Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Massive Haemoperitoneum Postovulation: A Rare Complication of Unmonitored Anticoagulant Therapy Ketav Samir Joshi, Neema Sourya Acharya, Sourya Acharya, Samir Vinod Joshi Derangements in coagulation profile due to ongoing anticoagulant medication can complicate the most primitive physiology in a woman, ovulation. Unmonitored anticoagulant therapy can lead to an array of complications, one of which is intraperitoneal haemorrhage secondary to numerous medical and surgical conditions. The resultant haemoperitoneum can cause sudden hypovolemic shock, especially in a patient with compromised cardiovascular status. This report narrates the case of a 30-years-old nulliparous female patient on anticoagulant therapy, operated for multiple cardiac defects and developed massive haemoperitoneum as a consequence of ovulation. The patient presented in shock to the Emergency Department with unstable haemodynamic status. A multi-disciplinary approach to the case converged on ruptured functional ovarian cyst as a working diagnosis. Conservative management of haemoperitoneum was decided upon, whereby correcting shock and providing pro-coagulant therapy along with blood products was the main line of management. All efforts failed soon after when the cyst wall ruptured catastrophically, leading to collapse of the general condition of the patient. Surgical approach was undertaken and a ruptured ovarian cyst wall was identified to be the cause. The cyst wall was subsequently repaired electrosurgically and the patient recovered well with an uneventful postoperative period. However, the characteristic feature of this case is the lack of follow-up due to lockdown restrictions of this continuum, the Coronavirus Disease-2019 (COVID-19) pandemic. The management of such cases must be carefully titrated, keeping in mind the risks and benefits of both pro-coagulant and anti-coagulant therapy wherein one can jeopardise the effects of the other. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=QD01-QD04&id=16046 https://doi.org/10.7860/JCDR/2022/50491.16046 Retrieval of Separated Endodontic Ni-Ti Rotary File with the Aid of Hypodermic Needle and K-File: A Case Report S Pallavi , NJ Nagaraj One of the most prevalent operational errors that can occur during endodontic therapy is instrument separation. A fractured instrument may cause a blockage in the root canal, impeding the cleaning and shaping process. There are numerous recommended ways for retrieving a separated instrument, some of which are challenging to implement in clinical practice. Some of these procedures may need removal of substantial root dentin, which may weaken the tooth structure. This case report describes an alternate method for removing a fractured endodontic instrument from the root canal using a hypodermic needle and a K-file. A 31-year-old female patient came to the Department of Conservative Dentistry and Endodontics with the chief complaint of pain in the upper left front tooth region since two weeks. The clinical and radiographic examination indicated the existence of a broken Nickel-Titanium (Ni-Ti) rotary file along the coronal third of the root canal till apex. Under magnification, the fragment was initially exposed by creating a 2 mm trough around the fractured instrument using ultrasonics. In order to fix the fragment, a hypodermic needle was introduced into the root canal and the K-file was fitted in the needle lumen. Together, the fragment was removed without any complications. This technique can be used as a safe, easy, and low-cost approach of fractured instrument retrieval from the root canal. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZD01-ZD03&id=16049 https://doi.org/10.7860/JCDR/2022/52253.16049 A Case of Facial Discoid Lupus Erythematosus (LE) with Oral Lichen Planus (LP): A Dig into Co-existence and LE-LP Overlap K Manoharan, D Manoharan, N Ashok Kumar, Arisha Salam A distinction between &#8216;co-existence of Lupus Erythematosus (LE) and Lichen Planus (LP)&#8217; and &#8216;LE-LP overlap&#8217; bears importance as the criterion for true overlap necessitates histological and immunological features of both LE and LP to be found in the same tissue specimen. However, in the present case report the lesions of LE and LP were present in two different sites. A 51-year-old male presented with a large erythematous scaly atrophic plaque on the right cheek with similar lesions on chin and lips for 10 years. He also had violaceous lesions on the bilateral buccal mucosa and a white lesion over the left buccal mucosa for three years. Discoid Lupus Erythematosus (DLE) and Oral Lichen Planus (OLP) were suspected. Dermoscopy of the facial plaque showed features consistent with DLE. Histopathology of the facial plaque confirmed the diagnosis of DLE, whereas the white plaque on the left buccal mucosa showed features of early invasive squamous cell carcinoma. Violaceous lesion over the right buccal mucosa showed features suggesting OLP. A Direct Immunofluorescence (DI) was also performed for the buccal mucosa to rule out the possibility of DLE with oral involvement, which turned out to be negative. Therefore, a diagnosis of synchronous presentation of DLE and OLP along with Squamous Cell Carcinoma (SCC) of the buccal mucosa was made and patient was treated with topical corticosteroids, systemic hydroxychloroquine and surgical intervention for the squamous cell carcinoma. It is also imperative that not only long standing cutaneous lesions, but also oral lesions like LP should be investigated and kept under observation to look for any early malignant changes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=WD01-WD03&id=16050 https://doi.org/10.7860/JCDR/2022/52554.16050 Atypical Recurrent Presentation of Histologically Aggressive Type of Basal Cell Carcinoma with a Challenging Management- A Rare Case Report Kalaimamani Ezhil Vendhan , Kamala Balakrishnan , Aparajita Gautam , S Harshitha , B Jeyaprakash Basal Cell Carcinoma (BCC) is the most common type of eyelid malignancy among white race individuals but is rare among blacks and Indians. The BCC predominantly affects the sun exposed parts like the neck, back and face (88-90%). These tumours are mostly located on the lower eyelid margin and the medial canthus as upper eyelids are protected from the Ultraviolet (UV) sunrays by the eyebrows and superior orbital margin. Although BCC seldom metastasizes, it is nonetheless considered malignant, since it can infiltrate adjacent tissues and cause substantial deformity and destruction. Here, authors have reported a rare case of 55-year-old female patient with recurrence of surgically treated BCC of upper eyelid involving eyebrow. Surgical excision is the most common employed treatment of choice in extensive tumours. Patient had extensive recurrent spread of BCC in left upper eyelid with multiple small ulcers in and around the left eye with pain and no Perception of Light (PL) vision. Exenteration of left eye was done followed by split skin autografting at the site. The BCC is usually not fatal, but early diagnosis and appropriate treatment promises better functionality and aesthetic outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ND01-ND03&id=16052 https://doi.org/10.7860/JCDR/2022/52952.16052 Pulmonary Aspiration Albeit Rapid Sequence Induction in Achalasia Cardia- Do we have an Infallible Technique? R Sripriya, R Mookambika, M Ravishankar, S Parthasarathy Achalasia cardia is among the conditions that pose a high risk of aspiration during induction of anaesthesia. This report is about a case of a 23-year-old male patient, where regurgitation and pulmonary aspiration occurred in a patient with achalasia cardia despite Rapid Sequence Induction (RSI). The risk of aspiration in conditions that cause stasis in the oesophagus is much higher due to the anaesthetic induced relaxation of the upper oesophageal sphincter and the proximity of the pooled contents to the oropharynx. The lower oesophageal sphincter being pathological in achalasia cardia does not relax. In this article, even though it is a case report of such an incidence, the various techniques that can be adopted to negate the risk have been explored. Preinduction oesophagoscopy and suctioning, video-laryngoscope guided intubation and ultrasound confirmation of Tracheal Tube (TT) position before initiating ventilation can be adopted in addition to head up positioning and RSI as an infallible technique to abolish the aspiration risk in patients with achalasia cardia. The case report is highlighted in the way to focus on describing safe ways of induction of anaesthesia where there is a high risk of aspiration. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=UD01-UD03&id=16056 https://doi.org/10.7860/JCDR/2022/52886.16056 Orbital Cholesterol Granuloma: A Rare Case Report Mihir Mohan Vaidya, Rashmi Chintan Parikh, Rahul Dnyandev Dhake, Hasib Ahmed Shaikh, Manish Sitaram Sabnis Orbital cholesterol granuloma is a rare entity which can cause proptosis, diplopia and extraocular movement restriction. It is often mistaken for other entities such as epidermoid, dermoid cysts and lacrimal gland tumours. Hereby, authors report a case of a 36-year-old male, who presented with proptosis of right eye and diplopia on upward gaze. Computed Tomography (CT) scan showed an extraconal lesion in superotemporal compartment of right orbit with erosion of bony wall. On imaging findings, epidermoid and dermoid cysts were considered as probable diagnoses. On histology, the lesion showed cholesterol clefts, foamy and haemosiderin laden macrophages and foreign body giant cells. Lesion was diagnosed as cholesterol granuloma. While being very rare at this site, this lesion carries a good prognosis with complete surgical excision. Patient showed marked postoperative improvement and was asymptomatic at discharge. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ED01-ED03&id=16067 https://doi.org/10.7860/JCDR/2022/52860.16067 <i>Strongyloides stercoralis</i> Hyperinfection in an Immunocompetent Patient: An Unusual Case Sibabrata Bhattacharya, Rima Das, Debapriya Baidya, Tapan Majumdar <i>Strongyloides stercoralis</i> is a soil-dwelling nematode causing endemic infection, mostly in immunocompromised individuals, in tropical and subtropical regions. However, strongyloidiasis has been reported in immunocompetent individuals in several case reports. Here, a case of an immunocompetent individual is reported. A 25-year-old male patient presented with chief complaints of abdominal discomfort with vomiting and weight loss since last three months. The pain was dull aching in nature and had no relation with food intake but vomiting worsened after taking food. Clinical diagnosis of inflammatory bowel disease was made and patient was started on steroid therapy. Later stool was sent for microbiological examination and <i>Strongyloides stercoralis</i> larvae was demonstrated. Patient responded to albendazole therapy which was given for seven days. Hence, strongyloidiasis should be suspected not only in immunocompromised individual but also in immunocompetent individuals as well. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=DD01-DD02&id=16078 https://doi.org/10.7860/JCDR/2022/51720.16078 Immune Complex-Mediated Crescentic Glomerulonephritis Dhruvi Reddy, Siva Ranganthan Green, R Hemachandar Immune complex-mediated Glomerulonephritis (GN) comprises a group of disorders including Immunoglobulin A (IgA) nephropathy, IgA vasculitis, lupus nephritis, infection-related GN {poststreptococcal, Hepatitis C Virus (HCV)}, and fibrillary GN with polyclonal Immunoglobulin (Ig) deposits. Infection-Related Glomerulonephritis (IRGN) is an immune complex-mediated injury which is triggered by an infection other than renal causes. With new evolving histopathological variants such as C3 Glomerulonephritis (C3GN), it can be challenging to consultants in both diagnostic and management aspects in differentiating it from IRGN. It is seen to occur alongside infection in adults with a greater risk of disease progression to End-Stage Renal Disease (ESRD). Here, the authors report a case of 33-year-old male who presented with gastrointestinal and urinary symptoms. Patient was initially diagnosed as infective diarrhoea with Acute Kidney Injury (AKI), and on further evaluation, renal biopsy was suggestive of immune-complex mediated crescentic GN. Patient was treated with steroids and there was an improving trend of renal function and positive outcome after treatment, with an overall good prognosis. Aetiology of this immune-complex mediated crescentic GN is however, unclear due to similarities between Postinfectious Glomerulonephritis (PIGN) and C3 glomerulopathy pathologically. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=OD01-OD03&id=16079 https://doi.org/10.7860/JCDR/2022/52470.16079 Retrograde Intubation for Airway Management of Firearm Injury in the Maxillofacial Region Manoj Kumar, Jay Brijesh Singh Yadav, Dheer Singh, Vimal Kumar Endotracheal intubation is one of the most important anaesthetic skills. Trauma to the maxillofacial region is challenging in terms of airway management. Airway management in such patients is difficult and decides the survival of the patient. Endotracheal intubation in patients with difficult ventilation and difficult intubation always remains a challenge, especially in the absence of a flexible fibreoptic bronchoscope. The retrograde catheter technique is an acceptable option for airway management in cases where oral intubation is not possible because of difficult airway or is not recommended because of fear of dislodgement of fractured segments of facial bones. The author here reports a case of a 30-year-old male with firearm injury in maxillofacial region posted for emergency surgery with anticipated difficult airway. Emergency retrograde intubation was done for the management of airway with successful outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=UD04-UD05&id=16081 https://doi.org/10.7860/JCDR/2022/52433.16081 A Rare Mesenchymal Neoplasm in an Uncommon Anatomical Site- Solitary Fibrous Tumour of Vulva Nupur Kaushik, Lalit Kumar, Prashant Singh, Juhi Singhal Previously, Solitary Fibrous Tumour (SFT) was thought to originate from the pleura, a relatively rare mesenchymal neoplasm with an indolent course. Vulva is a very uncommon site of extrathoracic SFT. This is a report of a very uncommon case of vulval SFT in a 30-year-old female with complaint of a swelling over vulval region. Fine Needle Aspiration Cytology (FNAC) of the growth was attempted twice and only blood was aspirated. The swelling was excised completely. On histological examination, the sections revealed a cellular tumour of ovoid-to-fusiform spindle cells with indistinct cell borders, with haphazard arrangement or patternless pattern along with proliferation of variable sized blood vessels. The diagnosis was finalised to be a benign stromal tumour (most probably SFT), which was confirmed on immunohistochemical examination using Cluster of Differentiation 34 (CD34), CD99 and Signal Transducer and Activator of Transcription 6 (STAT6) markers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ED04-ED06&id=16085 https://doi.org/10.7860/JCDR/2022/53505.16085 Mesiodens with Supernumerary Root in a Non Syndromic Child: A Rare Case with Unusual Morphology and its Management Umapathy Thimmegowda, Sanchitha Venkatahanumaiah, Nagarathna Chikkanarasaiah, Navin Hadadi Krishnamurthy Supernumerary teeth, also known as hyperdontia, are an odontostomatologic aberration characterised by the presence of an excessive number of teeth. They are divided into four categories based on their shapes and sizes: conical, tuberculate, supplementary and odontomes. The most typical location for mesiodens is the palatal midline between the two maxillary central incisors. Mesiodens is common with incidence of occurrence being 0.3-0.8% for primary teeth and 0.15-3.8% for permanent teeth. A supernumerary root is characterised as the existence of an extra root than the typical number, but a mesiodens with a supernumerary root is a very unusual condition encountered, and its occurrence in children is extremely rare. This unusual morphology is not associated with any syndromes. In the present case, the morphology of the crown of mesiodens was found to be conical in shape both clinically and radiographically, but on extraction of mesiodens unusual root morphology with a supernumerary root was seen. Variations in the crown morphology where the crown of mesiodens had five lobes that was separated by developmental grooves and root dilacerations have been noted. However, no case of mesiodens with a supernumerary root has been reported in the literature by far and this paper attempts towards it. Therefore, the present case emphasises on the importance of considering the morphological variations prior to the onset of the treatment. So, hereby authors present a eight-year-old female with rare and unusual case with a mesiodens with a supernumerary root and its management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZD04-ZD06&id=16091 https://doi.org/10.7860/JCDR/2022/52467.16091 Percutaneous Balloon Retrieval Technique for Fractured Biliary Drainage Catheter in a Paediatric Patient: Can a Major Surgery be Averted? Amrin Israrahmed, Somesh Singh, Rana Vishwadeep Mall, Rajanikant R Yadav Percutaneous Transhepatic Biliary Drainage (PTBD) involves temporary placement of an external drainage catheter into an obstructed bile duct prior to internal biliary stenting or surgery. Chronic indwelling PTBD catheters can develop surrounding adhesions and are prone to fractures and retention during their removal. Retained segments can cause impaired biliary drainage, inflammation and recurrent cholangitis. Retrieval of retained catheters can be done by endoscopic/surgical/percutaneous techniques. In patients who have undergone Hepatico-Jejunostomy (HJ), endoscopic removal is not possible and percutaneous/surgical removal are the only options. The authors present a case of a five-year-old child who came for removal of a fractured, retained PTBD catheter, nine months after undergoing HJ. The catheter was removed by a percutaneous balloon retrieval technique. The objective here is to highlight the technical challenges encountered and present a modification of the usual balloon retrieval technique used to successfully remove the catheter and thus avert a major surgery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=TD01-TD03&id=16113 https://doi.org/10.7860/JCDR/2022/52391.16113 Variable Origin of Axillary Artery Branches in Indian Male Cadaver- A Case Report N Esakkiammal, WMS Johnson, R Archana In clinical and surgical procedures, the variable origins of the axillary artery branches are significant for identifying uncommon signs and symptoms. The present case report documents an unusual origin of the axillary artery branches during dissection of a male cadaver in the Anatomy Department of an undergraduate and postgraduate teaching medical college in India. Normally, the superior thoracic artery arises from the first part of the axillary artery. In the present case, the second part of the axillary artery gave rise to a common trunk, from which the thoracoacromial, lateral thoracic, and subscapular arteries originated. Further, the thoracodorsal, circumflex humeral, and posterior circumflex humeral arteries originate from the subscapular artery whereas the anterior circumflex humeral artery only originates from the third part of the axillary artery. During surgical procedures performed in the region of the axilla, anatomists, radiologists, and cardiologists need to be aware of variations in the origin of axillary artery branches. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=AD01-AD02&id=16124 https://doi.org/10.7860/JCDR/2022/54876.16124 Palatal Infection by Multidrug Resistant Non Fermenting Gram Negative Bacilli in a COVID-19 Positive Patient Mimicking Black Fungus Infection- A Case Report Lino Varghese Koshy, Ambujavalli Balakrishnan, Jaison Jayakaran, Priyadarshini Shanmugam As the second wave of Coronavirus Disease-2019 (COVID-19) swept through India, many patients developed serious bacterial secondary infections such as pneumonia, sepsis and fungal infections such as mucormycosis. Among the bacterial infections, the most common organisms associated with secondary bacterial infections were <i>Pseudomonas aeruginosa</i>, <i>Acinetobacter baumannii</i> and <i>Stenotrophomonas maltophilia</i>. Here, authors present a rare case of 31-year-old COVID-19 positive male patient with sepsis who developed palatal necrosis due to infection caused by a non fermenting gram negative bacillus resembling the lesions seen in mucormycosis. The necrotic tissue, bronchoalveolar lavage fluid and blood samples were sent for culture. Blood cultures yielded <i>Elizabethkingia meningoseptica</i> and necrotic tissue yielded <i>Stenotrophomonas maltophilia</i>. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=DD03-DD04&id=16125 https://doi.org/10.7860/JCDR/2022/52879.16125 Transnasal Extraction of Mesiodens and Guided Eruption of Unusual Impacted Central Incisor: A Case Report and Review of Literature Senthil Kumar, Arun Kumar, Prasad, Davidson Rajiah, Deepa Mesiodens is one of the developmental problems in children and adolescents. Mesiodens is a supernumerary tooth in the midline between two central incisors which eventually causes poor aesthetics, food impaction, malocclusion and cyst formation. Here, authors presents a rare case of a 13-year-old male with unusual impacted inverted permanent maxillary left central incisor and horizontally placed mesiodens lying palatal to the permanent maxillary left central incisor. The patient presented with unerupted permanent upper left central incisor. Although most unerupted teeth require surgical removal, surgical-orthodontic treatment may be needed when maxillary incisors are involved due to the aesthetic impact. Surgical-orthodontic treatment aims at the complete alignment of natural teeth and does not require prosthetic intervention. This case report also reviews current literature on the treatment and multidisciplinary management of this problem. Early diagnosis and treatment are recommended to prevent any orthodontic and pathological complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZD10-ZD13&id=16122 https://doi.org/10.7860/JCDR/2022/50514.16122 A Case of Mesenteric Border Intestinal Perforation- An Unusual and Unnoticed Site of Perforation Tharun Ganapathy Chitrambalam, Pradeep Joshua Christopher, Sundeep Selvamuthukumaran, Lokesh Reddy, Preetam Anguraj Incisional hernia which if not repaired at the earliest might increase in size and eventually end up in complications like incarceration or strangulation. Perforation of the bowel loop in case of incarcerated or strangulated incisional hernia without any precipitating events like trauma is very rare. Intestinal perforation, if identified is a life-threatening condition that requires emergency surgical management. Perforation of the small bowel along its mesenteric border is a rare entity with only very few cases being reported. Authors hereby, present a case of a 55-year-old female with long standing incisional hernia who was diagnosed as an incarcerated incisional hernia after Computed Tomography (CT) and was proceeded with an exploratory laparotomy, which on further exploration revealed perforation of the incarcerated ileum along its mesenteric border for which resection and anastomosis was done. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=PD01-PD02&id=16133 https://doi.org/10.7860/JCDR/2022/54883.16133 A Rare Case of Primary Pulmonary Synovial Sarcoma Thilagarani Kuppusamy, Sowmya Devi Ajith Prasad, Maheshwaran Kuppanasamy Gounder Synovial Sarcoma (SS) is a rare mesenchymal neoplasm arising commonly from the periarticular tissue. Primary SS involving the lung accounts for less than 0.5% of all lung tumours. SS are high grade aggressive tumours affecting the extremities of adolescents and young adults. Clinically, patient presents with cough, breathing difficulty, chest pain or haemoptysis and imaging studies may reveal a mass lesion but for definitive diagnosis, histopathology and immunohistochemical examination is needed. Hereby, authors report a case of 39-year-old female diagnosed with primary pulmonary SS with particular emphasis on the pathologic findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ED07-ED08&id=16167 https://doi.org/10.7860/JCDR/2022/51278.16167 Disorders of Sexual Development-Pathological Profile of 45 Cases at a Tertiary Care Centre Gwendolyn Fernandes, Pooja Mhashete, Minal Desale Disorders of Sexual Development (DSD) are rare syndromes, which show congenital discordance between chromosomal, gonadal and phenotypic sex. A retrospective analysis was performed to analyse the histopathological profile and spectrum of a large number of cases of DSD received at a tertiary care centre. There were 45 cases of DSD encountered over a period of eight years, from January 2012 to December 2020. Detailed evaluation of each case with respect to demographic details, clinical features, imaging and pathology was done. All cases were classified as per Chicago Consensus Classification (2006) modified in 2010. The 46, XY DSD were the most common 26 (57.78%) cases, followed by sex chromosomal DSD 14 (31.1%) and 46, XX, DSD 5 (11.1%). Among 46, XY DSD, Complete Gonadal Dysgenesis (CGD) (Swyer syndrome) and Complete Androgen Insensitivity Syndrome (CAIS) had the highest number of cases, with 30.77% cases of each. Among 46XX, DSD, cases of ovotesticular DSD amounted to 80%. In sex chromosomal DSD, cases of Mixed Gonadal Dysgenesis (MGD) amounted to 78.57%. Out of 45 cases studied in this series, 20% cases showed neoplasms, of which 8.89% were malignancies. Nine out of 45 (20%) patients had neoplasms, out of which 5 (55.6%) had benign tumours while 4 (44.4%) had malignant tumours. Five patients had gonadoblastoma and three of these had co-existent dysgerminoma. Two patients had sertoli cell adenomas, one seminoma and one serous cystadenoma. Frequent clinical features noted were primary amenorrhoea seen in 25 (55.5%) cases and ambiguous genitalia seen in 18 (40%) cases, while the most common location of gonad was intra-abdominal in 30 (66.6%) cases. Streak gonads were seen in CGD, MGD and Turner&#8217;s syndrome. Malignant germ cell tumours were seen in CGD and CAIS. Early diagnosis, good histopathology and follow-up are essential in the management of DSDs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ER07-ER13&id=16165 https://doi.org/10.7860/JCDR/2022/53120.16165 Impact of Cognitive Behavioural Intervention for Tic Disorders in Children Shilpa Hegde, Heta Shah, Chandrashekar Shettigar, Bhagyashee Mehandale Tic disorders are one of the most prevalent neurodevelopmental disorders and if unattended, can have other psychological impact. It can present as poor academic performance, poor concentration, low confidence, anxiety, depression and many others. The present case series is about seven children diagnosed with tic disorder, as per Diagnostic and Statistical Manual (DSM) 5 criteria. These children underwent standard behavioural training module comprising of behavioural rewards, Habit Reversal Training (HRT), relaxation training, identification and management of emotions and social skills training; which was planned following case conceptualisation. Yale Global Tic Severity Scale (YGTSS) was used before starting therapy and while completing the therapy. Considering the severity of symptoms and distress caused by them, three children were started on medicine (clonidine) along with therapy. Same therapy module was provided online for those children (three) who were not able to come for direct training due to geographic distance and Coronavirus Disease 2019 (COVID-2019) pandemic restrictions. All the seven children showed favourable improvement in terms of severity and improvement in the co-morbid conditions. All of them responded to the individualised treatment protocol and showed difference in pre (mean=38) and post (mean=12) total tic severity score suggesting response to treatment. Among them, two children scored zero. The present case series demonstrates the application of behavioural therapy including varied strategies as per the individual case conceptualisation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=SR04-SR06&id=16170 https://doi.org/10.7860/JCDR/2022/51371.16170 Conjunctival Myxoma: Series of Three Cases of a Rare Ocular Tumour Yasmeen Khatib, Vinita Pandey, Yogita Sable, Rahul Pandey, Prajakta Gupte Conjunctival myxomas are very rare benign tumours of mesenchymal origin which pose a diagnostic challenge clinically and radiologically. They usually present as asymptomatic slowly growing cystic lesions involving the bulbar conjunctiva. Two cases were with usual presentation while one was with unusual presentation. Two cases of conjunctival myxoma (59-year-old female patient and 65-year-old male patient) involving the bulbar conjunctiva and one (56-year-old female patient) in the palpebral conjunctiva are reported. Anterior segment examination and fundoscopy were within normal limits. A clinical diagnosis of conjunctival cyst, pinguecula and pyogenic granuloma was made in the three cases, respectively. Excision was done in all the cases and a diagnosis of myxoma was made based on the characteristic histological and immunohistochemical features. No systemic involvement was seen. The authors hereby report the present cases because of their rarity and to emphasise that, histopathology is required to distinguish it from other conjunctival lesions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ER04-ER06&id=16077 https://doi.org/10.7860/JCDR/2022/51706.16077 A Case Series of Recalcitrant Pemphigus Rajkumar Kannan, Samuel Jayaraj Daniel, Poornima, Ramesh Aravamuthan Pemphigus consists of a group of life threatening autoimmune bullous disorders characterised by flaccid blisters and erosions of the skin and mucosal membranes of oral, laryngeal, conjunctival, pharyngeal, anal, vaginal etc. Pemphigus vulgaris involves mucosa in 50-70% of the patients. Pemphigus is associated with other autoimmune disorders like myasthenia gravis and thymoma. Primary subsets of pemphigus include pemphigus vulgaris, pemphigus foliaceus and paraneoplastic pemphigus. Pemphigus vulgaris constitutes nearly 70% of cases of pemphigus, with its antigens desmoglein 1 and 3, which are calcium dependent calmodulins, being the crucial targets for IgG1 and IgG4 classes of antibodies. If left untreated at an early stage, pemphigus vulgaris is associated with significant morbidity and mortality. The authors present a case series of five patients (34-year-old male, 68-year-old male, 52-year-old male, 74-year-old female and 65-year-old female) presenting recalcitrant pemphigus with focus on the various factors that affect the disease outcomes, morbidity and mortality. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=WR01-WR05&id=16084 https://doi.org/10.7860/JCDR/2022/53400.16084 Clinical Presentation and Outcome of COVID-19 in Children: A Case Series Ritesh Kumar Agrawal, Meenakshi Pandey, Ashok Singh, Nirali Sanghvi, Kusumlata Yadav The novel Coronavirus Disease 2019 (COVID-19) is an illness caused by Severe Acute Respiratory Syndrome 2 (SARS-CoV-2), which affects children as well as adults. This case series pertains an observation on six patients, aged 10-17 years, who were admitted to the hospital and found to be COVID-19 positive on testing. All patients had history of contact with COVID-19 positive confirmed family members. Most common symptoms were fever (n=4), cough (n=2) and breathlessness (n=2). No patient had any pre-existing co-morbidity. Raised levels of C-Reactive Protein (CRP) and D-dimer were present in 4 (66.6%) patients each and elevated serum ferritin levels were seen in 3 (50%) patients. Peribronchial cuffing was seen in chest X-ray of one patient. Supportive therapy along with antibiotics (azithromycin and doxycycline) was given to all children. Mean duration of hospital stay was 7.5 days. No patient required intensive care support. All patients recovered at discharge. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=SR01-SR03&id=16136 https://doi.org/10.7860/JCDR/2022/51443.16136 Clinical Evaluation of Myelin Oligodendrocyte Glycoprotein Antibody Associated Disease- A Case Series Rahul Gupta, Ramji Sharma, Deepali Sharma In recent years, there has been lot of research on Myelin Oligodendrocyte Glycoprotein Antibody (MOG-IgG) associated disease. It&#8217;s clinical phenotype overlaps with Multiple Sclerosis (MS) and Neuromyelitis Optica Spectrum Disorder (NMOSD), however many questions related to clinical characteristics and pathogenetic role of MOG antibody is still unanswered. Hereby, authors report a case series of nine patients (five females and four males), describing their seropositivity for MOG antibody and clinical characteristics of MOG antibody associated disease. The clinical presentation, radiology, acute treatment and long term management were analysed. The most common presentation was optic neuritis followed by Longitudinally Extensive Transverse Myelitis (LETM). Tab. Azathioprine was most commonly used medicine for disease modifying therapy (long term immunosuppression). The attacks are more severe than MS but recovery is better than antibodies to Aquaporin-4 (AQP4-IgG) seropositive NMOSD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=OR01-OR03&id=16178 https://doi.org/10.7860/JCDR/2022/54943.16178 Management of Mirizzi Syndrome in a Tertiary Care Centre of Southern India- A Series of 10 Cases Rohith Muddasetty, Sivakumar Kalyanashanmugam, Prabhakaran Raju, Sugumar Chidambaranathan, Naganathbabu Obla Lakshmanamoorthy Mirizzi syndrome is a rare condition characterised by obstructive jaundice due to compression of Common Hepatic Duct (CHD) by a stone impacted in the neck of gall bladder. Incidence is around 1-2% in patients with symptomatic cholelithiasis. Preoperative diagnosis and management is challenging. Authors have retrospectively analysed the records of patients undergoing cholecystectomy in our institute for the past five years and selected those patients who had final diagnosis of Mirizzi syndrome were reviewed and following results were arrived. From January 2016 to February 2021, 446 patients underwent cholecystectomy. Out of these, 10 (2.24%) patients had final diagnosis of Mirizzi syndrome. Male:Female ratio was 3:7. Mean age at presentation was 49.5 years. Most common presenting symptoms were pain abdomen and jaundice. Mirizzi syndrome was preoperatively diagnosed only in 3 (30%) patients. Others were diagnosed during surgery. Type I in four patients, type II in three patients, type III in two patients and type IV in one patient. These patients were treated with either total or subtotal cholecystectomy. Open approach was used in 8 (80%) patients and laparoscopic approach in 2 (20%) patients. Biliary drainage procedure was done in all patients, T-tube drainage in 5 (50%); Roux-en-Y Hepaticojejunostomy (HJ) in 3 (30%) and Hepaticoduodenostomy in 2 (20%) patients. Thus, the authors concluded Mirizzi syndrome being one of a rare complication of long standing cholelithiasis, which poses a challenging task for diagnosis and management. High index of suspicion is required to identify and treat Mirizzi syndrome in order to avoid bile duct injuries. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=PR01-PR04&id=16068 https://doi.org/10.7860/JCDR/2022/51530.16068 Intestinal Metastases from Unknown Primary Masquerading as Primary Colonic Neoplasms- Diagnostic Dilemma Elucidated by Detailed Clinical Evaluation Meghadipa Mandal , Anadi Roy Chowdhury Intestinal metastasis from unknown primary may simulate a primary colonic neoplasm in its clinical presentation. The gross histopathological examination may also mimic primary intestinal pathology. The diagnostic dilemma is furthered by paucity of available knowledge due to the limited literature. This article discusses three such cases (50-year-old male, 60-year-old female and 65-year-old female), all of which clinically presented with bowel symptoms, either in the form of acute abdomen or intestinal obstruction. The imaging studies pointed towards an intestinal pathology. Although the initial presentation was dubious, on delving into the medical and surgical history, all of them had a previous known malignant neoplasm on different sites like skin, ovary and cervix. The diagnosis of intestinal metastasis of melanoma, High Grade Serous Carcinoma (HGSC) of ovary and Squamous Cell Carcinoma (SCC) of cervix, respectively, were supported by suggestive histomorphology and ancillary studies like immunohistochemistry in one of the cases. The most alluring of the above three cases was that of intestinal metastasis from melanoma, where lack of melanin pigment made the histological diagnosis difficult. After retrieving medical history along with diffuse S100 and HMB45 positivity, definitive conclusion could be opined. Thus, clinical history of the patient was the cornerstone for definitive diagnosis in all of the three cases. Primary colonic neoplasms and intestinal metastasis from previous known malignant neoplasms have totally different clinical and prognostic outcomes. So, identification of these cases is extremely important from treatment point of view. It is possible only based on detailed clinical evaluation, clear suspicion, suggestive histomorphology and suitable ancillary investigations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ER01-ER03&id=16054 https://doi.org/10.7860/JCDR/2022/52552.16054 Definitive Impression Technique for Maxillary Defects in Patients with Reduced Mouth Opening- A Novel Approach Vinay Dutta, Arun Khalikar, Sattyam Wankhede, Suryakant Deogade Palatal defects are categorised as a multicausal pathology, with its aetiology ranging from trauma and microbial infections to oncogenic origin. This by and large leads to surgical defects of the palatal tissues which warrants immediate treatment. Due to this, the patient faces a plethora of challenges, namely psychological, functional and social. These defects can be catered to by means of surgical closure or prosthetic therapy. Thereby, this uplifts the patient&#8217;s self-confidence and performance of day-to-day activities. However, surgical closure by free flaps is not feasible in all cases due to the dearth of favourable tissues or prevalent co-morbid conditions. So, this makes fabrication of a palatal obturator the treatment of choice to rehabilitate these cases. An obturator is a maxillofacial prosthesis which blocks the oro-nasal communication and thus ameliorates the mastication, phonation and aesthetic profile of the affected subject. For fabricating well-fitting obturator prosthesis, making an accurate impression with appropriate spatial orientation of the orofacial structures is imperative. Many obstacles come in the way of a prosthodontist while making impression in such cases due to the complexity of the supporting stomatognathic system in terms of compressibility and multitude of geometric planes of the tissues. These patients present with restricted mouth opening due to scarring of tissues or radiation therapy. In this article, the authors describes a technique which predominantly addresses most of the problems related to the impression making procedures in patients treated with maxillectomy experiencing limited mouth opening. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZH01-ZH03&id=16043 https://doi.org/10.7860/JCDR/2022/52775.16043 All Ceramic Pressable Lithium Disilicate Maryland Bridge: A Case with Two-Year Follow-up Shruti Potdukhe https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZJ01-ZJ02&id=16069 https://doi.org/10.7860/JCDR/2022/52084.16069 Mucormycosis in a Diabetic Patient Post COVID-19 Afrah A Aldelaimi, Tahrir N Aldelaimi https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZJ03-&id=16090 https://doi.org/10.7860/JCDR/2022/53108.16090 Perceived Anxiety and Stress among Pregnant Women during COVID-19 Pandemic: A Cross-sectional Study Manju Leelavathy, Manjusha Viswanathan, Anil Bindu Sukumaran, Regi Jose, Nazeema Beevi, Susanna John <b>Introduction:</b> Mental health and well-being is as important as physical health during pregnancy. But the Coronavirus Disease-2019 (COVID-19) pandemic has caused more anxiety and stress among pregnant women. The augmented levels of anxiety and stress may have detrimental effects on antenatal women. Anxiety and depression in pregnancy can lead to adverse pregnancy outcomes like increased risk of abortions, preterm labour and even foetal deaths. <b>Aim:</b> To assess the anxiety and stress levels among pregnant women attending a tertiary care hospital in Thiruvananthapuram, Kerala during the COVID-19 pandemic and to determine the associated factors. <b>Materials and Methods:</b> A cross-sectional study was conducted among 348 pregnant women attending a tertiary care teaching hospital in Thiruvananthapuram District in Kerala during the period between October 2020 to November 2020 using a validated tool, Pandemic Anxiety Stress Scale for pregnant women (PASSP). Higher scores indicating higher perceived anxiety stress with a maximum score of 60, categorised as normal, mild, moderate and severe with score between 0-14, 15-29, 30-44, and 45-60, respectively. Qualitative variables were expressed in frequency and percentage. Multivariate logistic regression was done to determine the factors associated with anxiety and stress. The p-value <0.05 was considered significant. <b>Results:</b> Mild anxiety and stress were seen in 160 (45.98%) pregnant women, 89 (25.57%) had moderate and 7 (2.01%) had severe anxiety and stress, 92 (26.44%) women had no anxiety. A total of 145 (41.67%) pregnant women were scared of vertical transmission to their baby. Multivariate logistic regression revealed that residents in urban area and pregnant women with other co-morbidities associated with pregnancy were the two significant factors (p<0.05) associated with anxiety-stress. <b>Conclusion:</b> About one-fourth of pregnant women had moderate or severe level of anxiety and stress. Antenatal women with pregnancy related diseases and those living in urban area had more anxiety and stress during pandemic. Measures need to be taken by health system to address the mental health of pregnant women. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=LC20-LC25&id=16134 https://doi.org/10.7860/JCDR/2022/52514.16134 Clinico-aetiological and Demographic Profile of Pancytopenia among Children in a Tertiary Care Hospital of Northern Part of West Bengal- A Cross-sectional Study Mousumi Das, Aniruddha Saha, Amita Giri <b>Introduction:</b> Pancytopenia is a trio of results caused by numerous medical conditions in which all blood cell lineages, such as leukocytes, erythrocytes, and platelets, are diminished in blood. Causes of pancytopenia seem to vary widely in different country and also in different regions within a country. Knowing common cause and common presentation of pancytopenia is of immense importance to determine the diagnosis, especially in resourceconstraint areas. <b>Aim:</b> To assess the aetiology, clinical profile of pancytopenia in a tertiary hospital in northern part of West Bengal. <b>Materials and Methods:</b> This hospital-based, cross-sectional, study was conducted in North Bengal Medical College and Hospital, Sushrutanagar, West Bengal, India, from July 2012 to June 2013. Patients having pancytopenia, on primary haematological investigation, admitted in the Paediatric Department of the hospital were included in the study. Patients already on definitive treatment for disease causing pancytopenia like kala-azar, leukaemia were excluded from the study. A physical examination was performed after obtaining a relevant clinical history, followed by a full blood count, including Peripheral Blood Smear (PBS) examination, and appropriate biochemical assays. An aspiration and evaluation of the bone marrow was performed. Statistical Package for Social Sciences (SPSS) Version 16.0 for windows (SPSS 16) was used. <b>Results: </b>There were 50 children, and the mean age of presentation was 7.3 years. Females constituted 52% and males were 48%. Aplastic anaemia was noted in 44% cases, 30% cases were diagnosed as megaloblastic anaemia, kala-azar in 18%, Acute Lymphoblastic Leukaemia (ALL) in 6% and Idiopathic Thrombocytopenic Purpura (ITP) in 2%, respectively. Mean age of presentation in aplastic anaemia was 7.6 years, while that in megaloblastic anaemia was 6.9 years. Female predominance was seen in both aplastic anaemia (59%) and megaloblastic anaemia (60%), while male preponderance was seen in ALL (66%). Generalised weakness was the most prevalent presenting symptom (100%) followed by fever (80%). Pallor (100%) was the most prevalent presenting sign, followed by glossitis (30%), which is commonly ignored. <b>Conclusion:</b> Though aplastic anaemia is an important cause of pancytopenia, treatable causes like megaloblastic anaemia, kalaazar should always be looked for as other possible aetiologies for pancytopenia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=SC20-SC23&id=16135 https://doi.org/10.7860/JCDR/2022/51595.16135 Prevalence of Macroprolactinaemia in Women with Hyperprolactinaemia: A Retrospective Study Flavia Almeida, Alap Christy, Varsha Birla, Raj Jatale, Kirti Chadha <b>Introduction:</b> Macroprolactinaemia causes asymptomatic hyperprolactinaemia in many patients which leads to misdiagnosis, inappropriate investigation and needless treatment in these patients. Though immunoassays for prolactin are sturdy and reliable, they are prone to interference from macroprolactin. Polyethylene Glycol (PEG) precipitation is used as a screening test for macroprolactinaemia. <b>Aim:</b> To find out the prevalence of macroprolactin in women with hyperprolactinaemia, this will help in evaluation and treatment of such patients. <b>Materials and Methods:</b> This retrospective study was conducted at a Global Reference Laboratory in Mumbai over a period of three and a half years from January 2018 to May 2021. Total available data of 1,15,149 women with age above 18 years were included in the study. Prolactin concentrations were measured before and after PEG precipitation. Macroprolactinaemia was characterised by percentage recovery and post PEG prolactin concentrations. Continuous variables were expressed as Mean&#177;Standard Deviation (SD), range and categorical variables as number and percentage. The differences in categorical variables were assessed with Chi-square test or Fisher&#8217;s-exact test. <b>Results:</b> Out of total 1,15,149 women, 36,247 (31.48%) women were observed to have hyperprolactinaemia. Prevalence of macroprolactinaemia using recovery criteria of &#8804;50% was 7.88%. Amongst the women diagnosed with hyperprolactinaemia maximum women were between 18-30 years age group i.e., 22,639 (62.46%). Macroprolactin and age were found to be statistically significant (p<0.05). Infertility, Oligomenorrhoea/amenorrhoea, and thyroid disorders was seen more frequently in hyperprolactinaemia than in macroprolactinaemia. Twelve women with prolactin values above 100 ng/mL were found to have macroprolactinaemia. <b>Conclusion:</b> Macroprolactin determination with the PEG precipitation method might prevent unnecessary tests and treatments during the diagnosis process and follow-up of patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=BC12-BC15&id=16123 https://doi.org/10.7860/JCDR/2022/52702.16123 Antifungal Susceptibility Testing of Five Antifungal Agents against Clinically Isolated Dermatophytes Species from a Tertiary Care Hospital in Northern India Sachin Sharma, Megha Maheshwari, Rameshwari Thakur, Sumesh Prasad Sah, Sapna Chauhan <b>Introduction:</b> Dermatophytosis form approximately 15-75% of all the mycological infections. Dermatophytes are closely related keratinolytic fungi with ability to degrade keratin and invade the skin, hair and nails causing dermatophytosis. <b>Aim:</b> To evaluate the Minimum Inhibitory Concentration (MIC) of antifungal drug against the isolated dermatophytes by broth microdilution method. <b>Materials and Methods:</b> The present cross-sectional study was conducted in the Department of Microbiology, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India. The duration of the study was August 2018-August 2020 and included 245 patients of which 165 samples were culture positive. A 10-20% Potassium Hydroxide (KOH) mount was prepared from the skin scrapings, nail clippings, and hair bits to look for fungal elements. The specimens were also inoculated on Mycosel media and Sabouraud Dextrose Agar (SDA) with chloramphenicol. The dermatophytes were identified on the basis of colony characteristics, Lacto Phenol Cotton Blue (LPCB) mount, nutritional requirement, temperature tolerance, urease production, and in-vitro hair perforation test. Antifungal susceptibility testing was done for all fungal isolates and performed by broth microdilution method. The descriptive statistics were reported as means with their Standard Deviation (SD). Data were statistically evaluated with International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) Statistics for Mac, Version 25.0., IBM Corp., Chicago IL. <b>Results:</b> In this study, the MIC range for all the 165 isolates for dermatophytes tested for antifungal susceptibility showed that itraconazole, terbinafine and voriconazole showed the lowest MIC range of 0.0019-0.5 &#956;g/mL followed by griseofulvin and fluconazole at MIC range of 0.125-32 &#956;g/mL. The MIC50 of itraconazole and terbinafine was seen lowest at 0.0313 &#956;g/mL followed by voriconazole at 0.0625 &#956;g/mL, griseofulvin at 0.25 &#956;g/mL for all isolated dermatophytes. Highest MIC50 with 4 &#956;g/mL was found for fluconazole against <i>T. mentagrophytes</i> and <i>T. violaceum</i>. MIC90 of terbinafine, itraconazole and voriconazole was seen lowest at 0.25 &#956;g/mL followed by griseofulvin at 1 &#956;g/mL for all isolated dermatophytes. Highest MIC90 of fluconazole was recorded at 16 &#956;g/mL for all isolated dermatophytes. <b>Conclusion:</b> Highest MIC50 with 8 &#956;g/mL was found for fluconazole against all isolated dermatophytes. MIC90 of terbinafine, itraconazole and voriconazole was seen lowest at 0.25 &#956;g/mL followed by griseofulvin at 1 &#956;g/mL for all isolated dermatophytes. Highest MIC90 of fluconazole was recorded at 16 &#956;g/mL for all isolated dermatophytes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=DC36-DC42&id=16172 https://doi.org/10.7860/JCDR/2022/53030.16172 Comparative Evaluation of the Effect of Herbal Irrigants on the Push-out Bond Strength of Epoxy Resin Based Sealer to Root Dentin: An In-vitro Study Shrutika Salkar, Chaitra Bakare, Deepti Chacko, Preeti Doddwad, Sonal Joshi, Neha Dhaded <b>Introduction:</b> Favourable outcome of root canal treated teeth depends on the irrigants used. Sodium Hypochlorite (NaOCl) is one of the most commonly used irrigants in endodontic treatment. NaOCl has cytotoxic effects; limited ability to eliminate bacteria, along with jeopardizing of the bond strength between epoxy resin-based sealers and root dentin. Contemporary medicine orchestrates the use of biological medical extract from natural plants. Herbal alternatives are coveted as they are readily available, less expensive, have enhanced shelf life and low toxicity. Despite that, literature is sparse regarding the effect of herbal irrigants on Push-out Bond Strength (PBS) of sealer to root dentin. <b>Aim: </b>To compare and assess the effect of the PBS of epoxy resin based root canal sealer to root dentin following the use of two novel herbal irrigants,10% proanthocyanidins (PAs) and 2% <i>Azadirachta indica</i> (neem extract) with 3% NaOCl. <b>Materials and Methods:</b> This in-vitro study was conducted in the Department of Conservative and Endodontics at KLE VK Institute of Dental Sciences, Belagavi, Karnataka, India, between June 2019 and August 2019. The study was done on 30 extracted single rooted human mandibular premolar teeth, of which root canals were prepared using rotary instruments. The use of standard susceptibility tests {Minimum Inhibitory Concentrations (MIC) and Minimum Bactericidal Concentration (MBC)} was done to determine appropriate concentration of the irrigant against <i>E. faecalis</i>. The teeth samples were randomly divided into 3 groups (n=10 each). Group 1 has teeth irrigated with 3% NaOCl (control group), Group 2 has teeth irrigated with 10% grape seed extract (10% proanthocyanidins) and Group 3 has teeth irrigated with 2% neem leaf extract (2% <i>Azadirachta indica</i>). Obturation of all the three groups were done with F3 gutta percha and AH Plus sealer followed by PBS testing using universal testing machine. One way Analysis of Variance (ANOVA) and Tukey&#8217;s Post-hoc tests were used for statistically analysing the data. The p-value <0.05 was considered as statistically significant. <b>Results:</b> Group 2 had significantly higher push-out bond strength as compared to Group 3 (p-value <0.001). However, there was no significant difference seen between Group 2 and Group 1 (p-value=0.207). <b>Conclusion:</b> It was concluded that the PBS of 10% proanthocyanidins was the highest, followed by 3% NaOCl and <i>Azadirachta indica</i>. However, biocompatibility and safety of these novel intracanal irrigants has to be assessed with the help of further clinical and in-vitro experiments to validate these findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZC38-ZC41&id=16173 https://doi.org/10.7860/JCDR/2022/46343.16173 Barriers and Motivators for In-house Blood Donation: A Cross-sectional Study from Tertiary Care Hospital, Kilinochchi, Sri Lanka Yashobha Thilakarathne , Dhanushka Hindagoda , Bhakthi Kumanayake , S Karunatheepa , Nethma Wijethilaka , Rahulan Kalainathan <b>Introduction: </b>Most Sri Lankan blood donations (93%) are from mobile blood donation campaigns. Restricted community gathering during the Coronavirus Disease 2019 (COVID-19) pandemic has adversely affected the blood supply. Further, Kilinochchi has lower blood donation rates than other Sri Lanka areas. <b>Aim: </b>To describe the level of donor satisfaction, identify the barriers and factors to increase in-house blood donors of a District General Hospital, Kilinochchi. <b>Materials and Methods: </b>This questionnaire-based cross-sectional study was conducted with 193 in-house voluntary blood donors in blood bank at District General Hospital (DGH) Kilinochchi, Sri Lanka, from April 2021 to July 2021. Donors with atleast one year of residence in Northern Province were included, and data was collected by pretested, self-administered questionnaire. The parameters assessed were socio-demographic data, donor satisfaction, blood donation information receiving methods, factors affecting blood donation, and factors to improve blood donation. Data entered and analysed using Statistical Package of Social Sciences (SPSS) version 22.0. <b>Results: </b>Out of total 193, 120 (62.17%) were regular donors. Majority donors were male donors, 168 (87.04%) and among 25-35 years group, 85 (44.05%). Most had completed grade 13 exam, 66 (34.19%), only 28 (14.5%) had a degree and 106 (54.92%) donors were within 10 km from the blood bank. The majority of 122 (63.21%) were aware from a friend, and 16.06% (n=31) were aware from YouTube. Gaining information from a friend was statistically associated with the distance to the blood bank (p-value=0.036). A majority 190 (98.44%) of the in-house blood donors were satisfied with the services provided by the blood bank staff, and 188 (97.40%) had stated they are confident about the facilities provided by the blood bank for in-house blood donation. <b>Conclusion: </b>Majority of the in-house blood donors were satisfied with the services provided by the blood bank staff and blood bank facilities. Delivering information regarding blood donation via friends to the population who reside close to the blood bank and awareness programs by healthcare workers would be the best method to improve in-house blood donations in this area. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=EC23-EC26&id=16174 https://doi.org/10.7860/JCDR/2022/52387.16174 Antibody Response Profile in COVID-19 Infection in Healthcare Workers: Insights from a Study at a Reference Laboratory Trupti Shetty , Anupa Dixit , Amar Dasgupta , Vineeth Nair , Heena Satam , Aditi Arora , Sanjay Arora <b>Introduction:</b> The Coronavirus Disease 2019 (COVID-19) pandemic has imposed an unprecedented burden on our healthcare system. Serological testing for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) antibodies serves as useful marker for determining an infection by the virus in the recent past and the immune response. The immune response, including the humoral response to the infection is one of them and the knowledge in this area is still evolving. Virus specific antibodies are expected to help in eliminating the virus and to provide protective immunity against reinfection. <b>Aim:</b> To serially monitor the total antibody response to SARS-CoV-2 in order to gain better insight into the duration of antibody persistence. <b>Materials and Methods:</b> This prospective observational and analytical study was conducted in 66 Healthcare Workers (HCW) with a history of Reverse Transcription-Polymerase Chain Reaction (RT-PCR) proven COVID-19 infection. The study was conducted between May 2020 to April 2021 at the Suburban diagnostics Central Processing Laboratory, Mumbai, Maharashtra, India. Serum samples were serially examined for the presence of total antibodies against the Nucleocapsid (N) protein of SARS-CoV-2 upto 180 days postinfection. A further follow-up examination was done at 360 days. A qualitative Electrochemiluminescence Immunoassay (ECLIA) was used for assessment of the antibody response. The Chi-square or Fisher-exact test was used to compare categorical variables and the Mann-Whitney U test, Kruskal Wallis test and student t-test were used to compare continuous variables across groups. For assessing relationship between variables, the Pearson test or Linear regression were used as appropriate. <b>Results:</b> Out of 66 healthcare workers, 32 were male (48.5%) and 34 were females (51.5%) with the median age of 29.5 years.<b></b> Out of 66 cases, 62 (94%) cases developed antibodies against SARS-CoV-2 at different time intervals, 48 cases during the 14-30 day interval, 10 cases during the 31-60 day interval, three cases during the 61-90 day interval and one case during the 90-120 days interval. Out of 35, 31 (88.6%) subjects could be followed-up at 360 days showed persistence of antibodies. No patient reported symptoms which would warrant a repeat RT-PCR test. <b>Conclusion:</b> This study showed that the antibody response to SARS-CoV-2 virus was sustained for 12 months postinfection in most cases. The absence of fresh infection in these cases during the study period suggests that the antibodies might protect against reinfection with the virus. So, it may be safe to defer vaccination in postinfection cases by 6-9 months thereby saving precious resources. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=LC37-LC42&id=16166 https://doi.org/10.7860/JCDR/2022/52061.16166 Predictive Value of Chest CT Score in Assessing Disease Severity and Short-term Mortality in COVID-19 Pneumonia at a Tertiary Care Centre in Northern India: A Prospective Observational Study Pradeep Kumar Roul, Ashish Kaushik, Poonam Sherwani, Kriti Yadav, Aditi Saini, O Budha Charan Singh, Anjum Syed, Prasan Kumar Panda <b>Introduction:</b> Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) infection, also known as Coronavirus Disease-2019 (COVID-19) is the global pandemic, first described in Wuhan city of China in December 2019. Its diagnosis depends upon real time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). On chest Computerised Tomography (CT), it is almost similar to other viral pneumonia with extensive parenchymal involvement. Semiquantitative scores depicting this extensiveness of involvement could correlate with disease severity, laboratory parameters, mortality like Intensive Care Unit (ICU) admission, requirements of ventilatory support and longer hospital stay. <b>Aim:</b> To define the role of chest CT score in determining disease severity, predicting poor prognosis and mortality of COVID-19 pneumonia in short-term follow-up. <b>Materials and Methods:</b> This prospective study enrolled 547 admitted real time RT-PCR positive patients for COVID-19 at All India Institute of Medical Sciences, Rishikesh, India from 15<sup>th</sup> April 2021 to 31<sup>st</sup> May 2021. All patients were assigned semi-quantitative CT scores based on the extent of lung parenchymal involvement of 20 lung regions in chest CT. Finally, 205 patients were enrolled for the final analysis. Clinical severity was matched with chest CT scoring and laboratory findings. Survival curves along with univariate and multivariate analysis was applied to define the role of CT scoring in predicting short-term prognosis. <b>Results:</b> Total 205 subjects were included in the study, of which the chest CT score showed a significant association with clinical severities (p-value <0.001). CT score was correlating significantly with increased serum C-Reactive Protein (CRP) (p-value=0.001) and D-dimer (p-value=0.01), and decreased lymphocyte count (p-value <0.001). A CT score &#8805;31 was found to be associated with an increased risk of mortality in both univariate and multivariate analysis {Odd Ratio (OR)=276.8; 95% Confidence Interval (CI)=45.21-1695.43; p-value <0.001}. <b>Conclusion:</b> Chest CT score can be imaging measure of disease severity and predict a higher probability of mortality in score &#8805;31. It can also predict other defined variables of short-term prognosis. So, it has an advantage in speedy diagnostic workflow of symptomatic cases, timely referral of patients to higher centre, and better management of critical care resources. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=TC05-TC11&id=16168 https://doi.org/10.7860/JCDR/2022/51808.16168 Evaluation of Lateral Flow Assay for the Diagnosis of Cryptococcal Meningitis and its Comparison with the Gold Standard and Other Laboratory Tests Kottarathil Malavika, Thayanidhi Premamalini, Anupma Jyoti Kindo <b>Introduction:</b> Cryptococcosis is a potentially fatal fungal disease affecting both immunocompromised and immunocompetent individuals. Hence, a Point Of Care Test (POCT) is required with higher sensitivity and specificity (100%), for the rapid detection of cryptococcosis which will be life saving for the patient. <b>Aim:</b> To evaluate the usefulness of Lateral Flow Assay (LFA) for rapid detection of Cryptococcal Antigen (CrAg) from Cerebrospinal Fluid (CSF) sample. <b>Materials and Methods:</b> This diagnostic/pilot study was conducted in Mycology Laboratory, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, over a period of six months (June 2019-November 2019). The CSF samples (n=37) from patients with suspected meningitis were considered for the study. Direct microscopy with gram stain, negative stain and histopathological stains was performed for all the CSF samples. Culture was done on basal medium, enriched media and special media. <i>Cryptococcus</i> genus specific Polymerase Chain Reaction (PCR) was also performed to confirm the isolates grown on the culture. Serological tests like Latex Agglutination Test (LAT) and LFA were also performed on all the samples. The LFA results were compared with microscopy, culture and LAT. <b>Results:</b> Among the 37 suspected meningitis patients, three grew <i>Cryptococcus</i> in culture which was considered as the gold standard in the diagnosis of Cryptococcal Meningitis (CM). Direct microscopic techniques had 100% specificity however their sensitivity was less i.e., 67%. LAT had a sensitivity of 100% and specificity of 94%. However, LFA in present study had a very good sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) (100%). <b>Conclusion:</b> The LFA for the detection of CM is considered to be an effective method when compared to the other conventional and serological methods with higher sensitivity and specificity. Hence, in present study authors evaluated the use of LFA in diagnosis of CM and found that this assay when used as a POCT, can give the results in short duration. Considering this as a pilot study, further studies including higher number of samples are essential to confirm the effectiveness of the findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=DC25-DC30&id=16138 https://doi.org/10.7860/JCDR/2022/52172.16138 Comparison of the Haematological and Psychological Parameters between COVID-19 Positive Pregnant and Non Pregnant Female: A Case-control Study from Tertiary Care Centre, Puducherry, India Gaurang Narayan, P Sabita, Rimi Singh, A Sivaraman <b>Introduction:</b> Pregnancy is associated with lot of physiological and psychological changes, and it becomes important to study these changes in the background of COVID-19. A simple Complete Blood Count (CBC) can help to indicate the COVID-19 disease severity. <b>Aim:</b> To understand the differences in the haematological and psychological parameters between COVID-19 infected pregnant females and age-matched non pregnant COVID-19 infected females. <b>Materials and Methods:</b> This case-control study was conducted in Department of Obstetrics and Gynaecology, Indira Gandhi Medical College and Research Institute, Puducherry, India, from October 2020 to December 2020. Data collection was in an ambispective manner. Haematological values {Total Leukocyte Count, neutrophil, lymphocyte, Neutrophil-Lymphocyte ratio (NLR) and Red Cell Distribution Width (RDW)} were obtained from routine CBC and for the psychological component (scales- beliefs, practices for prevention of infection, fear, global) a pre-tested validated questionnaire was used. The questionnaire used the Likert scale and comprised of a total of 29 questions with a maximum score of 145. These scales analysed psychological apprehensions in general population and its impact on pregnancy and reproductive health of women. Categorical variables were expressed as mean&#177;Standard Deviation (SD). Student t-test was used for comparison of means. <b>Results:</b> The present study included 80 participants with 40 in each of the pregnant and non pregnant group. The total leukocyte count, neutrophil, lymphocyte, NLR and RDW were the haematological parameters with statistically significant difference between the two groups (p-value <0.001). While the mean total score of COVID-19 psychological impact in the COVID-19 pregnant women was 79.42&#177;20.18 and higher in COVID-19 non pregnant women (88.92&#177;20.77). <b>Conclusion:</b> The significant difference in the haematological parameters of both the groups indicates the differential impact of COVID-19 in pregnant women. &#8216;Coronaphobia&#8217; is on the rise and addressing this concern is important for holistic delivery of healthcare in patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=QC09-QC13&id=16139 https://doi.org/10.7860/JCDR/2022/52682.16139 Respirators and Surgical Masks Artefacts on Phantom using Magnetic Resonance Imaging during COVID-19: A Cross-sectional Study Shashi Kumar Shetty, MM Jaseemudheen, U Raghuraj, R Kayalvizhi <b>Introduction: </b>It is suitable for a patient to wear a respirator or face mask during any radiological investigation during Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) pandemic. Some face masks may have nanoparticles, or antimicrobial coating, which may comprise metal to help shape the mask according to user face shape. This kind of ferromagnetic substances can cause artefacts in the image. <b>Aim: </b>To detect and compare the artefacts while using different types of respirators and surgical masks in the Magnetic Resonance Imaging (MRI) phantom images. <b>Materials and Methods: </b>This was a prospective cross-sectional study which was conducted from July 2021-September 2021. Two not resistant to oil-based aerosols with 95% efficiency to airborne particles (N95) respirators and two types of 3-ply surgical disposable masks with a metal and plastic nose holder were used. The N95 respirators were of Halo N95 Filtering Facepiece 2 Particulate Matter (FFP2) PM 2.5 and Suchi N95 S-7400, while the surgical masks were from Venus 3-ply V-1010 with a metal nose holder and the Thea Tex Filtra 3-ply with plastic nose holder. A polymethyl methacrylate plastic phantom was used with 1.5 Tesla (Siemens Magnetom Avanto) MRI scanner for imaging. <b>Results: </b>When exposed to the metal detector both N95 respirators and one of the surgical masks with a metal nose clip showed strong ferromagnetic attraction. Both respirators and a surgical mask with a metal nasal holder showed magnetic susceptibility artefacts. The signal loss is caused by dephasing of spins from metal strip on the image. <b>Conclusion: </b>All the patients must have a recognised MR safe masks prior to an MRI investigation. When this is not possible to follow, metallic components from the face mask should be removed before the patient&#8217;s arrival at the MR room. After removing the metal strip from the mask, the paper tape may be applied across the nasal bridge region for adequate transmission control and to maintain the intended function of the mask. The mask with a plastic nasal holder was ideal to use in an MR environment since it doesn&#8217;t have any distortion in the image. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=TC01-TC04&id=16140 https://doi.org/10.7860/JCDR/2022/52429.16140 25-hydroxy Vitamin D and Calcium Levels in Patients of Drug Resistant Tuberculosis: A Retrospective Study from a Tertiary Care Institute of Eastern India Satyadeo Choubey, Manish Shankar, MD Arshad Ejazi <b>Introduction:</b> Drug Resistant Tuberculosis (DR-TB) is a rapidly escalating problem. Vitamin D and calcium serum levels can be an important determinant of Multidrug-Resistant Tuberculosis (MDR-TB) infection, progression to disease. The link between the serum level of 25-hydroxy vitamin-D {25(OH) D and MDR-TB is an emerging area for conducting evidence-based research. <b>Aim:</b> To assess the serum 25(OH)D and calcium levels and its deficiency in all the patients with drug resistant tuberculosis. <b>Materials and Methods:</b> This retrospective, observational study was conducted in the Department of Pulmonary Medicine, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India, from October 2019 to October 2020, in the newly detected 100 patients experiencing DR-TB. Patients sputum/body fluid samples were subjected for GeneXpert/Line Probe Assay (LPA) examinations to confirm resistance to anti-tubercular drugs. The frequency and prevalence of mean serum vitamin D and mean serum calcium levels were recorded based on age and gender. DR-TB categorised into H-Mono resistance, MDR-TB, Pre-Extensively Drug Resistant (PreXDR) and Extensively Drug Resistance Pulmonary Tuberculosis (XDR-PTB), based on GeneXpert and LPA of sputum/body fluid. Descriptive statistics were used to determine the characteristics of all the patients. All the statistical analysis was done using the Statistical Software for Data Sciences (STATA) software. <b>Results:</b> Mean age of study population was 31.12&#177;15.49 years. Among them 63 were males and 37 were females. The mean serum vitamin D level of 10.87&#177;8.49 ng/mL (deficient) and serum calcium level of 8.62&#177;0.82 mg/dL (normal) was reported. Mean serum vitamin D levels were deficient in all the four types of DR-TB (p-value=0.04), while changes in mean serum calcium level was non significant (p-value=0.15). <b>Conclusion:</b> All patients with DR-TB have significant propensity to vitamin D deficiency. While changes in mean serum calcium level was non significant. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=OC20-OC24&id=16141 https://doi.org/10.7860/JCDR/2022/55211.16141 COVID-19 Vaccine Behaviour among People Attending a Tertiary Care Centre, Punjab, India Ravi Kumar Garg, Kranti Garg, Nitin Gupta, Vishal Chopra, Ankur Gupta <b>Introduction:</b> Coronavirus Disease 2019 (COVID-19) appropriate behaviour and vaccination are two critical defenses in the fight against this pandemic. As these need to be followed religiously, this preventive behaviour should be thoroughly investigated. <b>Aim:</b> To examine the COVID-19 vaccine behaviour amongst people attending tertiary care centre at Patiala, Punjab, India. <b>Materials and Methods:</b> A cross-sectional study was conducted on 200 individuals attending the Outpatient Department of Government Medical College at Patiala, Punjab, India, from 15<sup>th</sup> July to 22<sup>nd</sup> July 2021. Individuals were administered socio-demographic questionnaire, General Health Questionnaire-12-Hindi version (GHQ-12), and COVID-19 vaccine related and COVID-19 appropriate behavior related questionnaire. Actual observation by the clinician regarding proper use of face masks, hand hygiene and social distancing was done and objectively scored on 0-10 for each item with a scale interval of 2. Analysis was conducted using IBM Statistical Package for the Social Sciences (SPSS) version 22.0. <b>Results:</b> Only 40% individuals were vaccinated. After eligibility, there was a mean delay of 4.20&#177;3.51 weeks (median: 4 weeks) and 13.40&#177;3.33 weeks (median: 12 weeks) in the vaccinated and unvaccinated individuals. Out of 120, 86 unvaccinated participants planned to get vaccinated in future. Significantly lower scores were obtained for actually observed COVID-19 appropriate behaviour (proper mask usage, hand hygiene and social distancing) as noted by the clinician vs the scores as reported by the participants. <b>Conclusion:</b> There were few takers for the COVID-19 vaccine, even weeks after eligibility. The COVID-19 appropriate behaviour was largely not being followed properly and the false sense of following the same complicated issues further. With multiple waves of the pandemic one after the other, and booster doses of vaccination, there is still an urgent need to sensitise the population at the grass root level regarding the COVID-19 vaccine behaviour to fight this pandemic. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=LC26-LC32&id=16142 https://doi.org/10.7860/JCDR/2022/54897.16142 Designing a Complaint Management Model in Iranian Hospitals Ahmad Mirab, Seyed Jamaledin Tabibi, Amir Ashkan Nasiri Pour, Ali Komeili <b>Introduction:</b> The effectiveness of the complaint management system in hospitals has a significant impact on the quality of healthcare services and improves client satisfaction. <b>Aim:</b> To develop and validate a patient complaint management model in Iranian hospitals. <b>Materials and Methods:</b> In the present mixed-methods study, basic information about the complaint management system (executive structure, executive mechanism, and control mechanism) in selected countries (Australia, United States of America (USA), United Kingdom (UK), South Africa, Turkey, and Iran) was reviewed in this study. Scopus, Science Direct, Web of Science, Magiran, Elsevier, Google Scholar search engine, and other databases compiled organisational websites and related and current articles. The Delphi method was utilised to identify the required items, and experts ultimately agreed upon 41 items. During the field study, 215 relevant complaint management experts and managers from across the hospital network responded to the relevant questionnaire. Exploratory Factor Analysis (EFA) and the EQS 6 and Statistical Package for the Social Science (SPSS) version 22.0 software packages were employed to identify and confirm the model&#8217;s dimensions. <b>Results:</b> The current state of the complaint management system in Iranian hospitals presents obstacles to enhancing service quality and customer satisfaction. Factors influencing countries&#8217; complaint management systems (41 items) were extracted based on expert opinions. The possible relationship between factors and their effectiveness was investigated using heuristic and Confirmatory Factor Analysis (CFA). Finally, four factors were identified and approved for inclusion in the proposed model: structural {Comparative Fit Index (CFI=1.347), managerial (CFI=0.325), executive (CFI=1.132), and compensatory (CFI=0.216)}. <b>Conclusion:</b> The patient complaint management system in Iranian hospitals can overcome existing challenges by reviewing and formulating structural, managerial, executive, and compensatory measures, as well as by drawing on the experiences of prosperous countries and by fostering coherence, improving service quality, and ensuring patient satisfaction. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=IC07-IC11&id=16143 https://doi.org/10.7860/JCDR/2022/53327.16143 Needle Probe- A Novel Instrument for Atraumatic Extraction of Broken Maxillary Root Apices Tripthi Shetty, Ranganath Jhawar, Prakyath Malli <b>Introduction:</b> Atraumatic extraction is the need of the hour to best preserve both hard and soft tissues. A novel instrument was designed, needle probe, in an effort to achieve the same efficacy with respect to extraction of maxillary teeth broken root fragments. <b>Aim:</b> The aim of the study was to assess the efficacy of using needle probe in removing fractured maxillary tooth apical sections in terms of application, use and its handling. <b>Materials and Methods:</b> In the present clinical, cross-sectional study, fifty patients requiring removal of fractured maxillary tooth root fragment as a complication of routine extraction were enrolled. The study was conducted between June 2020 to June 2021. Patients were assigned irrespective of gender, age or tooth, to group A (n=25) where extraction of root pieces was done using endodontic H files and group B (n=25) in whom extraction was done using the novel needle probe. Data was tabulated accordingly and analysed using Statistical Package for the Social Sciences (SPSS) version 22 and categorical data between groups were analysed using Student’s t-test with significance level set at 0.05. <b>Results:</b> The average time taken for successful removal of the root fragment in Group A was 3 minutes 3 seconds±23 seconds and 2 minutes 12 seconds±46 seconds in Group B. All inclusive, the needle probe proved to have excellent ease of operation, access and visibility in 24%, 24% and 36% cases as opposed to the conventional use of H files with minimal complications and tissue trauma. <b>Conclusion:</b> Failure to retrieve the broken root is mostly associated with ankylosed and hypercementosis roots. The needle probe can be promising in its use for atraumatic root fragment extraction. The novel needle probe is easy to use, quick in application and hence results in better patient compliance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZC27-ZC30&id=16144 https://doi.org/10.7860/JCDR/2022/52600.16144 Effects of Progressive Gaze Stability Exercises on Balance and Gait in Vestibular Neuritis Patients: A Quasi-experimental Study Priya Chauhan, SD Shahanawaz, Gaurav Kapoor <b>Introduction:</b> Gaze stability exercises are the exercises that are used effectively to improve gaze stability during head movement in various vestibular disorders patients, and to improve balance in static and dynamic movements of the same. <b>Aim:</b> To compare the effectiveness of progressive gaze stability exercises to improve balance and gait in patients with vestibular neuritis. <b>Materials and Methods:</b> This quasi-experimental study was conducted at Outpatient Department of SGT hospital, Gurugram, Haryana, India, from November 2018 to March 2019.<b></b> A total of 26 subjects were randomly assigned into two groups, group A received progressive gaze stability exercises with conventional therapy (n=13) and group B received conventional therapy (n=13). Group A received Vestibular Rehabilitation Therapy (VRT) for 25 minutes a day five times a week for four weeks. group B conventional training which consisted of balance exercises. Participants were assessed with Mini Balance Evaluation Systems Test (Mini-BESTest) and dizziness handicap inventory to access the performance of balance and functional limitation, respectively. Data was analysed by using the Statistical Package for the Social Sciences (SPSS) version 20.0 for statistical analysis. A level of significance was set at p-value <0.05. <b>Results:</b> The finding of the study showed no significant change for baseline parameters between the experimental and conventional groups with respect to age (p-value=0.097), gender (p-value=0.573), height (p-value=0.682), weight (p-value=0.945), duration of illness (p-value=0.579). Both the groups showed significant improvement with in group, when measured using dependent t-test for Mini-BESTest and Wisconsin Gait Scale. The comparison of postintervention scores of Mini-BESTest and WGS between group A and group B showed significant difference (p-value=0.001) and (p-value=0.002) respectively. <b>Conclusion:</b> The present study has provided preliminary evidence that progressive gaze stability exercises when coupled with conventional balance exercises may improve gait and balance in patients with vestibular neuritis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=YC12-YC15&id=16145 https://doi.org/10.7860/JCDR/2022/51238.16145 Is Male Infertility a Concern of Time? Comparison of Semen Parameters over a Five Year Period among Sub-fertile Men Visiting a Fertility Centre in Chennai, Tamil Nadu, India S Pramodita, VM Anantha Eashwar, GB Pavithra, Timsi Jain, Yogesh Mohan <b>Introduction:</b> Semen parameters, especially sperm count, concentration, progressive motility and volume have been said to be diminishing over time among men in developing countries like India. <b>Aim:</b> To compare the semen parameters (semen concentration, normal forms, progressive motility and defects) of sub-fertile males visiting Advanced Reproductive Care (ARC) fertility Centre in Chennai. <b>Materials and Methods:</b> This cross-sectional study was conducted in Advanced Reproductive Care, Inc. (ARC) International Fertility and Research Centre, Chennai, Tamil Nadu, India, from the period between January 2015 to December 2019. Total 50 semen samples were selected randomly each year bringing the total to 250 samples which were included in the study. Masturbation was the major method of semen collection. The semen was analysed for the various parameters like semen concentration, normal forms, progressive motility and defects in the laboratory under microscope on wet preparation of slides as per the standard guidelines. The various semen parameters along with the age of the participants were entered in Microsoft Excel and analysed by Statistical Package for the Social Sciences (SPSS) version 22.0. <b>Results:</b> Total 250 semen reports were included in the study. Subjects belong to age group between 20 to 60 years. It was found that there was a statistically significant mean difference among progressive motility (25.14&#177;16.37 in 2015 to 17.30&#177;11.41 in 2019; p-value=0.009), semen concentration (78.1&#177;61.15 in 2015 to 65.96&#177;57.85 in 2019; p-value=0.001) among the semen samples over the years. There was a decreasing trend with the semen parameters, being lower than optimal over the years. <b>Conclusion: </b>The study findings suggested that there was a decrease in semen parameters over the years and further studies have to be carried out to find the various environmental and lifestyle factors which could be responsible for the same. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=QC14-QC17&id=16152 https://doi.org/10.7860/JCDR/2022/51688.16152 Prevalence of Oral Lesions and Nicotine Dependency among Tobacco Users in an Urban Community of Vellore, South India Libin Benance Jacob, JS Jesija, Madhu Mohan, Ruby Angeline Pricilla, Jasmin Helan Prasad <b>Introduction:</b> Tobacco consumption is one of the most leading causes of preventable deaths around the world. According to the World Health Organisation (WHO), eight million deaths occur annually due to tobacco usage. <b>Aim:</b> To identify the prevalence of oral lesions among people who use tobacco, their knowledge on health hazards of tobacco use and the dependence on nicotine among adults in the age group between 18 to 60 years. <b>Materials and Methods:</b> A community-based, cross-sectional study was conducted in Department of Community Medicine, Christian Medical College, Vellore, Tamil Nadu, India, among an urban community of Vellore, between January 2019 to June 2019. This study included 930 participants. An interviewer administrated questionnaire was used to assess the prevalence of tobacco and dependence on nicotine among adults. The participants who use tobacco were examined for oral lesions. Univariate analysis was performed to highlight the variables and logistic regression model was used to find the adjusted odds ratios and p-values . A p-value<0.05 was considered statistically significant. <b>Results:</b> The total number of adults who participated in this study was 930. The median age group among the study population was 38 years and the mean age was 38.26&#177;12 years. About two-third (62.2%) of the participants were females. The proportion of adults currently using tobacco in any form was 24.19% (n=225), with those using Smoking Tobacco (ST) was 59.1% (n=133), Smokeless Tobacco (SLT) was 38.6% (n=87) and using both ST and SLT were 2.2% (n=5). The prevalence of oral mucosal lesions was found to be 60.1% with smoker&#8217;s palate (N=96) being the most frequently occurring oral mucosal lesion. The nicotine dependence was found to be significant in the subjects with age more than 45 years and had used tobacco for more than 20 years. On the analysis of the knowledge on health hazards, it was identified that 76.3% of the participants were aware that use of tobacco in any form can cause oral lesions. <b>Conclusion:</b> This study highlights that oral lesions and nicotine dependence are highly prevalent among the tobacco users. This emphasises the need for community based oral health awareness programs highlighting the consequences of tobacco usage in order to prevent the incidence of oral cancers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZC31-ZC37&id=16156 https://doi.org/10.7860/JCDR/2022/51308.16156 Neurobehavioural and Neurochemical Changes in Arsenic Induced Cerebellar Toxicity in Male Sprague-Dawley Rats: An Experimental Study Ravi Shankar Prasad Sawan, Sridevi Nangali Srinivasa, Shashidhar Kurpad Nagaraj <b>Introduction:</b> Sodium arsenite, an inorganic arsenic, is naturally present at high level (>50 &#956;g/L) in ground water. Drinking ground water is the biggest threat to public health. Though, there are numerous reports on arsenic neurotoxicity, the arsenic effect on cerebellar neurotoxicity remains vague especially its chronic effect on its neurobehavioural and neurochemical alterations. <b>Aim:</b> To evaluate the neurobehavioural and neurochemical alterations caused by sodium arsenite in cerebellum of rats. <b>Materials and Methods:</b> This experimental study was conducted in the Central Animal House at Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER) from November 2019 to February 2020 for a period of 90 days. Total 16 male sprague-dawley rats were randomised into two equal groups. Group I: Control, received normal saline. Group II: Sodium arsenite, doses of 50 Parts per Millions (PPM) for 90 days through oral gavage. Rats were subjected to Open Field Test (OFT) for locomotor and exploratory behaviour and Beam Walking Test (BWT) for motor coordination and balance. Following behavioural tests, rats were anaesthetised. Blood was drawn from a retro-orbital puncture. Brains were dissected and cerebellum was separated. Concentration of Malondialdehyde (MDA), Nitric Oxide (NO) and activity of Glutathione Peroxidase (GPx) were assessed spectrophotometrically in serum and cerebellum of rats. Mean&#177;SD was used for normally distributed data and groups were compared using independent t-test, whereas for non-normally distributed data, Median (25<sup>th</sup>-75<sup>th</sup> Percentile) was used and Mann-Whitney U-test was used to compare groups. <b>Results:</b> Arsenic-treated rats showed a significant increase in arsenic concentration in serum and cerebellum (5.5&#177;1.6 ng/mL, 2.76&#177;0.56 &#956;g/g, respectively) compared to control (1.14&#177;0.43 ng/mL, 0.65&#177;0.29 &#956;g/g, respectively). There was a significant decrease in locomotor and exploratory behaviour and impairment in motor coordination and balance in arsenic treated rats with a p-value <0.001 in comparison with control rats. The arsenic treated rats had significantly enhanced concentration of MDA and NO level and reduced activity of GPx in serum {16.84 (13.84-18.87), 33.79 (30.05-37.17) nmol/mL, and 6.89 (5.24-8.5) mmoles of Reduced glutathione (GSH) oxidised/min/mL, respectively} compared to control {8.81 (8.36-9.48), 17.66 (15.33-21.29) nmol/mL, and 15.16 (12.77-16.59) mmoles of GSH oxidised/min/mL, respectively} and also found increased concentration of MDA and NO level and reduced activity of GPx in tissue {7.98 (7.14-8.92), 24.67 (21.4-28-22) nmol/mg of protein and 2.66 (1.19-3.86) mmoles of GSH oxidised/min/mg protein, respectively} compared to control {3.02 (2.35-3.61), 13.93 (11.0-16.16) nmol/mg of protein and 7.63 (7.08-9.19) mmoles of GSH oxidised/min/mg protein, respectively}. <b>Conclusion:</b> The oral administration of sodium arsenite at the doses of 50 PPM for 90 days showed interesting alterations in neurobehavioural and neurochemical parameters related to cerebellum of rats. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=AC10-AC14&id=16157 https://doi.org/10.7860/JCDR/2022/53048.16157 A Prospective Study of Supine Percutaneous Nephrolithotomy with a Modified Technique: A Safe and Desirable Tool in the Armamentarium of Urologists Vimal Kumar Dixit, Vivek Kumar Vijjan, Amulya Aggarwal <b>Introduction:</b> Supine Percutaneous Nephrolithotomy (PCNL) has failed to gain popularity despite the various advantages, primarily due to a lack of standardised technique. A simple and replicable technique is needed to increase its popularity amongst urologists. <b>Aim:</b> To simplify and standardise the puncture technique of supine PCNL and compare it with the Clinical Research Office of the Endourological Society (CROES) PCNL global study. <b>Materials and Methods:</b> A prospective interventional study was conducted in a tertiary care hospital in Dehradun, Uttarakhand, India, between June-December 2020. A total of 82 consecutive patients underwent the procedure with a modified technique of initial puncture using bony landmarks. The results of present study were compared with the outcomes of the patients who underwent supine PCNL in the CROES PCNL global study which is the largest prospective database regarding the supine and prone positions of PCNL till date. Statistical analysis of various demographic variables, patient characteristics and results was done using Statistical Package for the Social Sciences (SPSS) version 24.0 software. <b>Results:</b> The mean age of patients was 47.52&#177;13.044 years and mean stone burden of 266.146&#177;172.430 mm<sup>2</sup>. The mean operative time was 85.59&#177;12.733 minutes. Lower calyceal puncture was done in 97.56% of patients. Stone clearance was achieved by a single puncture in 73 (89.0%) patients while 9 (11.0%) patients required two punctures. Sixteen patients (19.51%) had postnephrostomy drain removal leak which settled within 24 hours. Only in one patient the leak continued beyond 24 hours but was managed conservatively. On comparison, it was observed that mean stone burden was lesser (p-value=0.0001) and the stone free rate was comparatively higher in present study (p-value=0.024). <b>Conclusion:</b> Supine PCNL is an effective and safe procedure in a subset of patients with predominant lower calyceal stone bulk. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=PC16-PC19&id=16158 https://doi.org/10.7860/JCDR/2022/53483.16158 Co-morbidities and Complications in COVID-19 Recovered Patients in Bhilwara District, Rajasthan, India: A Descriptive Study Mahesh Kumar Choudary, Shalini Jain, Surendra Meena, Daulat Meena, Arun Gour, Shalabh Sharma <b>Introduction:</b> Coronavirus Disease-19 (COVID-19) infection is associated with high rates of pulmonary and extrapulmonary complications that may continue to incur morbidity, disability and delayed mortality in survivors. These include hyperglycaemia, cardiac injury, acute ischaemic or haemorrhagic stroke, neurological deficits, acute kidney injury and liver injury. <b>Aim:</b> To describe symptoms and complications being faced by COVID-19 recovered patients, as well their socio-demographic profile and co-morbidities. <b>Materials and Methods:</b> This was a cross-sectional descriptive study conducted for the period of 12 months from April 2020 to March 2021. Out of nearly 10,000 recovered COVID-19 patients, 1000 patients were selected randomly. The patients were categorised gender-wise (male and female) and locality-wise (urban and rural) and an attempt was made to find if any significant difference exists in the symptoms and complications based on above categorisation. The test used for this purpose was Chi-square test and Fisher&#8217;s-exact test. <b>Results:</b> Mean age of participants was 50.2&#177;15.7 years and 43.8% had co-morbidities. Common complications included hyperglycaemia (n=28), acute kidney injury (n=8), acute liver injury (n=5), cardiovascular accident and stroke (n=5), septicaemia (n=8), ischaemic heart disease (n=7), deep vein thrombosis (n=2), cytokine release syndrome (n=10) and post COVID-19 fibrosis (n=3). For septicaemia, a statistically significant difference (p<0.001) was found between urban and rural areas whereas no significant difference in post COVID-19 complications between males and females was observed. <b>Conclusion:</b> The most common co-morbidity was diabetes mellitus and most common complication reported was hyperglycaemia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=LC33-LC36&id=16159 https://doi.org/10.7860/JCDR/2022/52205.16159 Efficacy of Magnesium Sulphate in Attenuation of Succinylcholine Induced Fasciculations- A Randomised Clinical Study S Bala Bhaskar, Y Vedashree, N Kiran Chand, D Srinivasalu <b>Introduction:</b> Magnesium Sulphate (MgSO<sub>4</sub>) pre-administration is effective in reducing Succinylcholine (Sch) induced fasciculations due to its effect at presynaptic end plate. Magnesium competes with calcium at the presynaptic end plate of neuromuscular junction and inhibits the release of Acetylcholine (Ach) from the motor nerve terminal and to a lesser extent, decreases the sensitivity of the postjunctional membrane and reduces the excitability of the muscle fibre. <b>Aim:</b> To evaluate three doses of MgSO<sub>4</sub> in reducing the incidence and severity of fasciculations. <b>Materials and Methods:</b> This prospective, randomised clinical trial was conducted at Vijayanagar Institute of Medical Sciences (VIMS), Ballari, India. Ninety consenting adult patients aged 20-50 years scheduled for elective surgeries with endotracheal intubation under general anaesthesia were randomly allocated into three groups- Group 1, Group 2 and Group 3, to receive Injection (Inj.) MgSO<sub>4</sub> 20 mg/kg, 30 mg/kg and 40 mg/kg, respectively, before induction. Induction with Inj. propofol (2 mg/kg) was followed by administration of Inj. Sch (1.5 mg/kg). The main outcome parameters were the incidence of fasciculations and grading of the severity. Haemodynamic responses from the basal levels and after intubation, and adverse effects to the study drugs were noted. Chi-square test was used to find the significance of study parameters on categorical scale among the groups. Probability values at <0.05 was considered as significant. <b>Results:</b> The incidence of fasciculations was 90%, 53.4% and 43.4% in groups 1, 2 and 3, respectively. Greater number of patients had grade 3 fasciculations in group 1 (20%), compared to group 2 and group 3 (3.4% and nil), respectively. The fall in blood pressure after MgSO<sub>4</sub> was comparable among the three groups. Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) increased by 23.5% and 18.5%, 7.9% and 4.1% and 2.8% and 2.7% in groups 1, 2 and 3, respectively at one minute. The SBP and DBP at 3<sup>rd</sup> and 5<sup>th</sup> minute stayed at statistically significant greater levels in group 1 as compared to groups 2 and 3, but were similar in groups 2 and 3 overall. The Heart Rate (HR) changes followed similar trend in all 3 groups. Incidence of feeling of warmth was highest in group 3 as compared to other groups. <b>Conclusion:</b> MgSO<sub>4</sub> at 40 mg/kg can be the optimal dose to suppress Sch-induced fasciculations, with better attenuation of intubation associated haemodynamic changes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=UC19-UC23&id=16160 https://doi.org/10.7860/JCDR/2022/53556.16160 Susceptibility Profile and Clinical Response of Fosfomycin and Other Antibiotics against Multidrug Resistant Gram Negative Urinary Isolates: A Cross-sectional Study Chinmoy Sahu, Sweta Singh, Sangram Singh Patel, Nidhi Yaduvanshi, Sanjay Singh, Ujjala Ghoshal <b>Introduction:</b> Irrational use of antibiotics to treat Urinary Tract Infections (UTI) has led to the development of Multidrug Resistant (MDR) bacteria in both community as well as the hospital settings. Fosfomycin has emerged as a novel therapeutic option to treat these UTI patients along with empirically used routine antibiotics. <b>Aim:</b> To assess the sensitivity, molecular resistance mechanisms and clinical response of fosfomycin along with other urinary antibiotics like nitrofurantoin, colistin, and imipenem. <b>Materials and Methods:</b> It was a cross-sectional observational study conducted from July 2018 to June 2019 in SGPGIMS, Lucknow, India. Stream urine samples of 24,782 patients were collected with clinical suspicion of UTI. The antibiotics were tested by disc diffusion and Minimum Inhibitory Concentration (MIC) methods. Genotypic analysis was done for testing resistance mechanisms in fosfomycin resistant isolates. Statistical tests were performed using Statistical Package for the Social Sciences (SPSS) software for Windows version 14.0. <b>Results:</b> Out of the 24,782 urine samples, 2,776 (11.2%) showed significant growth of pathogens with 334 drug resistant isolates among them. Gram negative bacilli 1846 (66.50%) was the most predominantly isolated pathogen in the cultures. Among the 334 drug resistant specimens, Escherichia coli {124 (37.13%)} were maximum in number. Total 79.6% (266/334) of the isolates were sensitive to fosfomycin including 88.7% (110/124) of <i>E. coli</i>, and 91.3% (105/115) of <i>K. pneumoniae</i> isolates. Colistin showed sensitivity in 87.1% (108/124) of the <i>E. coli</i> isolates; followed by Imipenem in 49.2% (61/124) and nitrofurantoin in 37.1% (46/124) of the isolates. Fos A genes were found to be the most prevalent in Fosfomycin resistant. About 41% of the patients showed favourable outcome and were cured with initiation of treatment as per sensitivity pattern. <b>Conclusion:</b> Fosfomycin has emerged as a safer option in MDR urinary isolates as compared to other urinary antibiotics including colistin. The drug needs to be more widely studied for its possible pharmacokinetics and dynamics as well as it&#8217;s possible implications in healthcare settings and patient management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=DC31-DC35&id=16161 https://doi.org/10.7860/JCDR/2022/52109.16161 Prevalence and Socio-demographic Determinants of Low Birth Weight Newborns: A Prospective Observational Study Ritu Singh, Surekha Tayade, Neha Gangane, Neha Chaudhary <b>Introduction:</b> Birth weight is not only strongly associated with foetal and neonatal mortality but also with stunted growth. Low Intelligence Quotient (IQ) in childhood, obesity and diabetes in adulthood. Despite all measures taken, the prevalence of Low Birth Weight (LBW) is not significantly decreasing in Southeast Asia {from 33% in 2000 to 27% in 2015 according to United Nations Children’s Fund (UNICEF) 2019 data}. Added to the surprise in UNICEF data from countries for LBW, from A-Z data, (A-Z data is data of LBW countries whose name starts from letter A to letter Z in alphabetical order) India was not included, because data from India was partial. <b>Aim:</b> to assess the prevalence and socio-demographic determinants of LBW in newborns. <b>Materials and Methods:</b> A prospective hospital-based observational study was carried out in the Obstetrics and Gynaecology Department of Mahatma Gandhi Institute of Medical sciences, Sewagram, Wardha, Maharashtra India, among 500 consecutive, consenting pregnant women from December 2017 to November 2019. Sociodemographic parameters and neonate birth weight was recorded. Statistical analysis was done by inferential statistics using Chisquare test and z-test with significance value considered at <0.05. Results: Among the total 500 subjects 162 (32.4%) had LBW and 338 (67.6%) Normal Birth Weight (NBW). By using Chisquare test, statistically significant difference was found in parity, socio-economic condition, mother’s education, area of residence of both the LBW and NBW groups (&#967;<sup>2</sup> =6.49, p=0.039; &#967;<sup>2</sup> =51.32, p=0.0004; &#967;<sup>2</sup> =12.95, p=0.012; &#967;<sup>2</sup> =5.66, p=0.017), respectively. <b>Conclusion: </b>The prevalence of LBW babies was 32.4%. Rural areas, low socio-economic condition, education, were significant determinants of LBW. As the parity increases birth weight increases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=QC18-QC21&id=16163 https://doi.org/10.7860/JCDR/2022/51339.16163 Efficacy of CBNAAT versus Adenosine Deaminase in Fluids in Extrapulmonary Tuberculosis Abhinay Krishna Soni, Prashant Puraskar, Akash Shrikhande, Shweta Soni <b>Introduction:</b> Tuberculosis though primarily, is a pulmonary disease, it may manifest as Extrapulmonary Tuberculosis (EPTB). The gold standard method for the diagnosis of extrapulmonary tuberculosis is blood culture. Increased activity of Adenosine Deaminase (ADA) is observed in tuberculosis. Cartridge-based Nucleic Acid Amplification Test (CBNAAT) or Gene Xpert Mycobacterium tuberculosis/Rifampicin (MTB/RIF) is based on Real Time-Polymerase Chain Reaction (RT-PCR). Extrapulmonary tuberculosis may present with varied features, may mimic malignancy, and pose a diagnostic challenge. <b>Aim:</b> To assess and compare the efficacy of Cartridge-based Nucleic Acid Amplification Test (CBNAAT) and Adenosine Deaminase (ADA) in cases with extrapulmonary tuberculosis. <b>Materials and Methods:</b> This cross-sectional study was conducted on presumptive cases of extrapulmonary tuberculosis presenting in Department of Medicine at People&#8217;s College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India, from November 2019 to August 2021. All the patients were subjected to detailed history and clinical examination including series of blood and radiological investigations. Apart from this, ADA analysis and CBNAAT was done in all the cases and were treated accordingly. The two tests were compared using Chi-square test. The p-value <0.05 were considered statistically significant. <b>Results:</b> Male predominance was observed and with no statistical difference in age (p-value=0.09) and gender (p-value=0.21). Out of 19 cases of Tubercular Meningitis (TBM) from total 125, ADA was raised in 10 (52.6%) cases, whereas out of 42 Tubercular Pleural Effusion (TBPE) and 24 Tubercular Peritonitis (TBP) cases, ADA was raised in 26 (61.9%) and 4 (16.7%) cases, respectively. Out of 19 cases of TBM, CBNAAT was positive in 4 (21.1%) cases, whereas out of 42 TBPE and 24 TBP cases, CBNAAT positivity was documented in 8 (19%) and 2 (8.3%) cases, respectively. Overall, the sensitivity of ADA was higher for detection of TBM and TBPE as compared to CBNAAT but the specificity of CBNAAT was higher for all the extrapulmonary tuberculosis. Overall diagnostic accuracy of ADA was higher (61.6%) as compared to CBNAAT (43.2%) for detection of extrapulmonary tuberculosis. <b>Conclusion:</b> Extrapulmonary tuberculosis poses diagnostic challenge and thus for diagnosis, evaluation of each component i.e., history, physical examination, blood investigations, fluid analysis, ADA estimation, and CBNAAT is important. Relying solely on single diagnostic modality may be associated with low diagnostic yield, and thus each step of patient assessment must be given equal preference so as to improve the diagnostic yield. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=OC25-OC28&id=16164 https://doi.org/10.7860/JCDR/2022/53715.16164 Comparative Evaluation of King Vision Video Laryngoscope, McCoy and Macintosh Laryngoscopes in Patients Scheduled for Mucormycosis Surgery: A Randomised Clinical Trial Michell Gulabani, Vibhor Gupta, Richa Chauhan, Suman Choudhary, Ashok Kumar Saxena, Prerna Vasudev <b>Introduction:</b> Mucormycosis, an aggressive fungal infection may result in a difficult airway owing to its inflammation. King Vision Video Laryngoscope (KVVL) is a useful addition to a difficult airway armamentarium. McCoy laryngoscope with hinged tip is well-known equipment of difficult airway cart. Conventional Macintosh laryngoscope dominates in anaesthesia practice. Standard, existing and contemporary devices were compared in difficult airways resulting from mucormycosis. <b>Aim:</b> To compare the relative performance of KVVL, McCoy, and Macintosh laryngoscopes based on the ease of intubation and haemodynamic response in patients with mucormycosis. <b>Materials and Methods:</b> The present study was a randomised clinical trial, conducted in a tertiary care government hospital, during June-August 2021 on 90 consenting patients of 18-65 years age, belonging to either sex with microbiologically confirmed mucormycosis undergoing debridement surgery. Group A was intubated with a non channeled KVVL, while group B had McCoy and group C had Macintosh laryngoscope. Primary outcome parameters were Cormack Lehane (CL) grade, time from laryngoscopy to successful intubation, number of attempts, any adjuncts or optimisation maneuvers, and any mucosal injury. Secondary outcome parameters were Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Blood Pressure (MBP) measured on arrival, before induction, after induction, and at 1, 2, 3, 5, and 7 minutes after intubation. Comparison of quantitative variables not normally distributed were analysed using Kruskal-Wallis test. Post-hoc analysis by Dunn&#8217;s multiple pairwise comparison test. Friedman test followed by pairwise comparison was done to compare haemodynamic parameters within each group. Chi-square test was used for qualitative variables. The p-value &#8804;0.05 was considered to be statistically significant. <b>Results:</b> The CL grade was lowest in group B (1.83&#177;0.38) against group A (1.93&#177;0.25), group C (2.13&#177;0.35) with p-value of 0.029. Time from laryngoscopy to successful intubation was the least in group B (19.5&#177;3.98 seconds) against group A (26.07&#177;9.8 seconds), group C (21.33&#177;3.74 seconds) with p-value of 0.002. No significant difference was there in the number of attempts, airway adjuncts/optimisation maneuvers, mucosal injury. Haemodynamic variables were comparable. <b>Conclusion:</b> McCoy laryngoscope was found to perform best in difficult airways resulting from mucormycosis. It was most effective for glottic visualisation, with the shortest time to successful intubation and, haemodynamic parameters were comparable to KVVL and macintosh laryngoscopes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=UC05-UC10&id=16070 https://doi.org/10.7860/JCDR/2022/53696.16070 Correlation of Standard ECG with 2D-Echo and Serum Troponin I in Locating the Site of Myocardial Infarction and its Extent- An Observational Study AC Sanjay Reddy, TR Pandiyan, Srinivasa Rao, YJ Visweswara Reddy, PE Dhananjaya <b>Introduction:</b> Cardiovascular diseases are the leading causes of death in developed countries, and its incidence is on the rise in developing countries. Electrocardiogram (ECG), 2 Dimensional Echocardiography (2D-Echo) and myocardial injury biomarkers help in the diagnosis, prognostification of Myocardial Infarction (MI). <b>Aim:</b> To correlate the findings of ECG, 2D-Echo and Troponin I levels in locating the site and extent of MI. <b>Materials and Methods:</b> This observational study was conducted in the Cardiology Intensive Care Unit (ICU)/ward, PES Hospital, Kuppam, Andhra Pradesh, India, from January 2019 to June 2020. A total of 99 patients of acute MI were studied at baseline, and repeat 12 lead ECG, 2D-Echo and serum troponin I levels were recorded. Ejection Fraction (EF) was estimated from the QRS score by means of a formula, and Echocardiographic correlation was obtained on the same day with ECG-QRS scoring by direct estimation of EF in &#8216;Q&#8217; wave infarction. High sensitivity cardiac Troponin &#8211; I was measured at the time of hospitalisation and repeated at six hours if required, and its levels were correlated to the extent of MI i.e., Left Ventricular Ejection Fraction (LVEF). The categorical data were analysed using Chi-square test and p<0.05 was considered as statistically significant. Regression analysis was done for associated factors. <b>Results:</b> There was better correlation between EF calculated from ECG-QRS scoring system and 2D-Echo (r=0.78, p-value <0.001). There was poor correlation between serum Troponin I levels at admission, and extent of MI i.e., LVEF as estimated by ECG and 2D-Echo (r=-237.13, p=0.334 and r=-120.78, p=0.585). There was a significant correlation between serum Troponin I levels at 72 hours of chest pain or peak values and extent of MI i.e., LVEF as estimated by ECG and 2D-Echo (r=-1446.14, p<0.001 and r=-1354.42, p<0.001). <b>Conclusion:</b> The location of MI, seen on ECG, correlated broadly with those seen on 2D-Echo. 2D-Echo was able to elaborate regional wall motion abnormalities in detail when compared to the ECG. LVEF can be calculated from ECG at bedside in Q wave infarction, which correlated fairly with 2D-Echo findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=OC05-OC09&id=16071 https://doi.org/10.7860/JCDR/2022/53075.16071 Fine Needle Aspiration Cytology of Giant Cell Tumour of Tendon Sheath Sonam Jain, Saumya Nanda, Malvika Shastri, Annu Nanda, Vaibhav Garg <b>Introduction:</b> Giant Cell Tumour of Tendon Sheath (GCTTS), also known as localised nodular tenosynovitis, is a slow growing benign soft tissue tumour arising from synovium of tendon sheath, bursa or joint. Clinically, the lesions occur as skin-coloured nodules typically on the extremities. These tumours occur more frequently on the upper limbs especially hands (77%) where they form the second most common tumour following simple ganglion cyst. <b>Aim:</b> To describe the cytomorphologic findings in GCTTS and their histopathological features. <b>Materials and Methods:</b> This retrospective study was conducted at Department of Pathology, ESI Hospital, New Delhi, India, in 12 diagnosed GCTTS cases for their cytological features from January 2015 to December 2017. Fine Needle Aspiration Cytology (FNAC) was performed with a 22-gauge needle attached to a 10 mL syringe. Smears were air-dried and stained with Giemsa stain. Cytomorphology of all the selected cases were analysed and descriptive statistics were used to evaluate the cases. <b>Results:</b> A total of 12 cases of GCTTS were retrieved. Diagnosis of GCTTS was made by FNAC in all the cases and confirmed by histopathological examination in half of the cases. The mean age of presentation was 39 years. Of these, 8 (66.67%) were women and 4 (33.33%) were men. The lesions were found most commonly over the index finger (n=5) followed by the ring finger (n=3), thumb (n=2), middle finger (n=1) and little finger (n=1). The most frequent clinical presentation was a painless, nodular, slow growing firm swelling over the finger. FNAC revealed cellular smears with few clusters and numerous scattered stromal cells along with interspersed multinucleated giant cells. <b>Conclusion:</b> A definitive preoperative diagnosis of GCTTS obtained through FNAC helps in formulating appropriate treatment plan. Histopathologic examination will confirm the cytological diagnosis and can help to predict recurrence by providing information on the resection margin, any satellite nodules, variable cell types and mitotic activity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=EC05-EC07&id=16072 https://doi.org/10.7860/JCDR/2022/50794.16072 Relationship of Bowling Speed with Power and Dynamic Balance in Bowlers: A Cross-sectional Study Abhishek Rohilla, Pooja Anand, Sajjan Pal, Abhista Sehdav <b>Introduction:</b> In the game of cricket, dynamic balance and the strength of lower limb muscles plays a major role while bowling or to control the bowling speed. Bowlers use different style of run ups to optimise their bowling speed. Therefore, for every athlete, physical fitness plays essential role. <b>Aim:</b> To find the correlation between bowling speed and lower limb explosive power and dynamic balance in state and district level cricket bowlers. <b>Materials and Methods:</b> This cross-sectional study was conducted at Cricket Gurukul, Faridabad, Mahadev Desai Cricket Academy, Faridabad, Haryana and Indraprastha Cricket Academy, Punjabi Bagh, New Delhi, India from January 2018 to January 2019. Total 98 male bowlers with age between 16-28 years, playing experience of atleast 6 months in University/District level and playing frequency atleast 5 days/weeks were included in the present study. Modified Star Excursion Balance Test (mSEBT) was used to measure the dynamic balance, broad jump test was used to measure lower limb explosive power and radar gun was used to measure the bowling speed. Data was analysed in the Statistical Package for the Social Sciences (SPSS) software 2.0 version. Descriptive statistics was calculated. Pearson&#8217;s correlation coefficient was calculated. The p-value <0.05 was set as statistically significant. <b>Results:</b> Mean age was 19&#177;3.1 years and Body Mass Index (BMI) was 23.1&#177;2.68 kg/m<sup>2</sup>. Dynamic balance showed positive correlation with bowling speed (r=0.227, p<0.0001) and lower limb explosive power showed positive correlation (r=0.638, p<0.0001) with bowling speed in cricket bowlers. <b>Conclusion:</b> It was found that, the bowling speed of the cricket bowlers can improve majorly, if the explosive power of the lower limb is improved, whereas, there is less impact of dynamic balance on the bowling speed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=YC05-YC07&id=16073 https://doi.org/10.7860/JCDR/2022/51194.16073 White Blood Cells in COVID-19: A Study on Viral Induced Cytopathic Changes in the Peripheral Smear Nidha Gaffoor, Archana Shetty, Aparna Muralidhar, Jessica Minal, PV Nikhil, Hima Sree Edupuganti <b>Introduction:</b> Laboratory parameters are crucial in diagnosis and prognosis of Coronavirus Disease 2019 (COVID-19). It would be of interest to explore morphological changes in infected White Blood Cells (WBCs). A detailed examination of peripheral smears may shed light on pathophysiology of infected cell lines and differentiate them from those in established viral infections like dengue and infectious mononucleosis. <b>Aim:</b> To study morphological changes of WBCs in peripheral smears of severe and non severe cases of COVID-19 patients. <b>Materials and Methods:</b> This cross-sectional study was conducted at a tertiary care centre, Dr. Chandramma Dayananda Sagar Institute of Medical Education and Research, Ramanagara, Karnataka, India, from April 2021 to August 2021 on 120 peripheral smears of adult COVID-19 positive cases. Abnormal morphological features were graded by counting 100 cells in each of neutrophils, lymphocytes and monocyte lineage. Changes were compared and analysed between severe and non severe groups using Statistical Package for Social Sciences (SPSS) software version 26.0. A p-value <0.05 was considered as significant. <b>Results:</b> The study included total of 120 cases (59 severe and 61 non severe) with a mean age of 47 years. Male to female ratio in severe and non severe categories were 1:1.2 and 1:0.6, respectively. Severe category patients (n=59) were associated with statistically significant leucocytosis (p-value=0.04), absolute neutrophilia (p-value=0.03) and higher grades of morphological changes- abnormal nuclear morphology (p-value=0.002) and Pseudo-Pelger-Huët anomaly in neutrophils (p-value=0.029), plasmacytoid lymphocytes (p-value=0.03), cytoplasmic granularity and atypical lymphocytes (p-value=0.04). Monocytes showed large coalescent vacuoles and cytoplasmic granules (p-value=0.03). Though present in non severe category (n=61), they were proportionately of lesser grades. <b>Conclusion:</b> Viral cytopathic effects in WBC lines on peripheral smear had significant clinical implications on disease severity, undermining need for a comprehensive study of viral induced morphological changes in hospitalised COVID-19 patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=EC08-EC11&id=16074 https://doi.org/10.7860/JCDR/2022/53011.16074 Utility of White Blood Cell Diluting Fluid (Turk’s Fluid) in Evaluation of Haemorrhagic Thyroid Cytology Smears in a Tertiary Care Centre- A Novel Study Amrutha Gorva, KL Shoba, K Chaithanya, V Arpitha <b>Introduction:</b> Fine Needle Aspiration Cytology (FNAC) has been one of the safest and accurate diagnostic technique in diagnosing thyroid lesions. But due to the vascularity of thyroid tissue, diagnostic cells get entrapped in blood clot unless rapid smearing is done.This results in repeat FNAC which is inconvenient to the patient as well as time consuming to pathologist. Therefore, an alternative is required to avoid repeat FNAC procedure. <b>Aim:</b> To evaluate the role of Turk&#8217;s fluid in haemorrhagic thyroid FNAC smears in comparison to conventional haemorrhagic smears. <b>Materials and Methods:</b> The present study was a prospective observational study, which was conducted for the period of six months (March-August 2021). A total of 30 cases were included in the study. Fine Needle Aspiration (FNA) sampling was done on patients with thyroid swelling. After the needling was done on the swelling, four smears were prepared. One was stained using haematoxylin and eosin (H&E). Rest of all the smears were stained by Conventional Giemsa (CG) method. One of these CG stained smears was immediately treated with Turk&#8217;s fluid for 10-20 seconds. The CG stained smears were compared with the Turk&#8217;s fluid Treated Giemsa (TTG) smears and evaluated for retention of Red Blood Cells (RBCs), visibility of nuclear and cytoplasmic details of thyroid follicular cells. <b>Results:</b> A total of 30 cases were included in the study. The retention of RBC was lesser in TTG compared to CG which was statistically significant (p-value <0.05). The visibility of cytoplasmic and nuclear morphology on TTG was better than that of CG which was statistically significant (p-value <0.05). <b>Conclusion:</b> The TTG smears improves visibility of cytomorphological features by reducing background RBCs and hence avoids repeat FNAC. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=EC12-EC14&id=16075 https://doi.org/10.7860/JCDR/2022/53666.16075 Comparison of Sequential Boost and Simultaneous Integrated Boost Volumetric Modulated Arc Therapy in Treatment of Head and Neck Carcinoma: A Prospective Interventional Study Abhishek Arora , Ramesh Purohit , Kiran chigurupalli , Menal Bhandari , AR Gupta , Shalu Peter <b>Introduction:</b> Volumetric Modulated Arc Therapy (VMAT) is a radiotherapy in head and neck cancer can be delivered by two boost techniques: Sequential Boost (SEQ) and Simultaneous Integrated Boost (SIB). There is still limited data comparing these two techniques. <b>Aim:</b> To compare SEQ and SIB planning techniques of VMAT in patients of Head And Neck Squamous Cell Carcinoma (HNSCC)in terms of disease response and acute toxicities. <b>Materials and Methods:</b> A prospective interventional study was conducted at Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India from January 2019 to December 2020. Total of 52 patients of HNSCC planned for radical chemoradiation were enrolled into two study arms SEQ-VMAT and SIB-VMAT. Chemotherapy was given with weekly cisplatin 40 mg/m<sup>2</sup>. Dosimetric comparison was done using Dose Volume Histogram (DVH) analysis. Response evaluation was done as per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 at 8-10 weeks follow-up. Acute toxicity evaluation was done as per Radiation Therapy Oncology Group (RTOG) toxicity grading. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 20.0 software. <b>Results:</b> A total of 52 subjects were included in the study, out of which 26 subjects were in each group. No significant difference was observed in demographic data in terms of age 56.2 vs 53.5 years, sex (24 males and 2 females in both the arms), disease site (oropharynx is the most common site 38.5% in both arms) and stage (IVA 69.2% in SEQ arm vs 46.2% in SIB arm and III 30.8% in SEQ arm vs 42.3% in SIB arm). Dosimetric data was comparable between the two arms. SIB-VMAT shows significantly higher incidence of acute dermatitis (grade1 dermatitis at two weeks 69.2% vs 38.5%, p=0.0279 and grade 2 dermatitis at six weeks 84.6% vs 38.5%, p=0.0007) and acute mucositis (grade 1 mucositis at two weeks 84.6% vs 38.5%, p=0.0007) as compared to SEQ-VMAT. SEQ-VMAT shows significantly higher incidence of dysphagia (grade 1 at four weeks 84.5% vs 50%, p=0.0087). No significant differences were observed in terms of xerostomia and laryngeal toxicity. No significant difference in overall response was observed between SIB vs SEQ (complete response 65.4% vs 53.85% p=0.40). <b>Conclusion:</b> SEQ appears better in terms of acute toxicities but SIB was more convenient as no re-planning was required.For head and neck radiotherapy SIB and Sequential VMAT are comparable in terms of overall response. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=XC01-XC05&id=16076 https://doi.org/10.7860/JCDR/2022/50041.16076 Effect of Calcium Hydroxide (CH), Triple Antibiotic Paste (TAP), Nano-sized CH and Nano-sized TAP as Intracanal Medicament on the Push-out Bond Strength of Biodentine: An In-vitro Study Gangavarapu Eswar Kowsik , Roopadevi Garlapati , Nagesh Bolla ,Sayesh Vemuri , Chukka Ram Sunil , Keerthi Priya Nandipati <b>Introduction:</b> Root perforations are one of the common procedural errors faced in endodontic procedures. The ideal root repair material must be capable of bonding to the dentin. Calcium Hydroxide (CH) and Triple Antibiotic Paste (TAP) are mostly used for root canal disinfection. <b>Aim:</b> To evaluate the effect of calcium hydroxide, triple antibiotic paste, nano-sized calcium hydroxide and nano-sized triple antibiotic paste as intracanal medicament on the push-out bond strength of biodentine. <b>Materials and Methods:</b> The present in-vitro study was conducted in Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur for a period of 1 month (March 2020). A total of fifty maxillary central incisors (n=50) were decoronated, instrumented with ProTaper rotary NiTi instrument followed by peesoreamers up to number 3, and were divided into five groups (n=10). Group I: CH, Group II: Nano CH, Group III: TAP, Group IV: Nano TAP and Group V: Control group. The respective medicaments were mixed with propylene glycol and placed to the working length. After one week, medicaments were removed using Passive Ultrasonic Irrigation (PUI). Later, samples were sectioned into slices of 2 mm thickness using hard tissue microtome, and biodentine root repair material was placed into lumen of the slices. All the samples were stored for one week at 37&#176;C, then subjected to push-out bond strength test. Data were analysed using one-way ANOVA, Tuckey, Dunnets Post-hoc test (p-value <0.05) <b>Results:</b> The highest push-out bond strength values were observed in the group IV (p-value <0.001) and least in the control group. Biodentine showed significantly higher resistance to displacement among the group II (p-value=0.431) and group IV (p-value=0.074) when compared with their conventional medicaments. <b>Conclusion:</b> Nano Triple Antibiotic Paste and Nano Calcium Hydroxide enhanced the push-out bond strength values of biodentine when compared to their conventional intracanal medicaments. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZC18-ZC22&id=16086 https://doi.org/10.7860/JCDR/2022/51958.16086 Tolerance of ALL Induction Therapy in Children with Limited Resources: A Retrospective Study from a Teaching Hospital Tanvi Khanna , Nitika Agrawal , Kunal Das , Brahma Prakash Kalra <b>Introduction:</b> Acute Lymphoblastic Leukaemia (ALL) is the most common malignancy in children. Due to the better understanding of biology, intensive multi-agent chemotherapy and improved supportive care, ALL is curable in majority of children. Induction phase is the most intense and critical phase of therapy. <b>Aim:</b> To examine the feasibility of high-intensity induction and its tolerance in a resource-limited setting in children with acute lymphoblastic leukaemia. <b>Materials and Methods:</b> This retrospective analysis was done on children admitted for ALL treatment. Data was collected for January 2016 to July 2018, regarding baseline characteristics, tolerance to induction therapy, morbidity, mortality, deviations from protocol, and induction outcomes among children with ALL treated at a tertiary care teaching hospital (Cancer Research Institute, Himalayan Institute of Medical Sciences, Dehradun, Uttrakhand, India). Confirmed cases of ALL with age upto 18 years, who took more than a week of planned induction were included in the study. Data was analysed using Chi-square and Fisher’s-exact test. <b>Results:</b> Four-drug induction was feasible and given to 76 patients during the study period. Mean age of the group was 9.3 years. Male: female ratio was 1.3:1. Remission was achieved in 63 (82.8%) patients. Four deaths occurred, and were attributed to infection. Hyperglycaemia (4), CNS events (2), peripherally inserted central line related thrombosis (2) and pulmonary tuberculosis (1) were noted. Febrile neutropenia was noted in 65 cases and seven cases required ICU care; two of them succumbed in the ICU. Baseline blood parameters, subtype of disease, protocol of treatment and age did not affect the induction outcome statistically. <b>Conclusion:</b> Intensive induction chemotherapy has varying complications and can be employed even in resource-limited settings with acceptable results https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=SC01-SC05&id=16087 https://doi.org/10.7860/JCDR/2022/51295.16087 Surge and Scare of Mucormycosis in the Backdrop of COVID-19 Pandemic Ooha Anyapu, Sreedevi Parvatini, Paparatnam Kalivarapu, Rajani Kuna, Jagadeeswari Suvvari <b>Introduction:</b> Mucormycosis is a rare opportunistic fungal infection. During the second wave of Coronavirus Disease-2019 (COVID-19), a remarkable increase in mucormycosis cases was observed. Diabetes mellitus is an independent risk factor for both mucormycosis and COVID-19. <b>Aim:</b> To assess the incidence of mucormycosis cases in COVID-19 infected and non COVID-19 infected patients and also to assess the related co-morbid conditions during the second wave of COVID-19 pandemic. <b>Materials and Methods:</b> This cross-sectional study was conducted from 15<sup>th</sup> May 2021 to 15<sup>th</sup> July 2021 in the Department of Pathology, GGH/Government Medical College, Srikakulam, Andhra Pradesh, India. The study included 63 cases of mucor suspects. The parameters analysed in this study were age, sex, COVID-19 status, co-morbidities, steroid status and radiological findings. A descriptive analysis was made from the data obtained. The information was analysed in data spreadsheets using Microsoft office excel 2010. <b>Results:</b> Out of total 63 mucor suspects, 60 (95.2%) cases tested positive for COVID-19 and 44 (73.3%) cases of them received corticosteroid treatment. Mean age group of 41-50 years with 27 (42.8%) cases with a male preponderance of 49 (77.7%) cases was noted. The most common identified risk factor was diabetes mellitus seen in 22 (34.9%) cases and diabetes associated with hypertension in 14 (22.2%) of the cases. Mucormycosis fungal hyphae were noted in 49 (77.7%) of cases on routine histopathological examination stain and 47 (74.6%) of the cases by special stains for confirmation. <b>Conclusion:</b> In the present study, it was observed that mucormycosis infection was most commonly seen in COVID-19 infected patients in post COVID-19 phase and also in minority of non COVID-19 infected cases with prior debilitating conditions. Therefore, it was concluded that, mucormycosis was positively associated with COVID-19 infected patients who have co-morbidities like diabetes mellitus and history of steroid usage. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=EC15-EC18&id=16088 https://doi.org/10.7860/JCDR/2022/53266.16088 Effect of Smart Phone Usage Time on Scapular Position and Respiratory Function: A Cross-sectional Study Jyoti Dubey, Jyoti Kataria, Richa Hirendra Rai <b>Introduction: </b>In recent times, the number of smartphone users has increased all over the world. The prolonged use of smartphone also shown increase in the musculoskeletal problems among the smartphone users. Smartphone usage become exceptionally desired by most of undergraduate students. Several studies are performed to asses the effect of smartphone usage among students. It has been suggested by many studies that the duration of smartphone usage is the better indicator of the addiction than the frequency of use. <b>Aim: </b>To study effect of smartphone addiction on respiratory function and position of scapula among undergraduate students. <b>Materials and Methods: </b>This cross-sectional study was conducted at School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, Delhi, India, from February 2020 to July 2020 on 110 undergraduate students of Delhi and National Capital Region (NCR). Smartphone usage duration along with scapula position and respiratory function was studied. Respiratory function testing was done by using Pulmonary Function Tests (PFT) Machine by RMS, Helios-401 Model. Scapula protraction was assessed by using keibers method of scapula assessment. Data was further analysed using t-test and Analysis of Variance (ANOVA) to find out variation among study population. <b>Results: </b>The mean age of study population was 22&#177;3.35 years and majority of study population fall under healthy group as per Body Mass Index Body Mass Index (BMI). There was no statistically significant change in the scapular position at rest (p-value=0.334), at 45&#176; abduction (p-value=0.840) and at 90&#176; abduction (p-value=0.595) of addicted subjects. There was no significance (p-value=0.083) change in Forced Expiratory Flow (FEF) 25-75%, also other parameters p-value do not show any statistical significance difference between the smartphone users less than 4 years, 4-6 years, >6-8 years, more than 8 years. <b>Conclusion: </b>No significant changes observed in pulmonary function tests and altered scapula positioning among the smartphone addicted users. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=YC08-YC11&id=16089 https://doi.org/10.7860/JCDR/2022/52631.16089 Assessment of Knowledge, Attitude and Practice of C-shaped Root Canals among Dental Students and Dentists in the Makkah Region of Saudi Arabia- A Cross-sectional Study Siddiq Ahmed, Abdulrahaman Mohammed Ali Aldughaysh, Baheej Ghazi Hamzah Alhazmi, Faisal Saud Mohammed Alsubhi, Zeyad Tariq Hilal Ashour <b>Introduction:</b> Thorough management of root canal anatomy and its variants is important for good prognosis of endodontic treatment. C-shaped root canal is one such important variation in root canal anatomy. Due to the complex nature of C-shaped root canals the clinicians should be familiar with this variation to achieve better success rate in endodontic treatment. <b>Aim:</b> To assess Knowledge, Attitude and Practice (KAP) among dental students and dentists of the Makkah region of the Kingdom of Saudi Arabia towards C-shaped root canals. <b>Materials and Methods:</b> A cross-sectional questionnaire survey was conducted for a period of five months from 25th September 2020 to 25th February 2021 in Dentistry program of Ibn Sina National College for Medical Studies, Jeddah using a self-structured, closeended, multiple-choice questionnaire consisting of 21 questions. The questionnaire was sent using online to 503 Dental students and Dentists of Makkah region of Saudi Arabia. The study population was selected using convenient random sampling. The questionnaire was constructed and validated with the help of five endodontists with adequate teaching and clinical experience. The data were analysed using IBM Statistical Package for the Social Sciences (SPSS) version 22.0 and descriptive statistics followed by Chi-square test was applied to test of variables in the questionnaire. <b>Results:</b> In the study population, 68.4% (n=344) were males and 31.6% (n=159) were females, 25.2% (n=127) were undergraduate students and 74.7% (n=376) were graduate dentists, 63.2% (n=318) believe most commonly C-shaped root canals are found in mandibular second molars, 49.3% (n=248) have strongly agreed that they are proficient in diagnosing C-shaped root canals, 75.7% (n=381) have agreed that knowledge of canal anatomy will be helpful during access preparation of C-shaped root canals, 48.5% (n=244) felt use of crown down technique will be effective in managing C-shaped root canals,72.8% (n=366) felt multiple visit endodontics is needed for successful management of C-shaped root canals and 25.8% (n=130) felt use of thermoplasticised guttapercha compaction will be helpful in obturation. <b>Conclusion:</b> Knowledge of anatomical variations of root canal system and the use of advanced endodontic instruments and techniques will enable the dentists to handle difficult root canal cases thoroughly for good prognosis of dentition. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZC07-ZC13&id=16082 https://doi.org/10.7860/JCDR/2022/52163.16082 Evaluation of Knowledge, Attitude, and Practices about Paediatric Dental Apps among Paediatric Dentists in India: A Questionnaire-based, Cross-sectional Study Krishna Sandeep Kadam, Niraj Satish Gokhale, Shivayogi Mallappa Hugar, Riddhi Shripad Joshi, Neha Kohli, Pooja Kishore Dialani <b>Introduction:</b> Dental anxiety is of prime concern for the paediatric dentist as it can prevent a child from seeking effective dental care by creating conditions that are challenging to the paediatric dentists and thereby not allowing to render the highest quality care. The dental application (apps) can be a useful tool in alleviating the anxiety in children, but these apps have not yet been evaluated for its use by paediatric dentists. <b>Aim: </b>To assess knowledge, attitude and practices about paediatric dental apps among paediatric dentists in India. <b>Materials and Methods:</b> This cross-sectional questionnaire-based study was conducted among 450 paediatric dentists in India. The study was conducted over a span of one month. A 16-item validated questionnaire with Cronbach&#39;s alpha coefficient value of 0.82, containing professional demographic data, knowledge, attitude, and practices about dental apps were distributed among the participants. The collected data was subjected to descriptive analysis was done using IBM Statistical Package for the Social Sciences (SPSS) software (version 20.0 Chicago IL, USA). <b>Results: </b>The study included (N=370) out of which 159 (42.97%) were female respondents and 211 (57.03%) were male respondents. The mean age of the surveyed professionals was 34.14&#177;9.11 years. The results showed that the correlation between knowledge and attitude was found to be highly statistically significant (p=0.0001) however, no statistically significant results were found when a comparison was made between knowledge and practices (p-value=0.7684) and also attitude and practices (p-value=0.0930). <b>Conclusion:</b> The study concludes that, there is a need for creating awareness about the use of dental apps as an adjunct with conventional behaviour modification techniques among paediatric dentists in our country https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZC14-ZC17&id=16083 https://doi.org/10.7860/JCDR/2022/52961.16083 Measurement of Subaxial Cervical Vertebral Height using Computed Tomography for Optimisation of Anterior Cervical Plate in North Indian Population Atul Sareen , Sumit Kumar , BB Manu , Rejo Varghese , Tankeshwar Boruah <b>Introduction:</b> The morphometric analysis of subaxial cervical spine is of importance to improve the surgical outcome of the patients who undergo Anterior Cervical Discectomy and Fusion (ACDF) with anterior cervical plating. The morphometric values of cervical spine vary for from population to population and so does the size of the anterior cervical plate. <b>Aim:</b> To analyse the average height of subaxial cervical spine and its implication in anterior cervical plating. <b>Materials and Methods:</b> The present cross-sectional study included 70 patients who underwent Computed Tomography (CT) scan for evaluation of cervical spine between May 2021 to October 2021 in VMMC and Safdarjung Hospital, New Delhi. The height of subaxial cervical spine (from C3 to C7 vertebrae) was measured from superior most to inferior most bony part on the anterior surface of the corresponding cervical vertebrae in midsagittal section (A) and superior most to inferior most of the central cervical vertebral body in midsagittal section (B) using Radiant viewer version 4.2.1 software. The Indian and imported anterior cervical plate, screw hole diameter and screw hole to plate edge were measured both on ventral and dorsal aspect with vernier caliper. The data was tabulated and mean, standard deviation and other variations were calculated. <b>Results:</b> The smallest vertebra was C5, A (11.62&#177;1.15 mm) and B (9.95&#177;1.35 mm). The vertebra C7 was the largest with measurements of A (14.07&#177;1.35 mm) and B (12.46&#177;1.29 mm). The total distance of cervical plate over the anterior cervical vertebral body measures 7.9 mm and 7.6 mm for imported and Indian implant, respectively. Considering the least cervical vertebral height of 9.95&#177;1.35 mm, the gap remaining from the adjacent disc after mounting imported and Indian implant was 2.05&#177;1.35 mm and 2.35&#177;1.35 mm, respectively. <b>Conclusion:</b> The vertebra C7 was the largest vertebrae and C5 was the smallest. Thus, the Indian and imported anterior cervical plate leaves a gap of less than 5 mm from adjacent disc to plate at C3, C4, C5 and C6. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=RC01-RC03&id=16080 https://doi.org/10.7860/JCDR/2022/53408.16080 Exploring the Newer Modalities in Teaching- learning and Research in Basic Medical Sciences during COVID Era Nov 25-27, 2021 Exploring the Newer Modalities in Teaching- learning and Research in Basic Medical Sciences during COVID Era Nov 25-27, 2021 https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=01-97&id=16017 https://doi.org/10.7860/JCDR/2022/43626.16017 Correlation between Interpupillary Distance, Inner-outer Canthal Distance and Inter Limbal Distance: A Cross-sectional Study Sheetal V Girimallanavar , Vittal I Nayak , Sahana Chetty , C Vasundhara <b>Introduction:</b> Interpupillary Distance (IPD) is the distance between the centres of two pupils which can be anatomical or physiological. There are various inter orbital distances which are important in studying the orbitofacial configuration and also in prescribing a correct spectacle. Among the various measurements IPD is the most important which is routinely measured using AutoRefarctometer (AR) machine or Pupil distance meter. <b>Aim:</b> To find the correlation between IPD and Inner Canthal-Outer Canthal Distance (ICOC) and Right Nasal Limbus to Left Temporal Limbus (RNL-LTL) distance and to derive a regression equation in calculating IPD from measurements like ICOC and RNL-LTL which are easier to measure. <b>Materials and Methods:</b> In this cross-sectional study with a sample of 100 subjects, participants were randomly selected from individuals attending Outpatient Department at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India, between March 2021 to August 2021. The IPD was measured using Auto-Refarctometer/Autorefractor Keratometer (AR/ARK) (Model: UNIQUE-RK:UNICOS URK 800F) and Pupillary Distance Metre (PDM) (Essilor). All the other measurements like Inner Intercanthal Distance (IICD), Outer Intercanthal Distance (OICD), RNL-LTL distance were measured using a transparent plastic ruler. Data was entered in Microsoft Excel and analysed using Statistical Package for the Social Sciences (SPSS) version 19.0. Categorical variables were presented as frequency and percentage. Multiple Linear regression was performed to find the factors associated with IPD using AR. The p-value <0.05 was considered as statistically significant. Independent sample t-test was performed to compare mean values between males and females. <b>Results:</b> Of 100 subjects, 60 were males and 40 were females, five subjects were <20 years and 95 subjects were =20 years. The analysis of the various distances found positive correlation between IPD measured using AR and PD meter with the other distances ICOC and RNL-LTL measured with transparent ruler, the strongest correlation found between RNL-LTL and IPD. The results were found to be statistically significant (p-value <0.001 for all these comparisons). A regression equation was derived to calculate IPD using ICOC and RNL-LTL distances and also using other inter orbital variables. <b>Conclusion:</b> Since there was a positive correlation between IPD and ICOC and RNL-LTL distances, these measurements which are easy to perform can be used to calculate IPD in situations where it’s difficult to get access to AR machine as in peripheral community based camps or rural settings and in children and uncooperative patients where it is difficult to use AR machine to measure IPD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=NC01-NC04&id=16047 https://doi.org/10.7860/JCDR/2022/52322.16047 Perceptions and Experience of Medical Students Regarding E-learning during COVID-19 Lockdown: A Cross-sectional Study Manisha Bhardwaj, Surender Kashyap, Deepak Aggarwal, Rajesh Bhawani <b>Introduction:</b> Medical education has been adversely affected during Coronavirus Disease-19 (COVID-19) pandemic. Imparting medical education through e-platforms exclusively was a novel experience both for students and teachers. Even though online classes have been ongoing since almost one and half year, not much data on perception and experience about e-learning among medical students is available from India. <b>Aim:</b> To evaluate perceptions, experiences and challenges faced by medical students regarding e-learning during lockdown period owing to COVID-19 along with their future preferences. <b>Materials and Methods:</b> The present study was a questionnaire based cross-sectional survey regarding use of e-learning during COVID-19 pandemic among 340 Bachelor of Medicine and Bachelor of Surgery (MBBS) and Bachelor of Science Nursing (BSc-NUR) students. It was conducted in the Department of Pulmonary Medicine at Shri Lal Bahadur Shastri Medical College and Hospital Mandi, Himachal Pradesh, India from May 2021 to July 2021. Students perceptions&#8217; of e-learning were assessed using the validated Technology Acceptance Model (TAM) model and responses were measured on 5-point Likert scale. Quantitative data was expressed by mean and standard deviation and significant level of differences between means were tested by Student&#8217;s t-test (unpaired). Proportions were compared by Chi-square test or Fisher&#8217;s-exact test. A p-value of <0.05 was considered statistically significant. <b>Results:</b> Out of 400 students, 340 responded of which 225 were females. Of the total 340 students, (n=333; 97.9%) respondents, had an idea of e-learning and more than half (n=188; 55.3%) had used any type of e-learning platform prior to onset of COVID-19. More number of MBBS students had used e-learning than BSc-NUR students (55% v/s 41%; p=0.033). Cell phone was the most common device (n=324; 95.3%) used. The quick sharing of material (n=258; 76%) and flexibility (n=233; 68.5%) were top rated benefits of e-learning. The key disadvantages were suboptimal practical training (n=222; 65.3%) and lack of face-to-face interactions (n=146; 43%). Majority of students voted for traditional learning (n=156; 45.9%) closely followed by blended learning (n=140; 41.2%). <b>Conclusion:</b> The students had an overall positive attitude towards e-learning and wanted to continue e-learning alongside traditional teaching i.e., blended learning. Exploration of merits and barriers to e-learning during pandemic can act as a guide to implement blended learning in medical curriculum for enhanced teaching/learning experience. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=IC01-IC06&id=16051 https://doi.org/10.7860/JCDR/2022/54803.16051 Microbiological Evaluation of Patients Admitted with Acute Respiratory Illness during First Wave of COVID-19 Pandemic in New Delhi, India Gitali Bhagawati, Sania Paul, Sarita Rani Jaiswal, Ashutosh Bhardwaj, Rekha Saji Kumar, Mansi, Anita Bhatia, Suparno Chakrabarti <b>Introduction:</b> The Coronavirus Disease-2019 (COVID-19) is associated with damage of cells of both innate and adaptive immunity, which results in immune system&#8217;s impairment leading to secondary infections. Microbiological evaluation helps in diagnostic as well as antimicrobial stewardship leading to accurate treatment of COVID-19 infected patients. <b>Aim:</b> To evaluate superadded bacterial and fungal infections in COVID-19 infected patients and to evaluate bacterial and fungal infections in COVID-19 non infected patients admitted with Acute Respiratory Illness (ARI). <b>Materials and Methods:</b> This retrospective study was carried out in a tertiary care hospital in Delhi, India, over a period of eight months (May to December 2020). Respiratory samples, received from indoor patients with history of ARI, were processed for COVID-19 (TrueNat based real time polymerase chain reaction) as well as for bacterial and fungal cultures following Standard Operating Procedures (SOP). Identification and susceptibility pattern was evaluated by Vitek2 compact system (bioM&#233;rieux, Inc. Durham, North Carolina/USA). Quality control strains used were American Type Culture Collection (ATCC) <i>Staphylococcus aureus</i> 29213, <i>Escherichia coli </i>25922 and <i>Candida parapsilosis</i> ATCC 22019. Minimum Inhibitory Concentration (MIC) levels were standardised as per Clinical and Laboratory Standards Institute (CLSI) guideline 2020. All statistical analysis was done by Chi-square test using Software Statistical Package for the Social Sciences (SPSS) version 22.0. <b>Results:</b> Total patients admitted with the history of ARI were 542; COVID-19 Positive Group (CPG) included 115 (21.22%) while COVID-19 Negative Group (CNG) included 427 (78.78%). Growth in bacterial and fungal cultures in CPG was 59.13% (68/115) while in CNG; it was 47.78% (204/427). Among the bacterial isolates, most common isolate was <i>Klebsiella pneumoniae</i> {CPG: 41.93% (26/62); CNG: 36.72% (76/207)}, followed by <i>Pseudomonas aeruginosa</i> {CPG: 33.87% (21/62); CNG: 31.88% (66/207)}. Fungal isolates in CPG was 19.48% (15/77) (p-value 0.0445). On comparing Antimicrobial Susceptibility (AST) pattern of Enterobacterales in both CPG (n=36) and CNG (n=102), no statistically significant difference was observed. Co-morbid conditions were found mostly in CNG 89% (140/158) with ARI while only 11% (18/158) was found in CPG. <b>Conclusion:</b> Secondary respiratory infections are quite common amongst COVID-19 positive patients. However, growth in culture, type of isolates, Antimicrobial Resistance (AMR) was almost similar with COVID-19 non infected patients admitted with ARI. Co-morbidity had the similar impact as COVID-19 infection with respect to co-infections. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=DC01-DC05&id=16057 https://doi.org/10.7860/JCDR/2022/51598.16057 Saline versus Metronidazole Peritoneal Lavage in Operated Cases of Peritonitis- A Longitudinal Study Deepak Kumar Gupta, Gurpreet Singh Gill, Tanuj Goel, Nikhil Mahajan, Dushyant Kumar Garg <b>Introduction:</b> Perforation peritonitis is a fairly common surgical problem. Despite recent advances in surgical practice, postoperative minor and major complications are common in patients of peritonitis. Intraoperative peritoneal lavage is an important operative management and the choice of fluid can affect the outcome. <b>Aim:</b> To compare the outcomes of peritoneal lavage using normal saline versus metronidazole in cases of perforation peritonitis in patients undergoing laparotomy, with respect to surgical site infections, sepsis, wound dehiscence, hospital stay. <b>Materials and Methods:</b> The present study was a longitudinal study done on 80 patients, divided in two groups with 40 cases in each group. In one group, peritoneal cavity was lavaged with 2 L of normal saline and closed after putting drains. In the other group, peritoneal cavity was lavaged with 2 L normal saline mixed with 100 mL (500 mg) of metronidazole and abdomen was closed in layers after placing two drains, kept closed for one hour after abdominal closure. Chi-square test was used, and p<0.05 was considered as level of significance. <b>Results:</b> The mean age of patients in metronidazole group was 47.72&#177;15.64 years, and was comparable to mean age 45.92&#177;15.26 years in saline group, difference was not significant (p=0.6039). Male/female in Metronidazole and Saline groups were 31/9 and 30/10, respectively. It was observed that the patients in metronidazole group had less surgical site infections (22.5%) compared to saline group 42.5% (p=0.056), less sepsis (20% vs 62.5%) (p<0.001), less wound dehiscence (5% vs 15%) (p=0.136), and shorter hospital stay with a mean&#177;SD of 9.975&#177;2.25 and 11.82&#177;2.85 days (p=0.0019). <b>Conclusion:</b> The metronidazole lavage is better than saline lavage. However, larger multicentric randomised controlled trials need to be done. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=PC01-PC04&id=16058 https://doi.org/10.7860/JCDR/2022/53422.16058 Rising Minimum Inhibitory Concentration of Azithromycin: A Therapeutic Challenge in Treating Enteric Fever Sandhya K Bhat, K Ravichandran, Reba Kanungo <b>Introduction:</b> Enteric fever continues to be endemic in the Indian subcontinent carrying with it significant morbidity, despite available antibiotics. With changing trends in antibiotic use, concern for emerging resistance to many common pathogens is very common. Taking enteric fever, as a case in point, there is evidence of increased use of azithromycin and third-generation cephalosporins. Documenting evidence of increasing concentrations of antibiotics, required to inhibit the organism, is necessary to alter the prescribing practice and to adopt course correction. This is required to modify antibiotic policies in health care setups both for the management of antibiotic susceptible and resistant cases of enteric fever. <b>Aim:</b> To document the rising Minimum Inhibitory Concentration (MIC) of azithromycin among <i>Salmonella</i> isolates. <b>Materials and Methods:</b> A cross-sectional study was conducted in Pondicherry Institute of Medical Sciences for a period of seven years (January 2014 to December 2020). A total of 168 clinical isolates from enteric fever cases were tested for drug resistance to azithromycin by disk diffusion as per Clinical and Laboratory Standards Institute (CLSI) guidelines. The MIC was estimated using the Epsilometer test. Results were interpreted as per CLSI 2020 guidelines. Spearman&#8217;s rank correlation coefficient (r) and two-tailed p-values were estimated to note the trend. <b>Results:</b> Out of 168 <i>Salmonella</i> isolates, 65 were <i>Salmonella</i> Typhi and 103 were <i>Salmonella</i> Paratyphi<i> A</i>. The MIC of these isolates ranged from 1.5-64 &#956;g/mL and three isolates were resistant to azithromycin with MIC &#8805;32 &#956;g/mL and nine isolates had a high level of MIC of 24 &#956;g/mL. Disc diffusion test results were consistent with MIC of azithromycin against <i>Salmonella</i> isolates from enteric fever. Regression coefficient for MIC for the given value of zone diameter for 65 <i>Salmonella</i> Typhi isolates was -0.579 (p<0.001, considered highly significant) and -0.475 (p<0.01, considered as significant) for <i>Salmonella</i> Paratyphi<i> A</i> isolates. Rising MIC to azithromycin was observed among <i>Salmonella</i> isolates over a period of seven years. <b>Conclusion:</b> There is a need to monitor the rising trend of MIC, which may pose a therapeutic challenge for treating enteric fever cases in near future. Regular MIC estimation can pre-empt overt resistance. Hence, MIC testing should be routinely done where facilities are available than doing only disk diffusion testing for enteric fever isolates. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=DC06-DC09&id=16059 https://doi.org/10.7860/JCDR/2022/51989.16059 A Retrospective Study on the Profile and Treatment Response of Patients with Mononeuritis Multiplex and Connective Tissue Diseases Mythili Seetharaman Varadhan <b>Introduction:</b> Though Mononeuritis Multiplex (MM) can be caused by many pathological conditions, vasculitis is the most important cause. <b>Aim:</b> To study clinical features of MM in patients with connective tissue diseases, the time of presentation of MM from disease onset, its association with disease activity, and functional outcome after treatment. <b>Materials and Methods:</b> A retrospective study was conducted at Outpatient Department (OPD) of Madras Medical College (Government Hospital), Chennai, Tamil Nadu, India, between April 2015 to April 2017. The study included medical records of 18 patients with connective tissue disease who had attended the OPD, with sensory and motor symptoms and who were also diagnosed with MM. Paired t-test was used to find associations. Disease activity levels were determined using various measures and modified Rankin Score (mRS) was used to assess the response to treatment. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 28.0. <b>Results:</b> Of the 18 study subjects 14 (77.8%) were 18-40 years of age, and 10 (55.6%) were females. The mean duration between the time of diagnosis of connective tissue disease and the development of MM was 18.17 months. Ulnar nerve was the most common nerve involved, 11 subjects (61.1%) had ulnar nerve involvement. Axonal neuropathy was present on nerve conduction studies in 17 (94.4%) of the study subjects and sensory symptoms on history were present in 100% of the study subjects. There was a statistically significant difference (p-value <0.001) between the mRS before treatment (3.89) and after treatment (2.78) for a duration of six months. <b>Conclusion:</b> It was seen that the disease activity indices for connective tissue diseases were quite high at the time of development of MM, and starting treatment would help improve the functional outcome as is evident by the difference in mRS. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=OC01-OC04&id=16060 https://doi.org/10.7860/JCDR/2022/52805.16060 Efficacy of Different Doses of Cisatracurium for Intubation for Surgeries under General Anaesthesia- A Randomised Clinical Study Sana Ahmed Shaikh, Arati Bhaskar Jadhav, Archita Rajaram Patil, Anupama Deepak Sahasrabudhe <b>Introduction:</b> Cisatracurium is a new non depolarising, Neuromuscular Blocking Drug (NMBD) with fast onset and short duration of action. It is a stereoisomer of atracurium with a potency of approximately three to four times greater than that of atracurium. As it is devoid of histamine release, it reduces the chances of adverse effects during operative procedures. However, the optimum intubating dosage needs to be established in patients. This warrants the need for studies focusing on the efficacy of different doses of cisatracurium and their outcomes. <b>Aim:</b> To study the efficacy of three different doses of cisatracurium {2x Effective dose (ED) 95, 4x ED95, and 6x ED95} for the time of onset of action, duration and haemodynamic stability offered for intubation. <b>Materials and Methods:</b> A double-blind, randomised clinical study was conducted from December 2017 to July 2019 at a tertiary care hospital and research centre, Kolhapur, Maharashtra, India. Total 90 patients, undergoing surgeries under general anaesthesia were allocated into three groups, group A received 0.1 mg/kg, group B received 0.2 mg/kg and group C received 0.3 mg/kg of cisatracurium. Time taken for Train Of Four (TOF) to reach 0 was taken as the onset of action, and appearance of TOF two, three or patient&#8217;s attempt to breathe was taken as duration of action. Haemodynamic changes were also assessed preoperatively and postintubation immediately after confirmation of placement of ETT. <b>Results:</b> Mean age 33.23&#177;6.26 years in group A, 37.70&#177;10.80 years in group B, 38.23&#177;8.764 years in group C (p-value=0.06).<b></b> Least time was required for the TOF to become zero by group C (5.10&#177;1.01 minutes) as compared to groups A and B (9.91&#177;1.39 and 7.48&#177;1.45 minutes) which was statistically significant (p-value <0.001). The duration of action was also more in group C (49.83&#177;5.33) compared to group A (27.23&#177;6.97) and group B (36.17&#177;7.62) (p-value=0.00001). Group C had better haemodynamic stability as the heart rate remained more stable than group A and group B. <b>Conclusion:</b> Higher dose of cisatracurium provides faster onset, longer duration of action with better cardiovascular stability. This predictable recovery from non depolarising muscle relaxation makes it a good choice of muscle relaxant agent for intubation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=UC01-UC04&id=16061 https://doi.org/10.7860/JCDR/2022/50991.16061 Identification of Factors Affecting Patient Safety in the Emergency Department: A Retrospective Study Mashael Althobaiti, Ahmad Joman Alghamdi, Mohammed Almalki, Ahmed S Alkarani, Sultan Alamri <b>Introduction:</b> Emergency Departments (EDs) have been described as complex, dynamic and at high risk for medical errors. Factors affecting the risk of medical error in the ED are related to communication, triage and medication management and upto 3% of all medical errors in hospitals take place in the ED. <b>Aim:</b> To identify the factors affecting patients&#8217; safety in the EDs of two major hospitals in Taif city based on Occurrence Variance Reporting (OVR). <b>Materials and Methods:</b> The present study was a cross-sectional retrospective study which was conducted from January 2018 to October 2020 at King Abdul-Aziz Specialist Hospital (KAASH) and from October 2018 to October 2020 at King Faisal Medical Complex (KFMC) in Taif city, Makkah, Saudi Arabia. The OVR data included six variables including category of OVR, name of hospital, year of OVR, type of report, who made the OVR and action taken by the hospitals, and was analysed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS). <b>Results:</b> This study found that 3,632 OVR reports were collected. Nearly two-thirds of all OVRs were associated with nursing care management issues, followed by identification/document/consent issues (9.4%), medical equipment issues (5.5%), housekeeping issues (0.2%) and laundry service (0.1%) representing the lowest frequency of OVR. Unsafe conditions accounted for 75.17% (2,730) of all OVR reports and only 24.83% (902) were incident reports. Staff nurses reported a majority of reports (89.5%), with 10.5% of OVRs reported by other healthcare workers. The primary actions taken by the hospitals in response to these reports were detection (72.3%) and prevention (17.4%), while only 10.3% was corrected. <b>Conclusion:</b> Patient safety is the primary challenge faced by healthcare providers at hospitals. Thus, OVR is a very important tool in order to avoid errors and limit harms ensuring healthcare quality and safety delivery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=LC01-LC05&id=16062 https://doi.org/10.7860/JCDR/2022/52095.16062 Role of CD10 as a Prognostic Marker in Invasive Breast Carcinoma Subitha Kandamuthan, Renu Thambi <b>Introduction:</b> Stromal markers have been proved as important markers in assessing the prognosis of invasive breast cancer. Cluster of Differentiation (CD)10 is a cell surface enzyme with metalloendopeptidase activity which is expressed in stroma of various epithelial malignancies. <b>Aim:</b> To estimate the expression of stromal CD10 expression in breast carcinoma and it&#8217;s association with other prognostic markers like Oestrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal growth factor Receptor 2 (HER2-neu), Ki-67and tumour grade. <b>Materials and Methods:</b> This study was a hospital based cross-sectional study conducted on 50 cases of breast cancer received in histopathology laboratory of the Department of Pathology, Government Medical College, Kottayam during a period of two years from July 2015 to June 2017. Adequate representative sections were taken and Haematoxylin and Eosin (H&E) staining was done. Immunohistochemistry (IHC) of the tissue sections was done by ER, PR, HER2-neu, Ki-67 and CD10. Descriptive statistics was used for the presentation of data showing number and percentages. Mantel-Haenzel (MH) Chi-square test was used for finding the association between CD10 and other prognostic markers of breast carcinoma like ER, PR, HER2-neu and Ki-67. <b>Results:</b> In this study, all patients were females with mean age of 57.26 years. CD10 was found associated with tumour grade with p-value=0.013. The association of CD10 with ER, PR, HER2-neu was statistically insignificant. Though the association of CD10 and Ki-67 was observed (MH Chi-square value was 0.015), but it was not statistically significant (p-value=0.903). <b>Conclusion:</b> A statistically significant association of CD10 with increasing tumour grade was observed and the association of CD10 with ER, PR, HER2-neu and Ki-67 was not significant. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=EC01-EC04&id=16063 https://doi.org/10.7860/JCDR/2022/51661.16063 Reliability and Validity of Gujarati Version of Epworth Sleepiness Scale: A Cross-sectional Study Darshana Nariya, Subhash Khatri <b>Introduction:</b> Daytime sleepiness is a common symptom of many sleep disorders. Epworth Sleepiness Scale (ESS) measures average sleep propensity of an individual for wide range of daily living activities. As it is a self-administered questionnaire, the Gujarati translation of ESS can be helpful for the evaluation of daytime sleepiness in clinical population. <b>Aim:</b> To find reliability and validity of Gujarati version of ESS. <b>Materials and Methods:</b> This cross-sectional study was conducted during August 2020 to February 2021. ESS is available in Gujarati language. Permission was taken to use and to find reliability and validity of Gujarati ESS from the Mapi Research Trust. This study was carried out in two phases: 1) Face and content validation by expert clinical review; 2) Test-retest reliability. The consensus method was used to find face and content validity of Gujarati ESS. The group of experts having mean experience of 10.5 years in different fields examined each item of Gujarati ESS. Each item of Gujarati ESS was scored either as rejected, accepted or accepted with modification. Procedure was continued till 80% of consensus for all items was achieved. Total 80 participants aged between 18-60 years were included in this study. To find reliability of Gujarati ESS, internal consistency and test-retest reliability was determined. The Statistical Package for Social Sciences (SPSS) version 24.0 was used to analyse the data. Test-retest reliability was determined by Intraclass Correlation Coefficient (ICC) and internal consistency was calculated by Chronbach&#8217;s alpha. <b>Results:</b> Total of 80 participants (mean age 42.68&#177;13.37 years; 34 males and 46 females) were studied. Normal BMI was observed for 20 participants, overweight participants were 26 and obese participants were 34. Gujarati version of ESS showed excellent test-retest reliability as evidenced by high ICC (ICC=0.94) and high Internal consistency (&#945;=0.97). Mean score of Gujarati ESS at baseline 13&#177;6.72 and after one week 12.98&#177;5.65. Values for Content Validation Ratio (CVR), Item level Content Validation Index (I-CVI), Modified Kappa (K), and Proportion of agreement were 1. The content of translated items was understandable and were related to quality of sleep and its evaluation. <b>Conclusion:</b> Gujarati version of the ESS has excellent reliability and good face and content validity. It is adequate and useful for evaluation of day time sleepiness in Gujarati speaking population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=YC01-YC04&id=16064 https://doi.org/10.7860/JCDR/2022/52494.16064 Clinical, Electromyographical and Radiological Comparison of Dawson’s Bimanual Technique of Guiding the Mandible with Wax Ball Orientation Technique© R Sushma , Anand Joshi , Pronob Kumar Sanyal , Pramod Kumar Ramachand Shaha <b>Introduction:</b> There are numerous methods to guide the mandible into Centric Relation (CR). The Dawson’s bimanual technique is a time tested and established method to guide the mandible into CR. On the other hand the author of the present study also has copyrighted a technique (wax ball orientation technique&#169;) to guide the mandible into CR. Hence, this methodological study was performed to compare the two CR techniques to guide the mandible in CR position using clinical, myographical and radiological assessment methods. <b>Aim:</b> To compare and assess which amongst the two (Dawson&#39;s bimanual techniques, and wax ball orientation technique) CR guiding techniques best guides the mandible to CR position using clinical, electromyographical and radiological assessment methods. <b>Materials and Methods:</b> This interventional and clinical study was conducted at School of Dental Sciences, KIMSDU, Karad, Maharashtra, India, from May 2019 to May 2020. The study included healthy dentate individuals having Angle&#39;s class I malocclusion without any occlusal interferences and an intact dentition except for 3rd molars. Two CR technique to guide the mandible were technique 1-Dawson’s bimanual technique and technique 2- wax ball orientation technique. The study was carried out in three phases: clinical, electromyographical and radiological. Difference between the centric points, workload on elevators, condylar position was statistically analysed. Descriptive statistics was used to analyse the difference between the centric points marked using both the techniques. Independent t-test was applied to compare the gender and the mean centric distribution. <b>Results:</b> Among the 45 study subjects considered for the study, 32 were females and 13 were males with the mean age of 21 years. No statistically significance difference was observed between the two techniques. Paired t-test showed that workload on elevators of both sides, Right Masseter in technique 1 and 2 had p-value=0.088, left Masseter in technique 1 and 2 had p-value=0.3, Right temporalis in technique 1 and 2 had p-value=0.463, left temporalis in technique 1 and 2 had p-value=0.429. There was difference between the Anteroposterior (AP) and Superoinferior (SI) position of condyle in relation to the fossa. AP measurement in the right side in tech 1 and 2 with p-value=0.448, AP measurement in the left side in tech 1 and 2 with p-value=0.178, SI measurement in the right side in tech 1 and 2 had p-value=0.803, SI measurement in the left side in tech 1 and 2 had p-value=0.259, which were statistically insignificant. Multivariate test showed statistically significant difference between gender and EMG, results whereas it was insignificant in Magnetic Resonance Imaging (MRI). <b>Conclusion:</b> The wax ball technique has similar accuracy as the Dawson’s Bimanual technique. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZC01-ZC06&id=16065 https://doi.org/10.7860/JCDR/2022/52846.16065 Seroprevalence of SARS-CoV-2 among the Healthcare Workers of a Tertiary Care Hospital of Northeast India during First Wave of COVID-19 Pandemic: A Hospital-based Cross-sectional Study Mithu Medhi, Reema Nath, Ezaz Hussain <b>Introduction:</b> During Coronavirus Disease-2019 (COVID-19) pandemic, Healthcare Workers (HCWs) are the frontline personals who are engaged in different facilities of the health system. So they always remain at a greater risk of exposure and acquiring the disease. They may also become a potential source of infection to the other patients as well to the community. <b>Aim:</b> To estimate the seroprevalence of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) specific Immunoglobulin G (IgG) antibodies among asymptomatic, COVID-19 negative HCWs of a tertiary care hospital. <b>Materials and Methods:</b> This hospital-based cross-sectional study was conducted in the Department of Microbiology in a tertiary care hospital of Northeast India. A total of 215 HCWs were recruited from 15<sup>th</sup> October to 14<sup>th</sup> December 2020 after taking written and informed consent. Inclusion criteria were: a) >18 years of age and both genders, b) asymptomatic, negative for COVID-19 either by Rapid Antigen Test (RAT) or Reverse Transcription Polymerase Chain Reaction (RT-PCR), c) working in the hospital for atleast last four months. Predesigned questionnaire was used for data collection. Serum samples were tested for SARS-CoV-2 IgG antibodies by Enzyme Linked Fluorescence Assay (ELFA) using VIDAS (VITEK ImmunoDiagnostic Assay System) platform. Chi-square test was used (Epi Info version 7 software) for data analysis. <b>Results:</b> The prevalence of SARS-CoV-2 IgG was 54 (25.12%) out of 215, which was highest in &#8804;30 years age group, 27 (32.14%) out of 84 (p=0.0261). Significant seropositivity was found among cleaners 22 (61.11%) out of 36 (p<0.01) and participants who reported having COVID-19-related symptoms in the previous months (p<0.013). However gender, daily patient contact, close contact with COVID-19 cases and working in COVID-19 units showed no significance. <b>Conclusion:</b> The study highlighted a high burden of asymptomatic SARS-CoV-2 infection among HCWs. A proper surveillance system is needed for estimating the burden of COVID-19 among HCWs as well as in the community for better understanding of the dynamics of the infection. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=DC10-DC13&id=16066 https://doi.org/10.7860/JCDR/2022/51664.16066 Outcome of Women Referred with Postcaesarean Complication in a Tertiary Care Centre in North India: A Retrospective Study Smriti Agrawal, Tripathi Vartika <b>Introduction:</b> Rate of Caesarean Sections (CS) has increased over the last few decades. There is an increased referral of women with postcaesarean complications. <b>Aim:</b> To evaluate the outcome of women with postcaesarean complications. <b>Materials and Methods:</b> This retrospective study was conducted at the Department of Obstetrics and Gynaecology, King George’s Medical University Lucknow, India over six months from August 2018 to January 2019. All the women referred with postcaesarean complications were included in the study. Women who had complications following CS performed at the centre were excluded. Demographic variables like age, socio-economic status, literacy, number of antenatal visits, indication for CS was obtained. The type of complication, number of places visited before admission, the interval between complication and admission, availability of referral documents, interventions required and outcome was noted. Chi-squared tests were used to test for statistical significance. The p-value was considered to be significant if <0.05. Analysis was done using Statistical Package for the Social Sciences (SPSS) software 20.0. <b>Results:</b> Total women enrolled were 146, with mean age of women was 27.69&#177;4.7 years. The youngest woman was 19 years, while the oldest was 36 years. Total 60.3% (88/146) women were referred from government centres, and the majority of women (82.18%) reached tertiary centres directly and had a referral document. The interval between complication and admission was within 24 hours in only 55 (37.66%) women. The most common reason for referral was septicaemia (39, 26.71%), followed by Postpartum Haemorrhage (PPH) (27, 18.49%). Mortality was seen in 35, 24.6% of women. <b>Conclusion:</b> Most women referred with postcaesarean complications were from the public health system with appropriate referral procedures. Timely referral after detection of complications will improve maternal outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=QC01-QC04&id=16126 https://doi.org/10.7860/JCDR/2022/52578.16126 Association of IHC p16INK4a expression and ELISA Plasma p16INK4a Protein in Squamous Cell Carcinoma of Uterine Cervix: A Concept of Liquid Biopsy Kalyani Raju, CV Raghuveer, SR Sheela, B Sharath <b>Introduction:</b> Cervical cancer is the 3<sup>rd</sup> most common cancer among women worldwide. p16 biomarker is the surrogate marker in cervical cancer and can be detected by Immunohistochemistry (IHC). <b>Aim:</b> To evaluate the association of IHC p16INK4a expression in tissue sections and Enzyme-linked Immunosorbent Assay (ELISA) p16INK4a protein in plasma of paired samples in Squamous Cell Carcinoma (SCC) of uterine cervix. <b>Materials and Methods:</b> This laboratory-based observational, pilot study was conducted at tertiary care centre of Sri Devaraj Urs Medical College in South India from June 2020 to May 2021. Total 17 new cases of SCC of cervix diagnosed by histopathology were considered for the study. The cases were staged as per International Federation of Gynaecology and Obstetrics (FIGO) staging system and classified by histopathology as keratinising and non keratinising types. IHC p16INK4a evaluation was done on tissue sections and classified as block positivity, ambiguity and negative. ELISA p16INK4a estimation was done using plasma from Dipotassium Ethylenediaminetetraacetic Acid (K2-EDTA) blood sample of same cases. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 22.0 software. <b>Results:</b> The age ranged from 30-80 years with mean of 54.3&#177;12.0 years. Plasma ELISA p16INK4a level ranged from 3.4-19.6 ng/mL with a mean of 7.2&#177;2.35 ng/mL in SCC of cervix. The plasma p16INK4a ELISA levels of 5.1 to 6.2 ng/mL, 6.0 to 6.6 ng/mL and 5.5 to 9.7 ng/mL predicts negative, ambiguity and block positivity of IHC p16INK4a expression respectively in corresponding tissue biopsy. Plasma ELISA p16INK4a levels were maximum in Non Keratinising Squamous Cell Carcinoma (NKSCC) followed by Well Differentiated Squamous Cell Carcinoma (WDSCC), Moderately Differentiated Squamous Cell Carcinoma (MDSCC) and Poorly Differentiated Squamous Cell Carcinoma (PDSCC). <b>Conclusion:</b> The plasma ELISA p16INK4a levels and IHC p16INK4a expression were maximum in higher disease stage compared to lower stage. This was a pilot study to evaluate the association between tissue IHC p16 expression and plasma ELISA p16 levels. Further study has to be done on larger study population with standardised procedure to prove the hypothesis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=XC06-XC10&id=16127 https://doi.org/10.7860/JCDR/2022/51540.16127 Comparison of Efficacy and Patient Response between 2% Lidocaine and 4% Articaine during Routine Dental Extractions Saba Nasreen, Shubham Kumar, Ritesh Vatsa, Kumar Pushpanshu, Mukesh Kumar, Devleena Bhowmick <b>Introduction:</b>Local Anaesthetic (LA) agents are chemicals that reversibly block the transmission of action potential of nerve membrane. Lidocaine has established itself as the gold-standard owing to its excellent clinical properties with minimal side effects. Articaine, a relatively newer LA agent is reported to have better clinical properties than lidocaine. <b>Aim:</b> To compare and evaluate the differences in total volume of LA agent used, onset of subjective symptoms and objective signs, total duration of anaesthesia achieved and postoperative pain assessment with 2% lidocaine and 4% articaine during routine dental extractions. <b>Materials and Methods: </b>This randomised clinical study was conducted by the Department of Dentistry, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India, from October 2020 to February 2021. A total of 200 patients (107 females and 93 males) requiring mandibular molar extraction were included in the study. The patients were randomly divided into two study groups. Group-I patients were administered with 2% lidocaine while group-II patients were administered with 4% articaine. Complete demographic and clinical details of all the patients were recorded. The volume of LA agent used, onset time for subjective symptoms and objective signs and total duration of anaesthesia was recorded. Postoperative pain was recorded on Visual Analogue Scale (VAS) on a scale of 0 to 10. All the variables were recorded in Microsoft excel sheet and were analysed by Statistical Package for the Social Sciences (SPSS) version 21 software. A two-tailed p-value less than 0.05 (p<0.05) was considered statistically significant. <b>Results:</b> A total of 200 patients participated in the study, where group-I patients (49 males and 51 females) had a mean age of 34.79&#177;10.43 years and group-II patients (44 males and 56 females) had a mean age of 35.41&#177;11.39 years. Statistically insignificant differences (p>0.05) were obtained for the following parametersvolume of LA agent used, onset time of subjective symptoms, onset time of objective signs and postoperative VAS scores. A statistically significant difference (p<0.05) was observed for total duration of anaesthesia. <b>Conclusion:</b> Both 2% lignocaine and 4% articaine are equally effective LA agents in patients undergoing mandibular molar extractions. However, 2% articaine exhibited significantly higher duration of total anaethesia when compared to 2% lidocaine. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZC23-ZC26&id=16128 https://doi.org/10.7860/JCDR/2022/48796.16128 A Study on Utilisation of Blood and Blood Components in a Tertiary Care Hospital in West Bengal, India Biman Mondal, MD Samsuzzaman, Sulagna Das, Dilip Kumar Das <b>Introduction: </b>Blood transfusion is an indispensable service component of inpatient as well as emergency management of care seeking patients in a hospital. Establishment of criteria for blood transfusion and adherence to such criteria is necessary to reduce blood wastage. It is necessary therefore, to conduct such studies for monitoring and improving transfusion practices as well as to find strategies for such improvement. <b>Aim: </b>To evaluate the pattern and appropriateness of blood and blood components utilisation, the status of transfusion practice in the hospital and assessing the wastage of blood. <b>Materials and Methods: </b>The present study was a retrospective record-based cross-sectional study. The data was collected in January-February 2021, from issue registers of blood bank of Burdwan Medical College and Hospital and also from the blood transfusion registers of the wards of Medicine, Obstetrics and Gynaecology, Paediatrics, Surgery and Orthopaedics Departments of Burdwan Medical College and Hospital using a pretested, predesigned schedule. For the month, June 2020, representative of the year 2020, details of Whole Blood (WB) and components cross-matched and transfused were noted. Utilisation rate (Units transfused&#215;100/Units cross-matched) and blood utilisation quality indicators {Crossmatch/Transfusion Ratio (CTR=Number of units Cross-matched/Number of units transfused), Transfusion Probability (%T=Number of patients transfused/Number of patients cross-matched&#215;100), Transfusion Index (TI=Number of units transfused/Number of patients cross-matched)<sup>2</sup> and Wastage Rate (WR=Number of blood units discarded/Number of blood units issued&#215;100)} were computed. <b>Results: </b>Total 1,544 units were cross-matched for 1,324 patients and 1,219 units were transfused to 882 patients. Overall utilisation rate was 78.95%. Department-wise utilisation rates in descending order were paediatrics 98.25% (112/114), Medicine 90% (478/531), Gynaecology and Obstetrics 73.84% (254/344) and Surgery and Orthopaedics 66.62% (375/555) departments respectively. The overall quality indicators of blood utilisation were CTR of 1.27, %T of 67.52%, TI of 0.92 and WR of 21.05%, respectively. <b>Conclusion: </b>Blood transfusion quality indicators demonstrated efficient blood utilisation. One-fifth of the cross-matched blood was not transfused. Non transfused blood units were not returned, resulting in wastage of blood, known as transfusion wastage. The overall utilisation rate was not acceptable. Higher blood wastage could be reduced with evidence-based blood utilisation strategies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=LC16-LC19&id=16129 https://doi.org/10.7860/JCDR/2022/52356.16129 Umbilical Cord Milking in Late Preterm Neonates and its Effects on Haematological and Haemodynamical Parameters- A Randomised Controlled Study B Sunil, MN Sindhuraj, P Athul <b>Introduction:</b> Delayed Cord Clamping (DCC) is a procedure, in which the cord is clamped after a short delay (30 s to 180 s) after birth. This improves iron status, reduce chances of anaemia and need for blood transfusion. However, DCC method compromised the success of resuscitation and induced various consequences, especially in neonates in need of emergency resuscitation. Umbilical Cord Milking (UCM), which is likewise a procedure of transporting additional blood from the umbilical cord to the newborn by milking or stripping the umbilical cord toward the baby, is an alternative to this approach. This study was conducted due to a lack of data on the use of umbilical cord milking in late preterm newborns. <b>Aim:</b> To study the effect of UCM on haematological and haemodynamical parameters in late preterm neonates. <b>Materials and Methods: </b>This single centre randomised controlled study was conducted, from November 2017 to August 2019 in the Department of Paediatrics, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India. Total 200 late preterm neonates fulfilling the inclusion criteria were randomised into cases (UCM group) and controls (Immediate cord clamping group). In UCM group, just after delivery, umbilical cord was milked towards the baby. In ICC group, cord was clamped and cut immediately. Primary outcomes included Haemoglobin (Hb), Haematocrit (Hct) and haemodynamic parameters (heart rate, respiratory rate and mean blood pressure), were noted at 48 hours of age. Clinical parameters (respiratory distress, need for oxygen, polycythemia and jaundice requiring phototherapy) were also noted. Student’s t-test, Chi-square/fisher-exact test were used to find out the significance of study parameters. <b>Results: </b>There was a significant higher Hb in UCM group (19.27&#177;2.64 gm/dL) than Immediate Cord Clamping (ICC) group (16.32&#177;2.09 gm/dL) with p-value=0.012 and higher Hct in UCM group (55.41&#177;5.07%) than the ICC group (48.99&#177;5.57%) with a p-value <0.001. Hence, there was higher placental transfusion in UCM group as shown by higher Hb and Hct in UCM group. There was also higher systolic, diastolic and mean blood pressure in the UCM group as compared to ICC group. Difference for mean arterial blood pressure was about 3 mmHg and was statistically significant (p-value <0.001). Hence, UCM leads to a higher mean arterial pressure at 48 hours of life. <b>Conclusion:</b> Umbilical cord milking provides a greater placental transfusion, as demonstrated by higher Hb, higher Hct, higher blood pressure, and lesser requirement for inotropes and blood transfusions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=SC16-SC19&id=16130 https://doi.org/10.7860/JCDR/2022/49476.16130 Fertility Awareness and its Association with Socio-demographic and Reproductive Variables among Women Seeking Fertility Treatment: A Cross-sectional Study Nisha Malik, Pooja Sinha, Smiti Nanda, Namita Batra, Vikram Singh, Ravishekar N Hiremath <b>Introduction:</b> In the last decade, there was a substantial reduction in fertility rates in Indian women. Despite a high burden of infertility, Fertility Awareness (FA) among people of reproductive age group is generally poor. Infertility is associated with significant negative impact on social and psychological well-being of the married couple. Therefore there is a need for awareness on fertility among Indian women. <b>Aim:</b> To assess the level of fertility awareness and determine the impact of socio-demographic and reproductive variables on FA among a cohort of Indian women seeking fertility treatment. <b>Materials and Methods:</b> A cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India, including 108 women seeking fertility treatment over a period of six months. Participants were interviewed with a 10 item questionnaire and categorised into low (score <40%), moderate (score 40-59%) or high FA level (score &#8805;60%) according to percentage of correct answers. The association of socio-demographic and fertility characteristics with FA levels was statistically analysed using Statistical Package for the Social Sciences (SPSS) software version 18.0. <b>Results:</b> Of the total 108 participants, majority (90.7%) of women were aged between 21-35 years and primary infertility (67.6%) was the most common type. The overall FA level was low in 27.8%, moderate in 44.4% and high in 27.8% study participants. Majority answered incorrectly about fertile period (60%) and age related fertility decline (55.6%). Nearly, two-thirds respondents believed that conception is not possible by any means if fallopian tubes are blocked. FA levels differed significantly between the age groups (p-value=0.001). The other socio-demographic and reproductive variables did not demonstrate any significant association with FA levels. <b>Conclusion:</b> Considerable gaps in knowledge and understanding of fertility issues were identified irrespective of their socio-demographic and fertility characteristics which warrant urgent attention. Targeted interventions are required to ensure easy to access accurate fertility information for couples&#8217; informed decision making. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=QC05-QC08&id=16131 https://doi.org/10.7860/JCDR/2022/52185.16131 Speciation and Antibiotic Susceptibility Pattern of Coagulase Negative Staphylococci in a Tertiary Care Hospital of Manipur, India Ningombam Homendro Singh, Rajkumar Manojkumar Singh, Urvashi Chongtham <b>Introduction:</b> Coagulase Negative Staphylococci (CoNS) are common opportunistic pathogens. They are increasingly being recognised as nosocomial pathogens and are associated with multiple antimicrobial resistance mechanisms particularly methicillin resistance. Therefore, rapid and reliable identification upto the species level is necessary to predict the potential pathogenicity or antibiotic susceptibility of each clinical isolate. <b>Aim:</b> The aim of the present study was isolation and speciation of CoNS from various clinical samples, and to determine their antibiotic susceptibility pattern. <b>Materials and Methods:</b> This study was a hospital-based cross-sectional study carried out in the Department of Microbiology, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur, India, during the period from September 2017-August 2019. Total 135 CoNS isolates were identified using conventional microbiological procedures and speciation was done following the scheme of Kloos and Schleifer. Antibiotic susceptibility was determined by using the Kirby Bauer&#8217;s disk diffusion method. Detection of methicillin resistance among CoNS was performed using cefoxitin disk (30 &#956;g) diffusion method. Data analysis was done using descriptive statistics. <b>Results:</b> CoNS isolates were identified from different clinical specimens, which included 88 (65.2%) from urine, 37 (27.5%) from blood, 3 (2.2%) from pus, 2 (1.5%) from catheter tip, 2 (1.5%) from wound swab, 1 (0.7%) each from aural swab, sputum and ascitic fluid. Predominant isolates were <i>Staphylococcus epidermidis</i> (40.7%) followed by <i>Staphylococcus haemolyticus </i>(19.3%), <i>Staphylococcus hominis </i>(11.9%), <i>Staphylococcus xylosus</i> (7.4%), <i>Staphylococcus saprophyticus</i> (6.0%), <i>Staphylococcus schleiferi</i> (5.2%), <i>Staphylococcus simulans </i>(4.4%), <i>Staphylococcus warneri</i> (3.0%), <i>Staphylococcus lugdunensis</i> (0.7%), <i>Staphylococcus capitis </i>(0.7%) and <i>Staphylococcus cohnii</i> (0.7%). Most isolates were resistant to penicillin (84.5%) and erythromycin (59.3%), and least to tigecycline (2.2%). No resistance to vancomycin and linezolid was seen. Methicillin sensitive CoNS (MSCoNS) was detected in 79 (58.5%) isolates and methicillin resistant CoNS (MRCoNS) in 56 (41.5%) isolates. <b>Conclusion:</b> This study demonstrated the occurrence of various species of CoNS in our healthcare set up with varying antimicrobial susceptibility pattern. Therefore, there is a need for accurate identification to species level by simple, inexpensive methodology and their antibiogram. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=DC20-DC24&id=16132 https://doi.org/10.7860/JCDR/2022/55012.16132 Analysis of COVID-19 and Mucormycosis Infection in Vaccinated and Unvaccinated Individuals: A Cross-sectional Study Kasturi Kshitija, Teeda Lakshmi Sri Naga Poojitha, Ande Dimple Sree Mounika, Deepak Rosha <b>Introduction:</b> Coronavirus Disease-2019 (COVID-19) pandemic unprecedentely led to health crisis in population across the globe. Even though the advent of vaccine has brought the spread of infection under control, shortage in vaccine supply, surge in breakthrough infections and associated mucormycosis in immunosuppressed individuals posed a potential threat. <b>Aim:</b> To know the incidence and outcome of COVID-19 with superadded mucormycosis in vaccinated and unvaccinated people. <b>Materials and Methods:</b> The present cross-sectional study undertaken for a period of four months. April to July 2021 in the Department of Respiratory Medicine at Tertiary Care Hospital, New Delhi, India. Hospitalised COVID-19 patients were enrolled in the study. Details of age, gender and co-morbidities were taken into account. In COVID-19 with mucormycosis, glycosylated haemoglobin value and steroid therapy were also noted. Clinical outcome for all the cases were analysed. Statistical analysis of the data collected was done with Statistical Package for the Social Sciences (SPSS) version 20.0 software. <b>Results:</b> Out of 134 cases, 84 and 50 cases belonged to vaccinated and unvaccinated groups respectively. Isolated COVID-19 infection was noted in 102 cases and COVID-19 with mucormycosis in 32 cases. Diabetes mellitus and steroid therapy showed to be the predisposing factors for development of mucormycosis in COVID-19 cases. High proportion of unvaccinated individuals died due to isolated COVID-19 infection compared to vaccinated individuals and it was found to be statistically significant. <b>Conclusion:</b> To combat serious threats caused by the COVID-19 pandemic, complete vaccination which offers maximum protection is mandatory. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=EC19-EC22&id=16114 https://doi.org/10.7860/JCDR/2022/53675.16114 Effect of Kinesio Taping in Patients with Cervical Radiculopathy: A Longitudinal Study Kopal Pajnee, Sheetal Kalra, Joginder Yadav <b>Introduction:</b> Cervical radiculopathy is the clinical condition when a nerve root in the cervical spine becomes inflamed or damaged due to compression because of various reasons resulting in a change in neurological function. Kinesio taping is a treatment method used by physical therapists to improve symptoms associated with musculoskeletal disorders. It can be stretched to 140% of its original length before being applied to the skin. It subsequently provides a constant pulling (shear) force to the skin, unlike traditional athletic tape. <b>Aim:</b> To study the effect of kinesio taping on pain, neck disability and physical function of upper limb in cervical radiculopathy. <b>Materials and Methods:</b> This longitudinal study was carried out at SGT Hospital Gurugram, Haryana, India, between February 2018 to August 2018. Fifty subjects, aged 18-50 years with positive response for the 4 test item cluster described by Wainner RS et al., were included in the study and were given manual therapy treatment, cervical stabilisation exercises and kinesio taping. There were three sessions per week for a total of four weeks. Neck Disability Index (NDI), Numeric Pain Rating Scale (NPRS) and Disability of the Arm, Shoulder and Hand (DASH) questionnaire were the outcome measures. The readings were noted at pre-level (0 week), mid-levels (at 2 weeks weeks) and at post-levels (at 4 weeks weeks). Comparison of different values was done using paired t-test. Level of significance was taken at p-value <0.05. <b>Results:</b> The mean age of patients was 48.1&#177;11.9 years. The NDI scores at 0 weeks, at 2 weeks, at 4 weeks were 46.00&#177;4.96, 30.48&#177;4.56, 14.84&#177;3.94, respectively. The DASH scores at 0 weeks, at 2 weeks, at 4 weeks were 59.52&#177;7.55, 34.49&#177;8.70, 0.74&#177;0.69, respectively. The NPRS scores at 0 weeks, at 2 weeks, at 4 weeks were 8.72&#177;0.7, 5.10&#177;1.07, 0.74&#177;0.69. All the variables showed significant improvement between different intervals. <b>Conclusion:</b> Kinesio taping method along with manual therapy treatment, cervical stabilisation exercises was effective in treating patients with cervical radiculopathy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=KC01-KC04&id=16115 https://doi.org/10.7860/JCDR/2022/46811.16115 Impact of Coronary Stent Price Regulation on the Interventional Cardiology Landscape of India: An Assessment of Health Economics Outcomes Hriday Arora, Alka Gupta, Divya Gupta <b>Introduction: </b>The cases of Coronary Artery Diseases (CAD) are on the rise in India, this can be attributed to various factors such as ageing, lifestyle, smoking, food habits, and higher income levels. Although, a large proportion of India’s population has access to some form of health insurance but the out of pocket expenditure is still extremely high as a percentage of total health spendings. <b>Aim:</b> To assess the impact of coronary stent price regulation on the interventional cardiology field in India. <b>Materials and Methods:</b> In this retrospective study, data was collected from online search at google and various other external data sources such as websites and published reports of World Health Organisation (WHO), Niti Aayog, National Pharmaceuticals Pricing Authority (NPPA) and Economic Times (ET) Health World. Line graphs for the percentage change in the number of percutaneous coronary intervention procedures, usage of Drug Eluting Stents (DES) pricing for government and private hospitals for the period 2016-2021 were plotted using Microsoft excel. <b>Results:</b> A high cost of coronary stents ranging from Indian Rupee (INR) 40,000 to INR 1,25,000 was a major contributor to a very high out of pocket expenditure in the field of interventional cardiology. In order to curtail this cost, a ceiling limit of INR 29,600 was imposed with respect to the prices of coronary stents in the year 2017 by the NPPA. Ever since a ceiling limit was imposed on the prices of coronary stents in India, there has been an annual increase of 3.7%, 13.1%, 12.6%, and 12.9% in the number of coronary intervention procedures for the years 2017, 2018, 2019 and 2021, respectively. Similarly, the usage of DES has also shown an annual increase of 8.9%, 14.7%, 10.5%, and 13.3%, respectively for the same years. <b>Conclusion: </b>At this juncture when the burden of CAD is on a rise in India, the efforts to make coronary stents more affordable will go a long way in the efficient management of CAD in the country. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=OC16-OC19&id=16116 https://doi.org/10.7860/JCDR/2022/55038.16116 Prevalence of Stunting and Thinness among School Going Early and Mid-adolescents of Idukki District in Rural Kerala: A Cross-sectional Study Robin Joseph Abraham, T Rehna <b>Introduction:</b> Adolescence is a period characterised by dramatic changes both physically and mentally. Under nutrition is a growing concern worldwide especially in developing countries like India. It has both short-term and long term concerns. <b>Aim:</b> To estimate the prevalence of thinness and stunting among school going early and mid-adolescents of Idukki district in rural Kerala, India. <b>Materials and Methods:</b> The present cross-sectional study which was conducted from June to October 2020 on 1005 subjects aged 10-16 years from four schools- two government and two private sector, selected by simple random sampling. Age group 10-13 years were grouped as early adolescents and 14-16 years were grouped as middle adolescents. After obtaining informed consent from the parents and school authorities, anthropometric measurements such as weight and height were recorded by standard technique. Body Mass Index (BMI) was calculated from height and weight measurements using the formula weight (kg)/height<sup>2 </sup>(metre<sup>2</sup>). The values were then plotted on age specific World Health Organisation (WHO) charts for height and BMI. The degree of stunting and thinness was categorised according to the position of the plot. Data was entered into excel sheet and analysed using Statistical Package for the Social Sciences (SPSS) 16.0. Statistical analysis was done using Chi-square test, to test the association between anthropometric data and age group and gender. A p-value <0.05 was taken as significant. <b>Results:</b> A 84 (8.4%) adolescents were stunted with equal prevalence in early 38 (8.5%) and mid-adolescents 46 (8.2%). There was no difference in the prevalence of stunting in males 44 (8.9%) and females 40 (7.9%). The overall prevalence of thinness among adolescents was 23.7%.with more thinness in early adolescents (27.4%) than mid-adolescents (20.7%). It was also found that males were thinner than girls especially among middle adolescents. <b>Conclusion:</b> Adolescent undernutrition continues to be an important public health problem in India. Hence, it will be prudent to give high emphasis on nutrition education programmes for adolescents. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=SC11-SC15&id=16117 https://doi.org/10.7860/JCDR/2022/55079.16117 Thoracic Mass Lesions in Children and their Management: A Prospective Interventional Study SB Srinibash, Prasanta Kumar Tripathy, Kaumudee Pattnaik, Pradeep Kumar Jena, Pramod Kumar Mohanty, Sushree Swagata Dash <b>Introduction:</b> Supine Percutaneous Nephrolithotomy (PCNL) has failed to gain popularity despite the various advantages, primarily due to a lack of standardised technique. A simple and replicable technique is needed to increase its popularity amongst urologists. <b>Aim:</b> To simplify and standardise the puncture technique of supine PCNL and compare it with the Clinical Research Office of the Endourological Society (CROES) PCNL global study. <b>Materials and Methods:</b> A prospective interventional study was conducted in a tertiary care hospital in Dehradun, Uttarakhand, India, between June-December 2020. A total of 82 consecutive patients underwent the procedure with a modified technique of initial puncture using bony landmarks. The results of present study were compared with the outcomes of the patients who underwent supine PCNL in the CROES PCNL global study which is the largest prospective database regarding the supine and prone positions of PCNL till date. Statistical analysis of various demographic variables, patient characteristics and results was done using Statistical Package for the Social Sciences (SPSS) version 24.0 software. <b>Results:</b> The mean age of patients was 47.52&#177;13.044 years and mean stone burden of 266.146&#177;172.430 mm<sup>2</sup>. The mean operative time was 85.59&#177;12.733 minutes. Lower calyceal puncture was done in 97.56% of patients. Stone clearance was achieved by a single puncture in 73 (89.0%) patients while 9 (11.0%) patients required two punctures. Sixteen patients (19.51%) had postnephrostomy drain removal leak which settled within 24 hours. Only in one patient the leak continued beyond 24 hours but was managed conservatively. On comparison, it was observed that mean stone burden was lesser (p-value=0.0001) and the stone free rate was comparatively higher in present study (p-value=0.024). <b>Conclusion:</b> Supine PCNL is an effective and safe procedure in a subset of patients with predominant lower calyceal stone bulk. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=PC10-PC15&id=16118 https://doi.org/10.7860/JCDR/2022/52582.16118 Estimation of Proinflammatory Cytokines and Mediator CD40 Ligand Levels in Young Tribal Subjects of Tripura- An Observational Study Debaprasad Chakrabarti, Partha Sarathi Pal <b>Introduction:</b> Obesity is the established risk factor for the development of cardiovascular diseases like hypertension, diabetes mellitus, chronic heart diseases and atrial fibrillation. Cytokines such as Interleukin-6 and Interleukin-12 (IL-6, IL-12) play a significant role in the development of obesity related disorders. Cluster of differentiation 40 (CD40) ligand, a trimetric protein structurally related to Tumour Necrosis Factor alpha (TNF-&#945;) family contributes to atherothrombosis by being a link between platelets, inflammation, thrombosis and atherogenesis. The present study was undertaken to explore the interplay between inflammatory cytokines and CD40 Ligand (CD40L) in young obese tribal subjects. <b>Aim:</b> To estimate the level of proinflammatory cytokines like IL-6, IL-12 and CD40 ligand in obese subjects and compare with non obese tribal subjects of Tripura, India. <b>Materials and Methods:</b> In this observational study, 60 non obese and 60 young obese tribal subjects within age group of 18-36 years were enrolled, over a period of two years from March 2014 to March 2016 at Tripura Medical College (TMC) and Dr. BRAM Teaching Hospital, Tripura, India. Serum levels of IL-6, IL-12 and C-reactive Protein (CRP) were estimated by Enzyme-Linked Immunoassay (ELISA). Plasma level of fibrinogen activity was measured by coagulation assay. The Homeostasis Model Assessment (HOMA) of insulin resistance was calculated as insulin (micro unit per milliliter) x glucose (milimoles/Ltr)/22.5. Soluble Cluster of differentiation 40 Ligand (sCD40L) in serum was determined by ELISA. Statistical analysis was performed using Mann-Whitney test, Chi-square test and regression analysis. <b>Results:</b> Cohort consisted of 19 (31.1%) males and 41 (68.3%) females whereas the control non obese group comprised of 16 (26.6%) males and 44 (73.3%) females. In the present study, the authors had observed that the biochemical parameters like fasting blood glucose, cholesterol, triglycerides and High-Density Lipoprotein (HDL) cholesterol were significantly higher in obese subjects compared to non obese subjects. Further, the authors observed that CRP, IL-6, IL-12 and fibrinogen level were statistically higher in obese subjects. A statistical significant difference was found in fasting insulin level and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) between obese and the non obese group. Finally, there was positive relationship between CD40 ligand and cytokines with obesity. <b>Conclusion:</b> The present study has demonstrated that the circulating levels of IL-6 and IL-12 have a strong relationship with obesity and other parameters of metabolic risk. It was also observed that there is a clear positive relationship between CD-40L and cytokine families. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=BC07-BC11&id=16119 https://doi.org/10.7860/JCDR/2022/51602.16119 Diagnostic Significance of Wet Mount Microscopy- A Retrospective Observational Study Abha Sharma, Poonam Sood Lomba, Bibhabati Mishra, Ashna Bhasin, Sulmaz Reshi <b>Introduction:</b> Wet mount microscopy is a rapid and easy conventional technique that provides a quick answer when positive and it provides an approximation of the infection burden. In this era of modern medicine where almost every infection is being diagnosed, using expensive and sophisticated molecular techniques, a simple wet mount examination of a clinical sample can still be relevant in several infections and play a significant role in the early diagnosis and treatment of infectious diseases. <b>Aim:</b> To focus and review the significance of wet mount examination of clinical specimens for diagnosis. <b>Materials and Methods:</b> A retrospective observational study with 11 cases was conducted at a superspeciality hospital in New Delhi over a period of six months from March 2019 to August 2019. Direct microscopic demonstration of motile <i>E. histolytica</i> trophozoites in saline wet mount of colonic biopsy specimens was done in patients presenting with non specific gastrointestinal symptoms. Positive cases were immediately reported to the clinician for further management. In view of this study, literature search was done on PubMed and Google scholar platforms for studies on wet mount examination of clinical specimens, data was analysed and all infectious diseases were identified for which wet mount microscopy will help in decreasing the Turn around Time (TAT) for diagnosing the infection from 24 hours to 20-30 minutes in real time. <b>Results:</b> Motile trophozoites of <i>E. histolytica</i> were seen in eight out of 11 cases studied. Amoebic serology by Enzyme-linked Immunoassay (ELISA) and histopathology for amoebic trophozoites was positive in all eight patients with 100% association between microscopic demonstrations of motile <i>E. histolytica</i> trophozoites in saline wet mount for amoebiasis. <b>Conclusion:</b> Right test at right time for clinical management of infectious diseases requires good communication between laboratory and clinicians. Direct Wet mount microscopy of clinical samples is rapid, simple, cost-effective method to decrease TAT and guide the clinicians to rule out infections and avoid unnecessary empirical use of antimicrobial drugs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=DC14-DC19&id=16120 https://doi.org/10.7860/JCDR/2022/51015.16120 Efficacy of Hot and Dry Bath (<i>Hammam-i-Har-Yabis</i>) in Activities of Daily Living for Management of Post Stroke Hemiplegia: An Exploratory Clinical Trial Mobassir Abbas, Abdul Nasir Ansari, Mohd Nayab, Umar Afzal, Adil Abdalrhman Abalkhai <b>Introduction:</b> Hemiplegia (Fa¯ lij) is usually caused due to obstruction (sudda) in ventricles of brain (butu¯ n-i-dima¯ gh) or base of the brain (mabda-un-nukha). Viscid and tenacious phlegm (Balgham) chokes the passages present in the nerves and blocks the transmission of motor impulses (Ru¯ h-i-Muharrik) into the organs to cause paralysis of a limb. Rarely, in the absence of any obstruction, the paralysis occurs due to unresponsiveness of organs due to their changed constitution (Sue-Miza¯ j-i-A'za¯ ). Turkish bath (H ? amma¯ m) is recommended for the resolution (Tahllul) and evacuation (Tanqiya) of viscid phlegm (Ghaleez Balgham) from impacted nerves by virtue of heat therapy to rejuvenate the motor functions in hemiplegia. <b>Aim:</b> To evaluate the effect of hot and dry bath (H ? amma¯ m-i-Ha¯ rYa¯ bis) in activities of daily living in management of post stroke hemiplegia. <b>Materials and Methods: </b>This open, single arm, exploratory clinical trial was conducted during January 2018 to February 2019 at NIUM hospital, Bangalore, on 30 diagnosed patients of post stroke hemiplegia. Patients were subjected with hot dry bath for 15 minutes at a temperature of 60&#176;C from day 1st till 30th day. A total of 10 sittings were given on every 3rd day. Barthel Index (BI), which consists of Activities of Daily Living (ADL), was used to assess the efficacy of hot and dry bath in the patients of hemiplegia. Friedman&#39;s test with Dunn&#39;s multiple comparison test was used to assess the efficacy of the treatment. <b>Results:</b> The mean age of the participants in the study was 42.54&#177;3.3 with male dominance. Statistically significant improvement was observed in BI scores between pretreatment to 15th day (p<0.01); 15th to 30th day (p<0.001) and pretreatment to 30th day (p<0.001). <b>Conclusion:</b> Hot and dry bath significantly improved the activities of daily living in the patients of post stroke hemiplegia. Another benefit of this therapy is infrequent and mild severity of side effects as compared to the oral medications in conventional system of medicine for post stroke neurodisabilities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=KC05-KC08&id=16121 https://doi.org/10.7860/JCDR/2022/53459.16121 Correlation of Dermatoglyphics with Clinical Characteristics of Cervix Carcinoma Patients at a Tertiary Care Centre in Kanpur, Uttar Pradesh, India K Pravallika, Vandana Tewari, Sheela Sharma, Anil Kumar <b>Introduction:</b> Cervix cancer is most prevalent cancer in females. Early detection and regular screening methods are helpful for the prevention of cervix cancer related morbidity and mortality. Early stages of development, dermatoglyphic features are generated under genetic influences, but they can be influenced by environmental variables during the first three months of pregnancy. These trends may reflect an individual&#8217;s genetic make-up and, as a result, his or her proclivity for particular diseases. Therefore, the dermatoglyphic prints may serves as a non invasive anatomic marker of cervix cancer risk, allowing for early detection and treatment. <b>Aim:</b> To characterise dermatoglyphics in cervix cancer patients and correlate them to principal clinical features. <b>Materials and Methods:</b> This cross-sectional study included 300 cervix cancer patients, analysed the clinical presentations and dermatoglyphics prospectively after obtaining ethics approval from a tertiary care hospital, Kanpur, Uttar Pradesh, India, during December 2016 to January 2020. The palmar dermatoglyphics (loops, arches, whorls and palmar angle) were obtained and evaluated for correlation with principal clinical features like vaginal discharge, postmenopausal bleeding, and intermenstrual bleeding using Spearman&#8217;s correlation test. <b>Results:</b> In this study, the frequencies of arches, loops and whorls were 81, 2051, 868 respectively. A strong positive correlation (r>0.92) existed between whorls of palmar digits and clinical features of cervix cancer. <b>Conclusion:</b> Dermatoglyphic patterns could be used to investigate the genetic cause of cervix cancer and could potentially be used as a non invasive anatomical screening method in high-risk patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=AC01-AC04&id=16092 https://doi.org/10.7860/JCDR/2022/52963.16092 Immunohistochemical Analysis in Salivary Duct Carcinoma of the Upper Labial Mucosa: A Rare Case Report Jigna S Shah, Jaya Dubey, Alka Bulchandani Salivary Duct Carcinoma (SDC) is a rare typically high grade, aggressive malignancy arising from the ductal epithelium of salivary glands characterised by ductal formations and central necrosis having pathomorphological resemblance to ductal breast carcinoma. Parotid and submandibular salivary glands are the most commonly affected while very few cases involving the minor salivary glands of the palate, labial mucosa, floor of mouth have been reported. This high grade malignancy must be treated aggressively by complete local excision with radical neck dissection and postoperative radiation therapy seems to offer maximum benefit for the patients. This article highlights a case of a 80-year-old male patient having an intraoral ulcer over a swelling which was since five years on the left side of upper lip with left submandibular lymph nodes enlargement is reported. An immunohistochemical analysis of the biopsy specimen was carried out which concluded a SDC. The swelling was surgically excised followed by postoperative radiotherapy and adjuvant chemotherapy. The patient was on a regular follow-up for two and a half years without any local recurrence or distant metastasis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZD07-ZD09&id=16093 https://doi.org/10.7860/JCDR/2022/52301.16093 Knowledge and Attitude towards Vitiligo and Psoriasis among Undergraduate Medical Students: A Cross-sectional Observational Study Chandrika Nayyar, Rajashekar Talari Srinivas, Hanumanthayya Keloji, Suresh Kumar Kuppuswamy, Savana Waikhom <b>Introduction:</b> Understanding the perspective on vitiligo and psoriasis of undergraduate medical students enables us to focus on lacunae areas in their knowledge, and train them to disseminate accurate information to the public. A positive attitude towards vitiligo and psoriasis in society will reduce the psychosocial burden on the patients and deliver better clinical outcomes. <b>Aim:</b> To assess medical student&#8217;s knowledge and attitudes towards vitiligo and psoriasis. <b>Materials and Methods:</b> This cross-sectional, questionnaire-based, observational study was conducted on 351 undergraduate medical students (third semester onwards) at Sri Devaraj Urs Medical College, Kolar, Karnataka, India, from January 2021 to March 2021. Questionnaire consisted of 28 questions about knowledge and 18 about attitude towards vitiligo and psoriasis, presented through Google docs to the medical students. A score of 75% was considered as having &#8216;good knowledge&#8217; and &#8216;positive attitude.&#8217; Fischer&#8217;s-exact test was used as a test of significance for qualitative data. Analysis of Variance (ANOVA) was used as a test of significance to identify the mean difference between more than two quantitative variables. The p-value <0.05 was considered as statistically significant. <b>Results:</b> The study included 351 participants, of which 171 (48.7%) were females and 180 (51.3%) were males. There were 89 (25.3%), 133 (37.9%), and 129 (36.8%) respondents from the second, third, and fourth years, respectively. Good knowledge was observed in 80.9% and 71.5%, and 87.7% and 72.4% had positive attitudes towards vitiligo and psoriasis, respectively. A statistically significant difference (p-value=0.002) was found in attitude between vitiligo and the year of MBBS. A statistically significant difference (p-value=0.004) was found in knowledge between psoriasis and the year of MBBS. Overall, 55.84% thought that psoriasis only concerns the skin. Good knowledge was directly proportional to a positive attitude. <b>Conclusion:</b> The majority of the undergraduate medical students had &#8216;good knowledge&#8217; and &#8216;positive attitude&#8217; towards vitiligo and psoriasis. Good knowledge was highly proportional to a positive attitude. Unfortunately, a considerably high number of participants reported that they would not marry a person with vitiligo or psoriasis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=WC01-WC05&id=16094 https://doi.org/10.7860/JCDR/2022/53155.16094 Lumbar Epidural Anaesthesia versus Caudal Epidural Anaesthesia- Intraoperative and Postoperative Profile in Paediatric Surgical Patients Pareesa Rashid, Khairat Mohd Butt, Sargam Goel, Aamil Haameem, Showkat Ahmed Gurcoo <b>Introduction:</b> Caudal and lumbar epidural are established techniques of central neuraxial blocks in paediatric anaesthesia. Learning them by landmark guidance is extremely important given the fact that they have a short learning curve and all centres may not be equipped with modern equipment like fluoroscopy and ultrasound. <b>Aim:</b> To compare lumbar epidural anaesthesia with caudal epidural anaesthesia in terms of the ease of needle and catheter insertion, efficacy in providing intraoperative and postoperative analgesia, haemodynamics, patient satisfaction and complications. <b>Materials and Methods:</b> This prospective observational study was done in the Department of Anaesthesiology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India between September 2016 and June 2018. Study included 60 patients, aged 2-15 years, of American Society of Anaesthesiology (ASA) grade I and II, undergoing elective infraumbilical surgeries. Patients were either administered General Anaesthesia (GA) and 0.2% ropivacaine 0.3 mL/kg through lumbar epidural catheter (Group L), or GA and 0.2% ropivacaine 1 mL/kg through caudal epidural catheter (Group C). Pain was measured postoperatively using Face, Legs, Activity, Cry, Consolability (FLACC) score and number of rescue top ups in the form of tramadol 1.5 mg/kg epidurally were noted. Student&#8217;s independent-test was employed for intergroup and, paired t-test and Fisher&#8217;s-exact test was used for intragroup analysis. <b>Results:</b> Out of 60 patients, the mean age&#177;Standard devation (SD) in lumbar technique group and caudal technique group was 8&#177;3.42 years and 6.56&#177;2.93 years, respectively. The age, gender distribution, intraoperative and postoperative vitals (heart rate, mean arterial pressure and oxygen saturation), number of rescue top ups, patient satisfaction were comparable between the two groups. On statistical comparison, needle insertion was easy in 21 patients in caudal epidural group (vs 13 in lumbar epidural group) and catheter insertion was difficult in 18 (vs 8 in lumbar epidural group) in caudal epidural block compared with lumbar epidural block (p-value=0.037 and 0.010 respectively). No complications were observed in any patient of either group except one patient in group C who had catheter occlusion in the postoperative period. <b>Conclusion:</b> Needle insertion was easy and catheter insertion was difficult in caudal epidural block compared with lumbar epidural block in paediatrics. Both the techniques provided comparable quality of analgesia, stable haemodynamics with minimum complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=UC11-UC15&id=16095 https://doi.org/10.7860/JCDR/2022/51831.16095 Comparison of Airtraq with Macintosh Laryngoscope for Endotracheal Intubation in Paediatric Patients: A Randomised Controlled Trial Yogita Dwivedi, Ankit Jain, Vijay Pratap Yadav, Atiharsh Mohan Agarwal <b>Introduction:</b> The Airtraq is a new intubation device that has been developed to facilitate tracheal intubation in patients with normal or difficult airway. The available paediatric sizes are 0, 1 and 2 and are of grey, purple, green colour. These can insert endotracheal tube of size 2.0-3.5/4-5.5/6-7.5, respectively. <b>Aim:</b> To evaluate the clinical efficacy of Airtraq laryngoscope in comparison with Macintosh by experienced Anaesthesiologist for intubation in paediatric patients. <b>Materials and Methods:</b> The randomised controlled trial was conducted at Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, from December 2015 to August 2017. Fifty healthy children, aged 2-10 years of American Society of Anesthesiologists (ASA) grades I/II, presenting for elective surgery were randomly allocated in two equal groups. Endotracheal intubation was done either using Airtraq or Macintosh laryngoscope. Duration of intubation (primary variable), number of attempts, ease of intubation, oesophageal intubation, optimisation maneuvers, Percentage Of Glottic Opening (POGO) scoring and haemodynamic parameters were compared between two groups. Patients&#8217; demographic data, intubation time, haemodynamic variables were analysed by Unpaired t-test. While number of attempts for intubation, ease of intubation, optimisation maneuvers and POGO scoring were analysed by Fisher&#8217;s-exact test. Data was presented as mean&#177;SD with categorical data presented as frequency (n) and percentages (%). The p-value of <0.05 was considered as significant. <b>Results:</b> There was no difference in demographic variables and duration of surgery between two groups. Intubation time, which was taken as primary variable, was found to be significantly longer in Macintosh (56.28&#177;6.02 sec) as compared to Airtraq (25.60&#177;3.73 sec) with p-value <0.0001. In terms of ease of intubation and POGO scoring, Airtraq was better as compared to Macintosh. Haemodynamically, Airtraq was found to be better as compared to Macintosh reflected by postintubation heart rate which was 110&#177;7.84 beats/min with Airtraq while 119.32&#177;10.61 beats/min with Macintosh (p-value=0.0028). The two groups were statistically comparable in terms of number of attempts, optimisation maneuvers and mean blood pressure changes. <b>Conclusion:</b> It can be concluded that Airtraq is a reliable and promising alternative to Macintosh for endotracheal intubation in paediatric patients as seen by duration of intubation, better laryngeal view, ease of intubation and haemodynamic changes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=UC16-UC18&id=16096 https://doi.org/10.7860/JCDR/2022/48692.16096 Near Peer Teaching in Pathology Practical Training- An Experimental Pilot Study Sathish Selva Kumar, Rajeswari Kathiah, Priavadhana, K Meenakshisundaram <b>Introduction:</b> Medical education requires teaching methods with student centric approach to train our Indian Medical Graduates (IMG) enabling them to perform the roles of a clinician, communicator, leader, lifelong learner and a professional. Near Peer Teaching (NPT) or Peer Assisted Learning (PAL) is one such method where peers who are not professional teachers belonging to similar social grouping and academic training helps each other to learn and also learn by teaching. <b>Aim:</b> To use the concept of NPT as an alternative teaching method in undergraduate pathology practical training and evaluate its effectiveness on the learners in comparison with the traditional teaching by Objective Structured Practical Examination (OSPE) and its acceptance among the participating students through feedback. <b>Materials and Methods:</b> In this experimental pilot study was conducted at ESIC Medical College and PGIMSR, Chennai, Tamil Nadu, India, for a period of three months (June-August 2019) 22 students who were allotted to the faculty for pathology practical sessions were divided into two groups- the regular (group A) and interventional (group B). The regular group was taught by faculty while in the other group the students were taught about the peer teaching principles and were made as tutors and tutees alternatively, until the intended spotters were completed in the 10 intended sessions over a period of three months. At the end of the study, all the students&#8217; assessment was done by OSPE and their feedback regarding the new method was obtained. Descriptive statistics and independent t-test (95% confidence interval) were used. The statistical significance was considered at the level p<0.05. The students&#8217; feedback was charted as percentage of responses. <b>Results:</b> Students&#8217; OSPE test scores of all the stations were better among the NPT group than the traditional method group with statistically significant difference observed in the slide identification spotter station (group A, 21.7&#177;7.1 vs group B, 15.3&#177;5.5, p<0.05). Majority of the students&#8217; response about NPT as a teaching method in pathology practical training sessions was positive especially with regard to providing a cordial learning environment (100% agreed), improved understanding (91.7% agreed) and retention of the topic (100% agreed). They also felt that the method will help to improve their communication skills, teaching skills and motivate towards self-directed learning. NPT can be used as an interactive Teaching Learning Method (TLM) in faculty resource poor settings. <b>Conclusion:</b> The NPT in pathology practical session is a simple, potent and a practical teaching method, with better results than the traditional teaching method. The method has been preferred and well accepted by undergraduate medical students in the present study. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=JC01-JC05&id=16097 https://doi.org/10.7860/JCDR/2022/54825.16097 Behaviour of Students of Senior Secondary School towards Caffeine in Western Uttar Pradesh, India Ishi jain , Alok Tripathi , Ravi Pratap Singh <b>Introduction:</b> On entering 11<sup>th</sup> and 12<sup>th</sup> standard students feels a load of studies and lack of energy to combat that, an increase in caffeine consumption is observed in students which have both short and long term side-effects. <b>Aim:</b> This study has been undertaken to throw light on the unspoken side of the coin called caffeine consumption by students of senior secondary school to relieve stress. <b>Materials and Methods:</b> This was an observational study done over a period of six weeks from 1<sup>st</sup> September to 15<sup>th</sup> October 2021. Data was collected from senior secondary schools of western Uttar Pradesh, India, via semistructured questionnaire which was followed by the audio-visual presentation about caffeine. After one week of presentation same questionnaire was distributed and change was evaluated and compiled in form of adequate tables to study the responses. Data were entered in an MS Excel and tabulated in form of tables. <b>Results:</b> Out of 1000 students, 920 (92%) students knew caffeine, among whom 500 (50%) students knew the side-effects of caffeine. A total of 780 (78%) students had a perception that caffeine is addictive. Among the reasons for caffeine consumption, to ward away sleep (51%) was the most prominent. Coffee was the most consumed caffeinated product (61%). <b>Conclusion:</b> From the present study, it be concluded that there is a lack of knowledge in students about caffeine intake and its side-effects which can affect their health. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=AC05-AC09&id=16098 https://doi.org/10.7860/JCDR/2022/53370.16098 Role of Modified RALES and Brixia Scores in Predicting the COVID-19 Positivity among the Suspected Patients: A Cross-sectional Observational Study Nitin Sinha, Divesh Jalan, Princi Jain <b>Introduction:</b> Computed Tomography (CT) chest plays an important role in triaging and managing patients of suspected COVID-19, especially in those where Coronavirus Disease 2019 (COVID-19) report is pending but CT chest has constraints of availability and cost. Chest X-ray (CXR) is a readily available investigation and is cheaper than a CT chest. Hence, any scoring on CXR which proves to be helpful in triaging and managing suspected COVID-19 patients will alleviate the dependency on CT chest. Modified Radiographic Assessment of Lung Edema Score (mRALES) and Brixia scores have been used to assess severity of disease and prognosis in COVID-19 confirmed cases. However, these two scores have never been used as a method to predict the confirmed COVID-19 pateints among the the suspected COVID-19 cases. <b>Aim:</b> To evaluate the role of mRALES and Brixia score along with clinical and laboratory parameters in predicting confirmed positive cases among suspected COVID-19 patients. <b>Materials and Methods:</b> This retrospective cross-sectional, observational study was conducted in Department of Medicine at Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, New Delhi, India, from 1<sup>st</sup> December 2020 to 15<sup>th</sup> December 2020. Case records of patients admitted with severe acute respiratory illness (suspected COVID-19) were accessed and used to fill up a proforma where clinical and laboratory parameters were recorded. Chest radiographs (posteroanterior and anteroposterior) of the patients were evaluated to calculate mRALES and Brixia scores. Sensitivity, specificity, positive preditive value and negative predictive value were calculated. The p-value <0.05 was considered as statistically significant. <b>Results:</b> Out of the 113 patients, 62 were males and 51 females. The COVID-19 positivity rate was 15.04% (n=17). Mean age of patients was 52.64&#177;15.63 years. Overall, the mean mRALES and Brixia scores were not statistically different between negative (mRALES=3.94&#177;2.51, Brixia=7.29&#177;4.642), and confirmed COVID-19 (mRALES=4.25&#177;2.56, Brixia=7.73&#177;4.84) patients. However, in the subgroup of patients with history of obstructive airway disease, Brixia score was significantly higher among COVID-19 positive patients (7.09&#177;4.70) as compared to COVID-19 suspected patients (0.53&#177;4.31). Presence of low TLC {<9550/mm<sup>3</sup> with sensitivity of 70.62%, specificity of 67.3%, Positive Predictive Value (PPV) of 26.7% and Negative Predictive Value (NPV) of 92.4%} and low ANC (<7580/mm<sup>3</sup> with sensitivity of 64.7%, specificity of 63.2%, PPV of 22.9% and NPV of 90.5%) significantly predicted the COVID-19 positivity among the suspected COVID-19 patients. <b>Conclusion:</b> mRALES and Brixia scores on CXR are not significantly different between suspected and confirmed COVID-19 patients and hence, cannot be used to judge who among suspected COVID-19 patients will turn out to be COVID-19 positive later. However, a TLC of less than 9550/ mm<sup>3</sup> and an ANC of less than 7580/mm<sup>3</sup> can predict COVID-19 positivity among suspected patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=OC10-OC15&id=16102 https://doi.org/10.7860/JCDR/2022/51204.16102 Comparison of Absorbable versus Non Absorbable Tackers for Fixation of Mesh in Laparoscopic Midline Anterior Abdominal Wall Hernia Repair: A Randomised Clinical Study Dhruv Gupta, Himanshu Agrawal, Nikhil Gupta, Yajushi Desiraju, Raghav Yelamanchi, CK Durga <b>Introduction:</b> Tackers are divided in two broad categories namely, absorbable and non absorbable. Absorbable tackers are believed to achieve sufficient tensile strength compared to conventional non absorbable tackers. It is a matter of debate that which type of tacker has an upper hand over the other especially in terms of postoperative pain and recurrences even after few years of clinical experience with these tackers and available clinical studies. <b>Aim:</b> To compare various aspects of absorbable versus non absorbable tackers for fixation of mesh in Laparoscopic Midline Anterior Abdominal Wall Hernia Repair for short period of follow-up. <b>Materials and Methods:</b> In this prospective randomised clinical study from November 2016 till March 2018 at Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia (RML) Hospital, New Delhi, India. Total of 80 patients of age &#8805;18 years with midline anterior abdominal wall hernia were included and randomised into two groups 40 patients each i.e. group 1 absorbable tackers and group 2 non absorbable tackers. Outcomes evaluated were postoperative pain, seroma formation, paralytic ileus, early recurrence (3 months follow-up) and duration of hospital stay.The data acquired was analysed using Statistical Package for Social Sciences (SPSS) version 22.0. Comparison of ordinal paired data was done using Wilcoxon signed rank sum test. The nominal categorical data was compared using Chi-square or Fisher&#8217;s-exact test as appropriate. A p-value of <0.05 was considered statistically significant. <b>Results:</b> Out of 80 patients included in this study with a range of 21 to 60 years, the median age was 30 years. There was no statistically significant association noted in terms of postoperative pain (p-value >0.05), seroma formation (p-value=1), paralytic ileus (p-value >0.05), length of hospital stay (p-value=0.801) and early recurrence (3 months). <b>Conclusion:</b> This study has shown that both non absorbable and absorbable tackers are associated with minimal postoperative complications and have similar postoperative morbidity. Both absorbable and non absorbable tackers are comparable for fixation of mesh in laparoscopic midline anterior abdominal wall hernia with respect to the above mentioned outcomes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=PC05-PC09&id=16103 https://doi.org/10.7860/JCDR/2022/50481.16103 Coronary Angiography Findings among Diabetics and Non Diabetics Presenting with Acute Coronary Syndrome: A Case-control Study Mainak Mukhopadhyay, Vijay Shankar Sharma, Shivesh Sahai, Auriom Kar, Kajal Ganguly <b>Introduction:</b> Patients with type-2 diabetes are at high risk for many Cardiovascular Diseases (CVD) such as coronary artery disease, stroke, peripheral arterial disease, cardiomyopathy, and congestive heart failure. <b>Aim:</b> To evaluate the coronary angiography profile in diabetics and non diabetics presenting with Acute Coronary Syndrome (ACS) in a tertiary care hospital in eastern India. <b>Materials and Methods:</b> This case-control study conducted from September 2018 to October 2019 at Nil Ratan Sircar Medical College, Kolkata,West Bengal, India, comprised 200 patients (100 were diabetics and 100 were non diabetics) diagnosed with ACS based on Electrocardiography (ECG) and cardiac enzymes. Data about baseline demographic, clinical and angiographic characteristics were collected. Moreover, angiographic thrombus burden grade, Cohen and Rentrop grade for collateral circulation, and Synergy Between Percutaneous Coronary intervention with Taxus and Cardiac Surgery (SYNTAX) score were also reported. <b>Results:</b> The mean number of vessel involvement was significantly higher in diabetics as opposed to non diabetics (2.1% vs. 1.5%, p-value=0.001). Left main coronary artery disease (20% vs. 10%, p-value=0.0012), ostio-proximal disease (36% vs. 20%; p-value=0.032), bi/trifurcation lesion (40% vs. 22%; p-value=0.032), diffuse disease (60% vs. 30%; p-value=0.012), chronic total occlusion (16% vs. 7%; p-value=0.008), coronary calcification (22% vs. 12%; p-value=0.04), and microvascular disease (10% vs. 4%; p-value=0.02) were significantly more frequent in diabetics compared to non diabetics. Even after thrombolysis, thrombus grade 4-5 was highly observed in diabetics than non diabetics (4% vs. 0%; p-value=0.001). Grade 3 collateral circulation was less frequently developed in diabetics than non diabetics (1% vs. 4%; p-value=0.001). High SYNTAX score was highly noticed among diabetics than non diabetics (36% vs 20%; p-value=0.03). <b>Conclusion:</b> Diabetics with ACS had more thrombus burden of higher grade along with lesser collaterals, and higher SYNTAX score. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=JC06-JC09&id=16104 https://doi.org/10.7860/JCDR/2022/51629.16104 Community Based Appraisal of Healthcare Service Utilisation and Determinants of Health Seeking Behaviour among the Elderly Population of Rural Western Maharashtra Sachin B Jadhav, Kalpak S Kadarkar, Harshawardhan N Mujumdar <b>Introduction:</b> To mitigate an inevitable phenomenon of population ageing, which has impact on nation&#8217;s development as well as on quality of life of population, health seeking behaviour and health service utilisation need to be increased, especially in rural areas. <b>Aim:</b> To assess health seeking behaviour, identify hurdles and measure health services utilisation. <b>Materials and Methods:</b> A community based observational descriptive cross-sectional study was conducted with 210 elderly population (60 years of age and above) to assess health seeking behaviour and to measure health service utilisation for the period from October 2020 to October 2021, in rural area of Tasgaon block of Sangli district of Maharashtra by Department of Community Medicine, Government Medical College, Miraj, Maharashtra, India. A pretested, prevalidated, semi-structured proforma and interview schedule were used to collect information. Descriptive statistics along with Chi-square test and Binary logistic regression were used as inferential statistical analysis. The p-value to be significant at p<0.05. <b>Results:</b> Out of total 210 participants, 48.09% and 51.91% were males and females respectively with male to female ratio of 0.93:1. Mean ages of males and females were 63.85 and 65.23 years respectively.Out of total 210 participants, 82% of participants had atleast one chronic morbidity at the time of study. Musculoskeletal morbidities were most common (46.67%). Among morbid participants, 56% utilised government health facility. Health service utilisation rate was 75.86%. Lack of enough money was most common reason (76.19%) for non utilisation of health services. Gender, educational level, residential arrangements and socio-economic class showed statistically significant association with appropriate or inappropriate health seeking behaviour. About 61% participants showed appropriate health seeking behaviour. The odds of having inappropriate health seeking behaviour were 7.76 and 10.19 times greater for middle class and lower class as opposed to upper class, respectively. Illiterates had 17.53 times higher odds to seek health inappropriately. <b>Conclusion:</b> Quality of health seeking behaviour can be improved by narrowing gender gap, increasing literacy rate and giving social assistance to elderly persons. It is an important need of hour to pay more attention to age related issues and promote holistic approach to deal with ageing society. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=LC06-LC10&id=16105 https://doi.org/10.7860/JCDR/2022/52681.16105 A Cross-sectional Study on the Prevalence and Clinico-social Profile of High Risk Pregnancies in Rural Tamil Nadu, India R Mohammed Ibrahim, SP Priyadarsini, R Abdul Nayeem, VM Somasundaram, N Saravana Kumar, R Balasubramanian <b>Introduction:</b> Around 10-30% of mother during their antenatal period can be classified as high risk and out of these 70-80% accounts to perinatal morbidity or mortality. Special care must be given to women with high risk pregnancies to make sure the best possible outcomes. Early identification and regular follow-up of high risk pregnancies will reduce the loss of mother as well as newborn. <b>Aim:</b> To identify the prevalence of high risk pregnancies and factors associated with it in rural Tamil Nadu, India. <b>Materials and Methods:</b> The present community-based cross-sectional study was conducted in rural field practice area in the Department of Community Medicine, Annapoorna Medical College, Salem, Tamil Nadu, India. High risk pregnancies were identified using a pretested semi-structured questionnaire and a scoring system developed by Dutta and Das (1990) on 235 women of more than 20 weeks of pregnancy. The association between high risk pregnancies and socio-demographic variables were analysed. The frequency, percentage and analytical statistics was done using Pearson&#8217;s Chi-square test. <b>Results:</b> The prevalence of high risk pregnancy among total of 235 pregnant mothers who were interviewed was found to be 15.32%, Moderate and high risk pregnancies combined were 42.13%, whereas 57.87% were of low risk pregnancy with no known risk factors. Major risk factors identified were anaemia (33.19%), undernutrition (31.06%), previous Lower Segment Caesarean Section (LSCS) (13.62%), abortion (8.51%). Early and late age at pregnancy was not associated with moderate to high risk pregnancy. Parity and high socio-economic condition were significantly associated with high risk pregnancy. <b>Conclusion:</b> The present study found that 42.13% pregnancies were moderate to high risk pregnancies. Early detection of these high risk pregnancies must be done at primary healthcare level using a uniform scoring system by a trained health workers, which may reduce the adverse events. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=LC11-LC15&id=16106 https://doi.org/10.7860/JCDR/2022/55133.16106 Understanding Attitude towards Gender, Sexuality, Sexual Health Needs and Information Seeking Behaviour amongst First Year Medical Students: An Observational Study Deepali Khatri, Mrunal R Shenwai, Priya Mardikar <b>Introduction:</b> The topics related to sexual attitude and reproductive health are not commonly and openly discussed. The scarcity of having open discussions especially with parents results in lack of awareness among adolescents about contraception, sexual values, beliefs and behaviour. First year medical students are usually in their last years of adolescence. In future, they are going to communicate with their patients on sexual health matters. Hence, it becomes essential to understand their own perspective regarding this. <b>Aim:</b> To understand the attitude of first year medical students towards gender, sexuality, sexual health needs and their information seeking behaviour. <b>Materials and Methods:</b> A cross-sectional survey was conducted, using a self-administered questionnaire. The study population comprised of 314, first year medical students aged between 17 to 20 years at Smt. Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India. The questionnaire included sections on communication within family and friends, personal attitude towards sexuality and gender and information seeking behaviour. Statistical analysis was done by Chi-square test using Statistical Package for the Social Sciences (SPSS) software. <b>Results:</b> Total 314 first year Bachelor of Medicine, Bachelor of Surgery (MBBS) students (135 males, 179 females with mean age of 18.35 years) participated in the study. More than 90% of students were interested to socialise with opposite sex, yet more than 50% of them did not want to be involved in premarital sex as it was against their religious beliefs. More number of boys (65.93%), as compared to girls (38.55%), agreed that it’s ok to have sex before marriage with proper contraceptive measures. Maintenance of virginity until marriage was important for girls (56.98%) as compared to boys (37.04%) which was statistically significant (p<0.001). Students lacked communication with their parents on the topics of sexuality. A 95.86% used internet to seek information on sexual health matters. Sexual problems (72.61%) and genital hygiene (73.89%) were the maximally searched topics on internet. Total 64.33% of students were interested in attending a formal course regarding sexual/reproductive health. <b>Conclusion:</b> Adolescent&#39;s attitude about sexual matters is guided by their religious beliefs. There is a dearth of communication between the adolescents and their parents on sexual health matters. Majority preferred seeking information from friends and/ or via internet which can be unreliable at times. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=CC01-CC05&id=16107 https://doi.org/10.7860/JCDR/2022/53754.16107 Evaluation of Community Medicine Postgraduate Theory Examination to Measure the Content and Cognitive Domain Coverage- A Retrospective Analysis M Rajalakshmi, Vinayagamoorthy Venugopal, Amol R Dongre <b>Introduction:</b> Assessment is a critical step in learning process. Postgraduate theory examination ideally should assess higher levels of cognition. In order to maintain high standard of public health the postgraduates of the specialty should be certified properly using the appropriate assessment methods. Since the assessment drives learning, ideally it should be aimed at judging a learner&#8217;s attainment of curriculum outcomes. <b>Aim:</b> To evaluate the postgraduate theory exam question papers from 2014 to 2018 in Community Medicine (CM) of various South Indian Universities and to measure the actual content coverage and cognitive domain coverage as per Bloom&#8217;s taxonomy. <b>Materials and Methods:</b> The present retrospective analytical study was conducted from April 2019 to July 2019 to assess the question papers from 2014-2018 in community medicine. Sixty theory exam question papers (20 per University) of last 5 years of three South Indian Universities namely Pondicherry (PU), Tamil Nadu (TN), and Kerala (KR) of CM subject were analysed for content coverage and to categorise the level of knowledge assessed as per Bloom&#8217;s taxonomy. The significance of difference between the data of various years was tested using Chi-square test. <b>Results:</b> Questions testing higher cognitive domain was found only in 15%, 3.75% and 2.5% of PU, TN and KR Universities, respectively. Epidemiology of communicable and non communicable diseases was the content that received maximum coverage of total marks, 25%, 21.25% and 18.5% in PU, TN and KR Universities respectively. Certain topics were not covered in many papers. There was no statistical difference in distribution of marks among various Universities in South India. <b>Conclusion:</b> Findings of this study may be used to redefine the distribution of contents and cognitive domain tested across universities ensuring the validity and reliability of the assessment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=JC10-JC14&id=16108 https://doi.org/10.7860/JCDR/2022/51597.16108 Biophysical Characterisation of Amadori Modified Human Serum Albumin: A Prognostic Biomarker for Diabetic Complications Binish Arif, Zubair Ahmad, Gulzar Ahmad Bhat, Syed Mudassar, Khursheed Aalam <b>Introduction:</b> Glycation of biological macromolecules particularly protein leads to the generation of early and Advanced Glycation End (AGE) products. The interest in early glycation of protein is driven due to the fact of Amadori modified proteins having role in diabetic complications. <b>Aim:</b> To analyse the biophysical characterisation of Amadori modified human serum albumin as a prognostic biomarker for diabetic complications. <b>Materials and Methods:</b> This in-vitro experimental study was conducted at Department of Biochemistry, J.N. Medical College, Aligarh Muslim University, Uttar Pradesh, India, from May 2010 to December 2012. The structural characterisation of EGPs was generated by incubating Human Serum Albumin (HSA) with glucose for about a week. The generation of Early Glycation Products (EGPs) of HSA was quantitated as Hydroxy Methyl Furfural (HMF) by ThioBarbituric Acid (TBA) assay and authenticated by boronate affinity chromatography. Moreover, High Performance Liquid Chromatography (HPLC) and Electro Spray Ionisation/Mass Spectrometry (ESI/MS) was carried out to validate the presence of Amadori product formed. Additionally, Circular Dichroism (CD) and thermal denaturation studies were used to investigate the structural changes in Amadori albumin. <b>Results:</b> Glycated HSA was obtained as detected by the presence of HMF and chromatography peaks. On stratification, the structural perturbation was observed in Amadori HSA. Furthermore, the generation of furosine was also confirmed by obtaining a new peak in the HPLC profile of glycated HSA. The ESI/MS result also substantiated the presence of Amadori products. <b>Conclusion:</b> The therapeutic strategies that negate the Amadori modification of albumin might be a logical approach in the prevention of diabetic complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=BC01-BC06&id=16109 https://doi.org/10.7860/JCDR/2022/51899.16109 Introduction of Module-based Training on Communication Skills among Interns in a Tertiary Care Teaching Hospital of Kolkata, India Sinjita Dutta, Meghna Mukherjee, Vineeta Shukla, Ankita Mishra, Ripan Saha, Subhra Sammujwal Basu, Mausumi Basu <b>Introduction:</b> Many of the problems in Indian healthcare settings resulting in mistrust, violence, allegations and litigations against doctors can be solved by effective communication between doctors and patients or their relatives. Interaction of the students as a community physician needs training in communication skills. A structured module-based training on communication skills during internship will help the interns to communicate effectively with patients and their relatives. <b>Aim:</b> To develop, introduce and evaluate a structured, validated module on communication skills for interns in a Tertiary Care Teaching Hospital of Kolkata, India. <b>Materials and Methods:</b> A quasi-experimental, prospective, non randomised educational intervention study was conducted in the Department of Community Medicine at Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India, from January to December 2020. A structured and validated module for teaching communication skills to interns was used to train one batch of interns posted (n=40) in the department, over two days. To establish the content validity of the module, the items on content validation were rated on a scale of 1-4 by 10 experts. The validators were asked about their responses favouring face validity of the module and the average of their responses were calculated. Post-training their knowledge, skills and self-reported efficacy were assessed. Feedback from the faculty (n=6), and the interns (n=40) were collected using structured survey forms with likert scale ratings and open-ended questions. The trained cohort of interns was also assessed on communication using the SEGUE (Set the stage, Elicit information, Give information, Understand the patient&#8217;s perspective, and End the encounter) Framework during patient encounter. <b>Results:</b> Post-training knowledge score (16.68&#177;2.5) was significantly higher than the pretraining score (15.45&#177;2.9). Also, there was significant increase in self-assessed knowledge (11.08&#177;3.7 and 17.23&#177;3.3) and skills (9.60&#177;4.6 and 16&#177;2.9) before and after the training. All the interns had positive attitude towards communication skill on the Communication Skills Assessment Scale (CSAS). The mean score of interns on assessment using the SEGUE framework was 16.6&#177;3.59. The satisfaction index of the items on the feedback survey obtained from interns ranged from 82.5% to 93%. There was 100% agreement by the faculty on the relevance, usefulness and use of the module by other departments for communication skill training. More faculty involvement and more such sessions were suggested by both groups as evident from thematic analysis of open-ended responses to the feedback questsions. <b>Conclusion:</b> The development and delivery of a structured training module on communication skills for interns improved the knowledge and skills of the interns. Both the faculty and the interns were satisfied with the module. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=JC15-JC20&id=16110 https://doi.org/10.7860/JCDR/2022/52388.16110 Clinical Profile and Short Term Outcome of Acute Encephalitis Syndrome in Children: An Observational Study from a Tertiary Care Centre, Tripura, India Sujit Kumar Chakrabarti, Sribas Das, Prasenjit Das, Sanjib Kumar Debbarma <b>Introduction:</b> Acute Encephalitis Syndrome (AES) is a group of neurologic manifestation caused by wide range of microbes, chemicals and toxins. Japanese Encephalitis Virus (JEV) is the major cause of AES in India. Isolation of aetiological agent in AES cases presents a fundamental challenge to prevention and management. Lack of study on AES in the paediatric population of Tripura prompted the authors to take up this study. <b>Aim: </b>To determine the clinical profile and short term outcome of children with AES from Tripura, India. <b>Materials and Methods: </b>This hospital-based cross-sectional observational study was conducted from November 2017 to April 2019 in the Department of Paediatrics at Agartala Government Medical College (AGMC), Tripura, India. Total 100 children, from 1 month to 12 years of age, fulfilling definition of AES were enrolled in the study. All the cases were managed as per institutional treatment protocol and were followed-up at one and three months following discharge. Case record, patient profile records and reports of investigations were the study tools. Chi-square test and Fisher&#39;s-exact test were used as per applicability to test the significance of difference of proportions using Statistical Package for the Social Sciences (SPSS) version 15.0. The difference was considered significant for a p-value <0.05. <b>Results:</b> Out of total, 30 patients (30%) were in 9-12 years age group, with slight male preponderance (1.1:1). Total 72 cases (72%) were from rural area. Common clinical features were fever, altered sensorium, seizures, irritability, abnormal movement, pallor, papilloedema, and lethargy. Abnormal laboratory parameters included leucocytosis (62%), anaemia (27%), hyponatremia (35%), and hypoglycaemia (16%) and elevated liver enzymes (15%). Immunoglobulin M (IgM) serology was positive for JEV (19%), scrub typhus (6%), herpes simplex virus (2%), dengue (2%), measles (1%), and enterovirus (1%). Magnetic resonance imaging brain was normal in 37% of the cases. About 54% of the cases recovered completely, 20% of the cases died and remaining 26% survived with sequelae. <b>Conclusion:</b> The AES is common among older male children from the rural area. Serologically JEV is most common cause. Total 54% cases recovered completely. Proportion of death and residual sequelae were higher in the JEV category. The observations of the study indicate need of extensive studies and scaling up of JE vaccination. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=SC06-SC10&id=16111 https://doi.org/10.7860/JCDR/2022/51692.16111 Long Term Use of Metformin and its Effect on Serum Vitamin B12 with its Oral Manifestations: A Review CJ Sanjay, Karthikeya Patil, D Nagabhushana, Romali Panda, VG Mahima Metformin is the most frequently prescribed first line therapy for Type 2 Diabetes Mellitus (T2DM) and it is one of the fewer antihyperglycaemics associated with improvements in the morbidity and mortality of cardiovascular disease associated with T2DM. Although there are major beneficial effects but it is shown to have disadvantages with long-term use of metformin. Recent studies have shown that metformin induces malabsorption of Vitamin B12, which may increase the risk of developing Vitamin B12 deficiency. Vitamin B12 is one of the integral nutritional components that affect the oral health with individuals with decreased levels exhibit various oral manifestations such as glossitis, glossodynia, recurrent ulcers, angular cheilitis, dysgeusia, lingual paraesthesia, burning sensations and pruritis. Most of the vitamin B12 deficiencies are associated with malabsorption syndrome, gastrectomy cases, and elderly people. The prevalence of oral manifestations with regard to metformin induced Vitamin B12 has to be considered as new paradigm in routine diagnosis and investigations. This review likewise revolves around the mechanism involved in metformin induced vitamin B12 deficiency and possible implications in the diagnosis and management of oro-mucosal lesions associated with such deficiency. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZE01-ZE06&id=16055 https://doi.org/10.7860/JCDR/2022/53256.16055 Exploring the Scope of Salivary Proteomics in Periodontal Diagnosis: A Narrative Review Meghana Sri Sai Ivaturi, Amitha Ramesh Bhat Periodontal disorders are among the most widespread chronic illnesses globally which impact the tooth-supporting tissues and have a multitude of ramifications for one&#8217;s quality of life. The purpose of periodontal diagnostic methods is to offer meaningful information to clinicians about the type, location, and severity of periodontal disease so that disease monitoring and therapy may be established. Due to a lack of proper molecular diagnostic tools, their early detection is still difficult. Proteomics, the promising new &#8220;omics&#8221;, has become an important complementary tool to genomics providing novel information and greater insight into biology. The value of multidimensional peptide resolving approaches in the characterisation of complicated proteomes cannot be overstated and thus can very much be used as diagnostic biomarkers in periodontal world. Since proteomics is considered more intricate and complicated than genomics, the sound and rich facts of proteins concerned in periodontitis can be applied in the analysis, avoidance and management of periodontal diseases. Despite several novel protein markers being recently enlisted by discovery proteomics through various methods such as Enzyme Linked Immunosorbent Assay (ELISA), immunoassays with Mass Spectroscopy (MS), Protein Topography and Migration Analysis platform (ProtoMap), Matrix Assisted Laser Desorption (MALDI) etc., their routine diagnostic application is hampered by the lack of validation platforms that can rapidly, accurately and simultaneously quantify multiple proteins in large populations. Furthermore, saliva contains a non invasively collected store of clinically relevant biomarkers, which, if properly employed, might aid in early illness detection and monitoring. Hence, in this context, this review aims to discuss the unravelling field of proteomics in brief and the scientific sphere of its development from laboratory to clinical practice and its implications in the field of periodontology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZE07-ZE13&id=16101 https://doi.org/10.7860/JCDR/2022/53091.16101 Impact of COVID-19 on Mental Health of Children and Adolescents: A Narrative Review Sharika Ashraf, Arjimand Yaqoob Coronavirus Disease 2019 (COVID-2019) pandemic created havoc on our planet, affecting all aspects of human life. It has resulted in human mortality and morbidity worldwide. It did not spare social and economic fabric of societies. It has resulted in huge psychosocial impact on human race. Various disease containment measures such as quarantine, physical distancing, complete lockdowns imposed by Governments across the globe has severely affected mental health of children and adolescents. The present article is aimed at reviewing various articles published regarding COVID-2019 pandemic impact on mental health of children with or without previous mental health problems. Different electronic databases, such as Science Direct, PubMed and Google Scholar were searched for articles describing impact on mental health of children and adolescents with/without previous mental health problems due to COVID-19. Search strategies included terms such as: &#8220;COVID-19&#8221;, &#8220;SARS-CoV-2&#8221;, &#8220;mental health&#8221;, &#8220;children&#8221;, &#8220;adolescent&#8221;, &#8220;behavioural impact&#8221;, &#8220;depression&#8221; and &#8220;anxiety.&#8221; The majority of children and adolescents experienced deterioration in their mental health as emergency measures were implemented throughout the world. Children diagnosed with pre-existing mental health problems or Autism Spectrum Disorder (ASD) experienced more negative changes compared with children/adolescents without pre-existing psychiatric diagnosis. There is increased anxiety, depression, irritability, sleep disorders, lethargy, dissatisfaction and fear of death. There is need to plan and implement strategies to provide easy and early access to mental health services for which various stakeholders should come together. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=VE01-VE03&id=16176 https://doi.org/10.7860/JCDR/2022/52034.16176 Biomedical Applications of Cold Plasma G Divya Deepak, Atul Plasma medicine is branch that employs Cold Atmospheric Plasma (CAP) as a potent tool for biomedical applications. CAP produces high-level reactivity (free radicals, electrons) and can be generated by noble gases. CAP is rich in Reactive Nitrogen Species (RNS) and Reactive Oxygen Species (ROS). These ROS and RNS which include Ozone (O<sub>3</sub>), Nitrous Oxide (NO), Hydroxyl Radicals (OH), and Nitrogen Dioxide (NO<sub>2</sub>), gas particles, charged ions, neutral reactive oxygen which are primarily responsible for decontamination of microbes in various living tissues. Furthermore, CAP only have high excitation energies of electrons as compared to neutrals and ions which makes CAP an excellent tool for application on cells and tissues without any thermal damage. Cold plasma has also been successfully implemented for virus disinfection as its regarded as eco-friendly, efficient and novel technique for decontamination of virus. CAP treatment has also enabled inactivation of virus strain in both plant and animal species without inducing any physiological damage to them. Plasma chemistry essential for inactivation of pathogens is dependent on fine-tuning of various parameters which include plasma supply frequency, gas composition, input energy duration, pulse form, and modulation which has led to development and research of numerous portable plasma devices for different treatment methods in plasma medicine. CAP generated is extensively applied for wide range of biomedical applications including dentistry, microbial disinfection (bacteria, viruses, fungi), treatment of skin diseases, wound treatment, and biofilm treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=KE01-KE08&id=16177 https://doi.org/10.7860/JCDR/2022/53693.16177 Evaluation of Changes in the Palatal Mucosal Thickness Post-augmentation using a Xenogeneic Collagen Matrix- An Interventional Study Purva Dalmia , Harinath Parthasarathy , Anupama Tadepalli , Lakshmi Ramachandran , Deepa Ponnaiyan <b>Introduction:</b> Palatal augmentation is a unique approach that has been developed to increase the donor mucosal thickness and to procure sufficient dimensions of Connective Tissue Graft (CTG) during soft tissue augmentation around natural teeth and implants. <b>Aim:</b> To evaluate the relative changes in Palatal Mucosal Thickness (PMT) followed by augmentation with xenogeneic collagen sponge. <b>Materials and Methods:</b> This was an interventional study conducted on 16 subjects presenting with multiple gingival recession defects and also indicated for root coverage procedures at Department of Periodontology, SRM Dental College, Chennai, Tamil Nadu, India from June 2017 to March 2018. PMT was measured using a customised stent at eight standardised points with respect to Canine (C), first Premolar (PM1), second Premolar (PM2) and first Molar (M1) located at 4 mm and 8 mm from the gingival margin. Xenogeneic collagen sponge was implanted at the donor site and postoperatively reviewed for two months. Changes in PMT were analysed using Mann-Whitney U test. <b>Results:</b> A total of 16 patients (12 male and 4 female; mean age 36.81&#177;7.27 years) were recruited in the study. At two months, statistically significant (p<0.05) increase in mean thickness of the palatal mucosa was observed at all the study points (at 4 mm: C- 5.24&#177;0.43 mm to 4.82&#177;0.39 mm, PM1- 5.47&#177;0.71 mm to 4.88&#177;0.48 mm, PM2- 5.71&#177;0.58 mm to 5.06&#177;0.65 mm and M1- 5.71&#177;0.58 mm to 5.24&#177;0.43 mm and at 8 mm C- 5.24&#177;0.43 mm to 4.47&#177;0.51 mm, PM1- 5.47&#177;0.62 mm to 4.41&#177;0.61 mm, PM2- 5.47&#177;0.62 mm to 4.35&#177;0.49 mm and M1- 5.65&#177;0.60 mm to 4.76&#177;0.43 mm). <b>Conclusion:</b> Xenogeneic collagen sponge implantation resulted in a significant increase in the thickness of palatal mucosa. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=ZM01-ZM04&id=16048 https://doi.org/10.7860/JCDR/2022/52397.16048 A Novel Method of Ultrasound-guided Modified Thoracolumbar Interfascial Plane Block for Perioperative Pain Control in Lumbar Spine Fusion Surgery: Experience based on Two Cases Srinivasan Parthasarathy, Balachandar Saravanan, Saranya Ragavan Thoracolumbar Interfascial Plane Blocks (TLIP) is commonly used for pain management after spine surgeries. It involves blocking the dorsal rami of the thoracolumbar nerves in the fascial plane between the multifidus and longissimus muscles. The clinical efficacy of the conventional TLIP block is well documented in the postoperative pain management for lumbar spinal surgeries. The novel ultrasound-guided modified TLIP block described here is relatively safe and easier to perform by the trainee Anaesthesiologists. Besides, the relevant sonoanatomic landmarks of the novel technique and its perioperative analgesic efficacy in patients undergoing lumbar spine fusion surgery are described here. Further ultrasound-anatomy correlation studies are required to investigate this novel approach TLIP block. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=UM01-UM02&id=16112 https://doi.org/10.7860/JCDR/2022/52207.16112 A Rare Case of Facial Trichofolliculoma Vignesh Nambi Ravi , TV Ramesh , Sivaramakrishnan Sangaiah , Suzsmi latha Saravanan Trichofolliculoma presents as a small, indurated dome-shaped nodule with a central pore from which several, slender white hairs emerge. The lesion usually develops in adults on the head and neck region, predominantly around the nose. Biopsy reveals a large, central dilated follicle from which several smaller follicles radiate. The central follicle contains keratin and vellus hair shafts. The smaller follicles are vellus hair follicles, both normal and aberrant, in various stages of development. The tumour is encased in a fibrous sheath that is separated from the normal dermis by clefts. A large number of merkel cells are usually present in the tumour, while the lesion is easily curative through a simple excision. Here, authors presents a case of 64-year-old male patient who reported due to the uncommon occurrences of trichofolliculoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=WD04-WD05&id=16099 https://doi.org/10.7860/JCDR/2022/52624.16099 Computed Tomography of Chest in COVID-19 Infection: A Narrative Review Jitender Singh, Tara Prasad Tripathy, Karamvir Chandel, Ranjan Patel Coronavirus Disease 2019 (COVID-19) is caused by a novel coronavirus that is very contagious. Asymptomatic infection to severe and deadly sickness is all possibilities. The gold standard investigation for diagnosing coronavirus infection is Reverse Transcription-Polymerase Chain Reaction (RT-PCR). Computed Tomography (CT) is an important imaging modality for the management of COVID-19 patients. A CT scan of the chest can also be used to check for disease sequelae. During the pandemic, several classifications and CT Scoring Systems (CT-SS) were devised to aid in triage and diagnosis. Literature search was performed in Google Scholar and PubMed databases, using these keywords and their combinations: COVID-19, CT, Ground-Glass Opacity (GGO), RT-PCR. The present review paper aims to summarise, discuss and illustrate the radiological findings of the COVID-19 as well as the current status of the CT chest in the management of the disease. CT is the best imaging method for detecting the involvement of the lungs, as well as the quickest way for determining the nature of abnormalities. CT has a vital role in the diagnosis, management, and prognostication of COVID-19 in the fight against the pandemic, as evidenced by extensive research. Understanding of the imaging characteristics of COVID-19 pneumonia, can help with early control of the disease spread, and CT severity score could be useful for clinical triage, prognosis evaluation, and follow-up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2022&month=March&volume=16&issue=3&page=TE01-TE06&id=16175 https://doi.org/10.7860/JCDR/2022/52321.16175