Journal of clinical and diagnostic research

Book Review of Learning Radiology, Recognising the Basics: Fourth Edition

Sudhanshu Tonpe

Written by William Herring, MD, FACR Vice Chairman and Residency Program Director (retired) Einstein Healthcare Network, Philadelphia, Pennsylvania. Published by Elsevier, Inc. ISBN: 978-0-323-56729-9 Learning radiology: Recognising the Basics, Fourth Edition (1), as the name implies, provides an overview of the fundamentals of radiology. It begins with an introduction to the basic modalities, including X-ray imaging, ultrasonography, Computed Tomography (CT), fluoroscopy, and Positron Emission Tomography (PET). This is followed by a discussion on recognising a technically adequate chest radiograph, normal pulmonary and cardiac anatomy and specific diseases in separate chapters. The book also covers various aspects of abdominal imaging, highlighting the most common radiological abnormalities encountered in day-to-day practice. The present edition includes chapters on breast imaging, paediatric imaging, and Magnetic Resonance Imaging (MRI). It concludes with multiple quizzes, some of which are available online only. In total, the book contains 30 chapters. Additionally, there is a section featuring video content that effectively illustrates the concepts covered in each chapter in an animated format, enhancing the learning experience of the basics of radiology. The first edition of learning radiology: Recognising the basics, was published in the year 2007 and the latest fourth edition currently under print is the 2020 edition. The fourth edition of learning radiology: Recognising the Basics showcases various modifications and enhancements, all within the framework of its original structure aimed at delivering essential foundational content succinctly and straightforwardly. This edition has been upgraded with newer images, improved quality of older images, and the addition of newer topics in ultrasonography, trauma, mammography, and interventional radiology. However, nuclear medicine is now an online-only chapter, which could have been included in the print edition. William Herring employs pattern recognition not only in conventional radiography but also in other modalities like CT, MRI, and nuclear medicine, combined with a case scenario in every chapter, making Learning Radiology all the more enjoyable and engaging. Although this book is written with first-year radiology residents in mind, undergraduates and consultants might also benefit from it if they want to learn the fundamentals of radiographic interpretation. One of the best features of the book is its emphasis on clinical correlation. The author provides numerous examples of how radiographic findings relate to specific clinical conditions. For instance, in the case of breast imaging, he discusses when and which modality should be used for masses during pregnancy, as well as for nipple discharge, mastitis, and breast abscesses. This approach helps readers develop a deeper understanding of the importance of radiology in patient care. Such topics are seldom covered in radiology books, which often discuss imaging findings in isolation, requiring readers to refer to surgery books for clinical correlation. The book’s writing style is characterised by its clarity and conciseness, facilitating reader comprehension. The author also includes helpful mnemonics and tips for remembering important information. Digital compendiums and supplementary materials direct readers toward compiling the most suitable radiological examinations, which are expected to be invaluable during medical ward evaluations. The author would recommend this book as a primer to understand the basics, from conventional radiography to PET-CT; however, it should not replace the subspecialty reading one ought to do to become a well-rounded professional.

Subcutaneous Emphysema in Laparoscopic Total Extraperitoneal Repair of Inguinal Hernia: A Rare Case Report

Vasundara, Darshana Tote, Anup Zade, Shubham Durge, Aditya Sriharsha Pedaprolu

Surgeries for inguinal hernias are among the most commonly performed procedures worldwide. Compared to traditional open surgery for inguinal hernias, there has been a rise in the use of Total Extraperitoneal (TEP) repair. TEP has been recommended as a safe method for the repair of inguinal hernias. The present report describes a case of subcutaneous emphysema, a rare complication observed after TEP. Subcutaneous emphysema is defined as the de novo creation or infiltration of air in the skin’s subcutaneous layer, which includes the epidermis and dermis. It can occur in various body parts. Factors contributing to the development of subcutaneous emphysema include total gas volume, gas flow rate, the use of a valveless trocar system and robotic fulcrum force. A 56-year-old male was planned for elective TEP surgery. Intraoperatively, the patient experienced a rise in End-tidal Carbon Dioxide (EtCO₂), which was followed by an examination that revealed subcutaneous emphysema extending up to the neck. Immediate measures were taken, including increasing the Fraction of Inspired Oxygen (FiO₂) to 100% and making nicks on the anterior chest wall and supraclavicular region. A repeat chest X-ray showed no recurrence of subcutaneous emphysema and the patient was discharged seven days postoperatively. Although subcutaneous emphysema is a rare condition, it can lead to life-threatening complications, such as pneumothorax. Therefore, early diagnosis and prompt treatment are essential.

Ayurvedic Management of Pakshmashata (Madarosis): A Case Report

Priyal Bansal, Dattatray Sarvade, BS Nycy, Mohammed Farhan Sheikh

Madarosis is characterised by either complete or partial loss of eyebrow or eyelash hair. Hair loss occurs due to interrupted blood supply to that region. In contemporary medicine, the management of madarosis includes hair transplant surgery or the use of steroids. There is no direct correlation to madarosis in Ayurveda; however, concepts like “Pakshmashata” described by Acharya Vagbhata exhibit symptoms that closely resemble this condition. In the present case report, a 30-year-old female patient presented to the Outpatient Department (OPD) of Kayachikitsa, complaining of sudden hair loss over the past month, accompanied by itching and a burning sensation in the affected area. A physical examination was conducted, and the patient was diagnosed with Pakshmashata. The treatment included Asthi Majja Pachak Kwath (a decoction for bone and bone marrow tissues), along with Manjistha (Rubia cordifolia) and Haridra (Curcuma longa), as well as a local paste (lepa). Jaloka Avcharan (leech therapy) was administered to the patient twice a month. For local application, Snehana (oil massage) with Eranda (Ricinus communis), taila was used three times a day. Significant improvement in hair growth in the affected area was observed during follow-ups on the 45th and 60th days.

Examining the Impact of Myofascial Release and Chest Mobility Exercises on Functional Scoliosis: A Case Report

Rohit Balasaheb Rahane, Arunmozhi Ranganathan, Priya Raj

Scoliosis is characterised by lateral spinal curvature, twisting of the spine and chest, and abnormalities in the sagittal profile. Physical therapy plays a crucial role in preventing the progression of scoliosis and its associated deformities, and in improving outcomes and quality of life. However, specific treatment methods for correcting the curvature and enhancing function are not extensively documented. Therefore, the present case report incorporated several techniques. A 17-year-old male visited the Physiotherapy Department with complaints of continuous pain in his lower back for the past 45 days. Due to the pain, the patient was not able to play football and sleep properly. Additionally, there was a notable postural deviation with a history of more than six years. His parents ignored his walking as stylish. Moreover, the patient stated that he had continuous pain, was not able to bend the spine backward, concentrate on studies and attend social gatherings. Upon spinal examination, scoliosis with a dropped right shoulder was observed. The patient was effectively treated using Myofascial Release (MFR) techniques combined with exercises to improve chest mobility. After management, the pain score showed a reduction, and there was improvement in the disability questionnaire. Significant changes were also noted in X-ray assessments and Range of Motion (ROM).

Radiological Evaluation of Huntington’s Disease: A Case Report

Soumyabrata Debnath, R Harshith

Huntington’s Disease (HD) is a rare neurodegenerative condition inherited in an autosomal dominant pattern, where Gamma Amino Butyric Acid-ergic (GABAergic) neurons in the basal ganglia progressively deteriorate. Symptoms include subcortical dementia, behavioural changes, midlife psychosis, and involuntary choreoathetosis movements. Imaging techniques like Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) show shrinkage of the caudate nucleus and putamen, alongside enlarged lateral ventricles. Diagnosis is confirmed through molecular analysis identifying the hallmark amplified Cytosine Adenine Guanine (CAG) triplet. The case report describes a 57-year-old female diagnosed with HD, presenting symptoms of accidental falls caused by involuntary jerky movements, along with behavioural changes and cognitive decline over three years. Initial Non Contrast Computed Tomography (NCCT) of the brain revealed bilateral basal ganglia and diffuse cerebral atrophy. Quantitative analysis indicated a decreased frontal horn width to intercaudate distance (FH/CC) ratio of 1.24 and an increased Intercaudate distance to inner table width (CC/IT) ratio of 0.30. Multivoxel Magnetic Resonance Spectroscopy (MRS) showed reduced N-Acetyl Alanine (NAA) and creatine (Cr) levels with an NAA/Cr ratio of 0.84. Magnetic Resonance Tractography and Diffusion Tensor Imaging (DTI) revealed elevated Fractional Anisotropy (FA) and diffusivity in the basal ganglia, and reduced FA with increased diffusivity in white matter tracts. Genetic analysis by Polymerase Chain Reaction (PCR) confirmed HD. Newer MRI like DTI allows early identification of disease and better assessment of disease progression and response to therapy. A multidisciplinary approach involving neurologists, psychiatrists, and other healthcare professionals is essential. Genetic counseling and psychosocial support are crucial for patients and their families. Early and accurate identification of HD is vital for timely interventions and improved symptom control.

A Case Report on Aesthetic Lower Lip Reduction Surgery

Priyanka Jaiswal, Deepika Ajit Masurkar, Bhairavi Kale

Patients these days are increasingly conscious of personal appearance, and much attention is being focused on the smile. Cosmetic dentistry is also in the race to become the most advanced and demanding dental subspecialty. Recently, aesthetic lip surgeries have been introduced, like lip repositioning, lip reduction and lip enhancement surgeries, to improve facial aesthetics. The authors present a case of a 28-year-old healthy male who reported to the Department of Periodontics with the chief complaint of poor aesthetics and large lips. His lower lip was double the size of the upper lip. Therefore, an aesthetic lip reduction surgery was planned. The lip reduction operation could successfully manage the large lower lip with no intra or postoperative complications. No recurrence was observed within a period of 12 months. Cheiloplasty balances the look of the top and lower lips, improving the appearance of the face as a whole.

Cytodiagnosis of Metastatic Thyroid Follicular Carcinoma in Left Iliac Bone with Occult Primary: A Case Report

Shreya Giri Goswami, Arvind Bhake

Bone metastasis of Follicular Thyroid Carcinoma (FTC) is an aggressive complication. Typically, follicular carcinoma remains confined to the thyroid gland, with distant metastasis occurring in 4-15% of cases. The lungs are the most frequent site of metastasis, followed by bone (2-13%). A peculiar clinical manifestation of FTC observed is the metastasis with the primary still remaining clinically occult. Solitary bone metastases are exceedingly rare and can easily be misdiagnosed as primary bone tumours on clinicoradiological assessment. This causes delays in the diagnosis and management. In these cases, the cytomorphology of cells on diagnostic Fine Needle Aspiration (FNA) was found to be useful in suggesting the primary origin of FTC. Distant bone metastases from follicular carcinoma on histopathological examination from biopsy specimens have been reported in the literature. The cytodiagnosis and cytomorphology of metastatic FTC by Fine Needle Aspiration Cytology (FNAC) are seldomly described in the literature. Involvement of the iliac bone in the metastasis of FTC is uncommon. The FNAC of such a bony lesion helps immensely not only in the diagnosis of the metastasis but also in suggesting the primary malignancy. Authors, hereby report a clinicopathological profile of one such rare case of a 74-year-old female with cytodiagnosis of FTC with no clinical thyroid swelling. The cytodiagnosis made from the primary lytic lesion involving the left iliac bone led to the retrospective radiological and histopathological work-up of the thyroid gland, confirming the occult primary carcinoma of the thyroid gland. The present case highlights the rare presentation and cytomorphological details of metastatic thyroid follicular carcinoma.

A Case Report on Theruptor Novo: An Antimicrobial Dressing in the Management of Venous Leg Ulcer

Subhash M Kale

Venous Leg Ulcer (VLU) is defined as any break in the skin that has either been present for longer than six weeks or occurs in a person with a history of VLU. VLUs are intricate and life-threatening ulcerations that result in significant expenses for health services. Compression therapy is the most preferable treatment choice for VLU. Beneath the compression devices (bandages or stockings), wound dressings are used as the primary layer to protect the wound and provide a moist environment to aid ulcer healing. Healthcare professionals face difficulty in making evidence-based decisions regarding the most appropriate treatment plan for a patient with varying needs due to the vast range of wound dressings. Hereby, the author presents a case study of a 53-year-old male patient with a non healing wound with pus discharge for 20 days over the lower limb. Theruptor Novo (Healthium Medtech, India) was used as the regular primary dressing along with planned treatment. By the end of three weeks, the wound size had reduced with a low exudate level, there was no sign of infection, and there was good granulation tissue growth.

Significance of Mrudu Virechan (Laxatives) and Specific Medicines in the Management of Bronchial Asthma: A Case Report

Shrish Jaiswal, Renu Rathi, Sonali Sahane, Bharat Rathi, Pawan Naukarkar

Difficulty in breathing, shortness of breath, fever, and cough are common respiratory complaints seen in bronchial asthma. It is the most prevalent chronic health issue affecting individuals in the paediatric age group. Tamaka Shwasa is one among the five varieties of Shwasa Roga in Ayurveda. The purpose of present case study was to examine how an Ayurvedic treatment plan might be applied to cases of bronchial asthma. Hereby, the authors present a case report of a 10-year-old female child who was brought to the clinic by her parents, presenting with complaints of difficulty in breathing, shortness of breath, and occasional sneezing. Based on the history taken and clinical examination, she was diagnosed as a case of Tamaka Shwasa, having suffered from it since, the age of five. The child was treated according to the treatment protocol cited in classic text books of Ayurveda that is Virechana and other medications, for a period of two months, divided into two sittings. After two months, there was a notable decline in clinical features, such as cough, breathlessness, and cold, as reported by her mother. Additionally, there was a decrease in the eosinophil count. The present case study demonstrates the role of Ayurveda in the management of bronchial asthma.

Cold Urticaria: An Under-recognised Cause of Perioperative Anaphylaxis

Monika, Himani, Monica Chhikara, Akshay Jaswal, Vivek Singh Kataria

Anaphylaxis is a rare but severe, potentially life threatening allergic reaction which commonly presents with cutaneous to multi-system involvement. The overall incidence rate of anaphylaxis during general anaesthesia varies greatly, ranging from 1:20,000 to 1:38. Cold urticaria, subset of chronic urticaria, is characterised with the presence of localised wheals to systemic and anaphylactic reactions. Physical urticaria can be due to physical stimuli such as friction, pressure, sun exposure and cold. Cold urticaria mainly comprises of physical urticaria rather which ranges from 3-33.8% with a higher incidence in cold climate. A case of physical cold urticaria was reported during perioperative period in a 40-year-old male who was posted in urology OT for a planned Ureteroscopy (URS). On pre-anaesthetic evaluation, patient’s medical, surgical and personal history found to be inconclusive. Patient was fit for surgery under ASA grade 1 and advised to be kept nil per orally for six hours for solid food and two hours for clear fluid. At the conclusion of surgery, patient developed shivering and was managed with warm blankets and radiant heater. After some time, patient develop wheals over chest, abdomen and lower back. Patient was managed with warm fluids, warming the patient, maintaining ambient OT temperature and drugs like injection pheniramine, epinephrine and dexamethasone to prevent catastrophic reaction. Through evaluation during preoperative period plays a key role in anticipation of these kind of untoward events. This case report describes the occurrence and management of this rare condition.

Adult Onset of Subacute Sclerosing Panencephalitis- A Case Report

Kedar S Takalkar, Pooja Raikar, Parag R Aradhey, Jiwan Kinkar

Subacute Sclerosing Panencephalitis (SSPE) is a rare, slowly progressive disorder that affects the entire nervous system. It primarily involves the cerebral cortex, subcortex and optic nerves. Caused by a mutated strain of the measles virus, the disease is mostly irreversible and devastating. It presents with gradually progressive cognitive impairment, extrapyramidal symptoms and sometimes seizures. Although commonly seen in unvaccinated children, SSPE of adult onset is uncommon. The disease is fatal and currently has no treatment. There have been many different presentations of this disorder, ranging from optic nerve involvement to gradual cognitive decline, but none have a good prognosis; ultimately, patients may become akinetic and mute. Here, the authors present an uncommon case of SSPE occurring at an older age (26-year-old male), with a rapid and atypical presentation resembling severe post-viral syndrome, which was later diagnosed as SSPE.

Early Onset Felty Syndrome in Rheumatoid Arthritis: A Case Report

Abhishek Kumar, P Harikrishnan, Manish Manrai, Abhinav Kumar

Felty syndrome is a rare and serious complication of Rheumatoid Arthritis (RA), characterised by a triad of RA, splenomegaly (enlarged spleen), and neutropenia (low neutrophil count). RA, a systemic autoimmune inflammatory disease marked by synovitis, commonly occurs in the fifth or sixth decade of life and often affects patients with a history of RA exceeding ten years. It is more prevalent in the Caucasian population due to the underexpression of the Human Leukocyte Antigen (HLA)-DR4 gene in African Americans. Felty syndrome requires the presence of neutropenia, defined as an Absolute Neutrophil Count (ANC) below 2000 cells/mm³, alongside splenomegaly and long-standing RA. Hereby, the authors present a case report of a 44-year-old female with a three-year history of RA, who presented with ascites for nine months and was found to have portal hypertension. Her diagnosis of Felty syndrome was confirmed based on the triad of RA, neutropenia, and splenomegaly, highlighting the importance of early recognition and management to prevent severe complications such as infections and systemic issues like portal hypertension.

Posterior Reversible Encephalopathy Syndrome with Addison’s Disease in a Known Case of Arnold Chiari Malformation

Satbir Kaur Malik, Sangram S Mangudkar, Mahabir Mishra, Sanket Genuji Shinde

Posterior Reversible Encephalopathy Syndrome (PRES) is a life-threatening neurological disease. The aetiology of Addison’s disease has been modified from infectious to autoimmune pathology. Underlying pathogenesis is insufficient production of glucocorticoids and mineralocorticoids. Case series with PRES syndrome and Cushing’s syndrome have been reported but PRESS with adrenal insufficiency is rarely published. We hereby report an operated case of Arnold Chiari malformation presenting with first episode of generalised tonic clonic seizure and diarrhoea for four days. Postictal confusion was present for two hours. She was previously diagnosed with Addison’s disease. Patient had hypotension and dyselectrolytaemia. Systemic examinations were within normal limits. MRI brain revealed features of PRES. The authors encountered certain challenges in her management which included persistent hypokalaemia, hypocalcaemia and hypotension. Patient is on regular follow-up and she is currently asymptomatic. Prompt diagnosis of PRES and intensive case treatment is a must for the betterment of prognosis.

A Case of Haemorrhages caused by Multiple Myeloma Induced Factor Deficiencies: A Bleeding Enigma

A 74-year-old male patient presented with anaemia, thrombocytopenia, and extensive haemorrhages over both thighs and back. A coagulation work-up revealed markedly elevated Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT). Reduced functional values of fibrinogen as determined by clot-based assay (126.4 mg/dL), as well as factor V (17.5%) and factor X (27.8%), were noted. These abnormalities were corrected by mixing studies with normal plasma. Neoplastic plasma cells were seen in the bone marrow biopsy, while abdominal fat biopsies showed no amyloid deposition. Serum electrophoresis and immunofixation were positive for monoclonal gammopathy. The patient was diagnosed with multiple myeloma complicated by multiple acquired factor deficiencies. The patient showed a complete response within six months of treatment, which included bortezomib and cyclophosphamide. Multiple myeloma is a monoclonal proliferation of plasma cells that results in increased production of free immunoglobulin light chains, resulting in increased paraproteins. These paraproteins bind with and inhibit various clotting factors, resulting in their inactivation and depletion. Factor X deficiency in these cases is usually attributed to concomitant amyloidosis, whose fibrils bind to Factor X. However, these deficiencies can occur in the absence of amyloidosis as well. While various reports of this entity have highlighted isolated factor deficiencies including factors V, VII, IX, and X, multiple factor deficiency is a rare occurrence, with no other cases being reported from southern India.

Netarsudil Associated Limbal Follicles: A Case Report

Rinky Thakur, Lalit Mohan, Bibhuti Prassan Sinha

Primary Open Angle Glaucoma (POAG) is one of the leading causes of irreversible blindness worldwide. Netarsudil, a Rho-kinase inhibitor and norepinephrine transporter, has recently been approved for reducing Intraocular Pressure (IOP), which is the single most clinically modifiable risk factor for this condition. Here, a case of a 53-year-old female with POAG who developed follicles along the corneal limbus following treatment with Netarsudil eye drops has been reported. The patient had been non-compliant with her POAG treatment for the past five years and presented with diminished vision (right eye greater than left) and raised IOP of 28 mmHg and 26 mmHg in the right and left eyes, respectively. The patient was started on Netarsudil (0.02%) eye drops once daily. After three weeks, the IOP had reduced to 19 mmHg and 18 mmHg in the right and left eyes, respectively; however, the patient still complained of itching and redness. A slit-lamp examination showed few follicular lesions on the limbus. Initial treatment for allergic conjunctivitis was ineffective, leading to a worsening of symptoms. Netarsudil was then discontinued, and dorzolamide was initiated instead, resulting in the resolution of symptoms within one week. The patient continued on dorzolamide without further issues. While Netarsudil is effective in reducing IOP, many of its potential adverse effects may still be unknown due to limited clinical experience. The present case report aims to contribute to the understanding of the safety profile of this drug. More such reports in the future will enhance this knowledge and help clinicians manage similar adverse situations.

Refracture of the Forearm Bones at the Same Site Three Months after Implant Removal: A Case Report

Saahil Singh, Nareshkumar Satyanarayan Dhaniwala

Refracture at the same site after implant removal is a rare complication, as fractures generally occur close to the plate end due to stress concentration. The reported case involves a patient with refractures of forearm bones at the previous site three months after implant removal. A 48-year-old, right-handed man complained of pain and swelling in his right hand after falling on a wet floor. He had a history of a similar injury three years earlier and was treated with plate osteosynthesis. The plates were removed three months before the present trauma. Radiographs revealed fractures of the distal one-third radius and distal one-fourth of the ulna with evidence of previous screw holes. He has been treated with a Low-contact Dynamic Compression Plate (LCDCP) and remains under follow-up. Refracture three months after implant removal at the site of the previous fracture site in both bones is a very rare occurrence and the present case report highlighted the importance of making a proper decision regarding union, when considering implant removal and post-implant removal care.

Challenges in Ventilation during Total Intravenous Anaesthesia in Patients with Laryngectomy Stoma: A Case Report

Saely Shekhar Paunikar, Vivek Chakole, Sanjot Ninave, Sambit Dash

The complete excision of the larynx, which includes the hyoid, epiglottis, and varying segments of the upper trachea, is known as a total laryngectomy. This procedure creates a defect that necessitates pharyngeal correction, as well as the formation of a permanent tracheostomy (tracheostome). Following a total laryngectomy, the trachea is brought to the skin as a stoma, and it is no longer anatomically connected to the digestive tract or oropharyngeal cavity. As a result, bag-mask ventilation, face masks, or nasal cannulas cannot effectively provide oxygen to the lungs. Intubation of the trachea from above the stoma via the oral or nasal route will also be unsuccessful. Hereby, the authors present a unique case of 73-year-old male patient with post-laryngectomy undergoing oesophageal dilation under Total Intravenous Anaesthesia (TIVA). Various challenges encountered while ventilating a patient with a laryngectomy stoma during TIVA has been discussed. Authors also emphasised various methods that can be considered for assisting ventilation in emergency scenarios.

Iatrogenic Tracheo-oesophageal Fistula in a Teenage Girl: A Case Report

Subramanya Kattepura, Apurva Bhaskar, Sowmya Gopinath

Acquired Tracheo-oesophageal Fistula (TEF) is a known entity in the paediatric age group; however, epidemiological data regarding this condition are sparse. Iatrogenic TEF is uncommon, present case is of a 14-year-old girl who is wheelchair-bound and on percutaneous gastrostomy feeding. She presented to the outpatient department with recurrent lower respiratory infections lasting more than six months. She is a known case of cerebral dural venous sinus thrombosis (CVT) and was artificially ventilated in the intensive care unit for three weeks. As a sequel to her neurological condition, she is paraplegic. Additionally, she experienced choking during each feeding and had bouts of prolonged coughing, which restricted her from taking oral feeds for over six months. Imaging revealed a cervical TEF. She underwent successful closure of this fistula and is now able to eat orally. This teenage girl had a fistula located above the level of the isthmus of the thyroid gland. It may have occurred during her tumultuous course in the intensive care unit, likely due to pressure necrosis of the tissue between the tracheostomy/endotracheal tube and the indwelling feeding nasogastric tube. A literature search did not reveal any similar cases in the paediatric population.

Effective Management of Irritable Bowel Disease (Grahani) through Ayurveda: A Case Report

Shubham Verma, Punam Sawarkar, Gaurav Sawarkar, Shweta Parwe

Grahani is an important part of the Mahasrotas (gastrointestinal tract). Grahani and Agni (digestive fire) have an Adhara Adheya Sambandha (mutual relationship). Jatharagni (digestive fire) governs the process of digestion, supported by the Tridoshas (three bio-humors). Due to a chronic imbalance of the Pachaka Pitta (digestive fire), Saman Vayu (the air entity that aids digestion), and Kledaka Kapha (the type of phlegm involved in digestion), a weak digestive fire (Mandagni) can lead to the release of food in its undigested form (Ama Utpatti), resulting in Grahani Roga. This condition is accompanied by symptoms (Lakshanas) such as Atisrushta Atibadha Mala (loose or constipated stools), Trushna (thirst), Arochaka (lack of taste), Aasyavairasya (altered taste), Praseka (excessive salivation), Shoona Pada Kara (oedma in the hands and feet), Asthisara Ruk (pain in the phalangeal joints and bones), Chhardi (vomiting), Jwara (fever) and Louhagandhi Amlodgara (burps with an iron-like pungent odour). In the present case of a 38-year-old female patient, the histopathology study revealed ulcero-inflammatory strictured colitis with transmural lymphoid follicles, indicative of Inflammatory Bowel Disease (IBD). According to the basic treatment principles of Ayurveda, Grahani (IBD) can be effectively treated using a combination of Shamana (palliative care) and Shodhana Chikitsa (purificatory procedures). The general approach in Grahani treatment involves the use of Agnivardhana (appetiser) drugs with Deepana (digestive stimulant) and Pachana (digestive aid) properties, which work to enhance the digestive fire (Agni). In the present study, the patient had stopped allopathic drugs, and the Ayurvedic treatment proved to be a safe remedy without any side-effects. The present case study demonstrates the critical contribution of Ayurveda to the effective treatment of Grahani (IBD).

Unusual Audiologic Profile in Unilateral Renal Agenesis: A Case Report

Anusha Rao Subramanian, Subhashini Dhandayutham, Narendrakumar Mariappan

Unilateral Renal Agenesis (URA) is characterised by the absence of one kidney, and typically manifests asymptomatically due to compensatory hypertrophy of the remaining kidney. The condition is often detected incidentally because routine screening for renal anomalies is not universal globally. URA is generally associated with mixed or sensorineural hearing loss. A case involving contralateral conductive hearing loss is discussed in the present case report. The present case involves a eight-year-old female with isolated URA and no other concurrent abnormalities. The present report highlights an atypical audiological profile in URA, diverging (conductive type of hearing loss) from the commonly observed sensorineural or mixed hearing loss patterns. Understanding such variations contributes to the broader knowledge of the genetic and developmental links between the auditory and renal systems. This case underscores the importance of comprehensive audiological assessments in individuals with renal anomalies, potentially broadening diagnostic considerations and therapeutic approaches.

Maxillary Mucormycosis in a Juvenile Diabetic Patient: A Case Report

Shreya Ghosh, Kishor Hiwale, Priya Chatterjee

One of the most fulminant and quickly spreading types of fungal infection, mucormycosis typically starts in the nose and paranasal sinuses after inhaling spores. Orbital and intracranial structures may become infected either directly or through blood vessels, leading to life-threatening complications. This infection most commonly manifests in the rhinomaxillary area, particularly in individuals with immunocompromised conditions like diabetes. Even with appropriate treatment, the disease’s mortality rate can exceed 40%, and it is challenging to detect. The standard treatment plan involves surgical debridement combined with systemically active antifungal medications, depending on the site of infection and risk factors. As a first-line treatment, lipid-based amphotericin B is recommended; however, posaconazole also shows promise. Hereby, the authors present a case report of a 15-year-old male patient with juvenile diabetes mellitus who had been experiencing pain and diffuse swelling in his left malar area for the previous two months. Following a histological analysis and clinical and radiographic evaluation by a multidisciplinary team, the patient was diagnosed with maxillary mucormycosis. Because of the abundant blood supply in the maxillofacial regions; however, more virulent fungi like Mucor can get past this obstacle. The purpose of present article is to show how early detection and treatment of mucormycosis in a young patient could prevent major morbidity and mortality from this potentially fatal illness . Additionally, it aimed to contribute to the local epidemiology of mucormycosis and raise awareness among stakeholders attention to the difficulties in treating this serious condition.

Entomophthoramycosis of Thigh: A Case Report with Review of Literature

Entomophthoramycosis is a sporadic, slow-growing subcutaneous infection that includes two distinct clinical forms: Basidiobolus ranarum (subcutaneous) and Conidiobolus coronatus (Rhinofacial), common in tropical countries like India. A 20-year-old male presented with painless progressive swelling of the anterolateral aspect of the right thigh, with a history of Incision and Drainage (I&D) not responding to antibiotics. A clinical diagnosis of a soft-tissue tumour was made. Magnetic Resonance Imaging (MRI) showed a subcutaneous lesion with inflammatory changes and overlying skin changes. Core biopsy showed spindle cells. Surgeons proceeded with a wide local excision of the lesion. Histopathology {Haematoxylin and eosin (H&E), Grocott Methenamine Silver stain (GMS), Periodic Acid Schiff stain (PAS)} proved to be subcutaneous zygomycosis showing Splendore-Hoeppli phenomenon. The patient was then started on antifungal treatment followed by skin grafting. In the present case, the granulomatous inflammation was not picked up in multiple random core biopsies and hence, a wide excision was done, leading to an avoidable extensive surgery.

Unravelling Anaesthetic Challenges in Patient with Diffuse Systemic Sclerosis: A Case Report

Madhu, Shally Jain, Vikas Kumar, Anurag Das, Harsh Lakhanpal

Systemic sclerosis or scleroderma is an uncommon autoimmune condition with a global incidence of 8 to 56 new cases per million per year, which commences from skin and progresses to affect multiple systems in the body. It is marked by abnormalities in blood vessels, sclerosis of connective tissues and atrophy of skin and internal organs. The systemic sclerosis treatment depends on the disease manifestation and are usually treated with vasodilators (for vasculopathy improvement and prevention of Raynaud’s phenomenon), prostacyclin analogues (for the prevention of Raynaud’s phenomenon refractory to oral vasodilators), immunosuppressants like methotrexate, cyclophosphamide, mycophenolate mofetil, low dose corticosteroids (for the treatment of skin hardening, interstitial lung disease and inflammatory arthritis) and antifibrotics like endothelin receptor antagonists (for the treatment of pulmonary artery hypertension). Avascular necrosis in systemic sclerosis can arise as a result of the macrovascular and microvascular effects of vasculitis and corticosteroid therapy. The multisystem involvement of systemic sclerosis can impact every aspect of anaesthetic care especially airway management. During perioperative management, numerous systemic manifestations like pulmonary artery hypertension, interstitial lung disease and cardiac arrhythmia should be considered. The regional anaesthesia serves as a safe alternative to general anaesthesia and useful adjunct in the management of postoperative pain, but can be technically challenging. This case report described a 61-year-old female patient who had a history of systemic sclerosis for past 25 years and was scheduled for a total hip replacement due to avascular necrosis and secondary osteoarthritis of the left hip. The patient was having difficult cannulation, interstitial lung disease and anticipated difficult airway because of microstomia, limited mouth opening and limited flexion and extension at atlantooccipital joint. But the patient was successfully managed with combined spinal epidural anaesthesia, which provided effective pain control and minimised the perioperative risk associated with general anaesthesia.

Application of the International Classification of Functioning, Disability and Health Model in Recurrent Guillain-Barré Syndrome: A Case Report

The present case report utilises the International Classification of Functioning, Disability and Health (ICF) model to assess the health condition and its impact on various health domains of a 46-year-old male who experienced recurrent Guillain-Barré Syndrome (GBS) for the second time within three years. The patient presented with sudden difficulty swallowing solid food and bilateral lower limb weakness, struggling to rise from a sitting position. The report explores the patient’s ICF profile, highlighting the effect of GBS on his daily life and recovery process. The patient’s remarkable recovery can be attributed to several factors, despite the challenges faced. These factors include good socio-economic status, motivation, family support and consistent physiotherapy. Together, these elements played pivotal roles in facilitating the recovery process.

A Diagnostic Conundrum in Case of Primary Central Nervous System Vasculitis Presenting as Young Stroke

Prakash Shende, Subashini Vadivel, Kunal Modi

Primary Central Nervous System Vasculitis (PCNSV) is a rare inflammatory condition affecting the blood vessels in the brain and spinal cord, without signs of systemic vasculitis. The symptoms of PCNSV are typically non-specific and varied. This case involves a 16-year-old female who arrived at the emergency department with tingling and numbness in her left upper and lower extremities since waking up that morning. Within hours, she developed significant weakness in her left arm and leg. She had no significant medical history, comorbidities, or history of substance use. On examination, her vitals were stable, and she was fully conscious and oriented. Neurological examination revealed right-sided mouth deviation and decreased muscle power in her left limbs, while sensory function remained normal. Routine blood tests were normal, except for mildly elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP). Autoimmune markers and complement levels were within normal limits. Cerebrospinal Fluid (CSF) analysis showed lymphocytic pleocytosis and mildly elevated protein levels. Magnetic Resonance Imaging (MRI) brain imaging revealed multiple small, acute, non-haemorrhagic infarcts in the right frontoparietal and temporo-occipital regions. MR angiography indicated thrombosis in the right internal carotid artery, with extensive thickening and constriction in various segments, consistent with PCNSV. She was treated with dual antiplatelet therapy, antiepileptics, methylprednisolone pulse therapy, and intravenous cyclophosphamide, followed by maintenance therapy with methotrexate and oral steroids. This case underscores the importance of early recognition and aggressive treatment of PCNSV to prevent long-term neurological deficits. Reporting this case is crucial as it highlights an atypical presentation in a young female, emphasising the need for awareness and comprehensive diagnostic approaches.

Anaesthesia for Laparoscopic Abdominal Surgery in a Morbidly Obese Female with Hypothyroidism and Hypertension: A Case Report

Sanjyot Ninave, Saiesh Raut Dessai

Obesity is characterised by a body weight that surpasses the expected or ideal weight by over 10%, considering factors such as height, age, body build, and sex. Another way to define obesity is based on body fat content: a male is considered obese if body fat exceeds 25% of his total weight, while a female is considered obese if body fat exceeds 30%. Abdominal obesity, prevalent in 40% of women in India, poses significant challenges in the realm of anaesthesia, particularly during laparoscopic abdominal surgeries. The co-existence of morbid obesity, hypothyroidism, and hypertension present intricate medical conditions that demand precise management. During the surgical procedure, issues related to large intraabdominal tumours and airway maintenance impact respiratory and circulatory dynamics. Notably, intraoperative challenges, including bronchospasm, hypotension, and respiratory acidosis, were addressed to ensure the patient’s well-being and a successful surgical outcome. The present case report provides insights into the comprehensive management of high-risk patients undergoing laparoscopic abdominal surgery. It underscores the significance of tailored anaesthesia strategies to mitigate complications and ensure a favourable postoperative recovery. This report presents the case of a 59-year-old female with obesity (BMI: 39.6 kg/m²), hypothyroidism, and hypertension who underwent laparoscopic abdominal surgery and discusses managing intraoperative challenges, such as bronchospasm, hypotension, and respiratory acidosis, and the postoperative care for successful patient recovery.

Purtscher-like Retinopathy following Acute Pancreatitis: A Case Report

Purtscher Retinopathy (PR) is also known as traumatic retinal angiopathy or lymphorrhagia retinae or retinal teletraumatism. It presents as occlusive retinal microvasculopathy distinguished by the presence of multiple retinal white lesions surrounding the optic nerve head and fovea, accompanied by perivascular clearing, often coinciding with intraretinal haemorrhages. Correlated conditions comprise of acute pancreatitis, crush injuries, severe head trauma, chest compression, long bone fractures, orthopaedic surgical procedures, Haemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP) syndrome and battered baby syndrome. PR is a rare microvasculopathy, which is occlusive in nature and causes sudden and painless diminution of vision following serious trauma but might also be associated with non-traumatic aetiologies as well. The term Purtscher-like retinopathy is used when it occurs due to non-traumatic causes. Here, the authors present a case of a 25-year-old female, admitted to the hospital for severe abdominal pain, persistent nausea and multiple episodes of vomiting since two days. Her laboratory findings and radiological investigations revealed findings suggestive of acute pancreatitis. On day 2 of admission, she reported a bilateral diminution of vision. The ophthalmic evaluation revealed visual impairment and characteristic retinal findings of Purtscher flecken, cotton wool spots and few intraretinal haemorrhages mainly in the posterior pole. This case highlights the association between Purtscher-like retinopathy and acute pancreatitis.

Case of Malignant Proliferating Trichilemmal Tumour in Gluteal Region

M Sowmiya, Keerthana Basavendra, G Murugan, C Srinivasan, Thanka Johnson

Malignant Proliferating Trichilemmal Tumour (MPTT) is a rare, malignant cutaneous adnexal tumour that originates from the outer root sheath cells of the isthmus of hair follicles. This article aims to report a rare case of a high-grade malignant trichilemmal tumour arising in the context of a proliferating Trichilemmal Cyst (TC) in a 65-year-old female who presented with a painless swelling in the left gluteal region that had been present for two months. There have been only about 100 cases reported so far. Both the clinical features and the imaging findings were suggestive of an ostensibly benign lesion. As a result, the cyst was excised; however, further histopathological evaluation revealed an unexpected case of rare MPTT. Consequently, a timely second revision surgery was performed to ensure tumour-free margins. This case illustrates that the diagnosis of MPTT is highly challenging. Without prior knowledge and a high index of suspicion, the diagnosis of MPTT could easily be missed. MPTT is often misdiagnosed as a variant of Squamous Cell Carcinoma (SCC). The subtle nuances of the unique histopathological pattern of MPTT can help differentiate it from SCC.

Physiotherapy Intervention for Binder’s Syndrome with Holoprosencephaly: A Unique Case Report

T Vaishnavi, KM Krishna Prasad, Aditi Bhat

Maxillonasal dysplasia, known as Binder’s syndrome, is a rare congenital deformity characterised by distinctive facial features, including a malformed midface and nose, as well as abnormal positions of the nasal bones. In addition, maxillary hypoplasia, or a shorter upper jaw, and nasal abnormalities may manifest as a flattened nose. Many cases of this condition are associated with other malocclusions, and those affected can be easily identified. Individuals with Binder’s syndrome typically present with an undeveloped upper jaw, a projecting lower jaw, a smaller nose, a flat nasal bridge, and midfacial hypoplasia. This is the first case report describing a physiotherapy method for maxillonasal dysplasia. Hereby, the authors present a case report of a six-month-old male child with Binder’s syndrome who exhibited delayed developmental milestones and physical anomalies. The child’s mother had a complicated pregnancy, culminating in an emergency caesarean section due to preterm premature rupture of membranes. The infant, born with Binder’s syndrome and a cleft palate, displayed poor head control, an inability to roll, and reluctance to engage in sensory interactions. Examination revealed bilateral cortical thumbs, hip joint abnormalities, and heightened sensitivity to touch. Magnetic Resonance Imaging (MRI) findings indicated semilobar Holoprosencephaly (HPE) and dysgenesis of the corpus callosum. Physiotherapeutic interventions focused on parent education and home exercise programs targeting developmental milestones. Over the course of two months, the infant showed significant progress in head control and rolling. Furthermore, after four months of training, the child gained sitting control. The present case underscores the importance of early intervention and parental involvement in optimising outcomes for children with Binder’s syndrome.

Idiopathic Hypoparathyroidism Presenting with Erythrodermic Psoriasis and Fahr’s Syndrome: A Case Report

Sanchit Uppal, Mini Bhatnagar, Aneet Mahendra, Harneet Narula

Idiopathic hypoparathyroidism may remain asymptomatic or present with hypocalcaemic neuromuscular manifestations. Dermatological manifestations like exfoliative dermatitis, pustular psoriasis and symmetrical brain calcification known as Fahr’s syndrome are uncommon in clinical practice. Even in absence of neuromuscular symptoms, hypocalcaemia associated with exfoliative skin lesions and symmetrical brain calcification should prompt investigation for hypoparathyroidism. A 40-year-old male presented with diffuse erythematous pruritic plaques and fever of 10 days duration. Auspitz sign was positive on examination. Investigations showed leucocytosis with neutrophilic predominance. He was admitted with a diagnosis of erythrodermic psoriasis with secondary infection. On the second day of admission he developed an episode of generalised tonic clonic seizure for the first time. Investigations into the cause of seizure revealed low serum calcium while computerised tomography of head revealed symmetrical calcification of bilateral basal ganglia. Further, he was found to have a low level of intact Parathyroid Hormone (PTH) level and hyperphosphataemia. Based on clinical, biochemical and radiological findings, a diagnosis of idiopathic hypoparathyroidism, psoriasis and Fahr’s syndrome was made. Serum calcium was corrected with infusions of calcium gluconate followed by oral calcium carbonate. The patient was kept under observation for seizure recurrence. Calcium and vitamin D supplements and hydrochlorothiazide were started and psoriasis treatment was continued. His skin lesions resolved over the next two weeks, serum calcium levels returned to normal level and no seizure episodes were reported over three months of follow-up.

Nail Patella Elbow Syndrome Presenting with Depression: A Case Report

Deepa Sangolkar, Shweta Borkar, Nakul Ambhore, Ashish Ambhore, Nayan Sinha

Nail-Patella Syndrome (NPS) is a rare autosomal dominant illness. Patients typically exhibit a tetrad of dysplastic finger or toenails, elbow dysplasia, hypoplastic or missing patellae, and iliac horns as their first musculoskeletal and dermatological symptoms. A higher occurrence of psychiatric disorders, such as depression and attention deficit hyperactivity disorder, has also been reported with NPS. This is a rare case of NPS, presenting with depression as the major symptom in an 18-year-old young girl who presented to the psychiatry Outpatient Department (OPD) with depressive symptoms like persistent low mood, loss of pleasure or anhedonia, loss of appetite, disturbed sleep, and thoughts of death. After 10 days of treatment with antidepressant drugs like Benzodiazepines, she was discharged and followed-up on an OPD basis. After a thorough evaluation, hypoplastic patella, swan-necked nails, radial head subluxation, and right eye glaucoma were also noted, and a final diagnosis of Nail-Patella Syndrome was made. A case of NPS can present in any department, such as in Medicine for nail dysplasia, in Orthopaedics for elbow or patella dysplasia, or in Dermatology for iliac horns. Here, the case was primarily presented to the Psychiatry department and later managed by a team of physicians, orthopaedicians, and psychiatrists. Careful illustration of the family history reveals more cases.

Graft Salvage in Management of Septic Knee Post-ACL Reconstruction: A Case Report

Raj Vinay Pawar, Ashwin Deshmukh, Rahul Salunkhe

The frequency of Anterior Cruciate Ligament Reconstructions (ACLR) has risen in recent years and is projected to continue increasing. Knee-joint infections consequent to this procedure, although rare, present a significant concern due to their potential severity. Hence, comprehending the progression of this complication and its detrimental effects if not promptly addressed is crucial. The impact of infection on the joint can vary depending on the duration between onset, diagnosis, and initiation of appropriate treatment. In some cases, the infection may have minimal consequences for the joint, while in others, it could lead to compromised viability of the Anterior Cruciate Ligament (ACL) graft, damage to the articular cartilage, or even premature onset of osteoarthritis. In the present case, a 42-year-old male had presented to the Orthopaedics Outpatient Department (OPD) six weeks postoperatively following an ACL reconstruction with clinical and laboratory findings pointing towards a septic knee. Lab findings suggested a raised ESR-71 mm/hr, CRP-127 mg/dL, and TLC-10,200/microL. The decision for immediate arthroscopic debridement with synovectomy was taken to achieve decompression all the while preserving the graft. This was followed by antibiotic saline irrigation for two days with strict antibiotic coverage following it.

Varied Lineage Thyroid Malignancies in Longstanding Thyroid Swellings: A Series of Three Cases

Long-standing thyroid swellings can present therapeutic and diagnostic challenges. Although benign, these nodules can harbour malignancies of diverse lineages ranging from those of follicular cell origin to rare malignancies such as lymphomas and paragangliomas. Here, the authors are sharing their three clinical experiences with thyroid neoplasms of long duration. The first case is a 42-year-old male patient who presented with an anterior neck swelling of 12 years’ duration. Postoperatively, a diagnosis of Mucosa-associated Lymphoid Tissue (MALT) lymphoma was made based on histopathology and immunohistochemistry. In the second case, a 43-year-old male presented with a neck swelling with eight years of history. Intraoperatively, the lesion was found to be locally aggressive with infiltration into the strap muscles and trachea. A tissue diagnosis of paraganglioma of the thyroid gland was made postoperatively. The third case involves a 72-year-old female who had undergone a left thyroidectomy 10 years back and presented to the Outpatient Department (OPD) with a history of right-sided neck swelling associated with dysphagia and a change in voice. The patient was diagnosed with anaplastic carcinoma, specifically squamous cell carcinoma. Thyroid lesions of abnormally large size create intraoperative problems concerning securing an adequate airway, locating anatomical structures, especially the Recurrent Laryngeal Nerve (RLN), parathyroids, and great vessels of the neck. Postoperatively, the tissue features may be very uncharacteristic, making reaching a proper diagnosis difficult. The use of immunohistochemistry helps in determining the cell lineage and type of malignancy.

Atypical Manifestations of Syphilis: A Case Series

BT Priya, R Sowmiya, Anandan Venkatesan, Ragini Rajan, M Deepa

Syphilis is a sexually transmitted disease with a wide range of clinical manifestations. Given the recent worldwide resurgence of syphilis, it is imperative to recognise various presentations of this great imitator. Apart from the classic ulcerative lesion of primary syphilis, known as a hard chancre, atypical presentations mimicking other diseases are also reported. A patient with carcinoma of the lip who was scheduled for surgery was diagnosed with an extragenital chancre during routine presurgery screening, leading to a change in the treatment plan for the patient. Other patients were initially treated for conditions such as scrotal eczema, psoriasis, and herpes before the correct diagnosis was made. Rare presentations, such as pustular lesions, paraphimosis, and cord-like thickening of the penis, were also observed in this case series. It is important to recognise these atypical manifestations, as doing so may facilitate early diagnosis and prompt management. Nine cases of syphilis in patients who exhibited atypical manifestations are presented in this case series and were diagnosed based on a high index of suspicion aided by laboratory confirmation.

Collagen-based Mesh in the Treatment of Posthernioplasty Mesh Infection in Ventral Hernias: A Case Series

Naveen Narayan, KN Rajesh, Chethan Shivannaiah, Suhas N Gowda

Posthernioplasty mesh infection in ventral hernias presents significant clinical challenges, including increased morbidity and prolonged treatment courses. The use of Surgicoll-Mesh® (collagen-based) in the management of infected posthernioplasty abdominal wounds has yet to be explored. It is thought to offer potential advantages in reducing infection rates and promoting tissue integration. Here, a case series showcasing the successful treatment of three patients with infected posthernioplasty abdominal wounds using Surgicoll-Mesh® to cover the defects is presented. All three cases demonstrated excellent outcomes, including resolution of infection, effective wound healing and no recurrence of hernias. This series highlights the potential of Surgicoll-Mesh® in managing complex abdominal wall infections.

Giant Haematometrocolpos due to Postvaginoplasty Stenosis

A 24-year-old nulliparous unmarried woman presented to the Gynaecological Department with complaints of abdominal pain for two years that has worsened over the past two days. The pain was dull aching with no aggravating or relieving factors. It was continuous in nature and was associated with a few episodes of vomiting. There was no history of fever or other constitutional symptoms. Vital signs were normal. The patient had primary amenorrhoea and cyclical abdominal pain, for which she was examined and diagnosed with vaginal atresia. Following this, she underwent neovaginoplasty 10 years ago, using the McIndoe vaginoplasty technique. However, the patient failed to undergo periodic vaginal dilatation. On examination, the abdomen was distended and tense with the presence of a large abdominopelvic mass lesion extending from the pelvis to the epigastrium. On per speculum examination, the urethra was not clearly visualised and the vaginal orifice appeared narrowed. On pervaginal examination, the cervix was not delineated and a hard, tense bulging mass was noted, occupying the vagina. Laboratory investigations revealed a low haemoglobin value of 7 g/dL. The rest of the routine investigations were normal. Clinically, a diagnosis of haematometrocolpos was made and the patient underwent ultrasound of the abdomen followed by Magnetic Resonance Imaging (MRI). The ultrasonography revealed a large abdominopelvic cystic mass representing a grossly distended uterine cavity and vagina, which showed echogenic contents (Table/Fig 1)a,b. There was narrowing at the level of the vagina, which was confirmed on MRI, with the endometrial and vaginal cavities showing T2 iso to mildly hyperintense contents suggestive of blood products/proteinaceous contents. The size of the distended uterus and vagina measured approximately 35×18 cm (Table/Fig 1)c,d. Postoperative changes were noted in the vagina with the loss of normal vaginal contour. There was associated mild left hydroureteronephrosis due to obstruction of the left ureter by haematometrocolpos. The patient underwent ultrasound-guided haematometrocolpos drainage with cystoscopy. The patient was placed in a lithotomy position and the surgical site was painted and draped. Under general anaesthesia and aseptic conditions, an incision was made below the urethra and the plane was dissected with ultrasound guidance, following which 4.5 litres of altered tarry chocolate-coloured blood was drained. Postsurgery, a per rectal examination was done to ensure the patency of the rectal mucosa. Foley’s catheter (22G) was inserted through the septum for continuous drainage. The patient received packed red blood cell transfusion preoperatively and postoperatively to improve the haemoglobin level. The abdominal distension and pain significantly reduced after drainage (Table/Fig 2)a,b. Post-drainage ultrasound images showed an empty endometrial cavity and a bulky uterus with heterogeneous echotexture (Table/Fig 2)c,d. Furthermore, the patient was referred to the plastic surgery department for vaginal reconstruction. Haematometrocolpos is the distension of the uterine cavity and vagina with blood due to anatomical mechanical obstruction to the evacuation of menstrual blood (1),(2). The common causes include imperforate hymen, transverse vaginal septum, vaginal atresia, vaginal hypoplasia and vaginal stenosis (2),(3),(4). In the present case, it was due to the failure of neovaginoplasty as the patient did not undergo periodic dilatation. The causes for patient non compliance with dilatation are that they are not comfortable, unpleasant and they often act as a constant reminder of the abnormality, as in the present case. Since the vaginoplasty technique used here was McIndoe and the patient does not engage in sexual intercourse, periodic vaginal dilatation is required for the rest of their life as it uses skin as a graft (1). Various other vaginoplasty techniques are available now which use peritoneal or intestinal grafts. Periodic vaginal dilatation is not required with these techniques (5). Ultrasound-guided drainage can be effective in patients with acute pain due to haematometrocolpos, as in the present case (3). Urinary retention and obstructive uropathy are also complications of haematometrocolpos (6). In the present case, there was mild left hydronephrosis due to ureteric obstruction by haematometrocolpos, which resolved after drainage. The present case highlights the importance of periodic vaginal dilatation in unmarried females undergoing McIndoe vaginoplasty.

Keratinocytic Verrucous Epidermal Nevi in a Child

Shivani Deepak Jangid, Bhushan Madke

A four-year-old male child was brought by the parents to the Dermatology Outpatient Department (OPD) with the complaint of a unilateral asymptomatic dark-coloured lesion over the right-side of the trunk, back, and upper limb since birth. The parents reported that the lesions increased in size proportionate to body growth, and the surface has become darker brown and rough. The child had age-appropriate weight and height and no history of neuro-developmental delay. Examination revealed large, dark brown, warty plaques in a linear pattern, strictly confined to the right half of the trunk and right upper limb. Two plaques (A and C) were seen to be extending from the anterior midline to the posterior midline (Table/Fig 1). The other two plaques (B and D) were limited to only the posterior part of the right half of the trunk (Table/Fig 2). Contact polarised dermatoscopy using DermLite® DL4 showed multiple dark-coloured, closely set warty islands with fissuring in between, reminiscing of ‘cauliflower appearance’ (Table/Fig 3). Serial excision was advised to the patient; however, due to poor socioeconomic conditions, they could not afford to seek the treatment. Verrucous Epidermal Nevus (VEN) is a benign, non inflammatory epidermal nevus that usually appears at birth or within the first few years of life. Generally, affecting the trunk or extremities, it can arise anywhere on the body. VEN represents a clone of epidermal cells carrying a somatic mutation that arose early in post-zygotic embryogenesis (1). When two genetically different cell populations arise from a post-zygotic mutation within an individual, it is referred to as somatic mosaicism, affecting a portion of the somatic cells in a particular body region (2),(3). Epidermal nevi can be caused by mutations in several different genes, including Rat sarcoma (RAS), Fibroblast Growth Factor Receptor 3 (FGFR3), phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), and keratins (KTR1 and KRT10) (4),(5). Post-zygotic somatic mutations in the FGFR3 gene account for nearly 33% of VEN (6). The nevi are due to genetic mosaicism, which reflects the migration paths of individual clones of genetically identical cells represented by Blaschko’s lines. According to the various patterns, the present case fits in the lateralisation pattern of Blaschko’s lines (type 5) (3). Saini S et al., discussed five cases of biopsy-proven VEN ranging from three years to 21 years of age, with the most common presentation being on the trunk as discrete to closely arranged verrucous hyperpigmented plaques. The family history was positive in three cases. Histopathology showed hyperkeratosis, parakeratosis, acanthosis, orthokeratosis and papillomatosis (1). Various treatment modalities have been used, including topical agents, cryotherapy, lasers, electrofulguration, and chemical peels, with varying clinical outcomes (6). Future therapeutic options include targeted therapy, acting on various mutated genes/proteins, thereby downregulating the constantly active receptor/protein and thus, normalising the differentiation and proliferation of epidermal cells.

Thunderclap Headache in a Patient with Dengue

A 45-year-old female patient with no prior comorbidities was admitted with three-day history of high-grade intermittent fever followed by generalised tiredness. There was no history of joint pains, prior headache or seizures. Serology for dengue was positive and she was admitted in the Department of Internal Medicine. She was managed conservatively with hydration and antipyretics. She had drop in platelet counts to less than 10000/μL which required administration of platelet transfusion. Immediately after platelet transfusion, patient developed sudden onset of severe thunderclap headache associated with elevated blood pressures (>160/90 mm). The headache was noted to increase with blood pressure rise. There was no history of weakness of limbs or blurred vision. Clinical examination revealed no focal neurological deficits or meningeal signs. Magnetic Resonance Imaging (MRI) of the brain (Table/Fig 1) showed T2 weighted hyperintensities involving the left occipital and bilateral fronto parietal regions. There was evidence of focal restricted diffusion on Diffusion Weighted Imaging (DWI) sequences and no evidence of contrast enhancement. MR Angio (MRA) (Table/Fig 2) showed evidence of multifocal stenosis and narrowing involving the left vertebral and right posterior cerebral arteries. The scans were discussed with the neuroradiology team and were felt to be suggestive of Posterior Reversible Encephalopathy Syndrome (PRES). The differentials considered were primary CNS angiitis and cerebral venous thrombosis. She was managed with antioedema measures and anti-hypertensive agents-Mannitol at a dose of 0.5 mg/kg/day, hypertonic saline infusion at 15 mL per hour and labetalol 200 mg per day and had complete resolution of symptoms. She was discharged after improvement. At two weeks follow-up, patient was asymptomatic and had no deficits. Repeat MRI done after three months showed complete resolution of the abnormalities seen on the initial scans confirming a diagnosis of PRES (Table/Fig 3). PRES is a clinico-radiological syndrome that was initially described by described by Hinchey et al., in 1996 (1). The characteristic features include holocranial headache, altered mental status, seizures, and visual disturbances (2). Visual disturbances can range from blurring of vision to field defects and cortical blindness (3). Seizures can progress to convulsive and non-convulsive status epilepticus (4). Other clinical features may include brainstem symptoms like nausea, gait ataxia and vomiting. The radiological features include white matter vasogenic oedema affecting the posterior occipital and parietal lobes of the brain. Conditions causing a sudden increase on blood pressure are those implicated in the pathogenesis of PRES. Peak blood pressures seen in this condition are usually in the range of 150 to 170 mmHg systolic. These include conditions like acute kidney injury, eclampsia and Guillain-Barré syndrome. Other causes include autoimmune diseases like thrombotic thrombocytopenic purpura and systemic lupus erythematosus, exposure to immunosuppressive drugs such as cyclosporine, tacrolimus and other chemotherapy agents (5). The common pathogenesis is the breakdown of the blood brain barrier causing endothelial dysfunction. Most of these cases have a good long term prognosis and recover well without any neurological sequelae. The evaluation of PRES includes a detailed clinical assessment including ophthalmological evaluation of fundi, vasculitis markers in serum, MRI imaging with MRA and lumbar puncture if needed. Differentials include Primary CNS Angiitis, Acute Demyelinating Encephalomyelitis (ADEM), Progressive Multifocal Leukoencephalopathy (PML) and ischaemic stroke. Management includes treatment of primary pathology, control of blood pressures, anticonvulsants and antioedema measures if needed. Thunderclap headaches are described as the most severe headache ever by patients and reach their peak within a few minutes. The two most common causes include Subarachnoid haemorrhage and PRES (6). Other causes include arterial dissections, intracranial haemorrhage, tumuors and venous thrombosis. There are two mechanisms that may be responsible for PRES in this case. The symptoms were caused immediately after platelet transfusion and this could have been a precipitating factor. There are multiple case reports of transfusion associated PRES. Blood transfusion leads to increased blood flow and viscosity, which causes impaired hypoxic vasodilation. This in turn leads to an increase in vascular resistance, leading to generalised cerebral vessel constriction (7). There are a few case reports of PRES occurring as a complication of dengue fever itself and the pathogenesis has not been fully understood (8),(9). The main reason could be related to endothelial dysfunction that leads to vasogenic oedema and decreased cerebral blood flow. Also, inflammatory cytokine release can increase vascular permeability with consequent brain oedema and PRES. The patient in the present case had dengue fever but developed symptoms immediately after a transfusion. The precipitating factor in the present case could have been both the dengue per se and the transfusion associated complication. This report highlights the importance of prompt recognition and treatment of this rare but important cause of headache in dengue patients.

Post-traumatic Myositis Ossificans: Rare Case Diagnosis through Histopathology

Simran Khan, Shakti Sagar

A benign disorder called Myositis Ossificans (MO) is characterised by aberrant bone production within muscles, which is frequently brought on by trauma (1). Myositis Ossificans Progressive (MOP) is a rare inherited autosomal dominant genetic disorder. Myositis Ossificans Circumscripta (MOC), the more common variant, is usually localised and acquired. It can be caused by a number of things, including burns, and traumatic MO (muscle or joint injuries). Iatrogenic MO occurs as a result of joint surgery, whereas neurogenic MO occurs due to acute insults to the central nervous system (2). Hereby, the authors present a case of an elderly patient who had a history of a cerebrovascular event and who fell during physiotherapy treatment, resulting in the development of MO in her hip joint. A 50-year-old woman presented to the Orthopaedic Outpatient Department with complaint of acute onset of pain at the left hip joint since 20 days, which was gradually progressing and increasing in intensity accompanied by fever and generalised weakness. She also complained of restricted joint movement at the hip joint 20 days after a fall during the physiotherapy session. She had a history of a cerebrovascular accident, indicating an acute infarct in the temporal lobe, which occurred one year ago. She was on medication of tablet aspirin 75 mg. The general and physical examination was normal. On clinical inspection in a standing position, there were no signs of swelling, sinuses, discharge, engorged veins, or shortening of the limb. On further inspection in the supine position, the left lower limb was externally rotated with the lateral border of the foot touching the bed and abducted. On palpation, there was no local rise in temperature, but tenderness was present over the anterior joint line of the hip. The patient was sent for haematology and biochemical investigation, which included calcium, phosphorus, and alkaline phosphatase levels. All the investigations were within normal values. The patient was then sent for radiographic X-ray imaging, which revealed an 8×4 cm mass that extended from the medial and anterior edge of the acetabulum to the lesser trochanter (Table/Fig 1)a. The differential diagnosis of soft-tissue sarcoma, haematoma, or traumatic myositis was made. The decision of surgical excision of the mass was made. During surgical intervention, the mass was noticed to originate from the anterior and superior aspect of the acetabulum, with significant attachment to the anterior and medial aspect of the femur near the level of the lesser trochanter (Table/Fig 1)b. It formed a bony bridge within the hip joint anteriorly, impeding normal hip movement. The procedure was uneventful, and the patient was shifted to the orthopaedics recovery room. For confirmation of diagnosis and appropriate postoperative treatment regimen, the surgical sample was sent to histopathology for confirmation of diagnosis. Grossly, a single, irregular, blackish-brown, bony-hard tissue piece was received (Table/Fig 1)c. Microscopic examination {Haematoxylin and Eosin (H&E) stained} revealed a characteristic zonal pattern, with the inner zone exhibiting plump fibroblasts and myofibroblasts. In some areas, immature bone was observed surrounding these zones. These histological features were suggestive of MOs (Table/Fig 1)d. Following surgery and histopathological diagnosis, the patient received treatment with indomethacin {an Non Steroidal Anti-inflammatory Drug (NSAID)} and was advised early physiotherapy. Subsequently, there was a reduction in pain, and the full range of motion of the hip joint was successfully restored. Three weeks postsurgery, the patient was discharged and was advised to follow-up after one week.

COVID-19 Vaccine Controversy: Will it Impact Public Trust in Other Vaccines?

Amitesh Datta, Savita Bhatia

Dear Editor, World-famous Nobel laureate Boris Pasternak rightly quotes, “Surprise is the greatest gift which life can grant us.” Likewise, AstraZeneca, a UK-based pharmaceutical giant, surprised and shocked the world by admitting in a UK court that the Coronavirus Disease-2019 (COVID-19) vaccine (marketed as COVISHIELD in India) “can, in very rare cases, cause Thrombosis with Thrombocytopenia Syndrome (TTS),” or simply, blood clots with low platelets. Later, the company decided to withdraw the vaccine from the global market due to commercial reasons. This pharma behemoth could not escape the scrutinising eyes of the scientific community and was held responsible for the development of TTS in several vaccinated patients (1). Although this confessed in the UK, the news was fired on social media platforms, caused a furore throughout the world, including India, where millions of people had received this vaccine for their survival (2). Therefore, an impactful concern that has been bothering us since the recent and ongoing controversy is: will we also lose faith in vaccines for other diseases? The COVID-19 virus was first detected in Wuhan City, China, in December 2019 and became a pandemic by March 2020 after spreading rapidly across the world (3). As of January 2024, it has caused more than 7 million reported deaths worldwide (4). The COVID-19 vaccination drive in India began on January 16, 2021, by administering COVISHIELD (Oxford-AstraZeneca by the Serum Institute of India) and COVAXIN (by Bharat Biotech Limited, India). Additionally, SPUTNIK-V (a Russian vaccine distributed by Dr. Reddy’s Laboratory in India) was also permitted for emergency use (5). From the beginning, the vaccination program for COVID-19 has been accompanied by controversy, with several questions-mainly related to the safety and efficacy of the vaccines-being at the centre of concern. More than 100 crore people have been vaccinated in the country, and now the vaccine manufacturing company is “letting the cat out of the bag” by admitting to the side-effects of the vaccine “in very rare cases.” To be honest, developing a completely risk-free vaccine is challenging, but when the advantages outweigh the risks, it can be used, which is the optimistic perspective of this controversy. However, COVID-19 has gone far away, leaving behind controversies that bother us to think about their impact on public trust in other vaccine-preventable diseases. We are living in an era where antimicrobial resistance is a serious issue, and the development of new drugs is rare. Vaccines may act as one of the most essential and effective public health interventions for the prevention of diseases. As we know, trust is one of the fundamental elements for the acceptance of any vaccine by society. Such controversies may influence vaccine hesitancy or the refusal of people to accept vaccines, not only for COVID-19 but also for other diseases like measles, polio, hepatitis, and diarrhoea. A similar viewpoint about increase in vaccine hesitancy across the globe has been put forth in a study done by Leonardelli M et al., (6). Another study by Dhalaria P et al., further documents vaccine hesitancy in India and its effects on vaccination coverage (7). A study from Southern India, where the literacy rate is 100%, also demonstrated that only 69.84% of people were fully vaccinated despite the easy availability of the vaccine. It also focused on the various causes that led to a decrease in the acceptance rate of vaccines among the population (8). This may raise certain questions in their minds related to the safety, efficacy, relevance, compatibility, and side-effects of vaccines. As a result, individuals may start losing faith in regulatory bodies or health professionals, leading them to turn to “alternative medicine” and refuse other medical facilities. Overall, national immunisation programs may be affected, particularly in the paediatric age group (6). It can, therefore, be concluded that the COVID-19 pandemic has already disrupted routine immunisation services, resulting in delayed and reduced vaccine uptake. Additionally, such controversies may heighten vaccine hesitancy, which is one of the major barriers to vaccination coverage and can have a meaningful impact on community transmission and herd immunity. Therefore, it is essential to ensure the safety and efficacy of vaccines, and trust-building efforts can be initiated through sustained vaccine education and by stopping the spread of misleading information.

A Letter to Editor Regarding Cystatin C as an Early Marker of Renal Dysfunction in Patients with Cirrhosis of Liver: A Cross-sectional Study

Anjali Garg, Abhijit Pratap

Dear Editor, The writers of present letter recently read an article titled “Cystatin C as an early marker of renal dysfunction in patients with cirrhosis of the liver: A cross-sectional study,” published on May 1, 2024, in the Journal of Clinical and Diagnostic Research (JCDR). I found it quite interesting, but I would like to highlight two corrections that are necessary for the article’s credibility. The first correction pertains to the Results section, in which there is a discrepancy between the interpretation and the data presented in (Table/Fig 1) (1). Among the study population, the majority of patients (26, 43.3%) were in stage 3 of Chronic Kidney Disease (CKD), not stage 2, followed by stage 2 with 21 patients (35%), according to the aforementioned table reference (1). The second correction involves the inclusion or exclusion criteria; specifically, it is necessary to clarify how early renal dysfunction patients were considered for the study. These changes enhances the understanding of the research findings presented in the article. As a reader and member of the scientific community, the writers urge you to consider issuing a correction or clarification for the aforementioned mistakes in the next available issue of the journal. Ensuring accuracy and transparency in published research is crucial for maintaining the integrity of scientific literature. The writers of the present letter appreciate your attention to this matter and look forward to seeing the necessary steps taken to address these errors. Author’s Response Dear Editor, Thank you for sharing the reader’s insightful comments regarding our recently published article. The authors appreciate the opportunity to clarify and address the noted discrepancies and suggestions. 1. Discrepancy in CKD stages interpretation: The reader correctly pointed out a discrepancy in the interpretation of the CKD stages in our results section compared to (Table/Fig 1). The authors here acknowledge this oversight and provide the following clarification: The majority of patients in the present study population were indeed in stage 3 of CKD (26 patients, 43.3%) when combining stages 3a and 3b, followed by stage 2 (21 patients, 35%). If authors consider stage 2 and stage 3a separately, stage 2 emerges as the most common (21 patients, 35%), followed by stage 3a. This distinction is crucial for accurate representation and understanding of the data. 2. Inclusion/Exclusion criteria for early renal dysfunction patients: The reader suggested adding considerations for early renal dysfunction patients to the inclusion/exclusion criteria. The authors would like to clarify that these criteria have already been included in the manuscript. The present study specifically aimed to encompass a comprehensive range of CKD stages, including early stages, to provide a broad understanding of the condition’s progression and management. Thank you for facilitating this constructive feedback process. The authors believe these clarifications will enhance the accuracy and clarity of the presently discussed study, and the authors look forward for your response. Sincerely, Dr. Jayanta Das

Correspondence to “Correlation between BMI and Static Biomechanical Lower Extremity Kinetic Chain Variables in Overweight Young Adults: A Cross-sectional Study”

Sandeep Pattnaik, Sunanda Bhowmik

Dear Editor, We are truly obliged to be able to read articles in your esteemed journal. We recently read an article published in your prestigious Journal of Clinical and Diagnostic Research under the Physiotherapy Section in 2023;17(5):YC01-YC06 by Bali NK et al., titled “Correlation between BMI and Static Biomechanical Lower Extremity Kinetic Chain Variables in Overweight Young Adults: A Cross-sectional Study” (1). The authors’ meticulous work is extremely beneficial in evaluating variables related to the lower extremity kinetic chain, including pronated feet, femoral anteversion, Q-angle, tibial torsion, plantar arch index, angle of the toe, and pelvic inclination. However, we would like to draw the attention of the authors to a few concerns. The authors intended to calculate the correct procedure of pelvic inclination in the manuscript. Nevertheless, there is a disagreement between the process described and the picture of the pelvic inclination portrayed in (Table/Fig 6), which is very challenging to understand. (Table/Fig 6) shows the angle of the toe out twice, but doesn’t show the use of an inclinometer, despite the procedure for placing one to measure pelvic inclination being precisely described. The authors should have specified the photos in the manuscript before the final draft. Craig’s test was used to compute the femoral anteversion yet it was already found to have poor reliability and validity. Consequently, stronger inference in variables would have been verified by the gold standard Magnetic Resonance Imaging (MRI) approach (2). Similarly, the measurement of Q-angle over an X-ray would have been a more efficient technique as compared to the physical examination method. The author should have used gold-standard methodologies to interpret the actual values of the variables to have a better understanding of the link between body mass index and lower extremity alignment factors, as physical examinations might increase human error (3). In the statistical analysis section, the normality of all the data was established by using the Shapiro-Wilk and Kolmogorov-Smirnov tests. Nevertheless, the Shapiro-Wilk test data, which is frequently used for small sample sizes (n<50), cannot be applied to this study because of its sample size of 160 (n>50) (4). The STROBE checklist should have been utilised by authors to ensure high-quality reporting and a transparent depiction of the strategies and procedures followed in this cross-sectional study (5). Regards, Authors and editor of the article.

A Letter to Editor Regarding Renal Profile and Non Alcoholic Fatty Liver Disease in Type 2 Diabetic Patient

Sarita Anil Shinde, Meenakshi

Dear Editor, We read the article “Correlation of Glycaemic Control and BMI with Renal Profile in Type 2 Diabetic Patients with and without Non Alcoholic Fatty Liver Disease (NAFLD): A Case-Control Study,” published by Padvi PV et al., in the May 2024 issue (BC01-BC06) of your journal (1). In the present study, the authors assessed the correlation between BMI status and HbA1c levels with the renal profile and electrolytes in T2DM participants with and without NAFLD. They concluded that elevated levels of urea, creatinine, and uric acid, as well as their positive correlation with HbA1c, establish a connection between NAFLD and renal impairment in T2DM. I would like to shed light on certain points: a) The progression of complications, such as nephropathy, is solely related to the duration of diabetes mellitus, which was not mentioned in the present study. Therefore, it is difficult to conclude that the increased levels of urea and creatinine are due to NAFLD in type 2 DM. b) For groups 2 and 3, only liver diseases and other types of diabetes patients were excluded; they have not mentioned renal disorders, which was the aim of the study. c) Group 2’s BMI (28.84±4.19 kg/m2) was significantly higher than group 3’s (23.51±2.09 kg/m2), indicating that group 2 was overweight while group 3 was normal, according to the World Health Organisation (WHO) cut-off value (2). Despite this, group 3’s renal parameters-such as urea, creatinine, and uric acid-are significantly higher than those of group 1, which had a BMI of (21.28±2.24 kg/m2). d) Increased exogenous protein was highlighted as one of the causes of hyperuricaemia in obese individuals in the discussion; however, it is well known that a high-protein diet gradually increases the capacity for urea production through urea cycle enzyme induction, not uric acid (3). e) The increased level of urea in group 2, which includes individuals with T2DM and NAFLD, is contradictory. In NAFLD, the accumulation of fat in the liver ranges from simple fatty liver (steatosis) to Non Alcoholic Steatohepatitis (NASH), which is associated with inflammation and can progress to cirrhosis and liver failure in severe cases. Urea synthesis is an exclusive hepatic function. In patients with steatosis and NASH, there is a progressive decrease in the concentration and activity of the enzyme Ornithine Transcarbamylase (OTC), which is associated with increased plasma ammonia concentrations and a functional reduction in the capacity for ureagenesis (4). Therefore, the urea level in this group should ideally be lower than that in group 3. f) Glomerular Filtration Rate (GFR) is considered a global index of renal function, which can be easily estimated (eGFR) using endogenous analytes such as creatinine and urea, which the authors could have included. Author’s Response a) The main aim was to assess correlation of HbA1c and BMI with RFT and electrolytes in T2DM with and without NAFLD. The study did not considered duration of DM as a variable in this article however the data collected had a duration ranging from 6-15 years which we can correlate in our upcoming work as suggested by the reader. Similarly, not only duration of DM but also persistent poor glycaemic control was one of the factors responsible for renal damage in DM participants (1), which was already been discussed in the discussion section. b) Participants were enrolled after taking detailed clinical history about the presence of any other liver or chronic renal diseases. As per the inclusion criteria, the study included participants with T2DM and NAFLD. We should’ve specified this in the exclusion criteria as well. c) Group 3’s renal parameters such as urea, creatinine and uric acid were significantly higher than those of group 1 (Controls), as the participants involved in that group are of type 2 diabetes mellitus leading to DN due to prolonged duration of DM as well as poor glycaemic control. Group 3 participants suffer from Type 2 DM although having normal BMI which was also reported by previous studies (2),(3). d) Urate is mainly produced in the liver and a high purine diet is prone to induce the overproduction of urate in the liver. Rapid economic development and lifestyle modification has led to a huge transition in dietary pattern including animal protein and dairy products which are high in purines since the buildup of purines can lead to elevated levels of uric acid which in turn may result in hyperuricaemia as discussed in discussion section (4),(5). e) The given mechanism is true and the levels of urea in group 2 were lower as compared to that of group 3. As the participants included in group 2 were of grade 1 fatty liver thus the urea levels are not that significantly low but are lower than group 3. f) The same was mentioned as limitation as well and as suggested by the reader surely, we will incorporate GFR as a parameter in our upcoming work. Thanks (1) Anjaneyulu M, Chopra K. Quercetin, an anti-oxidant bioflavonoid, attenuates diabetic nephropathy in rats. Clin Exp Pharmacol Physiol [Internet]. 2004;31(4):244-48. Available from: http://dx.doi.org/10.1111/j.1440-1681.2004.03982.x. (2) Vaag A, Lund SS. Non-obese patients with type 2 diabetes and prediabetic subjects: distinct phenotypes requiring special diabetes treatment and (or) prevention? Appl Physiol Nutr Metab. 2007;32(5):912-20. Doi: 10.1139/H07-100. PMID: 18059616. (3) Pallavi M, Suchitra MM, Srinivasa Rao PVLN. Role of adipokines, oxidative stress, and endotoxins in the pathogenesis of non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus. Int J Res Med Sci. 2019;7(5):1644-52. Available from: https://doi.org/10.18203/2320-6012.ijrms20191652. (4) Kalra S, Vithalani M, Gulati G, Kulkarni CM, Kadam Y, Pallivathukkal J, et al. Study of prevalence of nonalcoholic fatty liver disease (NAFLD) in type 2 diabetes patients in India (SPRINT). J Assoc Physicians India. 2013;61(7):448-53. (5) Hong F, Zheng A, Xu P, Wang J, Xue T, Dai S, et al. High-protein diet induces hyperuricemia in a new animal model for studying human gout. Int J Mol Sci. 2020;21(6):2147. Doi: 10.3390/ijms21062147.

Analgesic Efficacy of Levobupivacaine versus Levobupivacaine with Nalbuphine in Surgical Site Infiltration Technique for Lower Abdominal Surgeries: A Randomised Controlled Study

Introduction: Wound site infiltration with local anaesthetic agents is one of the simplest and safest techniques, improving postoperative analgesia as part of multimodal analgesia following general or regional anaesthesia. Adding an adjuvant to local wound infiltration can provide a longer duration of analgesia with fewer side-effects. Aim: To compare the analgesic efficacy of local wound infiltration with levobupivacaine alone versus a mixture of levobupivacaine and nalbuphine for postoperative pain. Materials and Methods: A double-blind randomised controlled study was conducted on 100 patients in GCS Medical College, Hospital and Research Centre, Ahmedabad, Gujarat, India. Patients were American Society of Anaesthesiologists (ASA) I-III, aged 18-70 years, and scheduled for abdominal surgeries. A standard general anaesthetic technique was used. Patients received local site wound infiltration during wound closure. A computer-generated random number was used to randomly divide patients into two groups. Group L received 18 mL of 0.25% levobupivacaine plus 2 mL of 0.9% normal saline (total of 20 mL), while Group LN received 18 mL of 0.25% levobupivacaine plus 2 mL of nalbuphine (20 mg), also totaling 20 mL for wound infiltration. Postoperative rescue analgesia was provided with intravenous injection paracetamol (1 g) on demand or whenever the Numeric Rating Scale (NRS) indicated a score of ≥5. Haemodynamic parameters such as Heart Rate (HR), Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP) were observed at intervals in the Post Anaesthesia Care Unit (PACU) and at 30 minutes, 1 hour, 2 hours, 4 hours, and 6 hours postoperatively. Side-effects of the adjuvant were also recorded. Chi-square tests and Independent t-tests were used to compare data between the two groups. Results: Demographic data, such as age, weight, height, ASA grade, and gender, were comparable between both groups (p-value >0.05). The total duration of analgesia in group LN was 9.20±0.79 hours, compared to 4.5±0.71 hours in group L (p-value <0.001), with better quality of analgesia in the adjuvant group and no reported side-effects, such as nausea, vomiting, bradycardia, hypotension, or sedation. Haemodynamic parameters showed that the Pulse Rate (PR) was 74.22±6.65 bpm, Systolic Blood Pressure (SBP) was 121±7.77 mmHg, and DBP was 74±7.05 mmHg, which were more stable in group LN at the 4-hour and 6-hour intervals of the postoperative period. Conclusion: Nalbuphine was an effective adjuvant for a single short local wound infiltration. Moreover, the combination of levobupivacaine with nalbuphine was found to be superior to levobupivacaine alone in patients undergoing lower abdominal surgery.

Evaluation of TREM1 Gene Expression in Stage II Grade A Periodontitis Patients with Type 2 Diabetes Mellitus: An Ex-vivo Study

Vazeeha Afrin Syed, Jaiganesh Ramamurthy

Introduction: Periodontitis and Diabetes Mellitus (DM) are two prevalent chronic conditions that are independently associated with dysregulated immune responses. The Triggering Receptor Expressed on Myeloid Cells 1 (TREM1) gene plays a crucial role in modulating immune responses and its dysregulation has been implicated in various inflammatory disorders. Aim: To investigate the expression levels of the TREM1 gene in healthy individuals as well as in those diagnosed with periodontitis, with and without DM, exploring the potential implications of the interplay between these conditions. Materials and Methods: In this ex-vivo study conducted at the Department of Periodontology, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India, from July 2023 to January 2024, gingival tissue samples were collected from three distinct groups: Group 1 (healthy individuals, n=10), Group 2 (periodontitis patients, n=10) and Group 3 (periodontitis patients with DM, n=10). Total Ribonucleic Acid (RNA) was extracted using a standardised protocol and complementary DNA (cDNA) synthesis was performed with a reverse transcription kit. Quantitative Real-time PCR (qRT-PCR) was employed to quantify TREM1 gene expression. An in-silico functional analysis was conducted to explore the possible mechanisms. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software version 27.0 (IBM Corp.) and GraphPad Prism 7.0 (GraphPad Software). A p-value of less than 0.05 was considered statistically significant. Results: The analysis revealed distinct patterns of TREM1 gene expression among the three groups. In periodontitis patients, TREM1 expression was significantly upregulated compared to healthy controls (p<0.001). In periodontitis patients with DM, TREM1 expression was significantly downregulated compared to periodontitis patients (p-value=0.0003) and upregulated compared to healthy individuals, although not significantly (p-value=0.229). Conclusion: The analysis revealed distinct patterns of TREM1 gene expression among the three groups. Notably, there was a decrease in TREM1 gene expression levels in the periodontitis with diabetes group compared to the periodontitis group.

Statistical Perspective on Coronary Angiography findings: Examining the Influence of Hereditary Characteristics, Behaviour, and Self-control Factors among Study Participants

Introduction: According to the World Health Organisation (WHO), the American College of Cardiology (ACC), and the American Heart Association (AHA), the issued prediction charts can be used to make an absolute prediction of a study variable’s Cardiovascular Disease (CVD) risk. This study aimed to examine the combined effects of gender, Family History (FH) of CVD, tobacco use, alcohol consumption, smoking, physical activity levels, and other health conditions on the presence of CVD confirmed by angiography. Predicting CVD risk is crucial; particularly because young individuals aged 25 to 40 are affected by these diseases and from the foundation of any nation. Moreover, CVDs significantly contribute to human mortality compared to other ailments. This approach sought to identify the risk factors for CVD. Aim: To investigate the impact and the association between hereditary characteristics, behaviour, and self-control factors on coronary angiography findings among the study participants from a statistical viewpoint. Materials and Methods: An observational cross-sectional study related to angiography report of 274 study participants visiting the Department of cardiology at Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra with complaints of CVD was conducted from January 2023 to May 2023. Statistical Analysis was performed with the help of Statistical Package for Social Sciences (SPSS) version 28.0, InStat and Microsoft Excel. Chi-square test was applied to study association of demographic study parameters with CVD. Logistic regression was carried out to develop the regression model. Results: Angiography significant CVD was associated with father’s history of CVD (40, 71.42%), alcohol consumption (68, 70.8%), tobacco chewing (115, 69.7%), no exercise (89,79.46%), diabetes (83,75.45%), and diabetic with medication (14,93.33%) showed significant associations with CVD. Logistic regression analysis identified these variables as the best predictors of CVD. Genetics, lifestyle choices, and co-morbidities all contribute to the risk of Coronary Artery Disease (CAD). Conclusion: The study effectively identifies and quantifies the relationships between hereditary characteristics, behavioural factors, and self-control measures with coronary angiography findings. Exercise and diabetic status are significant predictors of the outcome, while tobacco-chewing leans towards significance and other studied variables are at their reference levels. This predictive model will help clinicians, patients, and their families in mentally preparing for confirmation of the disease’s presence or absence.

Comparison of Holmium Laser Enucleation of Prostate versus Bipolar Resection of Prostate in Patients with Benign Prostatic Hyperplasia: A Prospective Interventional Study

Introduction: Surgical treatment for Benign Prostatic Hyperplasia (BPH) has advanced significantly in recent years. Transurethral Resection of the Prostate (TURP) is a minimally invasive procedure associated with a low risk of complications and clinical limitations, including life-threatening Transurethral Resection (TUR) syndrome, as, well as higher costs due to longer hospital stays and challenges in managing large glands. Aim: To compare the safety and effectiveness of prostate enucleation using Holmium Laser Enucleation of the Prostate (HoLEP) with bipolar resection of the prostate in cases of BPH. Materials and Methods: A hospital-based prospective interventional study was conducted in the Department of Urology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, from January 2020 to July 2022. The study included 60 patients, divided into two groups of 30 each. Males aged ≥45 years with recurrent Lower Urinary Tract Symptoms (LUTS) secondary to BPH, with or without Acute Urinary Retention (AUR) (drug-refractory) or with failed medical therapy (alpha-blockers, 5-alpha reductase inhibitors), were included in the study. In the first group, HoLEP was performed (Group I), while in the second group (Group II), patients underwent bipolar resection. Data were analysed and statistically evaluated using Statistical Package for the Social Sciences (SPSS) software version 21.0. A p-value of less than 0.05 was considered statistically significant. Results: The mean age of patients in the HoLEP group was 60.25 years, while in the Bipolar TURP (B-TURP) group, it was 59.67 years. Both groups had similar proportions of patients with moderate urinary symptoms {International Prostate Symptom Score (IPSS)} and large prostates (>80 grams). The mean amount of irrigation fluid used (40.83±9 litres vs. 21.2±5.9 litres) and the duration of surgery (106.33±14.24 min vs. 67.4±9.73 minutes) were significantly higher in the HoLEP group compared to the B-TURP group (p-value <0.001). Postoperative catheterisation time (1.003±0.23 days vs. 2.38±0.52 days) (p<0.001) and length of hospital stay (3.2±0.65 days vs. 4.67±1.32 days) (p<0.001) were significantly longer in the B-TURP group compared to the HoLEP group. Both the HoLEP and bipolar resection of the prostate groups did not experience significant intraoperative or immediate postoperative complications; however, one patient in the HoLEP group developed urethral stricture as a late complication. Conclusion: The B-TURP procedure is an equally effective and feasible method for treating BPH patients, with a smaller learning curve and lesser financial burden.

Comparative Evaluation of Antimicrobial Activity of 0.2% Lemongrass Oil and 0.2% Chlorhexidine as a Preprocedural Mouth Rinse: A Randomised Controlled, Parallel Design, Split-mouth Clinical Trial

Introduction: The aerosols produced by an ultrasonic scaler contain bacteria that may enter the respiratory systems of both dental surgeons and patients. Lemongrass oil is one of the essential oils with enormous antibacterial, antifungal, antioxidant, anti-inflammatory, and antipyretic effects. Aim: To evaluate and compare the efficacy of commercially available preprocedural mouth rinses, containing 0.2% lemongrass oil mouthwash and a 0.2% chlorhexidine gluconate solution, in reducing the levels of viable bacteria in aerosols. Materials and Methods: This single-centre double-blinded randomised controlled parallel design split-mouth clinical trial was planned among patients in the Department of Periodontics attending Vishnu Dental College and Hospital in Bhimavaram, Andhra Pradesh, India. The study was conducted for 40 days, from August 2022 to October 2022. Two distinct types of preprocedural mouth rinses (lemongrass oil and chlorhexidine) were used on 56 participants with Stage II or III and Grade B periodontitis. A total of 56 subjects were randomly assigned to two groups: Group A (0.2% lemongrass oil) and Group B (0.2% chlorhexidine), using a simple coin toss method. Colony-forming Units (CFUs) with and without rinsing in each group were assessed and studied. CFUs collected on blood agar plates were counted during ultrasonic scaling both with and without rinsing. International Business Machine (IBM) Statistical Package for Social Sciences (SPSS) version 20.0 was used for data analysis. Paired t-tests and independent t-tests were used for intragroup and intergroup comparisons for both groups. Results: The mean CFU count in the chlorhexidine group without rinsing was 259.6±26.6, and with rinsing, it was 140.7±22.6, which was statistically significant (p-value <0.001). In the lemongrass oil group, the CFU count without rinsing was 263.5±26.9, and with rinsing, it was 147.18±33.82, which was also statistically significant (p-value <0.001). In the intergroup comparison, the p-values for both groups-using preprocedural rinse (Group A vs. Group B for quadrants 2 and 3) and without preprocedural rinse (Group A vs. Group B for quadrants 1 and 4)-were 0.40 and 0.58, respectively, which were not significant. Conclusion: Both preprocedural mouth rinses were equally effective in reducing microbial counts in aerosols during ultrasonic scaling.

Variation of Adipokines in Obese versus Non Obese Patients with Polycystic Ovary Syndrome and its Association to Visceral Adiposity Index: A Cross-sectional Study

Chaitali Maitra, Rishika Raj, Arjun Maitra, Ramesh Chandra Gupta

Introduction: Obesity is a prevalent co-morbidity in Polycystic Ovarian Syndrome (PCOS), causing metabolic disturbances that lead to changes in endocrinological homeostasis. Adipokines are proinflammatory molecules secreted by adipose tissues that affect metabolic and endocrinological mechanisms. Excess androgen secretion alters fat distribution and deposition, leading to increased visceral obesity in PCOS, which is a major concern for the development of cardiometabolic events. Aim: To assess the Visceral Adiposity Index (VAI) and levels of different adipokines in non obese and obese PCOS patients, and to establish the relationship between VAI and circulating adipokines in both non obese and obese phenotypes of PCOS patients. Materials and Methods: This cross-sectional study was conducted at the Mayo Institute of Medical Sciences, Barabanki, Uttar Pradesh, India from November 2019 to August 2021. A total of 144 patients diagnosed with PCOS according to the Rotterdam criteria were divided into non obese and obese categories based on Body Mass Index (BMI). VAI was calculated using a sex-specific formula, and serum levels of adiponectin, resistin, and leptin were measured by Enzyme Linked Immuno Sorbent Assay (ELISA). Fasting glucose, insulin, and serum lipid profiles were evaluated. Data were statistically analysed using Student’s t-tests and Pearson’s correlation coefficient. Weighted linear regression was used to detect any relationships between adipokines, obesity indicators, and VAI. Results: A total of 144 female patients with a mean age of 27.47±0.33 years suffering from PCOS were included in this study. VAI was significantly higher (p-value=0.034) in non obese patients than in obese patients. There was a significant correlation between VAI and resistin (r-value=0.302, p-value=0.011) and leptin (r-value=0.308, p-value=0.009) in the non obese PCOS group. Additionally, there was a significant association between obesity indicators {BMI, Body Fat Percentage (BFP), Waist Circumference (WC), and Hip Circumference (HC)} and VAI; this association was absent in the obese subgroup. According to the regression model, leptin was the only statistically relevant predictor for VAI among the studied PCOS patients (t-value=2.278, p-value=0.024). Conclusion: VAI was higher in non obese PCOS patients. An imbalance in adipokines (leptin and resistin) may lead to the accumulation of visceral fat without significantly affecting BMI.

Midterm Comparative Analysis of Functional Outcome of Uncemented versus Cemented Total Hip Arthroplasty: A Retrospective Cohort Study

Introduction: The key objective of Total Hip Replacement (THR) is to deliver a hip joint that is pain-free, mobile, and stable. For this procedure, both cemented and uncemented methods are offered. Aim: To compare the mid-term functional outcomes of uncemented Total Hip Arthroplasty (THA) versus cemented THA. Materials and Methods: A hospital-based retrospective cohort study was conducted on 60 cases of THA (both cemented and uncemented) operated at a tertiary-level medical institute in north India between January 2012 to December 2018. In this retrospective cohort study, sixty (60) hip replacements (both cemented and uncemented) were performed on patients between the ages of 25 to 70 at a tertiary care institute in rural north India between 2012 and 2018. Patients over the age of 25 who were diagnosed with pure hip arthritis due to conditions such as avascular necrosis, osteoarthritis, or hip developmental dysplasia and who were eligible for either an uncemented or a cemented THA were taken into consideration for inclusion. Retrospective patient monitoring was done based on Harris Hip Score (HHS) from January 2019 to August 2020. Results: In the cemented group, the mean age of the patients was 58.90±8.97, whereas in the uncemented group, it was 52.47±10.29. Out of 30 participants, 17 were male and 13 were female in the cemented group, and 19 male and 11 female participants were included in the study in the uncemented group. The difference between the cemented and uncemented groups’ HHS was significant during the immediate postoperative period (p=0.01). Nevertheless, there was no discernible difference at the long-term follow-up at one year (p=0.76), two years (p=0.20), three years (p=0.29), four years (p=0.86), and five years (p=0.47). Three years following surgery, radiographic evidence of osteolysis and loosening was observed in two instances (6.6%) in the uncemented group and two case (6.6%) in the cemented group. Conclusion: While cemented fixation offers better immediate functional results than uncemented fixation- such as less pain and faster pain-free full weight-bearing. Both have proven to be equally successful in the long run, with statistically insignificant differences.

Assessment of Cardiac Autonomic Neuropathy in Subclinical Hypothyroidism Using Short-term Heart Rate Variability: A Cross-sectional Study

Ankita Roy, Joyashree Banerjee, Bulbul Mukhopadhyay, Debarati Bhar

Introduction: The thyroid gland and the hypothalamus are closely linked to the cardiovascular system through the Autonomic Nervous System (ANS). The actions of thyroid hormones target the cardiovascular system, affecting homeostasis, which includes contraction, rhythm, blood flow, and peripheral vascular resistance of the myocardium. To assess the function of the ANS that influences the cardiovascular system, Heart Rate Variability (HRV) is an important and increasingly used tool. Aim: To investigate cardiac autonomic changes as assessed by short-term HRV in Subclinical Hypothyroidism (SCH) and to determine whether there is any association between Thyroid Stimulating Hormone (TSH) levels and the Low Frequency/High Frequency (LF/HF) ratio as well as the Standard Deviation of NN intervals (SDNN). Materials and Methods: A cross-sectional analytical study was conducted at R.G. Kar Medical College and Hospital, Kolkata, West Bengal, India from November 2022 to October 2023. Both males and females aged 18-55 years with newly diagnosed SCH (cases, n=50) and healthy individuals (controls, n=50) were included in the study. HRV was recorded using a Physiograph Polyrite-D instrument equipped with bioamplifiers, four channels, and accessories {Record Mangement System (RMS) latest software-version 1.2.5}. The study variables included anthropometric parameters, biochemical parameters (TSH), and HRV parameters such as SDNN and the LF/HF ratio. Relevant data were collected using standard statistical methods, including Statistical Package for Social Sciences (SPSS) version 20.0, unpaired Student’s t-test, and Pearson’s correlation coefficient. Results: The present study found a significant increase in the LF/HF ratio in SCH patients (1.28±0.75) compared to controls (0.90±0.32). There was a significantly lower SDNN value among cases (40.63±21.89) compared to controls (79.86±15.36). No significant changes were observed in Heart Rate (HR), Systolic Blood Pressure (SBP), or Diastolic Blood Pressure (DBP) between cases and controls. The LF/HF ratio and TSH value showed a positive correlation (r=0.09, p=0.57), while SDNN exhibited a negative correlation with TSH value (r=-0.08, p=0.58) among the cases, but neither correlation was statistically significant. Conclusion: The present study concludes that there is a significant change in the LF/HF ratio in newly diagnosed SCH patients. Therefore, the evaluation of short-term HRV can be utilised as a routine screening test for improved medical care.

The Impact of Sensory Processing on Sleep among Children with Autism Spectrum Disorder: A Systematic Review

S Deepak Vignesh Raj, Ganapathy Sankar Umaiorubagam, Redkar Simran Sandeep

Introduction: Sleep disturbances are highly prevalent among children with Autism Spectrum Disorder (ASD). Many studies on sleep in children with ASD have reported a high incidence of irregular sleep patterns and poor sleep quality. Recent research has highlighted the potential link between Sensory Processing (SP) difficulties and sleep disturbances in children with ASD. Therefore, a comprehensive knowledge of the evidence exploring the relationship between SP and sleep in children with ASD is needed to provide insights into targeted interventions and support strategies to improve sleep outcomes and the overall quality of life in children with ASD. Aim: This systematic review aims to investigate the relationship between SP and sleep in children with ASD aged 3 to 12 years. Materials and Methods: A comprehensive search of articles was conducted across databases, including Scopus, PubMed, and OTseeker. The following major keywords were used during the database searches: Sensory processing, sensory integration, sensory processing disorder, sensory integration disorder, sleep, sleep disorder, sleep problems, sleep disturbances, and autism spectrum disorder. The McMaster Critical Review Form for Quantitative Studies was utilised to evaluate the methodological quality of the included articles. Results: Through electronic and manual searches, 2,612 articles were identified after removing duplicates. Among these, nine articles published between January 2012 and December 2022 met the predetermined inclusion criteria. Of these, eight studies reported a statistically significant correlation between SP difficulties and sleep disturbances. Conclusion: This review underscores the significant impact of SP challenges on the sleep quality of children diagnosed with ASD, aged 3 to 12 years.

Maternal and Perinatal Outcomes of Low-risk Pregnancies with Amniotic Fluid Index <5 cm: A Prospective Cohort Study

Swapna Mohan, Shobha Sreedharan Pillai, Suman Paul

Introduction: The optimal management of Isolated Oligohydramnios (IO) is controversial. The general consensus is to deliver after 36 weeks. This has led to higher rates of obstetric interventions and adverse neonatal outcomes. Aim: To compare the pregnancy and perinatal outcomes of low-risk pregnancies with IO (Amniotic Fluid Index [AFI] <5 cm) with that of low-risk pregnancies with normal levels of amniotic fluid. Materials and Methods: A prospective cohort study was conducted at the Department of Obstetrics and Gynaecology at Government Medical College, Ernakulam, from April 2018 to March 2020. A total of 66 low-risk singleton pregnancies with IO (AFI <5 cm) between 34 and 40 weeks of gestation were compared with 132 low-risk pregnancies with normal AFI (AFI 5-24), matched by parity and gestational age. The obstetric outcomes measured were gestational age at delivery, mode of delivery, presence of Meconium-Stained Amniotic Fluid (MSAF), presence of Non-reassuring Foetal Heart Rate (NRFHR), stillbirth, and maternal complications. Neonatal outcomes measured were prematurity, birth weight, admission to the Neonatal Intensive Care Unit (NICU), duration of NICU stay, and the presence of Respiratory Distress Syndrome (RDS), Transient Tachypnea of the Newborn (TTN), Meconium Aspiration Syndrome (MAS), seizures, Necrotising Enterocolitis (NEC), Intraventricular Haemorrhage (IVH), Hypoxic Ischemic Encephalopathy (HIE), need for phototherapy, infectious morbidity like suspected or culture-proven sepsis, hypothermia, hypoglycaemia, and Neonatal Death (NND). A composite adverse neonatal outcome was defined as the presence of any one of the above. Continuous variables were calculated as mean with Standard Deviation (SD) or median with Interquartile Range (IQR) as appropriate. The test of significance done using the Student’s t-test. Categorical variables were calculated as numbers (%) and compared using the Chi-square test and Fisher’s exact test. All tests were two-sided, and a p-value of less than 0.05 was considered statistically significant. Results: The mean age of patients in the low AFI group was 26±4.87 years, while in the normal AFI group, it was 24.8±4.39 years. Pregnancies complicated by IO were characterised by a higher rate of labour induction {38 (57.6%) vs. 26 (19.7%), p-value <0.001} and caesarean delivery {34 (51.5%) vs. 35 (26.5%), p-value <0.001}. IO had a significantly higher rate of low birth weight babies {35 (53%) vs. 28 (21.2%), p-value <0.001}, non-vertex presentations {6 (9.1%) vs. 0, p-value <0.001}, and NRFHR {10 (15.2%) vs. 6 (4.5%), p-value=0.001}. Neonates in the low AFI group had a higher rate of admission to the NICU {20 (30.3%) vs. 20 (15.2%)} and composite adverse outcomes {24 (36.4%) vs. 20 (15.2%)}. Conclusion: The isolated oligohydramnios is associated with a higher rate of labour induction, caesarean delivery, and low birth weight babies. Adverse neonatal outcomes may be due to the combined effects of prematurity and low birth weight, rather than to IO per se.

Maternal Perception and Attitude towards Television Food Advertisements Targeting Children: A Cross-sectional Questionnaire Study from Pune, India

Introduction: Television food advertisements targeting children are recognised as a significant health risk, influencing their dietary choices and contributing to the increasing prevalence of Non Communicable Diseases (NCDs) among children in Low and Middle-income Countries (LMICs). Understanding maternal perceptions and attitudes towards these advertisements is crucial for designing effective public health interventions. Aim: To evaluate maternal perceptions and attitudes toward television food advertisements targeting children, specifically among mothers of children aged 4-11 years. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatric and Preventive Dentistry, Dr. D. Y. Patil Dental College and Hospital, Pune, Maharashtra, India, from May 2023 to November 2023. A total of 332 mothers of children aged 4-11 years were divided into two groups: Group 1 (mothers of children aged 4-7 years) with 159 participants, and group 2 (mothers of children aged 8-11 years) with 173 participants. A prevalidated, closed-ended questionnaire consisting of 24 questions was administered to the mothers. The reliability of the questionnaire was ensured through the preliminary exploratory study and expert reviews, achieving a Cronbach’s Alpha value of 0.84. Data analysis was performed using descriptive statistics and Chi-square tests to compare perceptions of mothers in both groups. Results: The study received 332 responses from mothers with children aged 4-11 years. Significant differences between the two age groups were observed. In group 1, 64 (52%) mothers mothers agreed, while 41 (57.7%) mothers in group 2 strongly agreed that their children show a keen interest in watching food advertisements. Additionally, 80 (55.9%) mothers in group 1 agreed, while 39 (44.8%) mothers in group 2 strongly agreed that their children do not understand the persuasive intent of food advertisements, with statistical significance (p-value=0.001). Most mothers, 75 (52.4%) in group 1 and 68 (47.6%) in group 2, agreed that reducing exposure to food advertisements would improve children’s eating behaviour (p-value=0.01). Moreover, 61 (64.9%) mothers in group 1 strongly agreed, and 77 (58.3%) mothers in group 2 agreed that seeing advertisements persuaded children to want unhealthy foods, highlighting significant differences between the age groups (p-value=0.004). Conclusion: Mothers recognise the negative impact of TV food advertisements on their children’s eating habits, particularly noting the use of cartoons and celebrities to promote unhealthy snacks and low-nutrition food that their children struggle to understand. The present study emphasises the urgent need for regulatory measures to protect young viewers and promote healthier dietary choices across different age groups.

Association of Anaemia with Metastasis in Non Haematological Malignancies: A Cross-sectional Study

Bhumika Vaishnav, Nirali Thakkar, Aniruddh N Wadivkar, Saish Mondkar, Kshitij

Introduction: Anaemia and cancer are two non communicable diseases with high global prevalence. The presence of anaemia in cancer patients is common, and its aetiology is multifactorial. Aim: To analyse the clinical profile, type and severity of anaemia in non haematological malignancies and to determine how the presence of metastasis affects it. Materials and Methods: A cross-sectional study was conducted in the Department of General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, between January 2022 and December 2023. Out of 1,294 patients diagnosed with malignancy, 190 subjects were analysed. The study included patients over 18 years of age diagnosed with non haematological malignancies who had anaemia according to the World Health Organisation (WHO) definition {females with Haemoglobin (Hb) <12 g/dL; males with Hb <13 g/dL}. The subjects were divided into two groups: patients with and without metastatic disease. All patients underwent complete haemogram, iron studies, serum vitamin B12 levels and serum folate levels. Anaemia was classified into types: normocytic anaemia, microcytic anaemia and macrocytic anaemia. The student’s t-test, Chi-square test and Fisher’s exact test were used to analyse and interpret the collected data. Results: Of the 190 selected subjects, 80 (42.1%) (group A) had metastatic disease, while 110 (57.9%) (group B) had no evidence of metastasis. The mean±Standard Deviation (SD) age of patients in group A was 55.43±11.12 years and in group B was 54.38±9.8 years. There were 90 males and 100 females in the study. The most common cause of anaemia was found to be chemotherapy-induced anaemia. The most common type of anaemia among all study subjects was normocytic anaemia (52.1%). The prevalence of severe anaemia was significantly higher in patients with metastatic cancers compared to those without metastatic cancers (p-value=0.0003). Conclusion: Chemotherapy-induced and normocytic anaemia were the most common types of anaemia in non haematological malignancies. Severe anaemia was more prevalent in patients with metastatic cancers. Anaemia in cancer patients should be monitored and managed optimally to improve outcomes.

Role of Epithelial-mesenchymal Transition in Utero-cervical Carcinoma: An Immunohistochemical Cross-sectional Study

Alok Singh, Jasbir Singh, Priya Awasthi, Ajay Shanker Sharma

Introduction: During the Epithelial-mesenchymal Transition (EMT) process, cells undergo a transformation in which they lose their epithelial characteristics and acquire mesenchymal traits. This phenomenon was observed during the metastatic stage of neoplastic disorders, such as cervical cancer. Certain indicators are present during EMT. Aim: To evaluate the role of EMT in utero-cervical carcinoma by analysing the expressions of E-cadherin and vimentin in histopathologically confirmed cases. Materials and Methods: This retrospective cross-sectional study was conducted over a period of two years, from January 1, 2013, to December 31, 2014, at the Department of Pathology in a tertiary care centre and referral hospital. A total of 50 histopathologically confirmed cases of utero-cervical Squamous Cell Carcinoma (SCC) were included in this study. These case were analysed focusing on variables such as age, age at marriage, parity, family history, and hormonal intake. Tumour stages and grades were assessed alongside E-cadherin and vimentin expressions using Immunohistochemistry (IHC). Results were statistically analysed, and the database was created in MS Excel (Version 2007) and analysed using IBM Statistical Package for the Social Sciences (SPSS) Statistics software version 20.0, with significance set at p<0.05. Results: Most cases occurred in the seventh decade of life (42%, 21/50). Out of the 50 tumours studied, 7 (14%) had a positive history of cervical carcinoma, and 6 (12%) had a positive history of hormonal intake. The cervical tumour stages and grades showed statistical significance in relation to family history (p-value=0.001, p-value=0.007) and hormonal intake (p-value <0.001), strongly indicating evidence against the null hypothesis. A total of 4 (8%) cases showed positive lymph node involvement, all of which were in stage 3; among these, 3 (75%) were in grade 3 and 1 (25%) was in grade 2. E-cadherin expression was higher in lower grade and lower stage tumours, while vimentin expression was higher in higher grade and higher stage tumours, as well as in all four lymph node-positive cases. Therefore, the downregulation of E-cadherin and the upregulation of vimentin expression signify EMT. Conclusion: The study concludes that E-cadherin and vimentin play crucial roles in EMT in cervical tumours. E-cadherin was more prevalent in lower grade and stage tumours, while vimentin was more common in higher grade and stage tumours, as well as in all lymph node-positive cases. Cervical tumour stages and grades were significantly associated with family history and hormonal intake. Despite contradictory findings in clinical trials, EMT markers like E-cadherin and vimentin will remain important in future research on cervical carcinoma.

In-silico and In-vitro Evaluation of Acetylcholinesterase Activity of Methanolic Extract of Vitex negundo

S Shobana Devi, D Anusha, K Karthika, Kavitha Ramasamy

Introduction: Vitex negundo has a myriad of medicinal uses, such as antioxidant, analgesic and anthelminthic properties, and it is used for dysmenorrhoea. The plant contains various phytochemicals, such as flavonoids, vitamins and casticin. All components of the plant are utilised medicinally due to the minimal occurrence of adverse drug reactions, making it a potential drug target for various chronic diseases. However, the role of this plant in neurodegenerative disorders, such as Alzheimer’s Disease (AD), has not yet been extensively studied. Aim: To evaluate the in-silico and in-vitro activity of the anti-Alzheimer properties of the Methanolic Extract of Vitex negundo (MEVN) leaves. Materials and Methods: The present in-silico docking study and in-vitro study were conducted in the Department of Pharmacology at Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India, over a period of two months. The in-silico analysis was performed to determine the intermolecular interactions between the ligand and protein of the top five scored molecules using PyMol software. To assess the Acetylcholinesterase (AChE) inhibitory property, the findings were presented as docking scores. Cell viability and cytotoxicity were evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, with results expressed as percentages for various concentrations: 6.25 μg/mL, 12.5 μg/mL, 25 μg/mL, 50 μg/mL, 75 μg/mL, and 100 μg/mL of MEVN. Results: The MEVN exhibited competitive inhibition of the AChE enzyme. There were active interactions between Agnuside, Isochlorogenic Acid B, Isochlorogenic Acid C, Kaempferol-3-O-rutinoside, and Quercetin found in the MEVN with AChE. The percentage of cell viability for the concentrations of 6.25 μg/mL, 12.5 μg/mL, 25 μg/mL, 50 μg/mL, 75 μg/mL, and 100 μg/mL, as determined by the MTT assay, was 98.62%, 98.86%, 97.19%, 96.66%, 91.86%, and 78.82%, respectively. The results indicated that MEVN does not exhibit any toxicity. Conclusion: The findings demonstrated that MEVN possesses AChE inhibitory properties and maintains cell viability, both of which are indicative of anti-Alzheimer activity. Therefore, MEVN can be further evaluated for its potential in preventing cell cytotoxicity and treating AD.

Assessing the Utility of Oxygen Desaturation Index as a Diagnostic Tool for Obstructive Sleep Apnoea: A Cross-sectional Study

Introduction: Obstructive Sleep Apnoea (OSA) is a common yet underdiagnosed condition with serious medical consequences if not recognised early. Despite its limitations, the Apnoea-Hypopnoea Index (AHI) remains the most studied parameter for assessing the severity of OSA. This situation has created a need for a preliminary, alternative diagnostic tool for the early diagnosis and severity assessment of OSA in resource-limited settings. Aim: To determine whether the Oxygen Desaturation Index (ODI) could serve as a simple yet equally effective diagnostic tool compared to the AHI in assessing the severity of OSA. Materials and Methods: A cross-sectional study was conducted in SRM Medical College, Chennai, Tamil Nadu, India, involving 100 patients who underwent Level III polysomnography for suspected OSA. The study spanned one year, from May 2023 to May 2024. Ethical clearance for the study was obtained from the Institutional Review Board (IRB). Pearson’s correlation coefficient was applied to assess the relationship between AHI and ODI scores. Cohen’s weighted Kappa analysis Bland-Altman plot, ROC curve analysis, and Youden’s J Statistic were performed to determine the best ODI threshold for OSA severity. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) version 22.0, ensuring robust and reliable results. Results: Analysis of the obtained parameters suggested a strong correlation (r=0.94, p-value <0.001) between AHI and ODI scores. ROC curve analysis indicated that an ODI >32 had good effectiveness in detecting severe OSA. Conclusion: The strong positive correlation and significant agreement between AHI values and ODI scores indicate that ODI could be reliable in diagnosing and assessing the severity of OSA, especially in resource-limited environments.

Haemodynamic Impact of Sitting versus Immediately Lying Down Position after Spinal Anaesthesia in Elective Caesarean Section: A Randomised Double-blinded Clinical Study

Shahbaz Hasnain, Raavi Swapna Lakshmi Priya

Introduction: Spinal anaesthesia is widely preferred over General Anaesthesia (GA) for caesarean sections due to its avoidance of airway complications and its ability to keep patients awake during childbirth. However, a common challenge associated with spinal anaesthesia is hypotension, which is caused by reduced sympathetic tone and aortocaval compression from the gravid uterus. Various methods, such as Intravenous (i.v.) fluid preloading and vasopressors, are used to manage hypotension, but it remains a significant concern. Aim: To compare the incidence of hypotension and the optimal duration of the sitting posture after subarachnoid block. Materials and Methods: This randomised double-blind clinical study involved 120 parturients undergoing spinal anaesthesia for caesarean sections, participants were assigned to three groups: S30, S60 (seated for 30 or 60 seconds postinduction), and L (laid down immediately). Haemodynamic parameters were monitored at specified intervals throughout the procedure. Appropriate tests of statistical significance, such as One-way Analysis of Variance (ANOVA) and the Chi-square test, were performed. Results: The demographic and anaesthesia characteristics of the study groups were comparable (p-value >0.05). Heart Rate (HR) was significantly higher in group L compared to groups S30 and S60 at 1, 2, 3, and 5 minutes postspinal anaesthesia (p-value <0.001). Systolic Blood Pressure (SBP) was significantly lower in group L compared to S30 and S60 at 2, 3, 5, 15, and 20 minutes (p-value <0.05). Mean Arterial Pressure (MAP) showed significant differences between groups at 1, 2, 3, 5, 10,15 and 20 minutes (p-value <0.05). Group L took less time to reach the T6 dermatome sensory level (3.8±1.9 min) compared to S30 (4.2±2.3 min) and S60 (5.41±1.7 min) (p-value=0.001). The motor block regression time was significantly shorter in S60 (151.7±20.4 min) and S30 (165.3±25.5 min) compared to L (179.3±19.7 min) (p-value <0.001). Conclusion: The study concluded that allowing patients to sit for 30 or 60 seconds after spinal anaesthesia for caesarean sections reduces the incidence of hypotension and improves haemodynamic stability compared to the immediately lying down position. The time to achieve a T6 sensory block was shorter in the immediately lying down position.

Efficacy and Safety of Uterine Artery Embolisation for Postpartum Haemorrhage: A Systematic Review and Meta-analysis

Rahul Arkar, Sagar Maheshwari, Joel Thomas, Kaurabhi Zade

Introduction: Postpartum Haemorrhage (PPH) is one of the main causes of maternal morbidity and mortality globally, accounting for about 25% of maternal deaths. Uterine Artery Embolisation (UAE) has gained recognition as a valuable non surgical treatment option for managing PPH, providing effective haemorrhage control while maintaining fertility. Aim: To assess the effectiveness and safety of UAE in the treatment of PPH. Materials and Methods: A thorough investigation was performed using PubMed, Scopus, Science Direct and the Cochrane Library to locate studies released between 2000 and 2024. The included studies comprised Randomised Controlled Trials (RCTs), case-control studies, and cohort studies that assessed the efficacy of UAE for PPH. The primary outcomes assessed were clinical success rates, technical success rates, and complication rates. Secondary outcomes included fertility preservation, postpartum recovery time, and the impact on future pregnancies. Data analysis was undertaken using Review Manager 5.3, with Mean Differences (MD) and Risk Ratios (RR) calculated for continuous and dichotomous outcomes, respectively. Results: Out of 437 identified studies, 13 met the inclusion criteria for evaluating the effectiveness of UAE as a treatment for PPH. These comprised five RCTs with 1,200 participants, four case-control studies with 800 participants, and four cohort studies with 1,000 participants. The RCTs were conducted in North America, Europe, and Asia, involving women who had experienced PPH. Case-control studies compared UAE recipients to those receiving alternative treatments, considering factors like age, severity of PPH, and obstetric history. Cohort studies followed UAE recipients over time to assess long-term outcomes. The pooled technical success rate was 96% (95% CI, 94.0-98.0; I²=20.0%; p-value=0.143), and the clinical success rate was 92% (95% CI, 88.0-96.0; I²=35.6%; p-value=0.012). The complication rate was 8% (95% CI, 5.0-11.0; I²=40.1%; p-value=0.021). These findings indicate a high effectiveness and reliability of UAE for PPH treatment. The diverse study types and participant populations enhance the generalisability of these results, underscoring UAE’s potential to improve outcomes for women experiencing PPH globally. Conclusion: UAE demonstrates high clinical and technical success rates with a relatively low complication rate, establishing it as a safe and effective intervention for PPH. Future studies need to look into lasting outcomes, including fertility preservation and impacts on subsequent pregnancies, to further substantiate UAE’s role in PPH management.

Role of Blended Learning in Imparting Early Clinical Exposure in Physiology for First-year Medical Students: An Educational Interventional Study

Ammathalli Aparna, Praveen R Singh

Introduction: Blended learning is a combination of online and face-to-face learning. With the introduction of a competency-based curriculum in India and Early Clinical Exposure (ECE) as a part of it, there is a need for innovative learning methods like the Blended Learning Method (BLM). Aim: To analyse the effectiveness of BLM in implementing ECE compared to the Non BLM or traditional method. Materials and Methods: This educational interventional study was conducted at the National Institute of Medical Sciences and Research, NIMS University, Jaipur, Rajasthan, India from April 2022 to October 2022. The sample population included Phase 1 MBBS students (n=110). Students were randomly assigned to two groups: the BLM group and the Non BLM group, each consisting of 55 students. The BLM group received ECE through a combination of digital and face-to-face methods, while the Non BLM group received traditional face-to-face ECE. Students’ performance was evaluated through standardised assessments. Students’ and faculty perceptions of the BLM method were assessed using a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Results: The comparison of pretest scores between both groups was statistically not significant. However, the post-test score comparison was statistically significant (p-value <0.05) for a few ECE sessions (sessions 1 and 3), with better performance observed in the BLM group. The paired t-test between pre and post-test scores was highly significant in both the BLM and Non BLM groups (p-value <0.0001). The student perception of the use of BLM was positive, while faculty perception indicated that they had difficulty using the BLM method to implement ECE. Conclusion: BLM can be an effective tool in the implementation of ECE sessions in physiology. It can enhance the self-directed learning ability of students.

Preliminary Immunohistochemistry Panel in Evaluating Carcinomatous Deposits in Brain from Unknown Primary: A Cross-sectional Study

Christy D Ramya, K Rama

Introduction: Metastasis to the brain as a first presentation is very rare and challenging. Metastatic tumours are ten times more common in the brain than primary intracranial neoplasms. Brain metastasis to brain causes severe neurological morbidity in a patient with cancer. In such cases, histopathology plays a pivotal role in the analysis of metastatic carcinomatous deposits, especially when they present as Cancer of Unknown Primary (CUP) site. A panel of immunohistochemical markers, especially Cytokeratin 7 (CK7), Cytokeratin 20 (CK20) and Thyroid Transcription Factor1 (TTF-1), helps in delineating the primary site of the tumour in cases of CUP. Aim: To evaluate the use of three basic immunohistochemistry markers-CK7, CK20 and TTF-1-in identifying the unknown primary source of brain metastasis. Materials and Methods: This is a cross-sectional study conducted over a period of two years, from June 2016 to June 2018, in the Department of Pathology at the Institute of Neurosurgery, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India. The aim of the study was to formulate an algorithm for the initial work-up of CUP in the Central Nervous System (CNS). The analysis of the origin of the occult primary tumour was performed using a panel of immunohistochemistry markers, including CK7, CK20 and TTF1, on paraffin-embedded blocks of patients with metastatic carcinoma deposits in the CNS with an occult primary site. The results were compared with the corresponding squash cytology preparations. The parameters studied included imaging, squash cytology, histomorphology and immunohistochemical analysis. The results were analysed using the IBM Statistical Package for the Social Sciences (SPSS) software version 20.0, using Chi-square test and Fisher’s-exact test. Results: The incidence of metastatic deposits in the CNS in our institute was 5.2% (82 out of 1553 cases). Squash cytology done intraoperatively was sensitive in identifying metastatic carcinomatous deposits in the CNS, as compared to the corresponding histopathological slides. Squash cytology was able to detected 41 cases prior to histopathological examination, resulting in a sensitivity of 82%. In the histopathological examination, adenocarcinoma was the most commonly observed morphology, accounting for 45 (90%) cases of the total. The most common pattern of staining was CK7+ CK20- TTF1+, which was found in 21 (42%) cases. Of these, 18 cases were confirmed to be lung carcinoma on follow-up, indicating a sensitivity of 85.7% for this staining pattern in detecting lung carcinoma. Additionally, there was one case in which lung primary was suggested, but no primary was detected, hence the positive predictive value of 94.7% for the test in detecting lung carcinoma; however, the specificity was only 50%. The next most common pattern of staining, CK+ CK20- TTF1-, accounted for 16 (32%) cases. The second most common tumours that was found to metastases to the brain from an unknown primary site were from the Gastrointestinal Tract (GIT). Conclusion: The results indicate that immunohistochemical analysis of CK7, CK20 and TTF1 is valuable for classifying the probable primary site in patients with metastasis from Cancers of Unknown Primary (CUP) in the CNS, especially in a resource-limited set-up. This panel provides a window for the rational use of organ-specific markers, serving as a cost-effective method of investigation. The authors also found that once histomorphology is indicative of carcinomatous deposits and this readily available basic panel is applied, it hastens the search for the primary. Hence, the present study helps initiating the treatment at the earliest especially in public sector hospitals where there is dearth of wide range of advanced immunohistochemical markers.

Comprehensive Anaemia Profile in Ulcerative Colitis Patients with Varying Disease Severities: A Cross-sectional Study

Manjri Garg, Pranjjal Sindhu, Kiran Dahiya, Sandeep Goyal

Introduction: Anaemia is the most common Extraintestinal Manifestation (EIM) associated with Ulcerative Colitis (UC) and has been linked to increased mortality in UC patients, with iron deficiency having the most pronounced effect. Moreover, iron deficiency in UC can occur with or without anaemia. Aim: To assess anaemia and iron deficiency, with or without anaemia, in UC patients. Materials and Methods: The present cross-sectional study was conducted in the Department of Medicine, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India, from August 2020 to December 2021. Study included 75 patients with UC and varying levels of disease activity. A complete haemogram, Red Blood Cell (RBC) indices, and serum iron studies {serum iron levels, Total Iron Binding Capacity (TIBC), Transferrin Saturation (TfS), and serum ferritin} were conducted. Patients were classified as having Iron Deficiency Anaemia (IDA), Anaemia of Chronic Disease (ACD), or mixed anaemia based on the results of the iron studies. Disease activity was assessed using the Mayo score. Patients were divided into group I (mild disease activity) and group II (moderate to severe disease activity). Haemoglobin (Hb), RBC indices and iron levels were compared between the two groups. Independent t-tests and Chi-square tests were employed for statistical analysis. Results: The mean±Standard Deviation (SD) age of the patients was 34.8±14 years, with a male-to-female ratio of 1.7:1. The mean±SD duration of the disease was 28.8±33.8 months (median: 12 months). Fifteen patients had mild disease activity, 52 had moderate activity, and eight had severe activity. The mean±SD Hb level among the patients was 11.1±2.0 g/dL. The mean±SD values for Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH), and Mean Corpuscular Haemoglobin Concentration (MCHC) were 80.4±7.7 fL, 26.4±4.0 pg, and 32.1±2.5 g/dL, respectively. The mean±SD serum iron level and ferritin levels were 59.3±29.1 mcg/dL and 27.2±27.9 ng/mL, respectively. The mean±SD TfS was 14.3±10.8%, while the mean±SD TIBC was 337.1±80.5 mcg/dL. A total of 45 (60%) patients had anaemia, and 16 (21.3%) patients had iron deficiency without anaemia. Among those with anaemia, 32 (42.7%) had IDA and 13 (17.3%) had mixed anaemia; none of the patients had ACD. In total, 61 (81.3%) patients had iron deficiency, with or without anaemia. Hb, RBC indices and iron studies were comparable between both groups. Conclusion: Iron deficiency anaemia is common in UC patients, affecting 60% of the cohort; however, iron deficiency without anaemia was also observed in 21.3% of patients. Changes in Hb, RBC indices and iron studies were independent of disease activity.

Efficacy of External Oblique Intercostal Plane Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Laparoscopic Upper Abdominal Surgeries: A Randomised Clinical Study

Introduction: Fascial plane blocks play a major role in aiding Enhanced Recovery After Surgery (ERAS) following upper abdominal wall surgeries. The External Oblique Intercostal (EOIC) plane block is a novel technique that targets the anterior and lateral cutaneous branches of the thoracoabdominal nerves. Aim: To compare the efficacy of the EOIC plane block with the Transversus Abdominis Plane (TAP) block. Materials and Methods: This double-blinded randomised clinical study was conducted at Narayana Medical College, Nellore, Andhra Pradesh, India, between June 3, 2023, and February 25, 2024, on 100 patients after obtaining ethical committee approval. These patients underwent upper abdominal surgeries, with 50 patients receiving bilateral EOIC block (Group E) and 50 patients receiving bilateral TAP block (Group T) using 0.25% Levobupivacaine and 8 mg Dexamethasone in a total volume of 30 mL on each side. The demographic details studied included age, sex, American Society of Anaesthesiologists (ASA) physical status, weight and key parameters such as dermatomal distribution, extent of analgesia, Numerical Rating Scale (NRS), time for first rescue analgesia, number of rescue analgesic doses and the Bruggemann comfort scale. Data were analysed using the Chi-square test for categorical data and the unpaired Student’s t-test for numerical data. Results: The demographic data did not differ significantly between the groups. Both groups had comparable average ages (Group E: 66.8 years; Group T: 67.1 years) and similar gender distributions. The distribution of patients across ASA classifications I, II and III, as well as heights and body weights, was also statistically similar and lacked significant differences. Patients who received the EOIC block exhibited greater dermatomal blockade from T4 to T10 in the midclavicular, anterior axillary and midaxillary lines compared to those who received the TAP block. The NRS scores at 6, 12 and 24 hours after surgery in Group E were lower than in Group T. The time taken for the first rescue analgesia was 12±4.2 hours in Group E compared to 4.4±3.02 hours in Group T, which was statistically significant. The number of rescue analgesic doses was 1.06±0.84 in Group E, compared to 3.52±1.3 in Group T, which was also significant (p<0.05). The Bruggemann comfort scale was superior in Group E compared to Group T, with statistical significance. Conclusion: The EOIC block is a superior and effective alternative to the TAP block for postoperative analgesia in laparoscopic upper abdominal wall surgeries. The extent of analgesia and dermatomal distribution of the EOIC block was greater than that of the TAP block, making the EOIC block more efficacious.

Novel Root Conditioner Apple Cider Vinegar versus Citric Acid on Teeth with Periodontal Disease: A Pilot In-vitro SEM Analysis

Introduction: Root biomodification in periodontal therapy aims at removing the smear layer and enhances the clot stability necessary for periodontal regeneration. Citric Acid (CA), EDTA, fibronectin has been used routinely. But if used injudiciously acidic erosion of the periodontal tissues might occur. Apple Cider Vinegar (ACV) an organic acetic has been reported to possess antimicrobial, anti-inflammatory and antioxidant effects. Aim: To assess the effect of smear layer removal and fibrin clot adhesion of ACV in comparison to CA on periodontally affected teeth. Materials and Methods: This pilot study was conducted at Sri Venkateswara Dental College and Hospital, Chennai, India, for three months, starting in January 2024 and ending in March 2024. 8 Teeth extracted due to periodontal reasons were cleaned, scaled and root planed. From the extracted teeth 16 dentin block samples were obtained, of which eight underwent CA testing (Control group) and eight underwent ACV testing (test group). The SEM analysis was done to assess the efficiency of smear layer removal and fibrin clot adhesion. Results: Under qualitative Scanning Electron Microscope (SEM) analysis, though ACV (50%) and CA (50%) group exhibited significant level of smear layer removal, complete dentinal tubule opening (RMSI score 2) was observed only in ACV category. In regard to Blood Element Adhesion Index (BEAI) both the groups demonstrated moderate fibrin clot adhesion (BEA score 2) in 50% of their samples. Considering both the parameters, root conditioning effects of ACV was better than CA. Conclusion: Teeth treated with ACV had a comparable effect as the CA in terms of root biomodification. This novel agent with several medicinal effects can be considered for future studies to determine its regenerative effectiveness.

Morphological Evaluation of Infraorbital Canal and its Relation with Surrounding Structures Utilising CBCT: An Observational Study

Introduction: Infraorbital nerve is the largest and terminal branch of the maxillary nerve. A lack of knowledge of variations in its course, such as Infraorbital Canal Protrusion (ICP)-which refers to the extension of the nerve from the infraorbital foramen into the maxillary sinus, could lead to iatrogenic injuries during procedures of the maxilla and antrum. Aim: To analyse and determine the morphometric variations of the infraorbital canal and its association with nearby structures utilising Cone Beam Computed Tomography (CBCT). Materials and Methods: A retrospective observational study was conducted in the Department of Oral Medicine and Radiology at Bhimavaram, Andhra Pradesh, India. The data obtained was between November 2019 to May 2023, during which 114 CBCT scans {228 Infra Orbital Canal (IOC)} were analysed retrospectively. IOC was divided into type 1, type 2 and type 3 Measurements taken for type 3 infraorbital canals included the distance from the IOC to the Infraorbital Rim (IOR), the horizontal distance from the IOC to the long axis of the canine, the maximum length of the nerve protruding into the sinus, and the maximum distance from the center of the canal to the roof of the sinus. The association between the types of infraorbital canals and variations in adjacent anatomical structures was evaluated using independent sample t-tests, Fisher’s-exact test, One-way Analysis of Variance (ANOVA), and Pearson’s Chi-square test. Results: Out of 228 IOC types, 78 were classified as type 1, 23 as type 2, and 13 as type 3 on the right side and 73 were type 1, 36 were type 2, 5 were type 3 on the left-side. Type 1 was higher in number both females and males on both sides, followed by type 2. The mean horizontal distance from IOC to the long axis of the canine {(IOC-Long axis of canine (LCR)} was statistically significant across different types on both the right and left-sides. The prevalence of Haller cells, mucosal thickening, pneumatisation of the middle concha, and maxillary sinus septa was present in 31 (27.19%), 44 (38.6%), 41 (36%), and 29 (25.4%) of the 114 individuals, respectively. Conclusion: A preoperative 3D assessment of IOC is crucial to preventing surgical complications by identifying potential anatomical variations, thereby minimise iatrogenic injuries.

Tibial Tuberosity Fixation in Complex Proximal Tibia Fractures using Thin Profile Distal Fibular Plate: A Prospective Study with 12-month Outcomes

Introduction: Proximal tibial plateau fractures are common intra-articular injuries that result from either direct axial compressive trauma or indirect coronal trauma. The standard fixation method is bi-columnar dual plating. In cases with additional tibial tuberosity fractures, a thin-profile distal fibular plate can be used for repair. Aim: To assess the clinical outcomes of a combined posteromedial, anterolateral, and thin distal fibular plating of the tibial tuberosity fractures, and also to assess the radiological outcome in complex proximal tibia Schatzker type 5 and 6 fractures with additional tibial tuberosity fractures. Materials and Methods: This prospective study was carried out at the Orthopaedics Department of Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India from January 2017 to January 2022, on 18 patients with tibial plateau fractures (Schatzker type V or VI) associated with tibial tuberosity avulsion fractures. These fractures were fixed with thin-profile distal fibular plates. The functional outcome of the knee joint was assessed after one year, using the Knee Society score. Descriptive statistics were used to compute means, Standard Deviations, and ranges. Student’s t-tests and One-way Analysis of Variance (ANOVA) were used to compare the means. The p-value of ≤0.05 was considered statistically significant. Results: The average age of the study population was 39.4±5.6 years. Road traffic accidents were the most frequent mode of injury in 14 (77%) individuals. No perioperative complications were noted. The average duration of surgery was 114±10.4 minutes, and the average blood loss was 146±40 mL, throughout the procedure. The Knee Society score at 12 months postoperatively was excellent at 93.6 (range 92 to 98). Radiographic bone union was observed after an average of 12.4 weeks. Conclusion: Multiplanar complicated proximal tibia Schatzker type V and VI fractures with tibial tuberosity avulsion fractures may be effectively treated using a novel technique of thin-profile distal fibular plating. The bi-columnar plates combined with open reduction and internal fixation through two incisions with thin distal fibular plates showed satisfactory results.

Changes in Ocular Functions after Bariatric Surgery: A Cross-sectional Study

Rania Medhat Fahmy, Abeer Alseddeeq

Introduction: Obesity is a critical problem worldwide, as it contributes to many pathological diseases. Therefore, Bariatric Surgery (BS) is considered an optimal treatment modality for achieving ideal weight. However, the eye and its functions can be affected after surgery due to the changes that occur throughout the body. Aim: To investigate and analyse visual functions following BS. Materials and Methods: This was a cross-sectional study conducted at Elite Hospital in Riyadh City, Saudi Arabia, from January 2023 to June 2023. A total of 16 subjects (32 eyes) were enrolled in the study. The subjects were categorised into three groups: preoperative BS (Group I), postoperative six months (Group II), and postoperative duration of one to two years (Group III). All participants underwent complete ophthalmological examinations, including Visual Acuity (VA) measurement using the Snellen chart, refractive error measurement by autorefractometer, colour vision testing using the Ishihara test, Intraocular Pressure (IOP) measurement, and anterior segment examination using a slit lamp. Additionally, a dryness assessment was performed using clinical tests. Finally, choroidal thickness and Retinal Nerve Fiber Layer (RNFL) measurements were obtained using Optical Coherence Tomography (OCT). Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) Software Grad Pack Base version 28.0. One-way Analysis of Variance (ANOVA) and Kruskal-Wallis tests were used to compare the mean values of the three groups. Post-hoc tests were employed for multiple comparisons between groups. The significance level was set at 5%. Results: The range of the participants’ ages was 24 to 47 years. It was revealed that Body Mass Index (BMI) was significantly influenced by the time elapsed since BS (p-value=0.04). In contrast, the effect of BS was not statistically significant between groups for both systolic and diastolic measurements (p-value >0.05). Moreover, the automated Central Foveal Thickness (CFT) showed a statistically significant difference between groups, with p-values of 0.013 for the right eye (OD) and 0.016 for the left eye (OS). Although there was no statistical difference in the effect of BS on the OD Ganglion Cell Complex (GCC) (p-value=0.338), there was a significant effect on the OS GCC (p-value=0.03). Post-hoc analysis indicated that participants in Group I had a higher BMI than participants in Group III, with a p-value of 0.036. CFT was significantly increased in Group II OS compared to Group I (p-value=0.016). Group III showed a significantly higher GCC than Group II (p-value=0.028). There was a significant difference in Goldmann IOP among the three groups (p-value=0.009). Additionally, a negative correlation was found between the duration of BS and BMI (r=-0.615, p-value=0.011) as well as for systolic measurements (r=-0.592, p-value=0.016). A strong negative correlation was also observed between Goldmann IOP and BS, which was statistically significant for the OD (r=-0.788*, p-value <0.001) but not for the OS (r=-0.346, p-value=0.189). There was a statistically significant difference in OD nasal choroidal thickness at 500 μm (p-value=0.03) and at 1000 μm (p-value=0.03) among the three groups. Conclusion: Hence, it can be concluded that some ocular functions were positively altered while others were negatively affected after BS. Choroidal thickness decreased in the six-month postsurgery group but increased in the one to two-year group. IOP decreased in the six-month postsurgery group and further decreased in the one to two-year group. CFT increased in the six-month group but decreased in the one to two-year postoperation group. GCC thickness decreased in the six-month group and increased in the one to two-year post-BS group. Measurement of such parameters could serve as a preoperative assessment, especially for glaucomatous and hypertensive individuals who are planning for future BS. These evaluations could also aid in the treatment of eye diseases after surgery. Additionally, normal individuals should undergo pre- and postoperative evaluations of their visual refraction, as this may be altered due to changes in posterior segment parameters, such as choroidal thickness. However, more studies are needed to validate these results.

Pattern of Adverse Drug Reactions at a Tertiary Care Hospital, Kerala, India: A Cross-sectional Study

S Sruthi, Manju K Nair, S Reshma

Introduction: With the rising use of medications, Adverse Drug Reactions (ADRs) have emerged as a significant public health issue. Therefore, establishing a robust pharmacovigilance system across the nation has become imperative. The present study focussed to analyse the trends and frequency of ADRs to enhance the safety of drug prescriptions and ensure public health protection. Aim: To assess the pattern of adverse effects, drugs implicated, causality, severity, and outcomes of ADRs reported to the ADR monitoring centre in the Department of Pharmacology, Government TD Medical College, Alappuzha, Kerala, India. Materials and Methods: This was a cross-sectional study in which 262 ADRs reported to the Department of Pharmacology, Government TD Medical College, Alappuzha, Kerala, India from May 2022 to April 2023 were analysed for patient demographics, drug and ADR characteristics, and the outcomes of the ADR. Causality and severity assessments of these ADRs were performed using the World Health Organisation (WHO)-Uppsala Monitoring Centre (UMC) scale and the modified Hartwig and Siegel’s scale, respectively. Data were tabulated using Microsoft Excel and expressed as mean, standard deviation, frequency, and percentage as appropriate, with the help of descriptive statistics using Epi Info 7 software. Results: A total of 262 ADRs were analysed. The mean age of the patients was 47.4±20.1 years. The majority were females 160 (61.1%). The intravenous route was the most common route involved in ADRs 158 (59.8%), followed by the oral route 91 (34.5%). Skin reactions accounted for more than half of the ADRs 151 (53.2%), followed by blood dyscrasias 48 (16.9%). Antibiotics were the most common group of implicated drugs 124 (44.9%), followed by anticancer drugs 43 (15.6%) and antitubercular drugs 34 (12.3%). Among antibiotics, cephalosporins (36.3%) were the most frequently encountered, followed by penicillins (30.6%). A total of 148 patients (56.5%) had recovered by the day of reporting, 146 (55.7%) ADRs were found to be ‘possible’ using the WHO-UMC causality scale, and 144 (54.9%) ADRs were classified as moderate severity. Conclusion: The study identified a widespread occurrence of ADRs, some of which increased healthcare costs due to prolonged hospital stays. The high incidence of ADRs from antimicrobials is concerning, as it contributes to antimicrobial resistance. This underscores the urgent need for prudent antimicrobial usage. The present study emphasises the importance of ADR reporting among healthcare workers and the necessity for hospitals to establish ADR reporting strategies for optimal patient care.

A Descriptive Study on Paediatric Ocular Trauma at a Tertiary Eye Care Centre, Andhra Pradesh, India

Introduction: Ocular trauma is one of the leading causes of treatable visual morbidity and blindness. Paediatric ocular injury accounts for 8 to 14% of total injuries in children. Ocular trauma in children differs from that in adults in terms of the objects involved in causing injury, as well as the evaluation and management protocols. Aim: To understand the causes, locations, contributing factors, and patterns of paediatric ocular trauma, along with its short-term visual outcomes in a tertiary care centre, Andhra Pradesh. Materials and Methods: This descriptive study was conducted at the Department of Ophthalmology, Great Eastern Medical School and Hospital (GEMS), Srikakulam, Andhra Pradesh, India, over a period of six months, from August 2023 to January 2024. A detailed history regarding the cause of injury and any systemic injuries was recorded. The demographic profiles of all patients were noted in terms of age, sex, location of injury, nature of the object causing injury, time of presentation, and treatment. A comprehensive ocular examination was performed, which included visual acuity assessment, slit lamp examination and fundus examination. All patients were managed according to established treatment protocols. Follow-up appointments were scheduled at one week, three weeks, six weeks, and three months. Results: In the present study, a total of 31 children under the age of 15 years were included. The mean age of presentation was 9.94±3.91 years. Most ocular injuries occurred in the age group of 11-15 years, accounting for 17 (54.83%) of cases. Regarding the location of injury, the most common site was the home, representing 15 (48.38%) of incidents. The object most frequently causing injury was a wooden stick, which constituted 7 (22.58%) of cases. Out of the 31 children, 25 (80.64%) presented with closed globe injuries, while 6 (19.35%) had open globe injuries, indicating that closed globe injuries were more common. The visual acuity was converted to log Minimum Angle of Resolution (MAR) units, with the mean preoperative Best-corrected Visual Acuity (BCVA) being 1.0726±0.7038 log MAR units. The mean postoperative BCVA after three months was 0.5720±0.6275 log MAR units. Linear regression analysis conducted between preoperative visual acuity and postoperative BCVA showed an r-value of 0.7681 and a p-value of <0.001, indicating a significant positive correlation. Conclusion: According to the present study, the most common location of injury was found to be the home, suggesting that increased supervision at home could be beneficial. Early identification and intervention will help prevent ocular morbidity in children.

Evaluation of Bisphenol-A Release from Vacuum formed Retainers after Immersion in Distilled Water using High Performance Liquid Chromatography: A Randomised Clinical Trial

Introduction: With the increasing demand for aesthetics, the popularity of Vacuum-formed Retainers (VFRs) has been on the rise. Bisphenol-A (BPA) is added to the polymers to make them clear and tough. BPA is identified as an endocrine disruptor linked to developmental defects, infertility, cardiovascular disease and cancer. The release of BPA from various orthodontic materials, including VFRs, has been reported infrequently and with variable results. Aim: To assess the effect of immersing VFRs in distilled water on BPA release in the saliva of patients wearing VFRs. Materials and Methods: This was a single-centre prospective randomised clinical trial. A total of 28 patients aged between 15 and 25 years, who had completed their fixed orthodontic treatment in 2021 at Bharati Vidyapeeth Deemed to be University (BVDU), Dental College and Hospital, Sangli, Maharashtra, India, were selected for this in-vivo study. Patients were randomly divided into two groups. Group I patients received VFRs without immersion in water before delivery, while Group II patients received VFRs that were immersed in distilled water at 37°C for 24 hours before delivery. Four samples of unstimulated whole saliva were collected across four different time intervals: T0 (before VFR delivery), T1 (after one hour of wearing retainers), T2 (after one week of wearing retainers) and T3 (after three weeks of wearing retainers). These samples were tested for BPA release using HPLC analysis. For numerical continuous data following a normal distribution, intergroup comparison was conducted using a one-way Analysis of Variance (ANOVA) test and intra-group comparisons were performed using a paired t-test. An alpha error of 5% and a power of 80% were maintained, with p<0.05 considered statistically significant. Results: The mean age of patients selected for the study was 20±5 years. Statistical analysis revealed that the mean release of BPA (0.33 ppm) in saliva was highest in patients from Group I at T1, decreasing to 0.177 ppm at T2 and further reducing to 0.013 ppm at T3. In comparison, the mean values of BPA release in the saliva of patients in Group II were significantly lower at all time intervals: T1 (0.07 ppm), T2 (0.009 ppm) and T3 (0.001 ppm). Intergroup comparison using a one-way ANOVA test showed that the difference in BPA release between the two groups was statistically significant (p-value=0.05). Tukey’s post-hoc test revealed statistically significant differences in BPA release between T1-T2, T2-T3 and T1-T3. Conclusion: Prior immersion of VFRs in distilled water for 24 hours at 37°C before delivery to patients can be a simple solution to reduce BPA release in saliva.

Comparison of Transdermal Nitroglycerine Patch and Oral Nifedipine for Tocolysis in Preterm Labour: A Prospective Interventional Study

Introduction: Preterm labour and delivery have a major contribution to perinatal mortality and morbidity. Tocolytic therapy reduces neonatal mortality and morbidity by prolonging gestation, allowing for corticosteroid administration and in-utero transfer to a tertiary care centre. There is a need to find out better tocolytic agent that is most effective and with the least side-effects. Aim: To compare oral Nifedipine and transdermal Nitroglycerine patch to achieve tocolysis in preterm labour. Materials and Methods: A prospective interventional study was conducted in the Department of Obstetrics and Gynaecology at Uttar Pradesh University of Medical Sciences, Saifai, Etawah, from January 2020 to June 2021. A total of 100 women presenting with signs and symptoms of preterm labour with live singleton pregnancy and intact membranes were included. All the women were divided into Group-A (n=50) and Group-B (n=50). Group-A received oral Nifedipine 20 mg of oral initially and 10 mg Nifedipine repeated after 30 minutes if the contractions persisted. Oral Nifedipine 10 mg was repeated every six hours till contractions subsided, and a transdermal Nitroglycerin patch (25 mg) was directly applied to the skin of the abdomen in Group-B. Demographic profile, the number of patients in which tocolysis was successful, improvement in Bishop score, prolongation in gestational age, maternal side-effects, and foetal outcomes in the form of birth weight, APGAR score, and NICU admission were recorded in both the groups on Excel sheet. Chi-square test and t-test were used to test the significance of the difference between categorical and continuous variables respectively. A p-value less than 0.05 were taken as significant. Results: In Group-A 94% (47 out of 50) achieved tocolysis while in Group-B 86% (43 out of 50) achieved tocolysis (p-value-0.182). The mean prolongation of pregnancy was 17.70±13.04 and 13.14±11.03 in Groups A and B, respectively. The maternal complication was significantly higher in Group-B as compared to Group-A (22% Vs 6%, p-value-0.0097). In Group-A mean birth weight was 2.422 kg±0.34 whereas in Group-B mean birth weight was 2.204±0.38 kg (p-value-0.0032). Conclusion: Both drugs oral Nifedipine and transdermal Nitroglycerine were found to be effective in the treatment of preterm labour.

Reflective Capacity of CBME Batch Undergraduate Medical Students in Comparison to Non CBME Batch Students Pursuing Internship in a Medical College of Central India: A Mixed-method Cross-sectional Study

Introduction: Reflection facilitates the enhancement of critical thinking and profound learning through obtaining a greater understanding of oneself and the circumstances at hand. There is a limited amount of published literature evaluating the reflective abilities of medical students in India. Aim: To evaluate and compare the reflective abilities of Competency-based Medical Education (CBME) batch MBBS students in Phase III, part 2, with non CBME batch MBBS students currently undertaking their internship by administering the Reflective Practice Questionnaire (RPQ) and via Focus Group Discussions (FGD). Materials and Methods: The present mixed-method cross-sectional study was conducted from January to August 2023 among 171 CBME batch and 129 non CBME batch MBBS students studying at Pt. JNM Medical College, Chhattisgarh, India. The RPQ consists of 40 items designed to evaluate not just the reflective abilities of a study group but also to gauge various other related psychological attributes. The mean values of each subscale were estimated and compared between the CBME and non CBME batches and analysed using the non parametric Mann-Whitney U test, with a p-value <0.05 considered significant. FGDs were also conducted for confirmatory and exploratory purposes. Also, feedback regarding the implementation of training on reflection and future course correction was taken from the study participants in FGD. Results: The mean age of students in the CBME batch and non CBME batch was 22.5±0.95 years and 24.1±0.36 years, respectively. The mean values of the confidence communication subscale of RPQ in the CBME and non CBME batches were 3.78±0.728 and 4.04±0.749 respectively, with a p-value of 0.002. The mean values of the Job Satisfaction (JS) subscale in CBME and non CBME batches were 3.86±0.728 and 3.90±0.789, respectively, with a p-value of 0.003. Conclusion: There was no significant difference between the two groups, except for the two aforementioned subscales, in which mean values in the non CBME batch were significantly higher. FGD, apart from confirming the above findings, also suggested the introduction of an e-logbook and effective assessment through it.

Clinicopathological Analysis of Adnexal Masses Presenting in a Tertiary Healthcare Centre, Karnataka, India: A Retrospective Observational Study

Sanjana K Murthy, Kala Katti, Ramya Karanam

Introduction: The ovaries, fallopian tubes, and the broad ligament make up the anatomical adnexa. Adnexal masses represent a commonly occurring issue in gynaecology. The majority of ovarian malignancies are detected at advanced stages. The clinical manifestations of adnexal masses vary, with many cancers either showing no symptoms or presenting with vague signs. In the reproductive age group, the most typical manifestation is a benign functional cyst. Aim: To conduct a clinico-pathological analysis of adnexal masses among women presenting at a tertiary healthcare centre. Materials and Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at Akash Institute of Medical Science and Research Centre, Devanahalli, Karnataka, India, from November 2022 to April 2024. The diagnosis of adnexal mass was based on clinical symptoms, abdominal examination, bimanual examination, and trans-abdominal ultrasound. The CA-125 and other tumour markers were sent depending on the risk of malignancy. All tissues were sent for histopathological examination. The data were collected and tabulated in a Microsoft excel sheet, and percentages were calculated. Results: This study included 38 cases, in which benign ovarian and para-ovarian cysts were the most common findings, observed in 21 cases (55.3%). There were six cases of benign serous cystadenoma (15.8%), three cases of teratoma (7.9%), two cases of high-grade serous carcinoma (5.3%), one case of germ cell tumour (2.6%), one case of mucinous cystadenoma (2.6%), two cases of endometriotic cysts (5.3%), one case of adnexal cystic degeneration of a fibroid (2.6%), and one rare case of primary fallopian tube carcinoma (2.6%). The most common presenting complaint was abdominal pain, reported in 21 cases (55.3%). Conclusion: Adnexal masses can present in a variety of forms, ranging from benign cysts to infections and cancers. A thorough history and clinical examination are essential for accurate diagnosis. Investigations support the diagnosis, and histology confirms it.

Development of a Blended Physiotherapeutic Module for Young Adults with Non-Specific Chronic Low Back Pain: A Feasibility Study

Jahnavi K Salian, Nityal Kumar Alagingi

Introduction: Non-Specific Chronic Low Back Pain (NSCLBP) is a prevalent non-communicable disease in India, burdening individuals psychologically and socially. Due to economic constraints, people prefer self-management rather than seeking professional advice. Therefore, their go-to search strategy for self-management is social media platforms. Many researchers have identified a lack of evidence in these social media videos. Aim: To develop and evaluate the feasibility of a blended physiotherapeutic module for young adults with NSCLBP. Materials and Methods: This feasibility study was conducted at Nitte Institute of Physiotherapy, NITTE (Deemed to be University), Deralakatte, Mangaluru, Karnataka, India from July 2023 to December 2023. This study involved three phases: identifying modifiable risk factors for exercise adherence in individuals with NSCLBP, developing a module, and evaluating its feasibility. Twenty-four young individuals with low back pain were given the blended physiotherapeutic module for four weeks, consisting of three sessions per week. The first two sessions were conducted online, and the following session was face-to-face. The data were analysed using SPSS software (SPSS Inc.; Chicago, IL) version 29.0.10. The collected data were summarised using Descriptive Statistics: frequency, percentage; mean, and Standard Deviation (SD). To compare the Quebec Back Pain Disability Scale (QBPDS) and Numerical Pain Rating Scale (NPRS) scores, repeated measures ANOVA was employed. The Bonferroni test was utilised for pairwise comparisons of QBPDS and NPRS scores. A p-value <0.05 was considered significant. Results: In this study, the average percentage of individuals who performed exercises for four weeks was 22 (91.7%), indicating high adherence. There was a significant difference (p-value <0.05) in the QBPDS as well as the NPRS from baseline to weeks -2, 3, and 4. Conclusion: The developed blended physiotherapeutic module for NSCLBP individuals was found to be feasible. Positive results were identified in reducing pain and disability after two weeks. This study aids individuals struggling with physiotherapy exercises in a digitalised society, suggesting that future research could incorporate real-time movement analysis and regional language databases and software that should be validated.

Evaluation of Cervical Spine Curvature and its Relation with Cranial Base in Class I, Cleft and Class III Malocclusion Individuals: A Cross-sectional Analysis

Dhwani Suchak, Ranjit Kamble, Renuka Talla, Nishu Agarwal

Introduction: According to the literature, an existing correlation is said to be present between craniocervical and craniofacial morphology. Recent studies have revealed that there are certain variations among the different forms of craniofacial patterns with respect to the morphology of the vertebrae. Since there are very few studies comparing the curvature of the cervical column in relation to the cranial base in Cleft, Class-I and Class-III individuals, this study was carried out. Aim: To provide a comprehensive comparative analysis of the curvature of the cervical vertebral column and its relationship with the cranial base in Class-I, cleft, and Class-III individuals within the Central Indian population. Materials and Methods: In this cross-sectional study conducted at the Department of Orthodontics and Dentofacial Orthopaedics at Sharad Pawar Dental College and Hospital, Sawangi (M), Wardha, Maharashtra, India, patients with skeletal Class-I, Class-III, and Unilateral Cleft Lip and Palate (UCLP) or Bilateral Cleft Lip and Palate (BCLP) in the Central India region were included. The study duration was eight months, from April 2022 to January 2023. The research involves a meticulous examination of 90 individuals, divided into three groups: Class-I individuals (n=30), cleft individuals (n=30), and Class-III individuals (n=30). A comprehensive set of radiographic and cephalometric measurements will be employed to assess cervical vertebral curvature. One-way Analysis of Variance (ANOVA) test was used for analysis. Results: With the exception of Sella-Nasion to Gonion Gnathion (SA-Go-Gn), where the p-value was 0.13, a statistically significant difference between Class-I and Class-III was seen for all angles. For Class-III cases with clefts, every angle revealed a statistically significant difference. Except for SN-Go-Gn (p=0.65), all of the angles revealed a statistically significant difference when compared to Class-I with Cleft, with a p-value <0.05. Conclusion: The modified curvature angle utilised in the present study facilitated the assessment of cervical curvature in Cleft, Class-I, and Class-III malocclusions, revealing differences in skeletal sagittal jaw relations, particularly in their cervical positions, as indicated by the study findings. Participants in skeletal Class-III had significantly straighter cervical columns than participants in skeletal Class-I. A significant difference between the maxillary base, mandibular base, and the midsection of the spinal column was seen between all three groups.

Estimation of Salivary Copper in Smokeless Tobacco users with Oral Premaligancies and Malignancies: A Cross-sectional Study

Introduction: The estimation of serum bioelements for the identification of oral premalignant and malignant lesions has been extensively studied. Higher amounts of copper have been found in all smoking and Smokeless Tobacco (SLT) products, which are responsible for the higher incidence of premalignant and malignant lesions in the oral cavity. Limited studies have shown the significance and role of salivary bioelements in premalignant lesions, such as Oral Submucous Fibrosis (OSMF) and oral leukoplakia, and malignant lesions like Squamous Cell Carcinoma (SCC) of the oral cavity. Aim: To estimate salivary copper levels in premalignant and malignant lesions of the oral cavity. Materials and Methods: The preent cross-sectional study was undertaken in Tagore Dental College and Hospital in Chennai, Tamil Nadu, India for a period of 6 months, from March 2022 to August 2022. A total of 50 patients were recruited and divided into five groups of 10 patients each: Group I- control group; Group II- SLT chewing habit without any oral lesion; Group III- 10 patients with Tobacco Pouch Keratosis (TPK); Group IV- 10 patients with OSMF; and Group V- 10 patients with oral SCC. About 5 mL of salivary samples were collected and centrifuged at 3000 rpm to obtain the supernatant saliva for analysis. The levels of copper were estimated using photo calorimetry. Statistical analysis was done using One-way Analysis of Variance (ANOVA) followed by a Post-hoc test. Results: A total of 50 patients with a mean age of 40±20 years were included in present study, comprising 46% females and 54% males. There was a statistically significant difference (p<0.05) between the mean salivary copper levels in the premalignant lesions of the oral cavity. Within the premalignant group, copper levels were found to be more in OSMF (Group IV: 296.64±56.08) compared to the other groups (Group II: 202.95±125.14; Group III: 229.25±73.35). In the oral cancer patients, no significant difference (p-value=0.174; not less than 0.001) obtained in salivary copper levels. Conclusion: Compared to the control group, salivary copper levels were significantly higher in cases of OSMF, followed by cases of TPK and non lesional cases.

Perception of First-year Medical Students’ Regarding Five Microskills of the One-minute Preceptor Model in Early Clinical Exposure: A Quasi-experimental Study

Mangala N Sirsikar, Shrabani Mohanty, Aga Ammar Murthuza

Introduction: Early Clinical Exposure (ECE) bridges the gap between theory and practice for medical students. The One-minute Preceptor (OMP) model, a widely used clinical teaching framework, promotes effective feedback and critical thinking efficiently. It employs five microskills: commitment, evidence probing, teaching rules, reinforcing correct actions, and correcting mistakes. This structured approach enhances clinical teaching in limited time, particularly in outpatient and ambulatory settings. Aim: To evaluate the perceptions of first-year MBBS students regarding the effectiveness of the five microskills of the OMP model during ECE. Materials and Methods: A quasi-experimental study was conducted at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India, from September 2019 to June 2020, involving 188 first-year MBBS students. Data were collected through questionnaires focusing on the OMP’s five microskills. Pretest and post-test scores were compared, and session feedback was obtained using a validated 10-item questionnaire. Paired t-tests and Analysis of Variance (ANOVA) were used for statistical analysis. Results: The study sample comprised 102 females and 86 males students (mean age 19.2 years). Results showed a significant increase from pretest (10.55±4.4558) to post-test (22.29±1.687). Students reported improvements in diagnostic capabilities (67.6%), understanding of clinical history (64.9%), self-directed learning (60.6%), critical thinking (58%), clinical reasoning (57.5%), and decision-making confidence (52.1%). The OMP also promoted motivation for rectifying mistakes. Conclusion: ECE using the OMP model proved to be effective in enhancing various aspects of students’ clinical skills and reasoning abilities. The study recommends including the OMP in preclinical competency-based curricula to prepare students for busy clinical practice and outpatient settings.

Histopathological Study of Obstructive Lesions of Small and Large Intestine: A Cross-sectional Study in Uttarakhand, India

Swati Pundir, Prabhat Pant, Vindhya Joshi

Introduction: Intestinal obstruction is the impairment or arrest of the passage of contents through the intestine. Tubercular aetiology is the commonest cause of small intestinal obstruction in developing countries, while postoperative adhesions are common in developed countries. Neoplastic aetiology is more common in Large Bowel Obstruction (LBO). Clinical and radiological findings are non specific, and histopathology is required for a definitive diagnosis of the aetiology. Aim: To study histopathological examination of obstructive lesions of the small and large intestine. Materials and Methods: The present cross-sectional study was conducted from January 2020 to September 2021, including a total of 77 cases of intestinal obstruction due to mechanical causes. Detailed gross and microscopic examinations were performed, along with routine and special stains (wherever required), in the Department of Pathology at Government Medical College, Haldwani, Nainital, Uttarakhand. Data were presented in numbers and percentages. Results: The present study showed a male predominance 46 (59.8%) with a male to female ratio of 1.5:1. The most commonly affected age group was 31-40 years 20 (25.9%). Constipation (76; 98.7%) was the most common clinical symptom, followed by abdominal pain 72 (93.5%). The small intestine was more commonly involved 35 (45.5%), with the ileum being the most commonly affected site 40 (53.2%). Among cases of large intestine obstruction, the caecum was the most common site 10 (14.2%). Perforation was the most common gross finding 25 (32.9%). Non specific inflammatory pathology was the most common cause of obstruction (23.5%), followed by adenocarcinoma (20.8%). Tubercular pathology was the third most common cause (11.9%). Conclusion: The present study highlights the important pathologies in the aetiology of obstruction. Prevention and early intervention can help control some of the infective diseases and avoid such emergencies. Early diagnosis and treatment of neoplastic pathology, which is a leading cause of LBO, are beneficial for the better management of patients. A detailed histopathological study of small intestinal specimens should be conducted in constant correlation with clinical and radiological findings for an accurate diagnosis.

Initiation and Continuation of Antitubercular Therapy during Early COVID-19 Pandemic Period in Sonepat, Haryana, India: A Cross-sectional Study

Murugadass Narendran, Anita Punia, Ramesh Verma, Deepika Kataria

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has halted the progress of India made towards the ambition of achieving Tuberculosis (TB)-free status by 2025. Steps taken to control the disease have affected many national health programs, including those for TB. Aim: To understand the delays in diagnosing and initiating therapy among TB patients receiving Antitubercular Therapy (ATT) during the early COVID-19 pandemic period. Materials and Methods: This was a cross-sectional study conducted in the Sonepat District of Haryana state, India. The study was conducted among 20% of the total Nikshay Portal-notified TB patients who received treatment from the public sector in the second and third quarters of 2020. Data was collected using a pretested semistructured schedule consisting of variables related to demography, past medical history, symptoms leading to TB diagnosis, place of diagnosis, time between symptom onset and diagnosis, duration taken for initiating therapy, and reasons for delays. The Chi-square test and Fisher’s exact test were used to test the significance of the differences. A p-value <0.05 was considered significant. Results: ‘Diagnostic Time delay’ was observed among 86 (35.1%) of the participants, with a 30-day median delay. ‘ATT initiation delays’ were observed in 51 (20.8%) with a four-day median delay, and 23 (8.6%) of patients reported at least one episode of treatment interruption. ‘Being diagnosed for other diseases’ 70 (28.6%) and ‘ignoring symptoms’ 28 (11.4%) constituted the major reasons for ‘Diagnostic time delay’. The non availability of drugs 11 (47.8%) and discomfort with drugs 07 (30.4%) were the major reasons for treatment interruption. Conclusion: Ignorance of symptoms and suspicion of other diseases constituted diagnostic delays, and therapy initiations were prolonged more during the pandemic period.

Comparison of Analgesic Efficacy of Levobupivacaine with or without Dexamethasone in Lower Abdominal Surgeries under Subarachnoid Block: A Pilot Randomised Controlled Trial

Introduction: Subarachnoid Block (SAB) is a commonly used technique for lower abdominal surgery. Dexamethasone has been proven effective as an additive when used with bupivacaine. However, there has been no study comparing the analgesic efficacy of dexamethasone with levobupivacaine under SAB. Aim: To compare the analgesic efficacy of levobupivacaine with or without dexamethasone in patients scheduled for lower abdominal surgeries. Materials and Methods: A pilot randomised double-blind controlled trial was undertaken in the Department of Anaesthesiology, University College of Medical Sciences Guru Tagh Bahudur (UCMS-GTB) Hospital, New Delhi, India on 60 patients with Americian Soceity of Anaesthesiolgy (ASA) grade I or II, aged 18-65 years, undergoing lower abdominal surgeries under SAB from January 2021 to August 2022. In Group LS, 12.5 mg of 0.5% isobaric levobupivacaine (2.5 mL) with normal saline (1 mL) was administered, and in Group LD, 12.5 mg of 0.5% isobaric levobupivacaine (2.5 mL) with 4 mg dexamethasone (1 mL) was given. Patients were assessed for sensory and motor block, haemodynamic parameters, pain score, and side-effects. Unpaired t-tests/Mann-Whitney U tests were used to determine significance. A p-value of less than 0.05 was considered significant. Results: The two groups were comparable in terms of demographic profile. The age in the LS group was 37.80±9.98 years, and in the LD group, it was 38.63±12.37 years. The male-to-female ratio in the LS and LD groups was 17:13 and 21:9, respectively. The weight range in both groups was between 50 to 67 kg. The Basal Metabolic Index (BMI) was 22.40±2.43 kg/m2 and 21.70±2.21 kg/m2 in the LD and LS groups, respectively. All these parameters, including height, had a p-value of more than 0.005, except for the duration of analgesia. The duration of effective analgesia was also longer in the LD group (247.00±36.69 min) than in the LS group (138.50±22.52 min) with a p-value of <0.001. The time of onset of sensory block was 9.13±2.98 minutes in the LD group and 10.30±3.06 minutes in the LS group, which was statistically insignificant. Conclusion: Authors concluded addition of 4 mg (1 mL) of dexamethasone to 2.5 mL of 0.5% isobaric levobupivacaine provides a clinically longer duration of effective analgesia with early onset and better quality of sensory and motor block than 2.5 mL of 0.5% isobaric levobupivacaine alone. Therefore, 4 mg of dexamethasone with 2.5 mL of 0.5% isobaric levobupivacaine is recommended for lower abdominal surgeries under SAB.

Analysing Public-private Partnership Practices for Haemodialysis Services using Collaborative Governance Framework: A Qualitative Study

Masyitoh Basabih, Eko Prasojo, Amy Yayuk Sri Rahayu

Introduction: Public-Private Partnerships (PPPs) are viewed as a solution for gaps in healthcare access, quality and affordability. Operational Cooperation (OC) is a common practice in haemodialysis services at regional hospitals in Indonesia. Aim: To analyse the implementation of OC for haemodialysis services at Regional Public Service Agency (RPSA) hospitals from the perspective of collaborative governance. Materials and Methods: This qualitative research utilised interviews, focus groups, and document analysis to explore the implementation of OC from a collaborative governance perspective. The study was conducted at Regional Hospitals, Regional Government Offices, the Ministry of Health, the Ministry of Home Affairs, Medical Device Companies, and the Association of Regional Hospitals of Indonesia from December 2021 to March 2022. Data were collected from in-depth interviews and Focus Group Discussions (FGDs) with 15 informants, including policymakers, hospital managers, and partner companies. Other data included nine national-level and 29 regional-level policy documents. NVivo software was used for coding and to ensure data validity through triangulation. The parameters evaluated included system context, drivers, collaborative processes, and collaboration outcomes according to Emerson’s collaborative governance framework. Results: The implementation of PPP for haemodialysis services at regional hospitals is driven by the need for these services and limited resources. Despite the incomplete policy framework, regional hospitals are taking steps to establish collaboration. Hospitals are streamlining operational process flows, creating a domino effect for other services. Even without a feasibility study, the implementation of PPP in regional hospitals in Indonesia has successfully addressed the community’s need for access to haemodialysis services. Conclusion: The implementation of PPPs in the form of OC has successfully expanded access to haemodialysis services. However, challenges related to policy, human resources, and corruption pose significant obstacles to the implementation of OC.

Reliability and Validity of Gujarati Version of Nomophobia Questionnaire: A Cross-sectional Study

Niyati Nileshbhai Patel, Dhwanit S Shah

Introduction: Nomophobia is considered a modern-age phobia whereby individuals fear being without a smartphone. The present study focuses on translating the Nomophobia Questionnaire (NMP-Q) into Gujarati to measure nomophobia. Aim: To assess the reliability and validity of the Gujarati version of the NMP-Q, aiming to enhance research, public health initiatives and clinical assessments. Materials and Methods: This cross-sectional study was conducted from May 2023 to November 2023 at the Department of Physiotherapy, Vidhyadeep Institute of Physiotherapy, Surat, Gujarat, India and comprised two phases: 1) Face and content validation through expert clinical review; 2) Test-retest reliability. Face and content validity of the Gujarati NMP-Q were determined using the consensus method with a total of 200 participants aged between 15-18 years. To assess the reliability of the Gujarati NMP-Q, internal consistency and test-retest reliability were evaluated. Test-retest reliability was determined using the Intraclass Correlation Coefficient (ICC) and internal consistency was calculated using Cronbach’s alpha. Results: A total of 200 participants (mean age 17.60±1.40 years) were included in the study. The Gujarati version of the NMP-Q demonstrated excellent test-retest reliability, indicated by a high ICC (0.986) and high internal consistency (0.972). The values for Content Validation Ratio (CVR), Item-level Content Validation Index (I-CVI), Modified Kappa (K) and Proportion of Agreement were all 1. Conclusion: The Gujarati version of the NMP-Q exhibits excellent reliability and good face and content validity. It is deemed adequate and valuable for assessing the level of fear of being without a smartphone in daily life among Gujarati-speaking school students.

Correlation between Pain, Disability, and Quality of Life in Young Adults with Chronic Non-Specific Low Back Pain: A Cross-sectional Study

Priti Mehendale, Madhavan Iyengar, Bhavana Gadhavi, Geeta Bhatt

Introduction: Chronic Non-Specific Low Back Pain (CNLBP) is characterised by persistent pain lasting more than 12 weeks. Common contributing factors include sedentary jobs, prolonged periods of inactivity or sitting, and a lack of physical activity. CNLBP can restrict everyday activities such as dressing and bathing, potentially leading to disability and a reduction in the Quality of Life (QOL). Aim: To determine the correlation between pain, disability, and QOL in young adults with CNLBP. Materials and Methods: A cross-sectional study was conducted from November 2021 to June 2024 at the outpatient department of KJ Somaiya College of Physiotherapy. After obtaining approval from the institutional ethical committee and based on the selection criteria, a total of 98 participants were included. The outcome measures utilised in the study included the Roland Morris Disability Questionnaire-24 (RMDQ-24), the World Health Organisation Quality of Life Brief Version (WHO QOL BREF), and the Numerical Pain Rating Scale (NPRS) to assess disability, QOL, and pain, respectively. Pearson’s correlation test was employed to determine the correlation between these parameters. Results: The findings of the study indicated non-significant correlation between pain and disability (r=0.0021, p=0.4918), between pain and QOL (r=-0.0016, p=0.9872), and a negative, non-significant correlation between disability and QOL (r=-0.1015, p=0.3196). Conclusion: The study concluded that there was no correlation between pain and disability, QOL and disability. Similarly, a negative non significant correlation was obtained between disability and QOL in young adults with CNLBP.

Study of VEP in Ethambutol Optic Neuropathy: A Cross-sectional Study

Introduction: One important first-line drug for treating Tuberculosis (TB) is Ethambutol (EMB), which carries a built-in risk of causing optic neuropathy, potentially resulting in permanent visual impairment. The subjective tests currently used in the diagnostic process, such as visual acuity and visual field assessments, may overlook early changes in visual function. The purpose of the present study is to investigate how well Visual Evoked Potentials (VEP) work as an evaluation tool for identifying optic neuropathy. Aim: To assess the utility of VEP in detecting subtle changes in visual function due to EMB-induced optic neuropathy. Materials and Methods: The cross-sectional study conducted at the Department of Physiology, B.J. Medical College, Ahmedabad, Gujarat, India, over approximately five months (August 2023 to December 2023) involved 62 eyes, with 30 eyes from TB patients undergoing EMB treatment and the rest serving as a control group. VEP recordings were made using a Personal Computers (PC)-based, 2-channel Recorders & Medicare Systems Pvt. Ltd. Nerve Conduction Velocity (NCV) Electromyography (EMG) Mark II machine with standard silver-silver chloride disc electrodes. VEP recordings were conducted regardless of the treatment period and the analysis focused on the amplitude and latency of the P100 wave, a critical component of VEP. Statistical analysis was carried out using Student’s unpaired t-test to compare the results between both groups, with p-values calculated. Results: The mean age of case was 40±17.4 years and controls was 31.12±12.54 years. The study revealed changes in VEP parameters, specifically showing a progressive reduction in P100 amplitude (p-value=0.0001). Conclusion: The present research highlights the potential of VEP as a sensitive and reliable method for assessing EMB-induced optic neuropathy. Incorporating VEP into routine ophthalmologic assessments for patients receiving EMB could improve TB management while reducing the risk of vision loss.

The Impact of Bariatric Surgery on Social Support, Resilience and Quality of Life: A Prospective Cohort Study

Vidhi Monga, Rayees Mohammad Bhatt

Introduction: Obesity has become a global health concern, with significant health risks and psychological consequences. Bariatric surgery has gained popularity as an effective treatment for morbid obesity. Therefore, with the increase in these diseases, it becomes crucial for people to manage their health and quality of life better. This study was planned to focus on the impact of bariatric surgery on quality of life, with a specific emphasis on social support and resilience. Aim: To investigate the impact of bariatric surgery on quality of life, with a focus on social support and resilience. Materials and Methods: This prospective cohort study was conducted at the Ckosmic Surgical Center in Moga, India, from June 01, 2022, to July 30, 2023. It included sixty participants who underwent pre- and post-assessments, comprising demographic data and psychological surveys. The inclusion criteria for this study were patients who had undergone bariatric surgery, had a BMI over 40 Kg/m2 or BMI over 35 kg/m2, were obese, and were aged between 18-65 years. By utilising the World Health Organisation (WHO) quality of life survey, this study compared pre and post-surgery results. The Statistical Package for Social Sciences (SPSS) analysis was employed to provide a more comprehensive evaluation of the results derived from complex datasets. Results: The results indicated significant improvements in quality of life and resilience following surgery, with a p-value of 0.01. However, social support remained stable, with no significant changes in scores. These findings contribute to the evidence supporting the benefits of bariatric surgery in treating morbid obesity. Conclusion: Bariatric surgery can enhance social support and resilience among obese patients. Therefore, the utilisation of surgeries such as One-Anastomosis Gastric Bypass (OAGB), Roux-en-Y Gastric Bypass (RYGB), and Sleeve Gastrectomy (SG) can offer substantial benefits in terms of both health outcomes and social support or resilience.

Safety and Efficacy of Bacillus coagulans SNZ 1969® Probiotic Supplementation in Reducing Infections in Malnourished Children: A Randomised, Double-blind, Placebo-controlled Study

MJ Fernandes, BR Daswani, AA Kinikar, RJ Soman

Introduction: Malnutrition, a significant global health challenge, increases children’s susceptibility to infections due to compromised immunity and altered gut microbiota. While probiotics have shown potential in improving gut health and immune responses, their efficacy in malnourished children, particularly those using Bacillus coagulans strains, remains understudied. Aim: To investigate the safety and efficacy of Bacillus coagulans SNZ 1969® among malnourished children aged between one and five years. Materials and Methods: A randomised, double-blind, placebo-controlled study was conducted at Byramjee Jeejeebhoy Government Medical College (BJGMC) and Sassoon Hospitals in Pune, Maharashtra, India among paediatric patients in the outpatient setting, after obtaining ethics committee clearance. Malnourished (moderately underweight) children were randomly allocated to either the probiotic group (B. coagulans SNZ 1969®) or the placebo group receiving the respective treatment for a duration of three months. Total days of illness, as well as the incidence of Gastrointestinal Tract (GIT) and Respiratory Tract Infections (RTIs), were assessed. Results: Out of 82 enrolled children, 46 (24 in the probiotic group and 22 in the placebo group) completed the full three-month study. A significant reduction in the total days of illness was observed in the probiotic group (p-value=0.009). Additionally, the probiotic group exhibited a slightly lower frequency of GIT and RTI episodes compared to the placebo group (1.32 vs. 1.48, p-value=0.077). A trend towards fewer days with respiratory symptoms in the probiotic group was noted compared to the placebo group (6.12±2.19 vs. 7.56±3.65; p-value=0.0687), along with a non significant decline in the occurrence of RTIs at the 31-60 and 61-90 day periods. Similar declining trends were observed for the occurrence of GI infections and total days with GI symptoms between the two groups (0.24±0.88 vs. 0.53±1.2; p-value=0.4593). B. coagulans SNZ 1969® treatment was well-tolerated, and no severe adverse events were reported. Conclusion: The study demonstrated a significant reduction in the total days of illness with B. coagulans SNZ 1969® treatment compared to placebo. Additionally, B. coagulans SNZ 1969® treatment was found to be associated with a non significant decrease in the occurrence of GI and RTIs, as well as a relatively shorter duration of infection among malnourished children under five years of age.

Role of Atorvastatin in the Development and Progression of Glucose Intolerance in Albino Rabbits: An In-vivo Experimental Study

Sansita Parida, Trupti Rekha Swain, Sabita Mohapatra

Introduction: Type 2 diabetes is associated with obesity and dyslipidemia, which are risk factors for cardiovascular disease. The Food and Drug Administration (FDA)-approved indications for statins are being broadened due to their lipid-lowering and pleiotropic effects; statins are currently among the most widely used drugs in patients with and without diabetes. Aim: To evaluate the role of atorvastatin at different doses in the development and progression of glucose intolerance or diabetes in albino rabbits. Materials and Methods: An in-vivo experimental study on rabbits was conducted over a total duration of eight months in the Department of Pharmacology at SCB Medical College, Cuttack, Odisha, India. The animals were divided into five groups of six rabbits each. Atorvastatin at 4 mg/kg and 2 mg/kg was calculated based on human doses corresponding to 80 mg and 40 mg, respectively. Both doses were administered to non diabetic rabbits, and 4 mg/kg atorvastatin was administered to alloxan-induced diabetic rabbits orally for six months daily. Diabetes was induced in two groups of rabbits by administering 100 mg/kg alloxan monohydrate in a 5% (w/v) solution in sterile saline intravenously. Rabbits with stabilised moderate diabetes, characterised by a fasting blood glucose level above 200 mg/dL (at least one month after alloxan injection), were used for the experiments. The effect of atorvastatin on glucose tolerance was assessed by determining Fasting Blood Sugar (FBS) and Glycated Haemoglobin (HbA1c) levels. The results were compared with those of normal and diabetic control rabbits and statistically analysed using Analysis of Variance (ANOVA) and Repeated Measures ANOVA (RMANOVA), followed by appropriate post-hoc analysis. Results: Atorvastatin at a high dose resulted in a 26.74% increase in FBS and a 20.50% increase in HbA1c; at the standard dose, it produced a 21.3% increase in FBS and a 17.99% increase in HbA1c, respectively. The diabetic group receiving high doses also showed a significant increase in FBS (11.7%) and HbA1c (10.25%). The increase in blood glucose parameters was significant in the high-dose group from the fourth month of statin therapy and in the standard-dose group at six months of therapy. Conclusion: The study revealed that atorvastatin at both doses significantly contributed to the initiation and progression of glucose intolerance in diabetic and non diabetic rabbits.

Evaluation of Drug Prescription using WHO Prescription Indicators at a Tertiary Care Teaching Hospital, Raipur, Chhattisgarh, India: A Cross-sectional Study

Introduction: Prescription patterns significantly impact healthcare quality and patient outcomes. Evaluating these patterns using World Health Organisation (WHO) indicators helps identify areas for improvement and ensures rational drug use. The present study was conducted to evaluate prescription patterns via WHO indicators, aiming to uncover insights, identify discrepancies and enhance prescription quality within the institute for improved healthcare outcomes. Aim: To evaluate drug prescription patterns using WHO prescription indicators in the prescriptions of outdoor patients at a tertiary care teaching hospital in Chhattisgarh, India. Materials and Methods: A cross-sectional study was conducted in the Department of Pharmacology at Department of Pharmacology, Pt. J.N.M. Medical College, Raipur, Chhattisgarh, India, from July 15, 2023, to October 15, 2023 (a duration of 3 months), involving 1,000 outpatient prescriptions at Dr. Bhimrao Ambedkar Memorial Hospital (BRAM), Raipur, Chhattisgarh. Ethical clearance was obtained from the Institutional Ethics Committee (IEC) (No./MCI/Ethics/2023/45 Raipur, dated 12/07/2023). Data were collected using a digital form and analysed statistically. Parameters evaluated included the average number of medicines per prescription, the percentage of drugs prescribed by generic name, the percentage of prescriptions containing antibiotics, the percentage of prescriptions containing injections, and the percentage of drugs prescribed from the Essential Drug List (EDL). Descriptive statistics were used to summarise the data, and analysis was performed using Microsoft (MS) Excel 2021. Results: The present study included 1,000 prescriptions. A total of 4,320 medicines were prescribed across these prescriptions, with 2,853 (66.04%) prescribed by their generic name. Injections accounted for 483 (11.18%) prescriptions, while antibiotics were included in 663 (15.34%) prescriptions. Additionally, 2,973 (68.81%) medicines were prescribed from the EDL. The average number of medicines prescribed per prescription was 4.3. Conclusion: The study revealed that while certain aspects of prescription practices aligned with WHO indicators, notable discrepancies persisted. The percentage of antibiotics prescribed per prescription was in accordance with WHO guidelines. Strategic measures are needed to enhance prescription practices and align them more closely with WHO guidelines.

Evaluation of GATA3 and p53 Expression in Urothelial Carcinoma and their Association with Clinicopathological Parameters: A Cross-sectional Study

Introduction: Bladder cancer is the tenth most common cancer worldwide, with 90% of bladder cancers are Urothelial Carcinoma (UC). In India, its incidence is 1.6 per lakh population annually. GATA3 is a recently used immunohistochemical marker which is highly sensitive for UC. Alterations in the p53 pathway play an important role in tumour progression and the assessment of prognosis. Aim: To study the expression of GATA3 and p53 in UC and their association with clinicopathological parameters. Materials and Methods: An ambispective cross-sectional study was conducted in the Department of Pathology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, from September 2020 to August 2022. A total of 50 cases of histologically proven UC were subjected to immunohistochemistry with GATA3 and p53. The expression of GATA3 and p53 was evaluated in UC, and their association with clinicopathological parameters like age, gender, personal habits, tumour site, symptoms and signs, histological grade, and invasion into lamina propria and muscle was studied. The Chi-square test was used to determine the relationship between all parameters, with a p-value <0.05 considered statistically significant. Results were analysed by standard software (Stata version 23.1). Results: GATA3 expression was observed in 94% (47/50) of cases of UC. GATA3 expression was associated with histological grade and muscle invasion, with 66.7% (4/6) expression in high-grade muscle-invasive UC, compared to 91.30% (21/23) in non muscle invasive UC, and 100% (21/21) in low-grade UC. Additionally, 66.7% (14/21) of low-grade UC showed p53 expression, whereas 80% (24/30) of high-grade UC demonstrated p53 expression. Conclusion: GATA3 is a sensitive and specific marker for UC. Its expression is highly variable among different histological types of UC and decreases with increasing grade of tumour in the study. p53 expression was associated with the histological grade of the tumour and was statistically significant in this study. GATA3 can be utilised to predict the probable grade of the tumour and its behaviour by correlating it with p53.

Diagnostic Performance of p16^ink4a in the Presence of E6/E7 mRNA in Formalin-fixed Paraffin Embedded Specimens: A Cross-sectional Study

Ravindra Pratap Singh, Surendra Kumar Verma

Introduction: Clinically significant High-risk Human Papillomavirus (HR-HPV) infection in Oral Cavity Squamous Cell Carcinoma (OCSCC) is not clearly defined. There is uncertainty regarding the true impact of HPV-related variability (ranging from 0% to 100%) when using the GP5+/GP6+/MY09/11 (L1) primer. The identification of HPV DNA in tumours is insufficient to establish a causal viral association; therefore, a gold standard test is required to determine HPV’s role in malignant cells by identifying the transcripts of the E6/E7 mRNA viral oncogene and the p16^ink4a biomarker. Aim: To assess the diagnostic performance of p16^ink4a in the presence of E6/E7 mRNA in Formalin-fixed, Paraffin-embedded (FFPE) specimens. Materials and Methods: This cross-sectional study was conducted in the Department of Pathology at JIPMER in Puducherry, India, from February 2019 to April 2022. Combined molecular markers p16^ink4a and E6/E7 mRNA (considered the gold standard) from FFPE specimens of newly diagnosed Squamous Cell Carcinoma (SCC) were analysed to identify biologically and clinically relevant Infections using Immunohistochemistry (IHC) and real-time Polymerase Chain Reaction (PCR). Results: This study indicates that tissue samples with p16 positive expression (score of 2 or higher) showed the presence of HPV E6/E7 mRNA, with a sensitivity of 100% and a specificity of 91.67%. The relationship between p16^ink4a and E6/E7 mRNA expression in all OCSCC cases was found to be significant (p-value=0.003). Conclusion: The study found a significant relationship between mRNA and p16^ink4a overexpression in tongue SCC. This finding suggests that alterations in mRNA expression levels are associated with changes in p16^ink4a expression in tongue cancer. Such understanding could potentially aid in the development of diagnostic or therapeutic strategies targeting these molecular pathways in tongue SCC.

Influence of Different Head and Neck Positions on Oropharyngeal Leak Pressure with the LMA Protector Airway: A Cross-over Study

Introduction: The assessment of seal pressure or leak pressure in supraglottic devices has commonly been used to confirm device functionality and for research purposes regarding laryngeal mask airways (LMAs). When used for controlled ventilation, the LMA Protector provides a better oropharyngeal seal pressure. Aim: To compare the Oropharyngeal Leak Pressure (OLP) in different head and neck positions with LMA protector airway device. Materials and Methods: In this cross-over study, thirty-five patients of either sex, aged 18 to 70 years, American Society of Anaesthesiology (ASA) class I and II, with a weight range of 50-70 kg, scheduled for elective surgery under general anaesthesia where a supraglottic airway device was indicated, were enrolled. In all 35 patients, the position of the patient’s head and neck was changed from neutral to flexion, extension, and right and left lateral rotation. The primary objective of the study was to compare the differences in OLP with changes in head and neck positions using the LMA Protector airway device. Results: The mean age of the participants was 42.26 years, and the average weight was 63.34 kg. The LMA Protector was placed in 18 females and 17 males. A Mallampati grade of I was noted in 16 patients, while a grade of II was observed in 19 patients. The OLP achieved in this study was higher, providing adequate ventilation and oxygenation in all positions. The OLP and tidal volume in flexion were higher compared to the seal pressure in the neutral position (31.89 cm H₂O, SD 5.080 cm H₂O vs. 34.49 cm H₂O, SD 4.804 cm H₂O, p<0.05). No significant difference in OLP was observed when changing to different head positions, i.e., in extension, right lateral, and left lateral positions. Conclusion: The LMA Protector is an effective device in terms of achieving high oropharyngeal seal pressure. It produced better oropharyngeal seal pressure in the flexion position compared to the neutral position.

Evaluation of Behaviour of Child and Acceptance of Multicoloured and Conventional Composite Materials: A Split-mouth Randomised Clinical Study

Introduction: The most crucial abilities for a Paediatric Dentist involve evaluating and managing children based on their behaviour. Children are often motivated to choose coloured restorative materials. They tend to hold their new fillings in high regard and are usually fascinated by the new materials in their oral cavity. Consequently, they are more likely to maintain the restoration, which greatly enhances their overall oral hygiene and fosters a favourable attitude towards therapy. Aim: To evaluate the behaviour of children and their acceptance of multicoloured and conventional composite materials: A randomised controlled trial. Materials and Methods: A split-mouth, single-blinded, randomised clinical study was conducted on 25 patients with Class I occlusal caries at the Department of Paediatric and Preventive Dentistry, Government Dental College and Hospital (GDCH), Nagpur, Maharashtra, India, from July 2023 to January 2024. Healthy children aged between 5 and 10 years, who were visiting the dentist for the first time, were selected from the Department of Paediatric and Preventive Dentistry. The chidren were divided in two groups-group 1, 13 (52%) children with blue coloured composite restorations and group 2, 12 (48%) chidren who received conventional composite restorations. Behaviour was assessed using the modified behaviour rating scale before and after treatment. Data analysis was performed using Statistical Package for Social Sciences (SPSS) software version 16.0 with the Wilcoxon’s Signed-rank Test. Results: Among total of 25 children, 14 (56%) were males and 11 (44%) were females with a mean age of 8.47±1.59 years. There was a significant improvement in the behaviour of children after treatment with blue coloured compomer (p-value <0.001), whereas the change in behaviour in the conventional composite group was non significant (p-value=0.157). Conclusion: Coloured restorative materials, such as blue compomer, show promising results in paediatric dentistry by promoting positive behaviour and satisfaction among children, potentially enhancing oral hygiene practices.

Effectiveness of Nitrous Oxide Inhalation Sedation Utilising Two Distinctive Gas Dissemination Systems in Paediatric Patients undergoing Pulp Therapy: A Non-randomised, Split-mouth, Crossover Clinical Trial

M Nandini Devi, Ganesh Jeevanandan

Introduction: The success of any dental treatment fundamentally predicated on completing procedures with minimal discomfort and optimal patient cooperation. However, achieving this goal becomes particularly challenging in paediatric patients, whose behaviour is often influenced by a myriad of factors, including fear, anxiety and the unfamiliarity of the dental environment. While non pharmacological behaviour guidance techniques play a pivotal role in managing such challenges, there are instances where they prove insufficient, necessitating the utilisation of pharmacological behaviour management strategies such as Conscious Sedation (CS). Aim: To evaluate and compare the effectiveness of Nitrous Oxide Inhalation Sedation (NOIS) utilising two distinctive gas dissemination systems, the Matrx Porter and the Consed machines, in paediatric patients undergoing pulp therapy. The focus is on assessing patient behaviour, pain perception, and sedation outcomes. Materials and Methods: This non-randomised, split-mouth, crossover clinical trial conducted in the Department of Paediatric and Preventive Dentistry at Saveetha Dental College and Hospital in Chennai, Tamil Nadu, India from June 2022 to August 2022 employed 80 healthy but anxious children, aged 4 to 8 years, who required multiple treatments involving local anaesthetic administration across two consecutive appointments. Informed consent was acquired from their parents to perform a procedure under NOIS. The participants were sedated using the Consed machine (Group-A) during the first visit and the Matrx machine (Group-B) during the subsequent visit. Differences in pain were measured using the Modified Wong Baker’s pain rating scale, and sedation was assessed using the Ramsay sedation scale during local anaesthetic administration, behaviour using Frankl’s behaviour rating scale was assessed before the start of treatment and during local anaesthetic administration. Statistical analysis, performed with the Mann-Whitney test, evaluated pain, behaviour, and sedation levels in children undergoing dental treatment with two distinct gas distribution systems. Results: The mean age of the children included in the present study was 7.3±1.212 years. The study found significant differences in behaviour scores between the two groups at two time points: during local anaesthetic administration (p=0.039) and after completion of treatment (p=0.048). Specifically, during local anaesthetic administration, Group-B showed a higher proportion of children exhibiting improved behaviour compared to Group-A. However, no statistically significant differences were observed in pain scores during local anaesthetic administration (p=0.089) or sedation scores (p=0.074) between the Consed (Group-A) and Matrx (Group-B) machines. Conclusion: There were no observed alterations in the sedation levels of children who underwent NOIS, regardless of whether it was administered by the Consed or Matrx machine.

Comparative Evaluation of Surface Roughness and Colour Stability of Four Different Composite Resins after Application of Desensitising Agents: An In-vitro Study

Introduction: Dentinal Hypersensitivity (DH) is a common clinical condition usually associated with exposed dentinal surfaces. Desensitising agents are regularly used by patients experiencing hypersensitivity, which can affect the physical properties of the existing restorative material. Aim: To evaluate the surface roughness and colour stability of four different types of composite resin restorations after exposure to a desensitising agent. Materials and Methods: The in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India from January 2024 to March 2024. Total 56 standardised composite resin discs of size 8×2 mm thickness were prepared using four different types of composites: microhybrid, nanofilled, nanohybrid, and flowable. They were further divided into control and experimental groups based on the application of a desensitising agent, with seven samples in each subgroup. The desensitising agent was applied twice a day for three minutes for one month. Surface roughness was evaluated using a surface profilometer, and colour stability was assessed using a spectrophotometer with the Commision on Ilumination (CIE) L*a*b* formula. The data were analysed using Student’s t-test for pair-wise comparison and One-way Analysis of Variance (ANOVA), with Tukey post-hoc tests for intergroup comparison. Results: The application of a desensitising agent on the samples resulted in a significantly greater effect on the surface roughness of the experimental subgroup than their control counterparts (p≤0.05). Among all groups, the nanofilled group exhibited the lowest surface roughness (0.418±0.047), and the colour change (1.87±0.00) was clinically acceptable. However, the flowable group had the maximum colour change amongst all the other groups (3.16±0.00). Conclusion: Within the limitations of the study, nanofilled composite resin restorative material has minimal surface roughness and colour change after exposure to the desensitising agent. It can be considered the material of choice for restoration in patients with DH.

Effect of Formal Training on Tooth Shade Matching Ability among Indian Dental Students in Diverse Clinical Settings: A Quasi-experimental Study

Akanksha Mahajan, Neha Jain, Pankaj Dhawan

Introduction: Selecting a correct shade is the key to success of any prosthesis, especially in the aesthetic zone. Variations of shade in a single tooth or the polychromatic nature of a tooth can impose greater challenges in shade matching. Therefore, it would be best if it is taught during the undergraduate course in dental schools. Aim: To evaluate the knowledge and shade matching skills among dental undergraduate students with and without training in three different clinical conditions. Materials and Methods: This post-test only quasi-experimental study was conducted with 377 undergraduate students of Indian origin studying in a dental teaching institute. The students were divided into two groups based upon their clinical training in shade matching: Group I (trained, n=197) and Group II (untrained, n=180). Three different patients, in terms of their shade complexity, were presented to both the groups and their shade matching ability was assessed. The results were subjected to statistical analysis using the Chi-square test and one-way Analysis of Variance (ANOVA). Results: Statistical analysis showed that the mean correct scores of the trained students were significantly higher than those of the untrained students (p=0.0001) in all three patients. There was a statistically significant difference (p=0.0001), as the trained group was better able to identify the correct or clinically acceptable shade compared to the untrained group in all three cases. Conclusion: The study concluded that training significantly improved the shade matching ability of dental undergraduate students in clinical conditions presenting varied complexities.

Perception and Attitude among Patients Receiving Local Anaesthesia in Chengalpattu District, Tamil Nadu, India: A Questionnaire-based Cross-sectional Study

Charumathy Rajkumar, Balaguhan Balasubramanian, GR Karthikeyan, V Sakthisri

Introduction: Dental local anaesthesia serves several purposes, the most common of which is to minimise pain during dental procedures, thereby improving patient comfort and facilitating treatment. It can also have therapeutic effects, such as temporarily relieving pulpitis pain. Patients often experience anxiety before and after receiving local anaesthesia. Aim: To evaluate the perceptions and attitudes of patients receiving local anaesthesia through a self-administered questionnaire. Materials and Methods: This cross-sectional study was conducted among 398 patients, including 218 males and 180 females, between August 2022 and October 2022, who underwent dental extractions at a dental hospital in Chengalpattu district, Tamil Nadu, India. A 15-item questionnaire was administered to the patients. The questionnaire comprised three domains: the first domain included questions before the administration of local anaesthesia, the second domain included questions during the administration of local anaesthesia, and the third domain included questions after the administration of local anaesthesia. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) software. Results: Of the participants, 126 (40.20%) were between 46 and 60 years of age. Males constituted 218 (54.8%) and females constituted 180 (45.2%) of the sample. Additionally, 76.38% of the patients were unaware of the preinjection topical anaesthesia. Moreover, 70.35% of patients experienced anxiety before the administration of local anaesthesia. During the administration of local anaesthesia, 300 (75.4%) of patients reported experiencing moderate pain. Many patients exhibited physical manifestations of fear, including sweating in 92 (23.12%), light-headedness in 102 (25.63%), and palpitations after the administration of local anaesthesia in 190 (47.74%). Conclusion: Anxiety was more prevalent among patients prior to the administration of local anaesthesia. Patients were more anxious about the fear of the injection rather than the fear of the extraction itself. The outcomes of anaesthesia may be significantly improved by educating patients about dental treatment processes.

Relationship between Gerotranscendence and Oral Health-Related Quality of Life among Elderly Population in Tertiary Care Hospital, Wardha, Maharashtra: A Cross-sectional Study

Dolly Gabada, Sheetal Khubchandani, Priyanka Paul, Amit Reche

Introduction: Gerotranscendence represents a shift in meta-perspective, transitioning from a materialistic and rational outlook to a more cosmic and transcendent one. This phase fosters resilience in older individuals, enabling them to overcome the challenges and despondency associated with ageing, thereby promoting a positive embrace of the ageing process. Remarkably, individuals with high levels of gerotranscendence, even in the presence of poor oral health, demonstrate the capacity to cope and adapt to their circumstances. This adaptive capability may contribute to an enhancement in their self-reported Oral Health-Related Quality of Life (OHRQoL). Aim: To evaluate the relationship between gerotranscendence and OHRQoL among the elderly population in the Vidarbha region. Materials and Methods: This cross-sectional study was conducted over a 6-month period from March 2023 to August 2023 in collaboration with the Department of Prosthodontics and the Department of Public Health Dentistry at the Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra on 350 participants. The study included volunteers aged ≥70 years, residing in homes or old age homes, and those visiting tertiary healthcare centers. Methodologically, data collection employed a self-made organised proforma. Oral examinations were conducted using Type III inspections with a mouth mirror. Gerotranscendence was assessed using the Gerotranscendence Scale Type 2 (GST2), which was validated and translated into Marathi. The Geriatric OHRQoL was evaluated using the Geriatric Oral Health Assessment Index (GOHAI), also translated into Marathi. The study used Chi-square tests for categorical variables and Pearson’s and Spearman’s tests for correlation analyses. Results: The average gerotranscendence score was 23.45 (95% confidence interval [CI]: 22.96, 23.94), reflecting a mid-level of gerotranscendence, indicating that the gerotranscendence score was neither low nor high. According to Pearson’s and Spearman’s correlation tests, the gerotranscendence score was significantly positively correlated with age and self-perceived need for treatment. The mean GOHAI score was 40.16 (95% CI: 39.55, 40.76). A substantial positive association between the GOHAI and self-perceived need for treatment was found using Pearson’s and Spearman’s correlation tests. When comparing gerotranscendence and GOHAI, Pearson and Spearman correlation tests revealed a significant positive association (p<0.001). Conclusion: Gerotranscendence was significantly positively correlated with OHRQoL, independent of objective oral status. Despite having poor oral health, elderly individuals with high levels of gerotranscendence may be better able to handle and adapt to their circumstances, which could result in an improvement in self-reported OHRQoL.

Infection Control Awareness and Practices among Dental Students in Gujarat: A Questionnaire-based Cross-sectional Study

Diptesh Sureshbhai Rami, Chirag Chauhan, Bhagyashree Shreyansh Sutaria

Introduction: In recent years, medical advancements have led to significant progress in infection control, reducing risks in healthcare settings. However, Healthcare-Associated Infections (HAIs) remain a major global concern, affecting millions of patients each year and increasing morbidity, mortality, and healthcare costs. Dental clinics are susceptible environments for disease transmission, exposing dentists to blood-borne pathogens. Vigilance and strict infection control measures are essential in dental settings to protect both practitioners and patients. Implementing universal precautions in dental schools is crucial for controlling cross-infection, as it ensures that students are equipped with the necessary knowledge and attitudes for effective infection control. Aim: To evaluate the knowledge, attitudes, and practices of infection control among undergraduate dental students in the state of Gujarat. Materials and Methods: A cross-sectional questionnaire study involving 229 undergraduate dental students assessed knowledge and attitudes towards infection control at Ahmedabad Dental College and Hospital in October 2020. Approval was obtained, and a structured questionnaire adapted from previous literature was utilised. Rigorous content validation and analysis were conducted, revealing strong internal consistency. Data collection was conducted online and analysed using Chi-square tests for significance. Results: In the study, 185 (80.7%) of the respondents were female, and the majority of subjects were “Interns” (81, or 35.4%). The study shows significant gender differences in Hepatitis B vaccination (p=0.038), with both genders mostly vaccinated. However, attitudes and practices towards infection control did not significantly differ by gender. The study also reveals associations between the year of study and Hepatitis B vaccination (p=0.013), as well as attitudes and practices related to infection control. Notably, a considerable proportion of students across all years did not use protective eyewear during aerosol procedures. Overall, the study highlights awareness of infection control, with some variations by gender and year of study. Conclusion: The participants in this study demonstrated good knowledge and a positive attitude regarding infection control protocols. However, the practice of infection control methods varied, and consistency was not found.

Application of a Novel Colour Palette for Determination of End-point Decalcification of Hard Tissues: A Cross-sectional Study

N Fazulunnisa Begum, Reshma Poothakulath Krishnan, Deepak Pandiar

Introduction: Decalcification is a technique used to remove calcium salts from hard tissue specimens, such as bone or teeth, to make them suitable for sectioning. X-rays, physical methods, and chemical methods are commonly used to determine the endpoint of decalcification. However, these procedures can be cumbersome, may deteriorate the specimen, and are often subjective. Aim: To determine the endpoint of decalcification of hard tissue specimens using a colour palette. Materials and Methods: A cross-sectional study was conducted in the Department of Oral Pathology at Saveetha Dental College and Hospitals in Chennai, Tamil Nadu, India, over a period of 5 months. A total of 25 hard tissue specimens (10 bone and 15 teeth) were subjected to decalcification in 20% formic acid. To evaluate the endpoint of decalcification, silver nitrate solution was added to the formic acid, and the colour change was noted. The resulting colour was compared with a previously patented colour palette (Patent number: 202241047215). Once a lighter colour was obtained, the specimen was processed, sectioned, and stained using Haematoxylin and Eosin (H&E). The slides were then evaluated by two pathologists. Results: A total of 8 (80%) bone samples exhibited excellent staining, while 2 (20%) samples showed a good staining score. Regarding the tooth samples, 14 (93.3%) showed excellent staining, and one (6.66%) tooth displayed a good staining score. Conclusion: The present method is a simple and safe way to determine the endpoint of decalcification for a specimen. It does not damage the tissue, thus preserving the integrity of the hard tissue specimen.

Prevalence and Severity of Pulmonary Hypertension in Patients with Chronic Kidney Disease Stage 4 and 5: A Cross-sectional Study

Jagannath Dhadwad, Anish Chitnis

Introduction: Chronic Kidney Disease (CKD) is a multifaceted medical condition characterised by the gradual loss of kidney function over time, often leading to a myriad of complications affecting various organ systems in the body. Among these complications, Pulmonary Hypertension (PH) has emerged as a significant yet under-recognised co-morbidity, particularly in patients with advanced CKD stages 4 and 5. PH is defined by elevated mean Pulmonary Arterial Pressure (PAP) and increased Pulmonary Vascular Resistance (PVR). Understanding the intricate relationship between CKD and PH is essential for effective management and improved patient outcomes. Aim: To study the prevalence and severity of PH in patients with CKD stages 4 and 5 and to explore the relationship between PH and co-morbidities such as Type 2 Diabetes Mellitus (DM2) and systemic Hypertension (HTN) in these patients. Materials and Methods: This cross-sectional analysis was performed in the Department of General Medicine at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India on 100 cases from September 2022 to May 2024. The patients were divided into CKD stages 4 and 5 based on the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. PH was diagnosed based on 2D Echocardiography (ECHO) and categorised into mild, moderate and severe. Quantitative variables were compared using an unpaired t-test between CKD stages 4 and 5. Qualitative variables were compared using the Chi-square or Fisher’s-exact test. Results: The mean age of the study participants was 56.25±12.45 years. A total of 66% of the study participants were diagnosed with stage 4 CKD. In this study, a statistically non significant association was seen between the stages of CKD and the grades of PH (p-value=0.74). No significant association was found between diabetes and PH (p-value=0.97) in CKD stages 4 and 5. The median Pulmonary Artery Systolic Pressure (PASP) was found to be higher in non diabetics and non hypertensives in CKD stages 4 and 5 and this was statistically significant (p<0.0001). Conclusion: The prevalence of PH among CKD patients was 78%. However, the severity of PH was not found to be significantly associated with the severity of CKD. Co-morbidities were present in a substantial number of cases, but no significant correlation was identified.

Rapid Detection Methods for Carbapenemase Producing Gram-negative Bacilli with Reference to Phenotypic Carba M Test: A Cross-sectional Hospital-based Study

P Ganesh Perumal, B Dhanush Kumar, T Priyadharsini, B Appalaraju, R Someshwaran

Introduction: Carbapenem-resistant Gram-negative Bacilli (CR-GNB) cause many serious infections, resulting in increased treatment costs, prolonged hospitalisation, and a high mortality rate among infected patients. The survival of carbapenemase-producing Gram-negative organisms is enhanced by mechanisms such as the presence of carbapenemases, reduced expression, and porin mutations. Accurate tests for rapid detection of bacterial antibiotic resistance are crucial for tracking, preventing, and containing the spread of resistant genes within hospitals and communities, as well as for guiding therapy. Aim: To evaluate the performance of the ‘Carba M test’ compared to phenotypic Carba NP tests, Carbapenem Inactivation Method (mCIM/eCIM) tests, and genotypic Carba R tests for the phenotypic detection and characterisation of various types of carbapenemase-producing GNB. Materials and Methods: A cross-sectional study was conducted in the Department of Microbiology at PSG Hospitals, Coimbatore, Tamil Nadu, India which has 1400 beds. The study was carried out over a period of 15 months (from June 2022 to August 2023). A total of 250 CR-GNB were included as the study population. A comparative evaluation of the Carba M test, Carba NP test, Carbapenem Inactivation Method (mCIM/eCIM), and Carba R test for the rapid detection of carbapenemase-producing GNB using standard methods was done. The data were analysed, and odds ratios and p-values were calculated for statistical significance at a 95% Confidence Interval (CI). Results: A total of 250 CR-GNB were isolated during the study period, of which 83 (33.2%) were from the Medical Intensive Care Unit (MICU), followed by the Medicine department with 24 (9.6%). Enterobacteriaceae accounted for the majority of the isolates, with 229 (91.6%), followed by Pseudomonas aeruginosa with 17 (6.8%) and Acinetobacter species with 4 (1.6%). Klebsiella pneumoniae was the most common isolate among Enterobacteriaceae, accounting for 216 (86.4%). Out of the 250 CR isolates tested by the Carba R test, 100 (40%) were positive for the Oxacillinase (OXA)-48 enzyme, 35 (14%) for the New Delhi Metallobetalactamase (NDM) enzyme, 4 (1.6%) for Verona Integron-encoded Metallobetalactamase (VIM), and all were negative for Imipenemase (IMP), and Oxacillinase (OXA), and Klebsiella pneumoniae Carbapenemase (KPC) genotypes. The sensitivity of mCIM/eCIM observed in the study was 67.12%, and specificity was 85.71% when compared to the molecular genotype (GeneXpert® Carba R test). The modified Carba NP test detected carbapenemases in 229 isolates, yielding an overall sensitivity of 95.07% and a specificity of 74.07%. The overall sensitivity and specificity of the Carba M test for detecting carbapenemase-producing GNB were 97.31% and 70.37%, respectively. The isolates producing Class A/D (OXA-48-like) enzymes were identified with sensitivities of 98% and specificities of 73.68%, while those producing Class B (NDM, VIM) enzymes showed sensitivities of 94.87% and specificities of 87.5%. Conclusion: The Carba M test is a cost-effective, feasible, and rapid phenotypic test for detecting and differentiating Class B from Class A/D carbapenemases. The Carba M test could serve as a supplemental test alongside the Carba R, Carba NP test, or mCIM/eCIM for diagnosing carbapenemase production in GNB.

Autonomic Functions in Young Infertile Women with Polycystic Ovarian Syndrome: A Case-control Study

Introduction: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine and metabolic disorder in women of reproductive age, characterised by chronic anovulation, high androgen levels, Insulin Resistance (IR), and low-grade inflammation. Women with PCOS face increased risks of cardiac and metabolic issues, along with observed sympathetic overactivity. Aim: To assess the status of autonomic responses in women with and without PCOS through Autonomic Function Tests (AFT). Materials and Methods: The present study was designed as a case-control study, volunteers were recruited from the infertility centre of a tertiary care hospital and studied in the Department of Physiology. The study included 80 infertile women aged between 18 and 40 years. The study participants were divided into two groups: Group P included 40 volunteers with PCOS, while Group N included 40 healthy volunteers without PCOS and without any co-morbid conditions. Autonomic functions, which determine the sympathovagal balance, were evaluated. The data were analysed using IBM Statistical Package for the Social Sciences (SPSS) version 20.0. Results: The cold pressor test failed to raise Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) in Group P (124.45±8.55 mmHg and 83.75±8.27 mmHg, respectively) as effectively as in Group N (131.40±4.69 mmHg and 89.80±6.79 mmHg, respectively), indicating baroreceptor reflex insensitivity. Similarly, during the hand grip test, the rise in SBP and DBP was significantly lower (p-value <0.001) in Group P (119.10±7.79 mmHg and 85.45±8.49 mmHg, respectively) compared to Group N (128±6.50 mmHg and 92.65±6.5 mmHg, respectively). The 30:15 RR ratio and Valsalva maneuver results showed that DBP was significantly lower in Group P compared to Group N, with no significant difference in SBP after standing in both groups. The 30:15 RR ratio and Valsalva ratio were significantly (p-value=0.008 and p-value=0.004, respectively) lower in Group P (0.73±0.11 and 1.23±0.16, respectively) compared to Group N (0.82±0.16 and 1.36±0.23, respectively). Conclusion: The present study reported diminished sympathetic overactivity and increased parasympathetic activity due to normal Body Mass Index (BMI) in both groups.

Assessment of Vranaropana (Wound Healing) Activity of Porana paniculata Roxb. in Wistar Albino Rats: An Experimental Study Protocol

Nitesh Laxman Shambharkar, Dattatraya Sarvade, Anita Wanjari

Introduction: Ethnomedicine is the study of medicinal plants and their traditional uses in treating a variety of illnesses. Research on ethnomedicine and ethnobotany has great potential to grow and produce new medications. Because medicinal plants include a variety of biologically active compounds, documenting ethnomedicinal information is crucial to the discovery of novel molecules based on traditional knowledge. Need of the study: The plant Porana paniculata Roxb. has Ethno-medicinal properties. Traditional healers in the state of Chhattisgarh use its root paste topically to treat wounds and cure bone fractures. Only a single paper has been published on its anti-inflammatory and analgesic properties. Its ability to cure wounds has not been the subject of any scientific research. Aim: The study aims to evaluate the wound-healing activity of the extract of the root of P.paniculata Roxb. in Wistar albino rats. Materials and Methods: An experimental study will be conducted at Datta Meghe College of Pharmacy and Research, Datta Meghe Institute of Higher Education and Research, Sawangi (Meghe), Wardha, Maharashtra, India from June 2024 to Dec 2024. The Botanical Survey of India (BSI) will verify the authenticity of P.paniculata Roxb. roots that will be obtained from Chhattisgarh in Grishma (mid-April to mid-June) or Shishira Ritu (mid-December to mid-February). Wistar albino rats, scientific-grade chemicals, and gram-positive and gram-negative microorganisms will all be purchased from reliable sources. The preparation of an extract ointment will be employed to evaluate the activity of wound healing, in Wistar albino rats utilising an excision wound model. The antimicrobial activity will be evaluated using an Agar well diffusion technique. Data obtained will be analysed using One-way ANOVA and a p-value less than 0.05 will be considered as significant.

Comparative Evaluation of Penetration of Two Irrigating Solutions into Dentinal Tubules using Diode Laser and Ultrasonic Activation: A Confocal Laser Microscopy Study Protocol

Palak Hirani, Manoj Chandak

Introduction: Endodontic therapy aims to eradicate pulpal and periapical diseases by removing bacteria from root canals. Despite thorough cleaning, the smear layer obstructs canal disinfection. Root canal preparation and irrigation, particularly with sodium hypochlorite, are essential for debridement. However, conventional techniques may leave areas untreated, necessitating innovative solutions like superoxidised water and Laser-activated Irrigation (LAI) for effective treatment. Need of the study: The effectiveness of root canal treatment is contingent upon the success of the irrigating solution and the mode used for its activation, which is directly reflected in its ability to penetrate dentinal tubules. Thus, the focus of this experimental in-vitro study is to identify the most suitable irrigating solution and an effective activation technique for better penetration into dentinal tubules. Aim: The study will evaluate and compare the penetration of Sodium Hypochlorite (NaOCl) and oxidised water irrigants into dentinal tubules using diode laser and ultrasonic activation. Materials and Methods: An experimental in-vitro study will be conducted in the Department of Conservative Dentistry and Endodontics at Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India, from August 2024 to May 2025. The approach involves categorising 60 recently extracted single-rooted teeth with fully formed apical foramina and intact occlusal morphology into six primary groups according to distinct irrigation techniques and the application of two different irrigants, resulting in 10 teeth per group. Decoronated specimens will be injected with a specific irrigant and activated using different techniques. The penetration of oxidised water into dentinal tubules by low-level laser therapy and ultrasonic activation will be evaluated and compared using confocal laser microscopy. The normality of the data will be analysed using the Kolmogorov-Smirnov test. If the data are normal, then the T-Analysis of Variance (ANOVA) test will be applied; if not, the Kruskal-Wallis test will be used at a 5% level of significance (p≤0.05).

Proton Magnetic Spectroscopy in Diabetic Brain: A Comprehensive Review

Harshad Prakash Naik, Dakshata Betkar, Adiel Bhandari, Omkar Uttam Gaonkar

Diabetes Mellitus (DM) is on the rise making it a major concern for global health. DM can be classified into type 1 or type 2, and both can lead to changes in brain metabolites. These can result in serious complications like cognitive decline, particularly if not managed properly by diabetic patients. Magnetic Resonance Spectroscopy (MRS) is a non-invasive technique that allows us to study the brain metabolite levels. The present review utilises available Magnetic Resonance Imaging (MRI) data to understand how brain metabolites are affected in both type 1 and type 2 diabetes (T2DM). Research shows that in individuals with diabetes, there are changes in important brain chemicals such as Creatine (Cr), N-Acetyl Aspartate (NAA), Myo-Inositol (MI), Choline (Cho), glutamate, and glutamine. A consistent finding across multiple studies showed a reduction in NAA levels, which is a key indicator of brain neuron health. This suggests that diabetes negatively impacts the function of neurons in the brain. Changes were seen in other metabolites indicating potential disruptions in energy regulation and membrane function. This review concludes that alterations in brain metabolites as measured using MRS, could serve as a non-invasive biomarker for tracking the progression of DM and its related complications.

Understanding the Challenges and Stressors Faced by the Parents of Children with Autism Spectrum Disorder: A Narrative Review

Neelam Narula, Pawan Kumar

Perhaps the most traumatic experience for a parent is watching their child suffer in front of their eyes. Parenting, by its very nature, is a stressful activity; however, the stress of caring for an autistic child along with the myriad challenges it brings, can take a toll on parents’ health. To meet the complex demands of a child with Autism Spectrum Disorder (ASD), families can suffer from emotional, financial, and even physical burdens, which in turn leave them with little time for self-care and can lead to mounting sleep deprivation. In this review, an attempt has been made to understand the various challenges and stresses faced by the parents of a child with ASD. This review specifically focuses on mental health challenges, lack of sufficient time for self-care, problems related to communication, challenges associated with caring for an autistic child, stigmatisation related to mental health disorders, and the financial burdens faced by the parents of autistic children.

Analysing the Therapeutic Potential of Epsom Salt across Multiple Human Physiological Systems: A Comprehensive Review

Sakshi Vats, Lakshyashree, Nishat Khan, Mansi Jain, Kamran Ali

Epsom salt, also known as magnesium sulphate, has received a lot of interest in the realms of medicine and cosmetics because of its numerous medicinal and cosmetic uses. This article presents a detailed overview of the use of epsom salt in these sectors, emphasising its efficacy and adaptability. In medicine, epsom salt is known for its muscle-relaxing effects, making it a popular choice for treating discomfort, tension, and stress. Epsom salt’s magnesium content is thought to play an important role in inducing muscular relaxation and lowering inflammation, making it a helpful adjunct therapy for illnesses like muscle cramps and fibromyalgia. Furthermore, its osmotic laxative qualities have been recognised, providing a gentle but effective remedy for constipation relief when taken orally in adequate doses. In cosmetics, epsom salt acts as a natural exfoliator, removing dead skin cells and impurities to reveal smoother, revitalised skin. Its ability to clear pores and enhance skin texture has made it a popular ingredient in skincare products including scrubs, masks, and lotions. Furthermore, epsom salt baths have become a luxurious self-care practice, valued for its capacity to relieve sore feet, soften skin, and promote relaxation.

Healing Properties of Apamarga Kshara (Achyranthes aspera) in Ayurvedic Medicine: A Narrative Review

Naveen Singh, Devyani Dasar

Apamarga Kshara is a traditional Ayurvedic powder formulation composed of the herb Apamarga (Achyranthes aspera) and processed alkaline materials. It is renowned in Ayurveda for its therapeutic properties and is used in various medicinal preparations to treat a range of health conditions. This blend holds promise in Ayurvedic medicine for its purported healing properties. A comprehensive analysis can shed light on its effectiveness and applications in holistic healthcare. ‘Kshara’ pertains to both ‘Paka’ (preparation) and ‘Vidhi’ (application). Its effectiveness among the sharper and auxiliary instruments is notable, as caustic alkali facilitates excision, incision, and scarification, helping to balance the three doshas and serving specific medical functions. Among the parasurgical techniques, Agni (cauterisation), Kshara (caustic alkali), and Jalauka (leeches) are all significant. However, Kshara is the most prominent because procedures such as excision and incision cannot be achieved with Agni and Jalauka. It is particularly used for targeted treatments, such as in the case of Arsha caused by Pitta dosha. The objective of present review is to compile data on the primary phytochemicals present in Apamarga Kshara and its pharmacological effects. Kshara, an Ayurvedic concoction featuring Apamarga (Achyranthes aspera) and processed alkaline substances, underscores its significance in Ayurvedic healing. The approach taken in present review involves a detailed analysis of the Sushruta Samhita. Acharya Sushruta detailed the properties of Apamarga Kshara, including its abilities to cut (Chedan), pierce (Bhedan), scrape (Lekhan), dry (Shoshan), and balance the three Doshas. Apamarga Kshar is particularly effective in managing digestive disorders, skin conditions, and urinary tract infections due to its ability to neutralise excess acidity and support detoxification. The preparation involves processing the ash of the plant with specific alkaline substances, resulting in a powerful remedy with diverse medicinal applications. Apamarga Kshar is particularly effective in managing digestive disorders, skin conditions, and urinary tract infections due to its ability to neutralise excess acidity and support detoxification.

Unravelling the Psychological Impact of Trimethylaminuria: Insights into the Management Strategies

Shravani Ganjewar, Bhagyesh Sapkale, Priyanshu Raj, Sangeeta Totade, Nitin Lade

Trimethylaminuria (TMAU), colloquially known as fish odour syndrome, is a rare metabolic disorder characterised by the body’s inability to properly metabolise Trimethylamine (TMA), resulting in a distinctive and unpleasant fishy odour in bodily secretions. This comprehensive review explores the pathophysiology, clinical manifestations, genetic basis, diagnostic challenges, and psychological impact of TMAU, along with management strategies. Genetic mutations affecting the flavin-containing monooxygenase 3 (FMO3) enzyme, which is responsible for TMA metabolism, contribute to the condition’s hereditary nature. Diagnosis can be challenging due to intermittent symptoms and overlaps with other conditions, such as Olfactory Reference Syndrome (ORS). The psychosocial impact of TMAU can be profound, leading to embarrassment, social isolation, and mental health issues. Management strategies include dietary modifications, supplements, antibiotics, and hygiene measures to alleviate symptoms. Despite advances in understanding TMAU, further research is needed to enhance diagnostic accuracy and therapeutic approaches, ultimately improving the quality of life for affected individuals.

A Pathologist Visit to the Zoo: A Review on Animal Eponyms in Pathology

Seema A Umarji, K Padmapriya, SR Mangala Gouri

The world of pathology encompasses a broad spectrum of diseases beyond the boundaries of specialties, with each disease having specific and interesting gross and microscopic features. Some of these features are pattern-based, while others are eponyms that compare them to objects, food, animals, etc., due to their striking resemblance and quick recall. Medical nomenclature is of vital importance, and it has significantly evolved historically, with etymological roots from Latin, Greek, and Roman languages of ancient times to the current internationally uniform codes of English and other modern languages. Eponyms are valuable medical literary epithets that have been used across specialties and include animal names, food names, discoverer names, geographic references, and more. The subject of pathology, in particular, has immense use of eponyms as they are valuable tools for assisting in adult learning, or andragogy. The specialty of pathology is unique in its complex patterns and diagnostic algorithm, always in need of alternate systems to arrive at quick and accurate diagnosis. Also known as intuitive thinking or reflex thinking, pattern viewing and eponyms trigger a reflex recognition system, reducing recall time and aiding in precise diagnosis. The present article aimed to review the terminological phenomenon of animal eponym usage in the context of pathological diagnosis.

A Case of Liver Cirrhosis with Inflammatory Autoimmune Liver Disease Associated with Portal Hypertension and Hepatic Haemangioma

Vaibhav Chandra, Pramita Muntode, Abhay Gaidhane Sourya Acharya, Shubham Nimkar

Autoimmune Hepatitis (AIH) is a rare autoimmune disease that damages the liver over time and, if left untreated, can progress to liver cirrhosis. Clinical manifestations range from asymptomatic patients to those with acute hepatitis or chronic liver failure. Chronic autoimmune liver disease causes persistent liver injury, which results in unresolved inflammation, proliferation of cells, and the formation of extracellular matrix proteins by stellate cells of the liver and portal myofibroblasts. Cirrhosis of the liver and the resulting loss of normal liver function are unavoidable. Cirrhotic patients have a higher risk of morbidity and mortality, and problems of portal hypertension and/or liver dysfunction result in substantial deterioration in the decompensated phase. The theory suggests that among idiopathic or cryptogenic chronic hepatitis, most of them are autoimmune in origin. It is considered one of the rare liver diseases, especially in the Indian population. Portal hypertension is a dangerous complication caused by an obstruction in portal blood flow, such as cirrhosis or portal vein thrombosis. Hepatic Haemangiomas (HH) are benign liver tumours that are made up of groups of blood-filled cavities lined by endothelial cells and fed by the hepatic artery. The vast majority of HH are asymptomatic and are discovered by chance during imaging studies for unrelated pathologies. Hereby, the authors present a case of 53-year-old female with chronic liver disease with ascites, fatty change, and nodular hepatocellular hyperplasia, which was later found to be cirrhosis of autoimmune origin.

Navigating into the Dental Management of a Child with Morphea: A Case Report

Shrayana Bhattacharya, Sudipta Kar, Dipanjan Debnath, Shabnam Zahir

Morphea, a morphological variant of Localised Scleroderma (LoS) that typically occurs in children, is an inflammatory disease of connective tissue leading to skin and underlying tissue sclerosis due to increased deposition of collagen. The aetiology of morphea is quite elusive. Morphea, along with other regions also affects oral and perioral tissues; the most common affected implication being facial skin and tongue rigidity. The author reports a case of a 10-year-old female who reported to the Department of Paediatric and Preventive Dentistry for retained maxillary anterior deciduous teeth. The patient also presented with scarring on her face, chest, and arms. Her lips were thin, rigid and partially fixed producing microstomia with decreased mouth opening. Clinical examination, blood tests, Contrast-Enhanced Computed Tomography/High-Resolution Computed Tomography (CECT/ HRCT) of thorax, Antinuclear Antibody (ANA) test, Antineutrophilic Cytoplasmic Antibody (ANCA) Test, Anti-dsDNA Test, systemic sclerosis/myositis profile, and histopathological evaluation confirmed the diagnosis of morphea. The management of morphea is multidisciplinary. Hence, the role of a paediatric dental surgeon in recognising the development of disease progression in a patient and avoiding any oral complications is very important.

A Case of Pernicious Complication of Radiotherapy: Osteoradionecrosis of Mandible with Extensive Bilateral Involvement Following Dental Extraction

Pulkit Khandelwal, Harish Saluja, Seemit Shah, Anuj Dadhich

Osteoradionecrosis (ORN) is a condition of bone necrosis following mucosal breakdown after radiotherapy. It can lead to significant reduction in quality of life. ORN, particularly in the mandible, is a severe long-term complication of radiotherapy for head and neck cancer. ORN causes ulceration of oral mucosa with exposure of necrotic bone, pain, trismus and suppuration leading to chronic infection and non-healing wounds. Radiation-induced fibrosis, chronic infection, fistulae and necrotic tissues make the treatment challenging. We report a case of mandibular ORN in a 50-year-old female following dental extraction. Devitalised alveolar bone of the mandible was exposed intraorally through ulcerated mucosa from body-to-body region with multiple cutaneous fistulae. The necrosed bone was surgically debrided and healing was uneventful at the time of discharge. The patient was referred for Hyperbaric Oxygen Therapy (HBOT) for further management. Prevention of ORN is important for proper management of patients who undergo radiation therapy to head and neck region.