatment outcome, and follow-up. The score of the “minimal UWDRS” correlated with the scores of the UWDRS for neurological subscores (r value: 0.6, p-value <0.001). Conclusion: M-UWDRS is a user-friendly, quick, and practical prescreening scoring scale for evaluating disorder severity and quantification of the outcomes in comparison to the UWDRS score, especially in resource-constrained and busy neurology departments. Scoring in WD will help in better prognostication of the disease.

Estimation of Serum Calcium Level among Hospitalised Infants with Acute Bronchiolitis: A Cross-sectional Study

Suman Gupta, Nirmal Kumar, Amardip Kaur, Deepak Kumar Gupta, Shifali Gupta

Introduction: Acute bronchiolitis is a common viral respiratory illness with clinical features ranging from mild to severe forms, requiring intensive care management. Calcium, a micronutrient, plays a significant role in numerous intracellular and extracellular events. Vitamin D deficiency is known to be associated with respiratory infections, and vitamin D metabolism regulates serum calcium and Alkaline Phosphatase (ALP) levels. Thus, calcium levels may be the actual causative factor at the molecular level to determine the severity of respiratory infections. Aim: To estimate and compare serum calcium levels in infants with acute bronchiolitis and controls. Additionally, it aimed to investigate the effect of sunlight exposure on calcium levels in infants presenting at a tertiary care centre. Materials and Methods: A cross-sectional study was conducted from October 2004 to April 2006, over two consecutive years, among 446 infants in the paediatric unit of a tertiary care centre in Delhi, North India. A total of 223 infants (<1 year of age) hospitalised with a diagnosis of acute bronchiolitis, presenting with the first episode of wheeze based on American Academy of Paediatrics (AAP) criteria (including coryza, fever, tachypnoea, tachycardia, paroxysmal wheezy cough, and irritability), were considered as cases. An equal number of age-matched controls (n=223), admitted for non respiratory illnesses, were included. Blood samples were collected for total serum calcium, phosphorus, and ALP, along with other relevant investigations related to their diagnosis. Statistical analysis was performed using Student’s t-test, Kruskal-Wallis’s test, and Chi-square test. Results: The study included 223 patients in both the case and control groups. In the control group, there were 76.58% males and 23.42% females, while in the cases, there were 81.53% males and 18.47% females. The mean age of cases was 5.78±3.45 months, and controls were 4.77±2.83 months, with a mean difference of 1.01 (95% CI, 0.42-1.59). The mean calcium levels were 9.00±1.43 mg/dL and 8.71±1.51 mg/dL in controls and cases, respectively, with a mean difference of 0.29 (95% CI- 0.02 to 0.56), which was statistically significant (p-value=0.037). There was no significant difference in phosphorus and ALP levels between the two groups. Conclusion: This study found an association between calcium levels and acute bronchiolitis. The findings suggest that low serum calcium levels might serve as a risk factor for acute bronchiolitis.

Correlation of Toe Grip Strength among Individuals with Knee Osteoarthritis with and without Fear of Pain: A Cross-sectional Study

Shreya Vinodara Poojari, Saumya Srivastava

Introduction: Knee Osteoarthritis (OA) is a common degenerative joint disease that affects millions of people worldwide. It is characterised by progressive loss of joint cartilage, resulting in pain, stiffness, and significant disability, leading to a reduced quality of life. Fear of pain is a significant psychosocial factor that affects individuals with knee OA, leading to decreased physical activity. However, the relationship between Toe Grip Strength (TGS) and fear of pain in individuals with knee OA is poorly understood, even though fear of pain has been known to impact strength in both the upper and lower limbs. Aim: To examine the correlation between fear and TGS among individuals with knee OA, both with and without fear of pain. Materials and Methods: This cross-sectional study was conducted at the Department of Physiotherapy, Nitte Institute of Physiotherapy, affiliated with the University of Mangalore, Karnataka, India, from April 2022 to March 2023. The study included 60 individuals, with 30 in each group, diagnosed with knee OA using the Kellgren and Lawrence (KL) grading system (grade 2 and above). The participants, both men and women aged between 45 and 80 years, were informed about the study’s purpose. The Fear Avoidance Belief Questionnaire (FABQ) form was completed by the screened patients, who were then divided into fear and non fear groups. Body Mass Index (BMI) was determined by measuring height with a wall-mounted device and weight using a traditional analog scale. TGS was evaluated in both groups using a pinch grip dynamometer. The Pearson correlation coefficient was used for data analysis, with a p-value <0.05 considered statistically significant. Results: The results of the current study indicated that the FABQ showed a negative correlation (p-value >0.05) with TGS (both right and left-side) (r: -0.296 (right) and -0.302 (left)), and a positive correlation (p-value <0.05) with the Numerical Pain Rating Scale (NPRS) (both during activity and at rest). Conclusion: This study revealed a significant association between fear and TGS in individuals with knee OA. Notably, Fear Avoidance Beliefs (FAB) exhibited a negative correlation with TGS while demonstrating a positive correlation with pain levels.

Development of a Valid Outcome Measure for Sensory Testing in Children with Cerebral Palsy: An Exploratory Sequential Research Design

Shikha Singh, Vandana Esht, Astha Agarwal, Jasmine Anandabai

Introduction: In Cerebral Palsy (CP), sensory perception is affected in addition to the motor symptoms. Now-a-days, treatment solely focuses on diagnosed motor deficiencies, often overlooking underlying sensory abnormalities and their examination. Therefore, including a clinical sensory examination in the evaluation of children with CP is crucial. Aim: To develop a validated measure for assessing sensory processing among children with CP. Materials and Methods: This study, conducted as part of a Ph.D. research project, employed an exploratory sequential research design. It commenced on March 1, 2020, and concluded on October 18, 2021, at the Physiotherapy Out Patient Department (OPD) of Swami Vivekanand Subharti University in Meerut, Uttar Pradesh, India. Validity tests, including Scale Level Content Validity Index (CVI) and Spearman rank correlation methods, were used alongside other subtests. The study consisted of two phases: Development and Validation. An extensive literature search and parent interviews were conducted to comprehensively understand and collect information on sensory issues. Based on this information, a preliminary questionnaire draft was created. Three categories of validity-content, face, and concurrent-were tested. Content validation involved employing a three-round online Delphi approach. Face validity was assessed through opinions from clinicians regarding the questionnaire’s appearance. Concurrent validity was established by comparing the Sensory Outcome Measure (SOM) with the criterion measure scale, Short Sensory Profile (SSP). Results: For all items, Content Validity Ratio (CVR) and item-level CVI values ranged from 0.8 to 1. The overall Scale Level CVI (average) for the scale was 0.890625. Experts exhibited a 96% agreement regarding the appearance of the questionnaire, indicating complete agreement. The Spearman rank correlation coefficient value was 0.866, and the correlation graph indicated a positive association between the two scales in terms of concurrent validity. Conclusion: The Sensory Outcome Measure (SOM) has been developed as a valid scale with high content and face validity, along with excellent concurrent validity. SOM is the first measuring scale developed in India and used for assessing sensory deficits in children with CP.

Extracellular Enzymatic Activity of Candida Species Isolated from Patients with Head and Neck Cancer Undergoing Radiation Therapy and its Correlation with Mucositis: A Cross-sectional Study

Neethu Babu, Chitralekha Saikumar, Jomon Raphael Chalissery, Harish Kumar

Introduction: The differences in enzymatic activity expressed by various Candida species determine their virulence and play a pivotal role in understanding the pathogenesis of candidiasis. Additionally, this knowledge aids in the development of new antifungal drugs that target these enzymes, thereby enhancing therapeutic approaches. Understanding the extracellular enzymatic activity of Candida species is crucial for the development of new anticandidial drugs targeting these enzymes. Aim: To determine the differences in enzymatic activity expressed by various Candida species isolated from patients with Head and Neck Cancer (HNC) undergoing Radiation Therapy (RT) and to correlate these differences with the severity of mucositis. Materials and Methods: This cross-sectional study evaluated the enzymatic activity of Candida species, including C. albicans and Non albicans Candida species (NAC), isolated from HNC patients undergoing RT at the radiation oncology department, Amala Institute of Medical Sciences, Thrissur, Kerala, India. A total of 276 patients were enrolled in the study over a four-year period (January 2019 to December 2022). Extracellular enzymatic activities such as proteinase, phospholipase, haemolysin, and esterase were detected using the plate method, as described previously. Mucositis was graded according to the Radiation Therapy Oncology Group (RTOG) criteria. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 23.0 (IBM, Illinois, US). The Chi-square test was used to analyse the variables, and the unpaired t-test was used to compare enzymatic activity. Spearman’s rank correlation was used to identify any correlation between mucositis and extracellular enzymatic activity. Results: A total of 97 Candida strains (56 C. albicans and 41 NAC) were isolated. There was no statistically significant difference between C. albicans and NAC species causing infections in men and women (p-value=0.390), as well as in those with diabetes (p-value=0.127) and hypertension (p-value=0.979). Proteinase, haemolytic activity, and esterase production were detected in 88 (90.7%), 84 (86.6%), and 67 (69.0%) isolates, respectively, while phospholipase activity was shown by 18 (18.5%) isolates. There was no statistically significant difference between C. albicans and NAC species regarding the mean phospholipase, proteinase, haemolysin, and esterase activity (p-value >0.05). C. albicans exhibited high activity for all four enzymes, while a considerable percentage of NAC showed moderate activity. High phospholipase and proteinase activity in C. albicans showed a good correlation (r=0.148 and r=0.186, respectively) with mucositis. Conclusion: C. albicans showed high activity for all four enzymes, indicating its virulence. The majority of C. albicans strains exhibited proteinase activity, which is associated with the severity of mucosal infections. The phospholipase activity has the potential to play a role in the emergence of drug resistance and should be closely monitored.

Ultrasonographic Assessment of Ovarian Volume: A Cross-sectional Study to Evaluate Ovarian Reserve and Its Impact on Reproductive Potential

Introduction: Ovarian Reserve (OR) serves as an important indicator of a female’s reproductive potential and remaining reproductive lifespan. With the societal shift towards delayed marriages and increased career focus among women, there is a growing need to understand the impact of age on fertility and the role of assisted reproductive techniques. Aim: To evaluate the volume of both left and right ovaries in asymptomatic females using ultrasonographic measurement of various morphometric parameters. Materials and Methods: This cross-sectional observational study was conducted in the Department of Anatomy, in association with the Department of Obstetrics and Gynaecology and Department of Radiodiagnosis, King George’s Medical University, Uttar Pradesh, Lucknow, India, from September 2016 to June 2017. Total 100 non pregnant females aged 19-49 years were included in the study. Ultrasonography was used to measure the Longitudinal Length (LL), Transverse Diameter (TD), and Anteroposterior Diameter (APD) of both ovaries (right and left). The volume of each ovary was calculated using the formula: 0.523×LL×TD×APD. Statistical Package for the Social Sciences (SPSS) software version 24.0 was used to assess the maximum, minimum, and mean±Standard Deviation (SD) for all the morphometric parameters of the right and left ovaries. A paired t-test was used to compare these morphometric parameters, and a p-value <0.05 was considered statistically significant. Results: The mean±SD age of the study participants was 34.06±9.35 years. The mean±SD of LL, TD, APD, and volume for the right ovary were 3.12±0.29 cm, 2.37±0.24 cm, 1.76±0.19 cm, and 6.78±1.08 cm³, respectively. The mean±SD of LL, TD, APD, and volume for the left ovary were 3.08±0.45 cm, 2.32±0.25 cm, 1.76±0.18 cm, and 6.61±1.06 cm³, respectively. A comparison between these morphometric parameters of the right and left ovaries did not reveal any statistically significant differences. Conclusion: The use of sonography is rapidly increasing nowadays in the field of gynaecology and reproductive medicine, and ovarian parameters are of great importance in diagnosing ovarian abnormalities in adolescents, PCOS, and ovarian cancer. In the field of reproductive medicine, ultrasound is helpful in serial follicular monitoring of females on ovulogens to assess their ovarian reserve.

Association of Adiponectin-Leptin Ratio and HOMA-IR in Obese Patients with and without Type 2 Diabetes Mellitus: A Cross-sectional Study

Introduction: Obesity is one of the leading causes of morbidity and mortality due to associated risk factors, including Type 2 Diabetes Mellitus (T2DM). Obese and diabetic patients have lower amounts of adiponectin. Leptin, a hormone released by adipocytes that controls hunger, is crucial in the emergence of obesity. Furthermore, it has been claimed that the Adiponectin/Leptin Ratio (ALR) correlates with Insulin Resistance (IR) better than adiponectin or leptin alone. Aim: To evaluate adiponectin, leptin, and Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) in obese subjects with and without T2DM and compare the variations, if any, from the normal subjects. Materials and Methods: This hospital-based, cross-sectional study was carried out at Sri Guru Ram Das (SGRD) University of Health Sciences, Amritsar, and Punjab Institute of Medical Sciences (PIMS), Jalandhar from January 2020 to December 2022. A total of 125 subjects of either gender aged above 18 years, visiting the medicine Outpatient Department (OPD) of PIMS, Jalandhar, were included in the study. Among them, 25 healthy volunteers served as controls. Serum levels of Adiponectin, Leptin, and Insulin were estimated using the Enzyme-Linked Immunosorbent Assay (ELISA) method. The data obtained were statistically analysed using one-way Analysis of Variance (ANOVA) test (with Bonferroni post-hoc). Results: A total of 125 participants were analysed in the present study, with 50 being obese with T2DM (mean age: 50.22±8.6 years), 50 being obese without T2DM (mean age: 46.9±9.8 years), and 25 being non obese non diabetic individuals (controls) (mean age: 42.8±9.09 years). A higher number of females 78 (62.4%) reported to the OPD compared to males 47 (37.6%). Although no statistical significance was found, there was a considerable decrease in adiponectin levels in obese and obese with T2DM subjects. Moreover, the leptin levels and HOMA-IR were increased in obese and obese with T2DM subjects compared to the control subjects. Conclusion: ALR may be used as a clinical marker for assessing the morbidity due to obesity and in T2DM subjects. Moreover, lifestyle modifications can be targeted to prevent IR.

Cord Blood Bilirubin as an Early Marker of Hyperbilirubinemia in Term and Late Preterm Newborns at 48 Hours of Life: A Prospective Cohort Study

Aparna Gilbert, Baburaj Stephenson

Introduction: Jaundice is a common clinical condition present during the neonatal period, which can be either physiological or pathological. Early discharge of newborns is a common practice in our country due to medico-social and economic reasons, making post-discharge follow-up of infants challenging compared to developed countries. Aim: To determine the correlation between cord blood bilirubin levels and the occurrence of hyperbilirubinemia at 48 hours of life in newborns with a gestational age of ≥35 weeks. Materials and Methods: This cohort study was conducted in the Department of Pediatrics at Dr SMCSI Medical College, Karakonam, Trivandrum, Kerala, India, over a one-year period from June 2017 to June 2018. The exposure variables included the mother’s blood group, baby’s blood group, mode of delivery, gestational age, gender, and weight of the baby. The outcome variables included cord blood and 48-hour serum total and direct bilirubin levels. The data was coded and entered into Microsoft Excel and analysed using Statistical Package for Social Science (SPSS) version 16.0. Descriptive measures were calculated, and the correlation between cord and 48-hour bilirubin levels was assessed using Pearson’s correlation coefficient formula. Other statistical tests applied were chi-square test and independent t-test. Results: Total subjects of 500 (243 female and 257 were males) participants were included in the study.Among the 21 babies who underwent phototherapy, 11 were female and 10 were male, and 15 were full term and six were late preterm for their gestational age . Of the 21 babies needing phototherapy, 15 were delivered by normal vaginal delivery, and six were delivered by LSCS. Correlation between cord blood bilirubin and serum bilirubin at 48hr is 0.477 with a p-value <0.001; which indicates mild correlation between the cord blood Total Bilirubin (TB) and serum TB. A cord TB value of 1.45 mg/dL had a sensitivity of 95.2% and specificity of 32.5%. A value of 1.55 mg/dL had a sensitivity of 90.5% and specificity of 40.9%. A cord TB value of 1.65 mg/dL had a sensitivity of 66.7% and specificity of 53.9%. These findings suggest that cord bilirubin levels can be used to predict which babies require further evaluation and treatment. Conclusion: Cord blood serum bilirubin can serve as a useful screening test for predicting neonatal hyperbilirubinemia and ensuring safe post-natal hospital discharge.

Significance of Rate-Pressure Product and Duke Treadmill Score in Predicting Disease Severity in Patients with Coronary Artery Disease: A Cross-sectional Study

Introduction: Exercise electrocardiography is a well-established and cost-effective investigation for evaluating Coronary Artery Disease (CAD). The Rate-pressure Product (RPP), which is the product of maximal Systolic Blood Pressure (SBP) and peak Heart Rate (HR) during exercise, is a widely accepted parameter reflecting cardiac work and evaluating ventricular function. The use of Duke Treadmill Score (DTS) improves the diagnostic accuracy of exercise-induced ST-segment depression and has been observed to provide independent prognostic information. It has been shown that DTS provides information about the complexity of coronary artery lesions assessed by invasive coronary artery testing. Aim: To determine the significance of RPP and DTS in predicting the severity and complexity of angiographic lesions in patients with Stable Ischemic Heart Disease (SIHD) and a positive Treadmill Test (TMT). Materials and Methods: This study involved 100 consecutive patients with a positive TMT but no prior history of Acute Coronary Syndrome (ACS) who underwent coronary angiography at Government Medical College, Kottayam, Kerala, India, between March 2018 and March 2019 after obtaining ethical clearance from the Institutional Review Board. The DTS and RPP were calculated for these patients. All patients then underwent coronary angiography, and their SYNTAX scores were calculated. Correlation analysis was performed to assess the relationship between DTS, RPP, and SYNTAX score using Spearman’s correlation coefficient. The Kruskall-Wallis test was used to compare risk factors among groups. Results: A total of 100 patients were evaluated, ranging in age from 40 to 74 years with an average age of 57 years. The average SYNTAX score was 15, ranging from 2 to 56. The average Duke TMT score was -5.2, ranging from 6 to -22. There was a significant negative correlation between DTS and angiographic severity determined by SYNTAX score (r=-0.702, p=0.001). The average RPP was 22174, ranging from 14000 to 37620. The study showed a significant negative correlation between RPP and SYNTAX score (r=-0.201, p=0.04). Diabetic patients had a significantly higher SYNTAX score compared to non-diabetics (r=-0.602, p=0.013). Additionally, a significant negative correlation was observed between the Metabolic Equivalents (METs) attained, duration of exercise, and the SYNTAX score. Conclusion: DTS and RPP derived from the exercise treadmill test have a significant negative correlation with the severity and complexity of CAD as determined by the SYNTAX score in coronary angiography.

Spectrum of Skin Changes in the Elderly Population at a Rural Tertiary Care Hospital in Northern India: A Cross-Sectional Study

Introduction: Ageing is a complex, natural process. Due to structural and physiological changes that occur as a consequence of intrinsic and extrinsic aging, the elderly population is highly susceptible to dermatological disorders. These changes are associated with significant morbidity and stress. Hence, it is important to have a better understanding of the dermatological needs of elderly patients. Aim: The aim of this study was to investigate the pattern and frequency of geriatric dermatoses in patients attending the Skin Outpatient Department (OPD) at a tertiary care centre. Materials and Methods: This cross-sectional observational study was conducted at the Department of Dermatology, Venereology, and Leprosy at BPS Government Medical College for Women, Khanpur Kalan (Sonepat), Haryana, India, from September 2022 to February 2023. A total of 300 patients aged 60 years and above, of either sex, who consented to participate were enrolled. Detailed history taking and dermatological examinations were performed, and relevant investigations were carried out. Data was collected, entered into a Microsoft Excel sheet, and analysed for frequency, percentage, and mean of variables. Results: Out of the total 300 patients, 155 (51.66%) were males and 145 (48.33%) were females. The majority of patients belonged to the age group of 60-69 years (n=171, 57%). Wrinkling (n=287, 95.66%) was the most common physiological skin finding, followed by dry skin (n=157, 52.33%). Among pathological dermatoses, infectious dermatoses were present in (n=134, 44.66%) patients, followed by eczemas (n=92, 30.66%). Papulosquamous disorders were seen in (n=17, 5.66%) patients. Hypertension was the most common systemic illness present in (n=53, 17.66%) patients. Conclusion: Physiological and pathological skin changes in the elderly are a common cause of consultation in dermatology OPD. Physiological changes were seen in all patients. Among pathological changes, infections were the leading dermatoses, followed by eczemas and papulosquamous disorders.

Breast Arterial Calcification in Screening Mammograms and its Correlation with Carotid Intima Media Thickness: A Cross-sectional Study

Introduction: Atherosclerosis is a leading cause of cardiovascular mortality worldwide. According to American Cancer Society (ACS) guidelines, screening mammography is optional for all women above the age of 40 years to detect breast cancer early. Incidentally, Breast Arterial Calcification (BAC) can be observed in mammograms. Women with BAC and additional risk factors like diabetes or hypertension may be referred for cardiovascular risk assessment in the future if there is a significant correlation between Carotid Intima Media Thickness (CIMT) and BAC. Aim: To assess BAC among women undergoing screening mammography and determine the correlation between BAC and CIMT. Materials and Methods: A cross-sectional study was conducted on 152 women who underwent screening mammography in the Department of Radiodiagnosis, Amala Institute of Medical Sciences, Thrissur, Kerala, India from May 2021 to October 2022. The presence and grading of BAC were determined using the Seimens Mammomat 1000 mammography unit, which captured two standard views: the Mediolateral Oblique (MLO) and Craniocaudal (CC) views. CIMT was measured using B-mode ultrasonography with an 8-13 MHz linear transducer, taking measurements from two contiguous sites at 1 cm intervals and calculating the average. Statistical significance was assessed at a 5% level, and the association was determined using Spearman’s rho correlation. Results: The mean age of the study population was 55.7±11.05 years. Among them, only 37 (24.3%) showed the presence of calcification in the breast arteries. The mean CIMT was 0.92±0.25 mm in the BAC (+) group and 0.72±0.24 mm in the BAC (-) group (p-value=0.001). Conclusion: The authors developed a BAC grading method after studying various previous studies and the present study found a significant positive correlation between the presence of BAC and CIMT.

Changing Trends in Aetiology of Amputations: A 12-year Retrospective Cross-sectional Study

Tufail Muzaffar, Gul Junaid, Kaleem UL Haque

Introduction: The Kashmir valley, which has experienced political instability since 1989, has witnessed a rise in amputations and a different aetiology compared to other parts of India. Limited data exists on the changing patterns of various causes of amputations before and after 1989 in the Kashmir valley, India. Aim: To analyse the demographic characteristics, amputation patterns, and different causes among amputees. Materials and Methods: A retrospective cross-sectional study was conducted at the Artificial Limb Centre (ALC) of Bone and Joint Hospital Barzulla, Srinagar, India. The study included 504 patients whose medical records were reviewed from 2006 to 2018 to identify the aetiology, geographical distribution, and level of amputation. Descriptive analysis was performed to determine the frequencies of various causes and levels of amputation. Results: The study found that the most common traumatic causes of amputation were Road Traffic Accidents (RTAs), firearm injuries, and blasts. Non traumatic amputations (vascular disease and malignancies) accounted for 30% of cases. Lower limb amputations (91.5%) were more prevalent than upper limb amputations (8.5%). Conclusion: Prior to 1989, RTA accidents were the major cause of amputations, but there was a surge in amputations caused by firearm injuries and blasts. Additionally, there has been increase in amputations caused by malignancies and dysvascular ischaemia in non traumatic causes.

Diabetic Foot Influencers on Twitter: A Cross-sectional Study

Introduction: Apart from the general usage of media as an effective tool for communication, network building, or branding, its relevance in the medical sector is becoming increasingly pertinent. Diabetic foot is a highly prevalent and serious complication of diabetes, which contributes massively to morbidity, fatality, or amputations worldwide every minute. However, awareness and understanding of proper foot care practices disseminated through massive outreach platforms like Twitter can significantly improve its management and decrease the social, economic, and medical burden due to amputations. Aim: To identify Twitter influencers discussing diabetic foot. Materials and Methods: This cross-sectional study was conducted from March 2022 to July 2022 to characterise the top 38 diabetic foot influencers on Twitter. The influencers were identified using proprietary software, Cronycle (London, UK), which uses a proprietary algorithm to calculate an influencer score based on engagement metrics such as retweets, likes, and views. This score determines the “influence” of a Twitter account within a specific topic of discussion. By leveraging its proprietary algorithm, Cronycle, powered by Right Relevance (a subsidiary), provides a platform to assess the influence of an influencer on a particular topic. It offers a normalised subject score ranging from 10 to 100. The search term “Diabetic foot” was queried within the Cronycle platform, leading to the generation of a dataset that was subsequently analysed using Microsoft Excel. Results: The analysis identified 38 influencers, consisting of 19 (50%) medical practitioners, 39% diabetic advocates, and 11% researchers. The research productivity could be reflected in the h-index for 17 influencers, which ranged from 1 to 84. Geographically, the majority of the influencers were from the US and UK. Conclusion: The study identified the credibility of influencers with mass influence on Twitter for diabetic foot. More inclusive participation from healthcare providers of all nationalities, especially from developing countries, can be of paramount importance in raising awareness of diabetic foot among the medical and general population. It can serve as a source of education and potentially lead to a reduction in diabetic foot complications.

Effect of Good Clinical Laboratory Practices Quality Training on Knowledge, Attitude and Practice among Laboratory Professionals- Quasi Experimental Study

Introduction: Good Clinical Laboratory Practices (GCLP) play a vital role in early and accurate diagnosis, providing high-quality data, and timely sample processing. Adhering to a robust Quality Management System (QMS) that complies with GCLP standards is crucial for laboratory personnel in a clinical laboratory to deliver outstanding healthcare services and reliable, reproducible reports. Aim: To assess the Knowledge, Attitude, and Practice (KAP) of laboratory professionals towards quality in the laboratory through GCLP training. Materials and Methods: This pre-test, post-test quasi-experimental study was conducted in the Department of Biochemistry at ESIC Medical College and Hospital, Faridabad, Haryana, India, from February 2022 to June 2022. The study included 58 participants, consisting of 22 doctors and the remaining laboratory assistants. GCLP online training program was conducted every Friday in March 2022 for four weeks. An online questionnaire containing 34 questions was administered to all the participants before and after the training. Data were collected and analysed using a paired t-test. Results: A total of 58 responses were received from the participants via Google form before and after the training. The results indicate no significant difference in participants’ responses to 12 closed-ended questions regarding QMS before and after training. A similar trend was observed for 22 questions on a Likert scale, where participants rated their agreement, neutrality, or disagreement. Conclusion: The study demonstrates that all technical staff fully complied with GCLP guidelines and accreditation requirements. Furthermore, the laboratory staff acknowledges the importance of Standard Operating Procedures (SOPs), document maintenance, record-keeping, and identifying non-conformities, all of which contribute to effective traceability of the testing process in the clinical laboratory.

Morphology and Histogenesis of Thymus as a Tool for Estimating Foetal Age: A Cross-sectional Study

Introduction: The thymus is located in the superior mediastinum and anterior part of the inferior mediastinum. It plays a crucial role in the development, differentiation, and clonal expansion of T lymphocytes. In forensic cases involving foetal death, accurate estimation of foetal age is essential. When the foetus is extensively damaged, other organs can be used to estimate age. The thymus, being retrosternal and well-protected, is easily accessible during dissection. Therefore, studying the gross features and histogenesis of the thymus can be helpful in estimating gestational age in cases of severely mutilated foetal specimens. Aim: To examine the morphological features and histogenesis of the thymus in aborted and stillborn foetuses from normal pregnancies. Materials and Methods: A pilot study was conducted using a cross-sectional design at the Department of Anatomy, BLDEDU’s Shri BM Patil Medical College, Vijayapura, Karnataka, India, from May 2016 to April 2018. The dimensions and histogenesis of the thymus were studied in a total of 50 human foetal thymus specimens, collected from normal pregnancies across different gestational age groups ranging from 12 to 40 weeks. The specimens were obtained from the Department of Pathology and the Department of Obstetrics and Gynaecology. The dimensions and weight of the thymus were recorded during autopsy. Slides were prepared, stained with Haematoxylin and Eosin (H&E), and examined under a compound microscope. The histogenesis of the thymus was studied to observe its maturation. Results: Foetal weight increased from 134.6±58.3 g at 12 weeks to 1942±598 g at 40 weeks. The weight of the thymus ranged from 0.2 g at 12 weeks to 5.9 g at 40 weeks. Crown rump length varied from 10.7 cm to 29.9 cm. The length of the thymus measured between 0.5 cm and 3.3 cm, breadth between 0.4 cm and 2.3 cm, and height between 0.2 cm and 0.9 cm from 12 to 40 weeks of gestation. Microscopic features observed in the present study at different gestational ages included a well-formed thick capsule at 17 weeks, lobulation starting at 19 weeks, cortico-medullary differentiation beginning at 17 weeks, appearance of epithelial cells around 19 weeks, and initial appearance of Hassal’s corpuscles at 17 weeks, with more numbers observed later on. Conclusion: The thymus can be used in forensic investigations to estimate the gestational age of mutilated foetuses. It exhibits varying features at different gestational ages, which can aid in thymectomy procedures. Additionally, these findings can be considered during prenatal imaging studies.

Effect of Isotonic Exercise on Cardiovascular Parameters in Medical Students with Different Body Mass Indices: A Cross-sectional Study

Introduction: Obesity is a known risk factor for hypertension. Baseline Heart Rate (HR) and blood pressure are known to scale linearly with Body Mass Index (BMI) values. Recent studies have reported an exaggerated acute response of blood pressure and HR to exercise. Aim: To assess the effect of isotonic exercise on cardiovascular parameters among individuals with different body mass indices in students at Osmania Medical College and look for any association between BMI and cardiovascular responses to isotonic exercise. Materials and Methods: A cross-sectional study was conducted in the Department of Physiology at Osmania Medical College, Hyderabad, Telangana, India, from January 2022 to December 2023, involving 100 healthy individuals with different body mass indices in the age group of 17 years-30 years. The subjects were divided into four groups based on their BMI. Baseline HR, Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP) were measured for all participants. Subsequently, the participants performed isotonic exercise for three minutes. Post-exercise HR, SBP, and DBP were measured immediately. One-way ANOVA was used to determine the significance of HR, SBP, DBP, Mean Arterial Pressure (MAP), and Pulse Pressure (PP) among the different BMI groups. A p-value of <0.05 was considered statistically significant. Results: A total of 100 subjects (28 males, 72 females) with a mean age of 18.64±0.92 years participated in the study. Significant differences were observed in pre-exercise HR (p=0.0002), SBP, DBP, and MAP (p<0.001), and post-exercise HR, SBP, DBP, and MAP (p<0.001) among the different BMI groups. Overweight and obese individuals showed an increased tendency for an exaggerated increase in HR. Changes in PP and MAP, affected by a combination of SBP and DBP, also showed statistical significance. Furthermore, there was an increased tendency for an exaggerated increase in blood pressure in the overweight and obese BMI groups. Conclusion: Individuals with higher BMI exhibit exaggerated increases in SBP, Mean and PP, as well as HR. Additionally, obese individuals demonstrated a significant elevation in DBP. The response of blood pressure and HR after exercise in overweight/obese individuals suggests a higher risk of developing hypertension and other cardiovascular diseases.

Autonomic Functions in Patients with Allergic Rhinitis: A Cross-sectional Observational Study

Himanshu Gupta, Jyotsna Shukla, Varsha Gupta, Abhishek Saini

Introduction: Allergic Rhinitis (AR) is an inflammatory disease of the nasal membranes characterised by nasal congestion, itching, rhinorrhoea, and sneezing. One of the primary factors contributing to the development of AR symptomatology is neurological. Both the Central Nervous System (CNS) and the Autonomic Nervous System (ANS) play important roles in the symptomology of such hypersensitivity reactions. Aim: To assess and compare the cardiac autonomic functions in AR patients with healthy controls. Materials and Methods: The present cross-sectional observational study was conducted in the Department of Physiology, SMS Medical College, Jaipur, Rajasthan, India from December 2021 to June 2022. Forty AR patients from the Ear, Nose and Throat (ENT) Department and 40 age and gender-matched healthy controls were enrolled from the employees working at SMS Medical College, Jaipur, Rajasthan, India. Parasympathetic function tests like the expiration to inspiration ratio, Valsalva ratio, and sympathetic function tests like Blood Pressure (BP) response to standing and BP response to sustained hand grip were performed and compared to assess the functional status of ANS in cases and controls. Primer version 6.0 was used for statistical analysis. The unpaired t-test was applied to the data of both groups, and a p-value <0.05 was considered statistically significant. Results: The increase in Diastolic BP (DBP) during isometric hand grip exercise was significantly lower in AR patients (p-value <0.001). The decrease in Systolic BP (SBP) upon immediate standing was higher in the AR group (p-value<0.001). The expiration to inspiration ratio and valsalva ratio were also significantly higher (p-value<0.05) in AR patients compared to the healthy controls. Conclusion: Patients with AR have relatively reduced sympathetic reactivity and escalated parasympathetic reactivity towards autonomic function tests compared to apparently healthy individuals. The ANS, affected in patients with AR, puts them at a greater risk of subsequent cardiovascular morbidity. Therefore, early assessment of autonomic functions should be considered for the early detection and management of such morbidities.

Effect of Educational Intervention based on Pender’s Health Promotion Model on Self-care Behaviours of Patients with Colorectal Cancer undergoing Chemotherapy: A Quasi-experimental Study

Vahideh Zenoozadeh, Abolfazl Payandeh, Maryam Seraji

Introduction: Colorectal cancer is the third most common malignancy in Iran. Self-care is one of the most effective non pharmacological interventions for controlling the effects of the disease and the side-effects of drugs. An educational intervention based on Pender’s health promotion model, which predicts health behaviours and self-care, can be implemented. Aim: To investigate the effect of an educational intervention based on Pender’s health promotion model on improving self-care behaviours among patients with colorectal cancer. Materials and Methods: This quasi-experimental study was conducted at Omid and Imam Reza Hospitals in Mashhad, Iran from June to August 2021. A total of 160 participants were divided into two groups: the experimental group (n=80) and the control group (n=80). The experimental group received four self-care education sessions (two sessions by a nurse and two sessions by peers), while the control group received no intervention. Data were collected using a questionnaire before, immediately after, and three months after the educational intervention. Statistical analysis was performed using independent samples t-test and Repeated Measures Analysis of Variance (RMANOVA). Results: The study included 103 male patients (64.4%) and 57 female patients (35.6%). At one month and three months after the intervention, the scores for awareness, attitude, behaviour, and the constructs of Pender’s health promotion model (self-efficacy, perceived social support, perceived benefits, perceived barriers, perceived emotions) significantly increased in the intervention group compared to the control group (p-value <0.001). Conclusion: The findings of this study indicate that the educational intervention based on Pender’s health promotion model effectively promotes self-care behaviours among patients with colorectal cancer.

Prevalence and Aetiology of Syndrome of Inappropriate Antidiuretic Hormone in Hyponatraemia: A Cross-sectional Study

SR Resmi, Anil Thomas, Ani Thampi, SK Mathew, Sunil Antony

Introduction: Hyponatraemia is a frequently occurring electrolyte abnormality. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is one of the common causes of hyponatraemia. SIADH is a disorder of impaired water excretion caused by the inability to suppress the secretion of Antidiuretic Hormone (ADH). The importance of determining the cause of hyponatraemia as SIADH is not only to seek the aetiology of SIADH but also to treat appropriately. Aim: To determine the prevalence of SIADH in patients with hyponatraemia and its causes in these patients. Materials and Methods: A cross-sectional study was conducted in the Department of General Medicine at Jubilee Mission Medical College and Hospital, Thrissur, Kerala, India. The study duration was one year and six months, from December 2014 to June 2016. A total of 100 individuals over the age of 18, who were admitted with serum sodium levels under 135 mEq/L, were chosen. Data on the causes of hyponatraemia and SIADH, laboratory evaluations, and assessments based on SIADH criteria were gathered using a structured proforma. The primary outcome variables included the aetiology of SIADH and the causes of hyponatraemia. Frequency and percentages were used to represent the data. The data were analysed using MS Excel. Results: Among 100 patients, the maximum number of patients with hyponatraemia were in the 59-78 years age group. Forty-two (42) had severe hyponatraemia (Na < 120 mmol/L). The most common cause of hyponatraemia was drug intake (diuretics + antihypertensives), which constituted 42 (42%) of the total 100 patients, followed by SIADH in 33 (33%) patients. Among the aetiologies of SIADH, cerebrovascular accident was the most common (9/100), followed by pneumonia and Selective Serotonin Reuptake Inhibitors (SSRIs) in five patients each. Among the non neurological symptoms, vomiting was the most common symptom in 28 (28%) patients, followed by lethargy in 15 (15%). Among the neurological symptoms associated with hyponatraemia, confusion was the predominant one seen in 10 (10%) patients, followed by drowsiness in 7 (7%). Conclusion: SIADH is an important cause of hyponatraemia with a high prevalence. The prevalence of SIADH in hyponatraemic patients was 33%. Among the aetiologies of SIADH, cerebrovascular accident was the most common.

Perceived Stigma among Injecting Drug Users: New Evidence from an Observational Study in an Opioid Substitution Therapy Centre of Kolkata, India

Manika Pal, Madhumita Dobe, Dipendra Narayan Goswami

Introduction: Injecting Drug Users (IDUs) are one of the high-risk groups for Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS). Opioid Substitution Therapy (OST) is a targeted intervention for IDUs. Substance abuse, coupled with the risk of contracting HIV, makes them feel stigmatised. There can be little doubt that IDUs face discrimination and stigma in various forms, which could be a potential barrier for them to seek professional help. Aim: To estimate the magnitude of stigma perceived by IDUs and to identify the associated factors. Materials and Methods: An observational, cross-sectional study was conducted on IDUs attending the OST centre of Calcutta National Medical College, Kolkata, West Bengal, India from April 2016 to March 2018. A total of 168 IDUs were recruited using the census method. The Perceived Stigma of Substance Abuse Scale (PSAS) was used to determine the perceived stigma faced by the study subjects. Factors such as living arrangements, finances for addiction, level of education, emotional attachment, and religiosity were chosen as the predictor variables. Statistical Package for the Social Sciences (SPSS) version 16.0 was used for data analysis. Descriptive statistics were used to summarise the data. Logistic regression was employed to examine the associated factors with perceived stigma. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was computed, and a p-value <0.05 was considered significant. Results: Out of 168, 107 (64%) IDUs reported perceived stigma above the mean value of PSAS. A significant association between perceived stigma and immoral means of finance for addiction (AOR [CI] 4.056 [1.617-10.174]), presence of emotional attachment with any of the family members (AOR [CI] 5.652 [2.588-11.9]), and lack of religiosity (AOR [CI] 5.685 [2.588-12.489]) was observed. Conclusion: There was an alarmingly high proportion of IDUs with perceived stigma. Immoral means of finance for addiction, lack of religiosity, and emotional attachment to family were associated with higher perceived stigma. Hence, appropriate emphasis should be given to information, education, and communication activities to address perceived stigma among IDUs in order to improve treatment adherence to OST among them. Moreover, there is a need for stigma reduction interventions in the larger community. Further research should explore the dynamics between perceived stigma and other predictor variables.

Effects of Dental Operating Microscope on Anxiety, Behaviour, and Treatment duration among Children in the 5-7 Year Age Group Undergoing Dental Restorative Procedures: A Randomised Clinical Trial

Introduction: Fear of the unknown causes anxiety in paediatric patients. The use of tell-show-do, along with audiovisual distraction, promotes positive behaviour and reduces anxiety. The use of a Dental Operating Microscope (DOM) as a visual distraction aid provides better cooperation in paediatric patients. Aim: To evaluate the effects of a DOM on anxiety, behaviour, and treatment time during a restorative procedure in paediatric dental patients. Materials and Methods: The present study was a parallel-arm, randomised clinical trial conducted at IGIDS, Puducherry, India, in 2022, over a period of four months. Healthy five to seven-year-old children on their first dental visit were selected (n=90) and divided into two groups using simple randomisation. Group A: Restoration of teeth without a DOM, and group B: Restoration of teeth using a DOM. Anxiety and behaviour were measured as soon as the child entered the operatory (T1), after tell-show-do for the procedure (T2), after cavity preparation (T3), and after completion of the restoration (T4). Caries removal efficacy and treatment duration were also assessed. The data obtained were statistically analysed using the Chi-square test and independent sample t-test (p<0.05). Results: Out of the 90 children who participated in the study, 47 (52%) were girls, and 43 (47%) were boys. There was a decrease in anxiety and improved patient behaviour during cavity preparation (T3) and after completion of restoration (T4) in group B (p<0.001). The operator also reported higher visual (71.10%) and tactile (95.60%) scores in caries removal, with a shorter treatment duration in groups where DOM was used (p<0.001). Conclusion: The use of DOM reduced anxiety levels and improved the compliance of children during dental procedures. Operator ergonomics and the quality of treatment could be enhanced by recommending DOM in regular paediatric dental practice.

A Retrospective Study of Puerperal Infection and its Aftermath: Current Scenario from a Tertiary Healthcare Centre, Telangana, India

Introduction: Even after decades of the development of low-cost and effective antibiotics, puerperal infections remain an important cause of preventable maternal morbidity and mortality. Aim: The aim of the present study was to determine the risk factors, morbidity, and mortality associated with puerperal infections. Materials and Methods: A retrospective study was conducted from March 2021 to October 2021, at the Obstetrics and Gynaecology Department of Gandhi Hospital in Telangana, India. The study included all women who delivered in this hospital and were referred within 42 days after delivery with fever and any of the following symptoms: pain abdomen, malodorous lochia, abdominal distention, subinvolution of the uterus, pelvic abscess, peritonitis, any system/organ failure, or shock. Various risk factors such as age, parity, socioeconomic status (according to the modified Kuppuswamy scale), BMI, rupture of membranes, mode of delivery, and comorbidities associated with puerperal infection were assessed. Complications following puerperal infection were also studied. Data analysis was performed using SPSS version 23.0, and the results were presented in frequency and percentages of categorical variables. Results: During the study period, there were 161 cases of puerperal infection. The majority of cases were between the age group of 26-30 years, constituting 72 (44.7%) cases. Among them, 86 (53.4%) cases were multiparous, 50 (31%) cases were primiparous, 10 (6.2%) cases were second gravida, and 15 (9.3%) cases were third gravida. Lower middle-class women accounted for 67 (41.6%) cases, and 85 (52.7%) cases were in the overweight range. Prolonged premature rupture of membranes for more than 24 hours was observed in 78 (48.4%) cases. Caesarean section was the mode of delivery for 90 (56%) cases of puerperal infection cases. The most commonly associated comorbidities were anaemia in 63 (39.1%) cases, severe preeclampsia in 47 (29.1%) cases, abruption in 31 (19.2%) cases, and diabetes in 20 (12.4%) cases. Prolonged hospital stay was observed in 144 (89.4%) cases, wound gaping in 26 (16.1%) cases, and disseminated intravascular coagulation in 24 (14.9%) cases. A total of 31 (19.2%) cases of women succumbed, mostly due to multi-organ failure. Conclusion: Early diagnosis, proper ICU facilities at all levels of healthcare, timely referral to tertiary facilities, health education, and strict aseptic measures would be crucial in tackling this menace.

Role of Sperm DNA Fragmentation Index in Semen Analysis in Couples with Unexplained Recurrent Pregnancy Loss: A Case-control Study

Ruchi Hooda, G Geeta Devi

Introduction: Infertility has been on the rise, and male factor infertility has gained attention in cases of Recurrent Pregnancy Loss (RPL). Traditional Semen Analysis (SA) has been the main diagnostic tool, but with advancements in Assisted Reproductive Technology (ART) and the need for more accurate testing, there is a demand for improved diagnostic tests that correlate with reproductive outcomes. Sperm DNA Fragmentation Index (DFI) is a parameter used to assess the degree of sperm DNA damage and is considered crucial in evaluating semen quality. Aim: To investigate the role of Sperm DNA Fragmentation (SDF) in patients presenting with RPL compared to a control group. Materials and Methods: The study was conducted over a two-year period from January 2021 to December 2022 at the Centre for Infertility Management and Assisted Reproduction (CIMAR), Edappal Hospital, Edappal, Kerala, India. The control group (Group A; n=31) comprised males aged between 21-45 years whose partners had no history of recurrent abortions. The case group (Group B; n=31) included males with two or more pregnancy losses. Sperm DFI analysis and routine SA were performed in both groups to assess semen parameters such as volume, concentration, progressive and non progessive motility, morphology, and DFI. Statistical analysis was performed using the Independent student t-test. Results: In the present study the mean age of males in Group A was 37.03±5.416 years and in Group B was 35.44±4.552 years. There were no significant differences observed between the case and control groups in terms of sperm volume (p=0.301), concentration (p=0.155), progressive motility (p=0.207), non progessive motility (p=0.178), and morphology (p=0.362). However, a statistically significant difference was found between the RPL and control groups for DFI (p<0.001), with a mean value of ±8.15 in the control group and ±19.35 in the case group. Conclusion: The present study demonstrates that SDF is an important factor in RPL, with couples experiencing RPL showing a higher incidence of SDF. Therefore, incorporating SDF analysis alongside routine SA should be considered, particularly in patients with a history of RPL.

Vascular Risk Factors and Biomarkers of Endothelial Dysfunction in Chronic Migraine patients- A Cross-sectional Study

Introduction: The available literature on vascular risk and endothelial dysfunction in patients with Chronic Migraine (CM) is limited. CM patients are known to have a higher risk of cardiovascular and cerebrovascular events. The present study aims to characterise the vascular risk and endothelial dysfunctions in CM patients and compare them with Healthy Controls (HC). Aim: To assess the vascular risk factors and biomarkers of endothelial dysfunction in CM patients and compare them with healthy non-headache controls. Materials and Methods: This cross-sectional study was conducted from October 2021 to January 2023 at the headache clinic of GB Pant Institute of Postgraduate Medical Education and Research in Delhi, India. The patients were diagnosed with CM using the International Classification of Headache Disorders-3 (ICHD-3) criteria. The patients were drug-naïve for preventive medications and did not have medication overuse headache. Clinical vascular risk factors such as Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Ankle Brachial Index (ABI), Body Mass Index (BMI), and Waist Hip Ratio (WHR) were measured. A battery of biochemical vascular risk factors, including serum C-reactive protein, leptin, insulin, fasting and post-prandial glucose, Glycosylated Haemoglobin (HbA1c), lipid profile, lipoprotein-A, pro-Brain Natriuretic Peptide (pro-BNP), and serum biomarkers of endothelial dysfunction like Intercellular Adhesion Molecules-1 (ICAM-1), Myeloperoxidase (MPO), Interleukin-6 (IL-6), Tumour Necrosis Factor-Alpha (TNF-alpha), Asymmetric Dimethyl Arginine (ADMA), fibrinogen, and von Willebrand’s factor were measured in all patients during the interictal period. Statistical analysis was done using the Statistical Package for Social Sciences (SPSS) version 25.0, and the Mann-Whitney U test, student’s t-test, and Chi-square tests were applied. Results: Thirty-two patients with CM and thirty-two non-headache healthy subjects were included in the study (age 30.6±8.8 years; 29 females and 3 males) vs. (31.7±7.9 years; 19 females and 13 males, respectively). Compared to HC, CM patients had significantly higher DBP (81.0±8.0 mmHg vs. 66.2±6.2 mmHg; p<0.001). Among the biochemical parameters, CM patients had higher post-prandial blood sugar (mg/dL) (140.2±10.7 vs. 136.6±7.0; p=0.021), HbA1c (%) (5.8±0.8 vs. 5.6±0.4; p=0.034), serum cholesterol (mg/dL) (146.9±36.2 vs. 131±20.8), and Triglyceride (TG) levels (mg/dL) (93.2±10.8 vs. 88.5±13.0; p=0.001) compared to HCs. Among the biomarkers of endothelial dysfunction studied, levels of ICAM-1 (pg/mL) (4.5±3.8 vs. 1.3±0.62; p<0.001), MPO (pg/mL) (415.4±266.0 vs. 108.9±141.4; p=0.001), IL-6 (pg/mL) (10.8±4.9 vs. 4.2±1.5; p<0.001), and ADMA (ng/mL) (32.6±28.3 vs. 23.5±22.1; p=0.008) were higher in the CM group compared to non-headache controls. Conclusion: This study found that patients with CM have significantly higher vascular risk and evidence of endothelial dysfunction compared to healthy non-headache controls. The significantly elevated biomarkers of endothelial dysfunction may possibly be related to persistent neurogenic inflammation in CM and require further exploration through larger studies.

Comparison of Clinical Efficacy of Bromelain with Paracetamol on Postoperative Sequelae after Surgical Removal of Impacted Mandibular Third Molar: A Split-mouth Randomised Clinical Study

Introduction: The most frequent oral and maxillofacial surgical operation carried out in an outpatient setting is the surgical extraction of impacted mandibular third molars. The removal of impacted mandibular third molars involves surgical trauma in a highly vascularised area, which causes inflammatory changes referred to as “sequelae,” including pain, swelling, and trismus. These symptoms gradually appear, peaking two days after the extraction. To limit these postsurgical inflammatory complications, surgeons have advised the patients to use proteolytic enzymes, such as bromelain, along with routine antibiotics, analgesics, and corticosteroids. Aim: To compare the clinical efficacy of bromelain with that of paracetamol on pain, swelling, and trismus after the surgical removal of bilateral impacted mandibular third molars with similar difficulty indices. Materials and Methods: The present study was a split-mouth randomised clinical trial conducted at the Department of Oral and Maxillofacial Surgery, Bharati Vidyapeeth DU Dental College and Hospital, Pune, Maharashtra, India, over a period of six months from August 2022 to January 2023. Twenty subjects requiring surgical extraction of an impacted mandibular third molar were selected for the study. All subjects were randomly assigned to receive one of the following treatments for five days after surgery: Cap. bromelain 500 mg-BD 24 hours preoperatively and continued until the 4th day postoperatively (n=10, Group A) or Tab. paracetamol 500 mg-TDS (n=10, Group B). Pain scores were evaluated using the Visual Analog Scale (VAS) on postoperative days 1, 2, and 3. Swelling and mouth opening were assessed on postoperative days 2 and 7. Intergroup comparison was done using Student’s t-test. Results: The mean VAS scores for pain evaluation were 6.60, 5.80, and 5.20 for bromelain on days 1 (p=0.001), 2 (p=0.001), and 3 (p=0.001), respectively. The difference between the swelling values for the bromelain group was significant, while there were no significant differences in the values of trismus. Conclusion: It was concluded that bromelain is a better analgesic and anti-inflammatory drug compared to paracetamol. There were no significant differences in the values of trismus.

Outcome of Dismembered Pyeloplasty in Children with Unilateral Pelviureteric Junction Obstruction: A Retrospective Observational Study

Introduction: Anderson-Hynes (AH) dismembered pyeloplasty is the standard procedure performed for the management of Pelviureteric Junction Obstruction (PUJO). Ultrasonography (USG) and diuretic renography are of great importance for the diagnosis and follow-up of PUJO. Aim: To evaluate the morphological and functional outcomes of open dismembered pyeloplasty in children with unilateral PUJO and to find the correlation between functional and morphological outcomes. Materials and Methods: A retrospective observational study was conducted, assessing the clinical charts of 200 children under 10 years of age with congenital PUJO who underwent open AH dismembered pyeloplasty in the Department of Paediatric Surgery at a teritary teaching Institute, Government medical college, Thiruvananthapuram, Kerala, India from from June 2015 to June 2020. The preoperative radiological assessment included renal USG and diuretic renography for all patients. Morphological and functional surgical outcomes were measured one year after surgery. The morphologic parameters analysed were the Anteroposterior Diameter (APD) of the pelvis and Parenchymal Thickness (PT). The functional outcome was assessed by improvements in Glomerular Filtration Rate (GFR), Split Renal Function (SRF), and drainage curve. Success was defined as improvement in function and morphology in follow-up USG and renogram after one year of surgery. Paired t-test was applied for statistical analysis using Statistical Package for the Social Sciences (SPSS) software version 23.0. Results: Among the total 200 patients,180 (90%) cases demonstrated improved renal function after pyeloplasty. Among the total 200 cases, males were 120 (60%) and females were 80 (40%). Morphologic outcome improved in 188 out of 200 (94%) cases. The overall outcome was good in 168 out of 200 (84%) patients. The results showed a moderate negative correlation for APD with respect to SRF (r=-0.677, p-value=0.01) and GFR (r=-0.430, p-value=0.01), whereas a moderate positive correlation was observed between SRF and GFR (r=0.423, p-value=0.01). Conclusion: AH dismembered pyeloplasty is an effective treatment for PUJO in children, not only relieving obstruction but also improving renal function. The present study recommends considering both morphologic and functional parameters to assess the success of the surgery.

Proportion of Allergic Bronchopulmonary Aspergillosis Presenting as Difficult-to-control Asthma in Patients Attending a Tertiary Care Centre using the Modified ISHAM Criteria: A Cross-sectional Study

Pillai Neetu Soman, Paulo Varghese Akkara, Sunny George, TP Rajagopal

Introduction: Difficult-to-control asthmatics, as defined by the Global Initiative for Management of Asthma (GINA), belong to a subset of patients whose symptoms remain uncontrolled despite adhering to maximal optimised therapy. Complex hypersensitivity reactions in response to airway colonisation with Aspergillus fumigatus, which occurs in patients with asthma or cystic fibrosis, are established factors for a poor response to treatment and frequent exacerbations. Only limited data related to Allergic Bronchopulmonary Aspergillosis (ABPA) is available from India, particularly from Kerala. Aim: To assess the occurrence of ABPA in patients with difficult-to-control asthma using the modified ISHAM criteria. Materials and Methods: This cross-sectional analysis was conducted in the Department of Pulmonary Medicine, Institute of Chest Diseases, Government Medical College, Kozhikode, Kerala, India from February 2019 to July 2020. The study population comprised asthmatics attending the Pulmonary Medicine Outpatient Services who were on regular medications, including optimal doses of inhaled corticosteroid and long-acting beta-agonist combinations. Patients with two or more exacerbations per year requiring systemic steroids for symptom control and a positive skin test for Aspergillus fumigatus antigen were further analysed using the modified International Society for Human and Animal Mycology (IHAM) criteria to determine the proportion of difficult-to-control asthmatics with ABPA. A total of 185 subjects were enrolled. Twelve patients opted out of the study, and the remaining 173 patients were screened using the modified ISHAM criteria. Statistical analysis was performed using Stastistical Packages of Social Sciences (SPSS) software version 21.0. Continuous parameters were expressed as mean and median, while categorical parameters were measured as frequency and percentages. Results: It was observed that 104 (60.1%) patients belonged to the age group between 41-60 years, while approximately 60 patients (34.7%) were below 40 years of age. Among the 173 patients, 86 (49.7%) tested positive for Aspergillus fumigatus antigen. Applying the ISHAM criteria, it was found that only 17 (9.8%) of these patients satisfied the criteria for co-existent ABPA. A total of 101 patients (58.4%) required at least one hospital admission, while 4 (2.3%) patients required more than three hospital admissions per year. Total 21 (12.1%) patients had IgE specific to Aspergillus fumigatus, while total IgE levels were elevated in 46 (26.6%) cases. Thirty-six cases (20.8%) had a high peripheral eosinophil count Conclusion: This study suggests the possibility of the treating physician overlooking 10% of asthmatics in this region who are being managed as difficult-to-control asthma, but who have co-existent ABPA. This subset should be identified early in the course and managed separately for better treatment response.

Impact of Post-acute COVID-19 Syndrome on Mental Health of Healthcare Professionals: A Cross-sectional Study

Introduction: Anxiety, depression, and poor sleep quality are the most common mental health issues in post-acute Coronavirus Disease-2019 (COVID-19) syndrome. Healthcare Professionals (HCPs) were overburdened and unable to focus on their own health issues. Previous epidemic diseases, such as Severe Acute Respiratory Syndrome (SARS) in 2003, also accompanied psychiatric issues in HCPs. In light of this, the purpose of this study was to identify the symptoms of COVID-19 that continue to affect HCPs and their associations with fatigue, poor sleep, anxiety, depression, and activity levels, in order to provide better care and treatment for them. Aim: To analyse the impact of post-acute COVID-19 syndrome on the mental health of HCPs and compare the results with non COVID-19 infected participants. Materials and Methods: A cross-sectional study was conducted at PGIMS, Rohtak in Haryana, India from October 2021 to September 2022. A total of 280 participants between 25-45 years of age, including doctors, nurses, and dentists involved in direct COVID-19 patient care, were included in the survey. They were divided equally into a non COVID-19 infected group and a post-acute COVID-19 syndrome group, with atleast three months having passed since infection. The survey included scales addressing anxiety, depression, and sleep quality, including the Zung Self-rating Anxiety Scale (SAS), Zung Self-rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI). The mean scores were compared between both groups using an Independent sample t-test. Results: The data of 240 participants were analysed and compared between both groups. The mean age was 32.41 years in the post-acute COVID-19 syndrome group and 31.24 years in the non COVID-19 infected group. The post-acute COVID-19 syndrome group consisted of a large proportion of doctors (60, 42.9%) and nurses (53, 37.9%), whereas the non COVID-19 infected group included doctors (47, 33.5%) and nurses (56, 40%). The results showed statistically significant differences for anxiety (p-value=0.001) and sleep quality (p-value=0.001), while no significant differences were found for depression (p-value >0.05). Conclusion: Anxiety and poorer sleep quality occur in healthcare workers suffering from post-acute COVID-19 syndrome. Creating multidisciplinary rehabilitation health teams in hospitals with clinician psychologists, physiotherapists, nurses, and psychiatrists is essential to address mental health issues in the post-COVID-19 population.

The Effect of N95 Mask on Peripheral Oxygen Saturation and Heart Rate among Indian Medical Professionals: A Quasi-experimental Study

Introduction: Among all face masks, N95 masks have been recommended for medical professionals involved mainly in patients with severe respiratory illnesses. Studies showing a decrease in peripheral oxygen saturation (SpO₂) and an increase in heart rate after N95 mask usage have already created panic/concern among medical professionals. On the contrary, a few studies have shown no such negative impact of N95 mask usage, thereby urging scientific communities to investigate/explore these contrasting results. Aim: To study the effect of wearing an N95 mask continuously for three hours on SpO₂ and heart rate specifically in Indian medical professionals. Materials and Methods: This was a quasi-experimental study conducted for a period of 2 months from June 15, 2022, to August 15, 2022, at Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India, with a total of 105 healthy Indian medical professionals aged 18-40 years (55 males, 50 females) (12 study participants dropped from the study midway). In each participant, SpO₂ and heart rate were recorded first without a mask (M0) and then with a mask (M3) after three hours of routine work in the hospital. Using Mystat statistical software (version 12.0), results were expressed as mean±Standard Deviation (SD), and Student’s paired t-test was used to compare the pairs of means. Results: Among the 105 eligible participants, 93 successfully completed the study, whereas 12 participants were excluded (dropout rate=11.42%). The study included 55 males (52.38%) and 50 females (47.61%) with an age range of 18-40 years and a mean age of 30.2±6.4 years. The SpO₂ levels statistically showed a highly significant decrease after three hours of wearing an N95 mask (96.5±0.83% in M0 vs. 93.98±0.6% in M3). Similarly, the heart rate statistically showed a highly significant increase after three hours of using an N95 mask (73.45±3.6 in M0 vs. 89.6±6.1 beats/min in M3). Conclusion: The authors highlighted lower SpO₂ levels and an increase in heart rate after three hours of N95 mask usage specifically in Indian medical professionals and thereby appeal to develop/upgrade the N95 mask by lowering its humidity, thermal stress, and breathing resistance.

Relationship between Chest CT Scan Findings and Clinicians’ Expectations in Diagnosis and Prognosis of Respiratory Disease Patients at a Tertiary Care Hospital: A Retrospective Observational Study

Ankit Aneja, Tanya Kumar, Nitin Goyal, Nitin Tangri

Introduction: The use of chest Computed Tomography (CT) scans has significantly increased in recent times, and it is also considered the preferred investigation method in various cases, including occult pneumothorax and interstitial lung diseases. Aim: To assess the relationship between chest CT scan findings/outcomes, clinicians’ expectations, and their influence on treatment outcomes. Materials and Methods: The present retrospective analytical observational study was conducted in the Department of Radiodiagnosis and Respiratory Medicine at a tertiary-level hospital, Adesh Medical College and Hospital, Kurukshetra, Haryana, India. The findings of the selected chest CT scans were classified as normal, incidental, or pathological. The response of the consulting physicians to these scans was divided into three grades: highly expected, moderately expected, and unexpected. The impact of these scans on patients’ treatment was divided into three categories: major, minor, and none. The collected data were analysed using the Statistical Package for Social Sciences (SPSS) version 28.0, and the Chi-square test was used to assess the association between different variables. Results: The mean age of study participants was approximately 58±15 years. Out of the total 74 scans (each belonging to a different individual), the findings of the chest CT scans revealed that 59 (79.7%) scans were pathological, 11 (14.9%) were incidental, and only 4 (5.4%) were normal. The outcomes of these scans were highly expected in 42 (56.7%) cases, moderately expected in 25 (33.8%), and unexpected in 7 (9.5%). These scans had a major impact on the patient’s treatment course in 28 (37.8%) cases, minor impact in 40 (54%), and no influence in 6 (8.1%) cases. The Chi-square test showed a significant association between chest CT scan outcomes and clinicians’ expectations, chest CT scan outcomes and their influence on treatment, as well as clinicians’ expectations and the effect of scans on treatment. The p-value <0.05 was considered statistically significant for all three cases. Conclusion: Chest CT scans significantly impact the diagnostic and treatment pathway for patients.

Comparison of Scar Quality using Polyglactin and Polyamide Suture Materials for Closure of Nasolabial Flap Donor Site Defects in Patients with Oral Submucous Fibrosis: A Research Protocol

Gauri Sharma, Deepankar Shukla, Nitin Bhola

Introduction: Scar formation is an unavoidable sequelae of any surgical procedure. The goal is to produce fine scars with the least complications. Literature mentions various surgical factors that may lead to better quality of scars, one of which is the type of suture material used. Few studies exist in the literature that have compared the quality of scars after placement of polyglactin and polyamide sutures. Additionally, no studies have been done to compare the quality of scars following reconstruction with nasolabial flaps in patients with oral submucous fibrosis. Need for the study: This study will help evaluate and establish the healing outcomes in nasolabial flaps in the form of scars after placing subcutaneous 4-0 polyglactin (VICRYL™ ETHICON) and 4-0 polyamide (ETILONTM ETHICON) sutures. This will eventually lead to minimal tissue reaction and more aesthetic scars with fewer complications. Aim: To evaluate and compare the quality of scars post-reconstruction with nasolabial flaps with subcutaneous polyglactin sutures and subcutaneous polyamide sutures. Materials and Methods: This is a prospective randomised triple-blinded trial which will be conducted in the Department of Oral and Maxillofacial Surgery, Sharad Pawar Dental College and Hospital (SPDCH), Sawangi (Meghe), Wardha, India. The trial will take place from July 2023 to June 2024. A total of 15 subjects with grade C Oral and Submucous Fibrosis (OSMF), who will undergo fibrotomy followed by reconstruction of bilateral nasolabial flaps, will be enrolled in the trial. Suturing of one side of the flap will be done using 4-0 polyglactin (VICRYL™ ETHICON) suture subcutaneously, and the other side will use 4-0 polyamide (Ethilon™ ETHICON) suture subcutaneously. The scar tissues will be periodically evaluated at one week, one month, and three months postoperative period to assess the healing outcomes and overall aesthetic appearance using the Patient and Observer Scar Assessment Scale (POSAS) using Chi-square test and Student’s t-test.

Limbal Stem Cell Deficiency: A Review Focusing on Staging, Diagnostic and Treatment Modalities

Archana Ramkrishna Thool, Vaibhavi Wasnik

The cornea being a transparent tissue acts as a refractive surface as well as a protective barrier of the eye. The corneal epithelium is being continuously replaced and renewed by the Limbal Stem Cells (LSC). The turnover of corneal epithelium is brought about by asymmetrical differentiation and self-renewal of LSCs, their migration to the cornea and desquamation of current corneal epithelium. LSC are undifferentiated cells that acts as progenitors of corneal epithelium and maintains corneal homeostasis. LSC resides in its own microenvironment known as LSC niche, which are capable of sustaining these tissue regenerating cells. Any intrinsic factors (e.g., toxic epidermal necrolysis or mucous membrane pemphigoid), extrinsic factors (e.g., thermal burns, radiations, chemical burns) or genetic defects (e.g., aniridia) cause impairment of LSC or its niche leading to Limbal Stem Cell Deficiency (LSCD). LSCD is associated with invasion of cornea by conjunctival epithelium, corneal opacity, and visual impairment. The diagnostic modality of LSCD includes fluorescein staining and slit lamp examination, impression cytology, confocal scanning and anterior chamber optical coherence tomography. The staging of LSCD is important for deciding the treatment modalities. In LSCD, the most common treatment modality includes LSC transplant from a healthy eye. Non LSC transplantation techniques are being used to prevent allograft rejection. In this review article, the authors aim to summarise the existing knowledge of the aetiology, staging and treatment modalities of LSCD.

Importance of Bio-electrical Impedance for Measurement of Body Fluid Status in Chronic Kidney Disease Patients on Maintenance Haemodialysis: A Narrative Review

Sheetal Namdeorao Sakharkar, Ruchira Shrikant Ankar

Assessing the precise body water status in patients with renal disorders is crucial for their health. It has been reported that chronic fluid overload is present even in the early stages of renal insufficiency. If volume overload in a patient with chronic renal failure is not controlled, serious problems such as pulmonary oedema, cardiac remodelling, and diastolic heart failure can develop. Bio-electrical Impedance Analysis (BIA) has emerged as one of the most useful tools, although randomised clinical studies are lacking to support its universal use. Early management of hydration may improve clinical outcomes, as it allows for personalised dialysis prescriptions and nutritional support. BIA practice is utilised as non invasive health monitoring for Body Composition (BC). BIA is a practical and inexpensive method. Moreover, BIA parameters estimated for disease prognosis analysis have been found to be reasonably predictable for both patient status and healthcare. Additionally, BIA is a simple, accurate, portable, quick, easy, and low-cost method. In patients with End-stage Renal Disease (ESRD) undergoing maintenance Haemodialysis (HD) treatment, excessive fluid volume is considered a risk factor for death. Furthermore, fluid elimination to achieve Dry Weight (DW) is a crucial component of HD treatment for ESRD patients. DW is an important concept related to patients undergoing HD. Conventional methods seem to be time-consuming and operator-dependent. BIA is a new and simple method that has been reported to accurately estimate DW. Estimating the dry weight of HD patients is a challenging task. Many tools are available, but not every HD centre has access to them. Several strategies have been used to develop a more standardised method of assessing dry weight in HD patients. The Bio-impedance Spectroscopy (BIS) device has been validated against gold standard methods of volume assessment. Body composition monitoring appears to be a helpful diagnostic tool that reasonably complements existing clinical methods in assessing the DW of HD patients. BIS identifies Fluid Overload (FO) as a virtual “Over Hydration (OH)” compartment, which is calculated from the difference between the measured extracellular volume and the predicted values based on a fixed hydration of lean and adipose tissue mass.

The Impact of the COVID-19 Pandemic on Mental Health Among the General Population: A Narrative Review

Chinmayee Arvind Ladole, Kedar S Takalkar

The Coronavirus Disease-2019 (COVID-19) has infected millions of people worldwide, resulting in a global burden for long-term care of sufferers. The impact of COVID-19 has affected the mental health of innumerable people. Emotional, psychological, and social well-being are all parts of our mental health, influencing our thoughts, emotions, and behaviours. Additionally, it affects how people respond to stress and make good decisions. For instance, depression raises the risk of a wide range of physical health issues, especially chronic illnesses like diabetes, heart disease, and stroke. The COVID-19 pandemic has infected millions worldwide, leaving a global burden for the long-term care of COVID-19 survivors. Therefore, it is imperative to study the short-term (post-COVID) and long-term effects of COVID-19, specifically as the local and systemic pathophysiological outcomes of other coronavirus-related diseases (such as Middle East Respiratory Syndrome - MERS and Severe Acute Respiratory Syndrome Coronavirus 2 - SARS-CoV-2) have been well-documented. Mental health was evaluated using four psychological measurement scales to assess fear of COVID-19, depression, general anxiety, and post-traumatic stress. The worldwide social and economic upheaval has resulted in the worst recession since the Great Depression. The Impact of Event Scale-Revised and the Depression, Anxiety, and Stress Scale can be used to evaluate the psychological impact and mental health status. The main themes include the biology of stress and the effect of infection on the brain. Adversity can cause anatomical and functional changes in the brain. Although cortisol, for example, can alter brain architecture, tolerable stress is mitigated by protective systems and interpersonal connections that promote adaptive coping. The risk of physical and mental illness, as well as cognitive decline, may increase due to toxic stress, which is often caused by prolonged activation. From a behavioural standpoint, it is essential to understand burnout, compassion fatigue, grief, and other psychological processes and strategies in the context of the COVID-19 pandemic. COVID-19 has adversely affected the mental states of people. The COVID-19 pandemic is associated with significantly high levels of psychological distress that meet the threshold for clinical relevance. Mitigating the harmful effects of COVID-19 on mental health is an international public health priority.

Overview of Genetics in Non Alcoholic Fatty Liver Disease: A Futuristic Cognizance

Sanjukta Mishra

Non Alcoholic Fatty Liver Disease (NAFLD) is an emerging epidemic worldwide. It comprehends simple steatosis to escalating steatosis with associated fibrosis, cirrhosis, and Hepatocellular Carcinoma (HCC). NAFLD patients are at increased risk of liver-related as well as cardiovascular mortality. It seems to have a robust interconnection with visceral adiposity, Insulin Resistance (IR), inflammation, and environmental factors. Although the pathogenesis of NAFLD is presumed to be linked to lifestyle patterns, nutritional factors, and genetics, the predictor of advancement of this disease spectrum caused by genetics stands imprecise. In the past decade, multiple genome-wide associations and large candidate gene studies have recognised the contribution of several genetic polymorphisms in regulating hepatic lipid metabolism, thus influencing NAFLD establishment and progression. Recent understanding of the genetic underpinning of NAFLD explains the involvement of several common naturally occurring variants in PNPLA3, TM6SF2, MBOAT7, GCKR, LYPLAL1 and PPP1R3B genes in the evolution of the disease. The genetic landscape may play a role to appraise the risk stratification and ascertaining the potential therapeutic target in NAFLD patients. The perspective of this review was to emphasise the genetic basis of the NAFLD spectrum, which modulates the severity and progression of the disease.

Is Centric Relation and Centric Occlusion Discrepancy an Enigma? An Orthodontic Perspective

Centric Relation (CR) and Centric Occlusion (CO) are commonly used references in clinical dentistry. CR represents bone-to-bone contact independent of teeth contact, while CO refers to occlusal contact between the maxillary and mandibular teeth. The coincidence or discrepancy between CR and CO has been the subject of many challenging debates. These reference positions of the mandible typically do not align in natural dentition. When a discrepancy exists, the mandible slides from CR to CO to stabilise the occlusion. Such functional interferences can result in occlusal wear, excessive tooth mobility, poor periodontal health, temporomandibular joint dysfunction, and myofascial pain. Orthodontists who follow gnathologic occlusion recommend using study models mounted on articulators in the CR position to coincide with the treatment of CR-ICP (Maximal Intercuspal Position - ICP). Generally, a discrepancy of 1.5 mm in the vertical and horizontal planes and 0.5 mm in the transverse plane is considered acceptable as it does not cause significant pathology. In the present article authors, we discuss the discrepancy between CR and CO, the dentofacial characteristics of patients with CR-CO discrepancy, its relationship with TMJ dysfunction, and its impact on cephalometric analysis and deprogramming. A clear understanding of CO and CR allows clinicians to approach treatment planning in an organised manner.

Beneficial Effects of Physical Activity on Stroke: A Narrative Review

Mansi Soni, M Balaganapathy

Stroke is a major health issue in the category of non communicable diseases, placing a significant burden on developed and developing countries in terms of long-term and specialised care. In today’s era, controlling the highly prevalent non communicable diseases is a primary focus, with preventive strategies taking precedence over treatment strategies. Physical inactivity is one of the contributing factors to stroke, highlighting the immense significance of physical activity for stroke survivors. Therefore, it is crucial to investigate and understand the positive effects of physical activity in preventing and managing stroke. This narrative review aims to explore and summarise the beneficial effects of physical activity in stroke prevention and management. By narrating these benefits, we hope to encourage stroke survivors to engage in sufficient physical activity to maximise their advantages.

The Management of Lateral Epicondylitis: A Narrative Review

Saran Malisorn

Lateral epicondylitis, commonly known as Tennis Elbow, affects approximately 1-3% of the population. Despite the absence of histological evidence of inflammation in the affected tissue, the term “epicondylitis” implies inflammation. The Extensor Carpi Radialis Brevis (ECRB) muscle is primarily affected, and the condition is attributed to excessive use of this muscle. Non surgical treatment options, such as rest, physiotherapy, cortisone injection, platelet-based therapies, and restricted movements, are recommended. Surgical intervention is suggested for cases involving physical impairment or chronic pain. This review aims to provide healthcare professionals with an understanding of the condition, including its causes, symptoms, diagnosis, and treatment planning options.

An Overview and Implication of High Intensity Laser Therapy in Neck Pain: A Narrative Review

High-Intensity Laser Therapy (HILT), also known as Class IV laser, is a relatively modern type of non invasive physical electrotherapy that has been used to treat a variety of conditions. However, there has been little research conducted on this equipment. HILT can be highly beneficial for treating painful neck-related disorders, as it offers various effects including bio stimulation, regeneration, analgesia, anti-inflammatory properties, and anti-oedema properties. Many disorders that cause neck pain can be effectively treated with HILT in combination with exercise. To gather essential information on the subject, electronic databases such as PubMed, Scopus, and Google Scholar were searched. The conclusions of the review indicate that HILT is highly efficient, affordable, and innovative. However, it has received minimal academic research attention and has not been widely used in Indian clinical settings. The evidence suggests that HILT is a highly effective physical treatment technique that significantly improves pain, Range of Motion (ROM), functional status, and Quality of Life (QoL) in patients with neck pain.

Immediate Effects of OM Meditation on Heart Rate Variability as a Stress Index During Different Phases of Menstruation: A Quasi-Experimental Pilot Study

Mansha Kanuga, Satish G Patil, Sweta Goudappanavar, Komal Ruikar

Introduction: Stress alters normal reproductive function, causing menstrual disorders up to infertility in females. Psychological stress is the most common lifestyle factor found to be associated with menstrual disorders among late adolescence and young adults. Yoga-based OM-meditation has been shown to reduce stress, but its effect on managing stress during different phases of menstruation in young females is not known. Aim: To evaluate if short-term practice of OM-meditation could induce a beneficial modulation in Heart-Rate Variability (HRV), a measure of stress index during various phases of the menstrual cycle in young females. Materials and Methods: A quasi-experimental study was conducted on 20 healthy young females with a normal menstrual cycle, aged between 18-25 years, and pursuing a medicine course at Shri BM Patil Medical College, Karnataka, India, from March 2020 to December 2021. Meditation group participants (n=10) practiced OM-meditation, while control group participants (n=10) relaxed quietly for 10 minutes. Each subject received an intervention thrice during the menstrual, proliferative, and secretory phases. Data was collected before and immediately after every intervention. Body Mass Index (BMI), Blood Pressure (BP), Heart Rate (HR), and HRV were measured. Distribution of data, within-group and between-group analysis was done. ANCOVA (Analysis of covariance) was used to determine the differences between groups. Results: Total 20 participants, n=10 in each, Meditation and control group, mean age of participants was 19.2±0.79 and 19.3±0.82 years, and the mean period of MC was 31.1±2.76 and 30.3±2.4 days in the meditation and control groups, respectively. There was no change in the baseline values of BMI, BP, and HR between the two groups, and they were within the normal range. Between-group analysis (ANCOVA) of HRV spectrum showed that OM-meditation had significantly decreased the Low-Frequency (LF) component of HRV (p<0.05) and LF/HF ratio (p<0.05), and increased the High-Frequency (HF) component (p<0.05) of HRV during all three phases of MC. Conclusion: The practice of OM-meditation for 10 minutes reduced sympathetic activity and shifted autonomic balance towards parasympathetic dominance. These changes suggest that OM-meditation can reduce mental stress and optimise autonomic regulation during different phases of MC. However, this needs evaluation in a larger trial.

Retained Malecot's Drain Tip after Percutaneous Drainage of Post-transplant Lymphocele: A Case Report

Madhur Anand, Sanchit Rustagi, Uday Pratap Singh, Hira Lal, Aneesh Srivastava

Percutaneous drains are commonly used to drain collections in surgical patients. The choice of drain can determine the potential complications. Herein, the authors presented a case of a 32-year-old female with a drain complication and its management in a post-transplant patient. The patient developed a post-transplant perigraft lymphocele and underwent drainage using Malecot’s catheter. However, during the removal of drain, the Malecot catheter accidentally broke, leaving the tip inside the perigraft region. To locate the tip, a non-contrast Computed Tomography (CT) scan was performed. Subsequently, the patient underwent a transperitoneal re-exploration, successfully removing the tip. It was discovered that the catheter tip had ingrown tissue between the prongs, impeding its removal. It is crucial to exercise caution in such situations as Malecot catheters may sometimes have ingrown tissue between the prongs, hindering their removal.

Spontaneous Ruptured Pyomyoma in a Nulligravida Female

A 41-year-old unmarried nulligravida female presented with complaints of dysuria and intermittent fever for one week. There was no history of menstrual symptoms, uterine instrumentation, or uterine artery embolisation. The patient was a known case of type 2 diabetes and was on insulin treatment. There was no history of hypertension, bronchial asthma, tuberculosis, or thyroid disorder. On examination, the patient had a fever (99.8o F) and stable vital signs. Abdominal examination revealed a uterus size equivalent to 16 weeks of pregnancy. Blood investigations showed leukocytosis with a predominance of neutrophils (Total White Blood cells (WBC) count: 22,370 cells/cu mm with 83% neutrophils) and an elevated Erythrocyte Sedimentation Rate (ESR) of 96 mm/hr. HbA1c was 12.1%, indicating uncontrolled diabetes with an estimated average blood sugar level of 301 mg/dL. A pap smear was negative for intraepithelial lesion or malignant cells. Abdominal ultrasound revealed an enlarged uterus measuring 11.5×9.3×7.9 cm with an anterior wall fibroid measuring approximately 8.3×8.4 cm in the fundal region (Table/Fig 1)a,b. Abdominal and pelvic MRI showed a large heterogeneous lesion with cystic areas measuring 9.0×9.2×8.8 cm in the right antero-lateral myometrial wall (Table/Fig 2)a-d. Based on the ultrasound and Magnetic Resonance Imaging (MRI) findings, the possibility of a large anterior wall subserous fibroid with cystic degeneration was considered. The patient underwent surgery, revealing an infected degenerated fibroid in the anterior wall of the uterus with pus drainage, indicating rupture. Foul-smelling pus of approximately 250-300 mL was drained from the peritoneal cavity. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. An intraperitoneal drain was placed, and the skin was closed with 2-0 ethilon. No intraoperative or post-operative complications occurred, and the specimen was sent for histopathological analysis (Table/Fig 3)a,b. Histopathology revealed a leiomyomatous uterus with degenerative changes. Culture and sensitivity analysis of the pus showed occasional pus cells, but no organisms were observed.

Torus Cingularis/Facialis: A Clepe to Talon Cusp

Sabarinath Balaraman, Ramya Sekar

Sir, Developmental abnormalities of the teeth may be caused by genetic influences, environmental factors, or idiopathic reasons. The causal effect axis has not been established in many of these disorders (1). Various developmental alterations related to tooth shape, such as fusion, concrescence, gemination, and accessory cusps, have been described. Talon cusp is one such developmental alteration of the teeth that was identified in 1892 by Mitchell WH as an extra horn-like cusp or an exaggerated cusp at the region of the cingulum, with no established causal-effect axis (2). Mellor JK and Ripa LW named it talon cusp, as it resembles an eagle’s beak (3). This developmental anomaly is the result of both environmental and genetic factors that affect early odontogenesis. Talon cusp is often observed in relation to Rubinstein-Taybi syndrome (Table/Fig 1) (4). Based on morphology, the talon cusp is divided into three types: Talon, Semi talon, and Trace talon (5). Previously, this structural abnormality mostly resembled the shape of an eagle’s talon. However, recent literature has reported various shapes, such as a heart or triangle, on the facial or palatal surface [3,6]. In the present literature, the authors proposed the term “Torus Facialis” or “Torus Cingularis” as an alternative name for talon cusp, which allows clinicians and academicians to adopt a terminology that explains the pathology as a whole. “Torus” is a Latin word meaning protuberance, swelling, or elevation. “Facialis” or “Cingularis” indicates the location where the enamel protuberance is evident on the tooth surface. “Torus Facialis” or “Torus Cingularis” is a scientific terminology that indicates the nature of the pathology, such as a hard tissue protuberance, and the anatomical location of the pathology on the tooth. Therefore, the use of the term “Torus Facialis” or “Torus Cingularis” would be more appropriate compared to talon cusp.

Correction: 2014 Jan,Vol-8(6): AM01

Shaifaly Madan Rustagi, Sanjeev Thakyal, Patnaik VV Gopichand, Foot Index in Right Footed Adults (Published in Journal of Clinical and Diagnostic Research. 2014 Aug, Vol-8(6): AM01 ) Owing to privacy concerns raised by the corresponding author her personal contact number has been removed.