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Aboobacker Mohamed Rafi, Manglin Monica Lisa Joseph Tomy, Ronnie Thomas, Chithra Valsan, Ug Unnikrishnan, Susheela J Innah, Praveenlal Kuttichira
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48703.15154

Abstract:
Introduction: The hallmark of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is high infectivity, pre symptomatic transmission and asymptomatic prevalence which could result in high cumulative numbers of infections, hospitalisations, and deaths. Kerala was the first state to confirm community transmission in July 2020. Healthcare Workers (HCWs) being in the forefront in the war against Coronavirus Disease-2019 (COVID-19) are more prone to acquire the infection and could possibly be asymptomatic sources for cluster formation. Knowing the development of immunity as shown by the presence of anti COV-2 antibodies in the population contributes to the epidemiological understanding of the disease. Aim: To determine the pattern of seropositivity of SARS-CoV-2 among the HCWs at Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India, six months after revoking the lockdown. Materials and Methods: This cross-sectional study was carried out among 423 HCWs of the medical college from September 5th to December 15th, 2020. Multistage sampling was done with the hospital block as the first stage and departments as the second stage. Blood sample was collected and Anti SARS COV-2 IgG antibody testing which targets the Spike Protein 1 (SP1) was done using the vitros chemiluminescence platform (Orthoclinical diagnostics, USA). For the summary of demographic characteristics, continuous variables were summarised as mean values and Standard Deviation (SD) while categorical variables were summarised as proportions. The χ2 test was used for comparing the epidemiological features between positive and negative cases. Chi-square test for trend analysis was done for exploring the relationship of the degree of severity with test positivity. All analyses were conducted using Statistical Package for the Social Sciences (SPSS) version 25.0. Results: Jubilee Mission Medical College had 2785 working staff at the time of study. A total of 423 staff consented and their samples were tested. Thirty seven staff members tested positive for COVID-19 antibody, yielding an overall prevalence of 8.75% (95% CI, 6.23-11.86). A 86.5% (32/37) of them were having a history of COVID-19 Antigen/Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) Positivity. A statistically significant linear trend (p-value=0.00001) was observed, between seropositivity and the degree of severity of COVID-19. Among the various factors which increase the risk of seroconversion, history of undergoing quarantine (p-value <0.001), contact with a confirmed case (p-value=0.002), contact with a caregiver for COVID-19 (p-value=0.001) and history of upper respiratory symptoms (p-value=0.001), were found to be significantly associated with positive serology. Conclusion: The pattern of seropositivity across the different category of HCWs observed in the present study showed a higher prevalence among nurses. Being an educational institution, it was obligatory to train all the elements of care delivery to the future generation of HCWs. Acquiring experience from a small but relevant sample was expected to facilitate larger community study envisaged in peripheral areas Jubilee Mission Hospital served.
Sachit Mahajan, Sanjay Kai, Sadaf Choudhary, Kiran Bala,
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/47085.15071

Abstract:
Introduction: Topical corticosteroids are most commonly used for the control of postoperative inflammation after cataract surgery. Topical steroids may cause increase in Intraocular Pressure (IOP) which, if left untreated may lead to progressive optic nerve damage and glaucomatous field defects. Aim: To compare the ocular hypertensive response of three commonly used corticosteroids in an effort to generate evidence for managing postcataract surgery inflammation more effectively. Materials and Methods: This randomised clinical trial was carried out for a period of one year from November 2018 to October 2019, among 150 patients undergoing cataract surgery. Patients were divided into three groups. Group A-50 patients received topical dexamethasone 0.1%, Group B-50 patients received topical prednisolone 1% and Group C-50 patients received topical difluprednate 0.05% four times a day for six weeks after cataract surgery. Postoperative IOP was recorded preoperatively, on first postoperative day and at the end of first week, third week and sixth week with non contact tonometer and statistical significance was assessed with the help of repeated measures mixed model Analysis of Variance (ANOVA). Results: The mean age of the patients was 64.4±9.39 years, 48% were males and 52% patients were females. Mean IOP in the three drug groups was not statistically significant at 1st week, 3rd week and at 6th week after cataract surgery. Two patients belonging to difluprednate group at the end of 1st week and one patient at the end of 3rd week after cataract surgery developed significant rise in IOP (>31 mmHg). Conclusion: It can be concluded that all three steroids were equally safe and did not cause any statistically significant rise in IOP over six-week postoperative period. However, higher values were noted in difluprednate group at the end of first and third week after cataract surgery.
Mosab Aldabbas, Tarushi Tanwar, Iram Iram,
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48613.15104

Abstract:
Introduction: Neck Pain (NP) is a major public health problem. Social and economic participation of many individuals gets negatively impacted due to NP. Fatigue and pain are common complaints in patients with this condition. Both can interfere with the daily life of patients by affecting the quality of sleep which can lead to psychological issues. But, the prevalence of fatigue and its association with pain, sleep quality and psychological factors have not been examined properly in patients complaining of NP. Aim: To examine the prevalence of fatigue and its association with pain intensity, depression, anxiety, and sleep disturbance in patients with NP. Materials and Methods: A cross-sectional study on 296 NP patients with a mean age of 30±7.2 years (181 males and 115 females) was conducted between March 2019 till November 2019. It was conducted at the Physiotherapy Department of the University and Amarjyoti College of Physiotherapy. The Multidimensional Fatigue Inventory (MFI), Hospital Anxiety and Depression, Pittsburgh Sleep Quality Index (PSQI) and Numeric Pain Rating Scale were used to evaluate fatigue, depression and anxiety, sleep quality and pain intensity, respectively. Spearman’s rank correlation coefficient and Mann-Whitney U test were used for analysis. Results: The point prevalence rate of severe fatigue in participants was 39.86%. Fatigue was significantly related with pain intensity, psychological factors, and sleep quality (p<0.05). We also observed a significant association between sleep quality and psychological factors in this sample (p<0.05). Conclusion: Fatigue was a prominent factor in patients with NP and it was associated with pain intensity, depression, anxiety, and sleep disturbance. Prevalence of fatigue was higher in chronic stage of NP than in the acute sage. Identifying these factors may help in prevention and management of NP and its co-morbidities.
, Anil Kumar Sharma
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48266.15096

Abstract:
Introduction: There is lot of stress and stress associated mental illness among the traffic police fraternity. Many environmental factors are responsible for this development. Measurement of the stress levels and implementation of coping strategies are very important to maintain the health of the traffic police. Aim: To assess the level of stress, depression, coping strategy and respiratory health status of traffic police at Anand district, Gujarat, India. Materials and Methods: This cross-sectional descriptive study including 100 participants was conducted by the Department of Mental Health Nursing, Manikaka Topawala Institute of Nursing, Charotar University of Science and Technology, Anand District, Gujarat, India from December 2019 to February 2020. Validated tool Job Stress Scale, standardised tool beck depression inventory, coping strategy scale were used to assess the level of stress, depression and coping strategy respectively. Spirometer was used to assess respiratory function. Analysis was done using Statistical Package for the Social Sciences (SPSS) statistical software version 20.0 and Spirometry Longitudinal Data Analysis (SPIROLA) software version 3.0.3. Results: The study reveals that majority (69%) of the traffic police were facing extreme stress, 11% of traffic police were suffering from mild mood disorder, 73% were having adequate coping skills, 88% were non smokers and 97% traffic police were not using any substances, 65% demonstrated expiratory Forced Vital Capacity (FVC) of 2.6%-3.5%, 66% demonstrated 2.6%-3.5% Forced Expiratory Volume in 1 second (FEV1), 76% experienced 96-100 FEV1/FVC ratio1, 53% experienced 6%-8% peak expiratory flow. Pulmonary function test found to be normal however, it is declined in smokers comparative to non smokers. Conclusion: The study concludes that stress and depression were observed in traffic police which they were managing with adaptive coping strategy. However, pulmonary function is found normal in comparing to predictive value, necessary precautions need to be taken by Traffic Police Department by offering protective device like mask to decrease the respiratory health issues.
Aparajita Dasgupta, , Bobby Paul, Soumit Roy, Pritam Ghosh, Akanksha Yadav
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48122.15178

Abstract:
Introduction: Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases. Thus, regular and accurate measurement of Blood Pressure (BP) is essential for its early diagnosis and follow-up. There is a surge in popularity of digital sphygmomanometer due to its convenience of use and functionality. In contrast, the traditional universally accepted sphygmomanometer is aneroid type, hence there arise a need for comparison of digital and universally accepted Aneroid Sphygmomanometer in terms of agreement and correlation. Aim: To evaluate the agreement and correlation between blood pressure measurement by digital and aneroid sphygmomanometer. Materials and Methods: The clinic based cross-sectional study was conducted in the Out Patient Department (OPD) of Urban Heath Centre, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India. Adults visiting the OPD on two chosen days of the week, between June 2019 to July 2019 were selected using systematic random sampling. A total of 400 participants were included. Agreement and correlation between BP measurements by digital and aneroid sphygmomanometer was analysed by Cohen’s Kappa, Bland Altman Plot along with sensitivity, specificity and predictive values using Microsoft Excel and Statistical Package for the Social Sciences (SPSS) version 16.0. the p-value <0.05 was considered significant for the statistical test in the analysis. Results: Cohen’s Kappa value (0.59) revealed these two tools had moderate agreement in diagnosing hypertension. Sensitivity and specificity of digital sphygmomanometer taking aneroid sphygmomanometer as gold standard is 86% and 83.1% respectively. The BP readings of these two-tools showed moderate correlation as Intraclass Correlation Coefficient (ICC) for Systolic BP (SBP) and Diastolic BP (DBP) were 0.804 and 0.624, respectively. Bland Altman plot showed gross disagreement of SBP findings and disagreement between DBP findings was also noted. Conclusion: Digital device was found to be less accurate in detecting hypertension. Therefore, more similar research work is solicited to verify the accuracy of the very easy to use, the Digital BP monitor.
Sasmita Panda, Subrat Kumar Samantara, Paresh Kumar Behera, Sashibhusan Dash, Sagarika Samantaray
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48240.15180

Abstract:
Introduction: Regional record is a useful strategy for the analysis of the clinicohistopathological presentation of Salivary Gland Tumours (SGTs) in a specific population by which appropriate management can be established. Aim: To investigate the clinicohistopathological presentation of SGTs in a tertiary care cancer centre, Odisha, India. Materials and Methods: This single centre hospital based cross-sectional study was carried in Acharya Harihar Post-Graduate Institute of Cancer, Cuttack, Odisha, India. Five years (from January 2015 to December 2019) clinical and histopathological data of SGTs were retrieved from hospital record section. The data collection and analysis was done from January 2019 to December 2020. The SGTs cases were classified under the histological criteria suggested by the World Health Organisation (WHO) in 2017. Count data were expressed as percentages and differences between the groups were compared using the Chi-square test. The results were analysed using Statistical Package for the Social Sciences (SPSS) computer software version 17.0. Results: A total of 319 neoplastic SGTs were included out of which malignant tumours were comprised of 144 (45.14%). Mucoepidermoid Carcinoma (MEC) was the most common malignant type while Pleomorphic Adenomas (PA) was reported as the most common benign type. The mean±SD age of the patients with benign and malignant tumour was 41.94±13.94 years and 46.09±13.33 years, respectively. The percentage of malignant neoplasms in the minor salivary gland was higher (37/60, 61.66%) than benign tumours. while in major salivary glands, it was found (107/259, 41.31%). In major salivary gland, greater involvement of the parotid gland was observed. The mean tumour size of the major SGT was 3.34±1.09 cm wereas the mean tumour size of the minor salivary gland was 2.35±1.26 cm. Conclusion: The PA and MEC were the most common benign and malignant types respectively. The knowledge regarding histopathological presentation of SGTs in present study would help to pathologist and surgeons for more accurate diagnosis and further management. As, the preoperative diagnosis of SGTs is very challenging,further study in this regard is needed.
Priyanka Mondal, , Mautoshi Saha, Sayan Kundu, Jayati Chakraborty
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48946.15155

Abstract:
Introduction: Estrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal growth factor Receptor 2 (HER2) status are routinely used to guide treatment decision for breast cancer. Treatment protocol in breast cancer is currently based on biomarker characteristic of primary tumour. But this biomarker status may change as the tumour progresses from primary to synchronous metastatic lymph node. Hence, it is important to know the biomarker status of these synchronous metastatic lymph nodes as it may serve as an important tool to guide management, evaluate prognosis and to anticipate the possibility of recurrent risk of primary invasive breast cancer. Aim: To study the expression of ER, PR, HER2 status in primary breast carcinoma and synchronous metastatic lymph node and to evaluate concordance and discordance between them. Materials and Methods: This study was observational, retrospective and prospective study conducted over a period of one and half years from February 2015 to October 2016 at ESI-PGIMSR, Maniktala, Kolkata, India, where 50 cases of breast carcinoma with positive axillary lymph node metastasis were studied. Haematoxylin and Eosin (H&E) sections were reviewed and representative paraffin blocks were selected. Immunostains were performed and scoring was done following standard protocols. Standard statistical methods were applied for analysis of data using chi-square test and kappa statistics and data was analysed using Statistical Package for the Social Sciences (SPSS) version 6.1.3 software. Results: Out of 50 cases the mean age of the patients was 50.56±10.5 years. Amongst ER and PR status, 24 out of 50 (48%) and 18 out of 50 (36%) were ER and PR positive respectively. HER2 positive cases were 48% i.e., 24 out of 50 cases. The overall discordance rates of ER, PR and HER2 was found to be 10%, 8%, 18%, respectively. The discordance rates of ER positive and ER negative cases were 4.2% and 15.4%, respectively. The discordance rates of PR positive and PR negative cases were 5.6% and 9.4% respectively, whereas 29.2% of HER2 positive cases were discordant in lymph node metastases. Conclusion: There was discordance between ER, PR, HER2 status of primary tumour and metastatic lymph node. Hence, assessment of these biomarker status in axillary lymph node metastases may be considered along with primary tumour in breast carcinoma work-up.
Nikhil, Subhashish Das, Snigdha
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48896.15157

Abstract:
Introduction: The productivity, quality of platelet apheresis collection has improved because of the considerable advancement in the automated cell separators. Automated cell separators have lot of sizeable scientific advances, but the alertness has been centered to Platelet Concentrates (PCs) quality than on safety of donor. Aim: To find the changes in haematological parameters and the consequences of apheresis and plateletpheresis on donor’s health. Materials and Methods: It was observational cross-sectional study done in laboratory at RL Jalappa Blood Bank, Tamaka, Kolar, Karnataka, India. The study was done from March 2019 to August 2020. A total of 300 healthy donors (plateletpheresis donors) were involved in the study. The plateletpheresis (Haemonetics MCS), predonation and postdonation haematological parameters such as haemoglobin concentration, Haematocrit (Hct), platelet, white and red blood cell count were calculated in all donors. The samples for Complete Blood Count (CBC) were secured from the donors, at the beginning and end of the procedure. Postdonation haematological parameters such as platelet count, haemoglobin, haematocrit, White Blood Cells (WBC), Red Blood Cells (RBC) counts of the donor was inscribed and comparison was done with the pre donation haematological parameters. Quality control of all Single Donor Platelet (SDP) products was done. All donors were evaluated for adverse donor reactions. The mean pre and post plateletpheresis values comparison was done utilising paired t-test. Statistical analysis was accomplished utilising Statistical Package for the Social Sciences (SPSS) software version 16.0. Results: Platelet count, haemoglobin, WBC count, RBC count and haematocrit were jotted down from 262 donors and a significant decrease was noticed in these parameters postdonation. Donor parameter platelet count (lac/mL) value was decreased from 273.57-224.28 whereas WBC count (cu/mm) predonation value decreased from 9.91-8.86 Postdonation, haemoglobin (g/dL) value decreased from 14.46-12.91, haematocrit (%) decreased slightly from 45.19-44.19, RBC count (million/mm3) decreased from 5.21-5.01. This concluded that the values decreased postdonation. Conclusion: The study conducted was safe from donor’s point of view. SDP is very effective in treatment of thrombocytopenia and is safe from recipient’s point of view.
Varsha Rangankar, , Sanjay Khaladkar
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/46820.14678

Abstract:
Holoprosencephaly is a rare intracranial malformation seen in newborns, resulting from a failure of separation of the forebrain into separate cerebral hemispheres. It is divided into three subtypes-alobar, semilobar and lobar. Encephalocele is a rare neural tube defect characterised by a defect in the cranial vault with herniation of brain parenchyma along with the overlying meninges. Author has reported a case of a male neonate born of a twin pregnancy to a 29-year-old primigravida presenting with a midline swelling in the frontal region. On imaging studies, the patient was diagnosed with semilobar holoprosencephaly and frontonasal encephalocele with dural arteriovenous fistula. Holoprosencephaly and encephalocoele are important congenital malformations; however association of the two conditions has been rarely described in the literature.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/47358.14777

Abstract:
Facial aesthetics plays a very important role in dentistry. Loss of teeth leads to the resorption of alveolar ridges, loss of support to the facial musculature resulting in diminished facial muscle tone, all of which lead to the slumping of the cheek. Authors here by present a case of a 59-year-old male patient who reported with the complaint of missing upper and lower teeth. Intraoral examination revealed completely edentulous maxillary and mandibular arches. Extraoral examination revealed sunken cheek and wrinkling of the skin. The patient was more concerned about his hollow cheek, so the treatment option advised for him was complete denture with detachable cheek plumpers. The technique used here precisely determines available space for cheek plumpers. But, despite of providing the maxillary cheek plumper, appearance of hollow cheek remained in lower third of face. So, the mandibular cheek plumper was also planned. This case report a novel, simple, straightforward, cost-effective and noninvasive technique of fabricating detachable cheek plumpers for maxillary and mandibular denture using customised ball attachment.
Chirag Manojkumar Modi, Suman Praveen Singh, Yagnesh Gajanand Pandya, Chirag Premjibhai Patel, Rupal Minesh Patel
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/47332.14627

Abstract:
Introduction: Carbapenem Resistant Enterobacteriaceae (CRE) are major cause of community as well as healthcare associated infections and have limited treatment options. Measuring the magnitude of the problem of CRE, it is important for making strategies to lower its spread. Aim: To assess the incidence and prevalence rate of CRE in a tertiary care hospital of Gujarat, India. Materials and Methods: Retrospective data was collected for a period from 2014 to 2018 using Laboratory Information System (LIS). Prevalence of CRE was determined as number of CRE isolated per 100 Enterobacteriaceae isolated during the study period whereas incidence rate was determined as number of CRE cases per 1000 patient-days. Consumption of Carbapenems was calculated as Defined Daily Dose (DDD) per 1000 patient-days. Demographic data including age, gender, location in the hospital and sample type from which CRE was isolated was also analysed using Microsoft Excel. Results: The incidence of CRE cases per 1000 patient-days in 2014 to 2018 was 1.66, 2.11, 1.90, 2.26 and 1.91, respectively with an overall incidence of 1.99 per 1000 patient-days. The overall prevalence of CRE over a period of five years was found to be 29.07%. Klebsiellasp. was the most common CRE and had the highest percentage of Carbapenem resistance among all Enterobacteriaceae. Conclusion: The rate of CRE in present study was high and worrisome. Screening of the patient for CRE, source isolation and stringent implementation of infection control practices is required to confine the spread of CRE in this institute.
Subhendu Sikdar, Sampa Sadhukhan, Amit Kumar Majumdar, , Soma Sarkar, Swagata Ganguly Bhattacharjee
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48616.15077

Abstract:
Introduction: Enterococci are usually normal human commensal of gastrointestinal tract predominantly. They are considered as an important nosocomial pathogen now a day due to its intrinsic as well as increasing acquired antibiotic resistance resulting in a great threat to modern Medicine. Aim: To determine prevalence of Enterococci isolated from clinical specimens with special reference to its virulence and antibiogram conventionally. Materials and Methods: A cross-sectional observational study was conducted over a period of two years (January 2019 to December 2020) with 326 Enterococci, isolated from various clinical specimens received by Department of Microbiology. Enterococci isolated from stool samples were excluded. They were identified and speciated conventionally as per standard laboratory protocol. Gelatinase, haemolysin and biofilm formation was determined for each isolate. Their antibiogram was also determined by disc diffusion methods over Blood agar followed by Minimum Inhibitory Concentration (MIC) testing (as per Clinical and Laboratory Standards Institute (CLSI) guideline). All statistical analysis was done by Chi-square test using Software Statistical Package for the Social Sciences (SPSS) version 22.0. Results: Among the total 4516 samples collected, growth of Enterococci was noted in 7.22% cases. Out of them, E. faecalis (84.05%) out numbered E. faecium. Urine was the most predominant (55.22%) sample. 73.93% isolates produced biofilm whereas 18.40% produced haemolysin and 19.94% produced gelatinase. Most of the isolates were susceptible to vancomycin (94.79%) and linezolid (98.77%). High level gentamicin resistance was seen in 54.6% cases. Ciprofloxacin was the most resistant antibiotic. Vancomycin Resistance Enterococcus (VRE) was detected in 5.21% cases only, out of which Van A type was detected phenotypically in most cases. Conclusion: The high rate of resistance to high-level gentamicin could fail treatment of gentamicin in combination with penicillin group of antibiotics. In clinical samples, the emergence of VRE strains makes treatment options more challenging.
Heena Dharamdasani, , , Stephen Sudhakar
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/47068.15011

Abstract:
Central Serous Chorioretinopathy (CSCR) is the detachment of the neurosensory retina and/or Retinal Pigment Epithelium (RPE) due to accumulation of fluid in the sub retinal space, mostly confined to the macula. Hereby, presenting a rare case of a 32-year-old patient with defective vision in both eyes, she was a known case of Chronic Kidney Disease (CKD) on haemodialysis. On examination best corrected visual acuity was 6/9, on dilated fundus examination with ring reflex in both eyes, Optical Coherence Tomography (OCT) macula showed detachment of the neurosensory retina from RPE with the sub retinal fluid. This case is considered to be rare due to the unusual association noted between CSCR and End State Renal Disease (ESRD), in a female patient with no history of usage of corticosteroids or known identifiable risk factors. Hence, it is essential to screen patients with ESRD for CSCR to prevent vision threatening complications.
L Daisy, , C Mrudula, P Rao Sushma
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/50027.15105

Abstract:
The architecture of the musculus uvulae is subject to controversy, especially with regard to its crucial role in maintaining the morphology of the cleft palate, and its involvement in surgical procedures of palate repair. Its functional role in the closure of the velum and elevation of the same leading to voice changes are also an element of debate. The fate and orientation of its muscle fibres and its reinforcement with other related muscles of the palate raise concerns with regard to its functional role. Its positioning in the soft palate would give us an insight on the exact role played by this muscle in velopharyngeal closure. Its nerve supply also remains shrouded by various theories without conclusive evidence. Hence, this review aims to highlight its morphological role for the same.
Suranjana Sur Mukherjee, Kakali Das Sarkar, Debalina Sengupta, Sunanda Sinhababu
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/49064.15131

Abstract:
Introduction: Coronavirus Disease-19 (COVID-19) pandemic forced everyone to stay indoors for a long period. The institutional education system got a backseat. But Bachelor of Medicine and Bachelor of Surgery (MBBS) syllabus had to be covered within a stipulated time frame. As with every academic curriculum, online teaching had to be implemented in MBBS courses too without any scope for developing adequate logistics beforehand. Teachers, as well as students, tried their best to cope up with this ‘new normal’. Every day student had to be online for few hours to attend their classes as per the modified roster during the pandemic. Aim: To gather the data regarding perspective, satisfaction and problems of online classes from the 1st year MBBS students and also to recommend the modifications for future curriculum and upgrade the quality based on the students’ feedback and suggestions. Materials and Methods: This cross-sectional observational study was done in a single day across three government medical colleges of West Bengal after eight months of continued online classes since lockdown. An online survey was conducted among the first-year students through google forms, which was mailed to every student’s email ID at a stipulated time of the day with prior notification. Out of 700 google forms sent, 527 responses were received. Responses were automatically analysed by google and were represented graphically. Results: Out of 527 responses received, 145 were from females (27.5%) and 382 were from males (72.5%). Students were ready to adapt to this new development and 54.6% were more or less satisfied with the teaching methodologies, though interruption with the internet hampered their classes very often. Some could not afford the online class due to logistic or financial constraints. A 67.9% of students learnt to acquire in-depth knowledge by themselves though a good number of students (56.7%) disliked online classes and lost interest in the topic. Conclusion: Online teaching cannot replace classroom teaching but can complement it as compulsive prolonged online teaching made the learning self-directed. A thoughtful blending of online and offline classes can be implemented to make an Indian Medical Graduate (IMG) a lifelong learner.
Shaikh Mohammad Aeraj, Tajuddin Chitapure
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48979:15061

Abstract:
Cervical radiculopathy is a syndrome in which the patient complains of pain along with sensorimotor deficits. This syndrome commonly develops due to compression of the cervical nerve roots. This report describes the case of 52-year-old histopathology laboratory technician who developed cervical radiculopathy due to prolonged cervical forward flexion while working on his table. The patient also complained of pain on the right scapular border. Radiographic analysis showed cervical spondylosis having osteophyte formation on spinous process of C2, C3, C4, C5 and C6 vertebras. Neural tissue tension test was positive for median nerve. He was treated consecutively with strengthening for shoulder abductors, shoulder adductors, scapula elevators and scapular protractors along with thermotherapy. His right medial border scapular pain and symptoms of cervical radiculopathy decreased in severity after the seventh day of treatment. Although the authors cannot suggest a cause-and effect relationship, this report allows for initial hypothesis development that thermotherapy approach may have clinical merit. Future studies in the form of well-designed, randomised clinical trials should be performed to evaluate the effectiveness of this approach in patients with cervical radiculopathy
Raksha Jaipurkar, Swapnil Saikhedkar, Dharmendra Kumar, Gaurav Sikri, Sushil Sharma
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48372.15118

Abstract:
Introduction: Written examinations are integral component of students’ assessments at formative and summative level. There is no blueprint of question paper available for the new curriculum in Bachelor of Medicine and Bachelor of Surgery (MBBS) Physiology curriculum which may lead to variations in question paper setting. This lack of consistency in question papers affects the preparedness and performance of students. Aim: To prepare the blueprint of MBBS Physiology Competency Based Medical Education (CBME) curriculum and to do content validity by comparing with Preliminary Examination (PE) and University Examination (UE). Materials and Methods: This was a descriptive study conducted over a period of six months from July 2020 till December 2020. The study was conducted in Armed Forces Medical College, Pune. There are 15 topics and 140 outcomes for Physiology MBBS course as per new CBME curriculum is divided into paper I and II according to Maharashtra University of Health Sciences (MUHS) syllabus. The main topics in each paper were further subdivided into subtopics for preparing learning objectives. Marks were allotted to each system taking into consideration optimum marks 97 for subjective with included options and 20 marks Multiple Choice Questions (MCQs). The papers of UE and PE conducted with new format were analysed for content validity. Results: The blueprint of paper I (subjective) shows marks allotted for General Physiology 12, Haematology 13, Respiratory System (RS) 15, Cardiovascular (CVS) 17, Exercise 05, Renal system 15, Gastrointestinal System (GIT) 12, Lifestyle Aging and Meditation 03 and Attitude, Ethics and Communication. (AETCOM) 05 marks. The blueprint of paper II (subjective) shows marks for the Nerve-Muscle 16, Central Nervous System (CNS) 25, Special senses 14, endocrine system are 18, reproductive system 15, and temperature 09. MCQs were also allotted proportionate marks for each topic. Content analysis of papers showed exercise Physiology and body temperature regulation were not assessed in UE. Conclusion: There was disproportionate representation of topics in formative and summative examinations in absence of blueprint. The blueprint should be an integral part of assessments.
, Dharmendra Uraiya, Neeraj Tripathi
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/49052.14976

Abstract:
Introduction: With increasing burden of Coronary Artery Disease (CAD) and ST-Elevation Myocardial Infarction (STEMI) in India, early risk stratification of patients is as important as making a correct diagnosis. Cardiac Troponin T (cTnT), C-Reactive Protein (CRP) and echocardiographic Regional Wall Motion Abnormalities (RWMA) are used to assess the patients of STEMI at presentation. The short term prognostic importance of these parameters also need to be known. Aim: To study the prognostic values of admission Cardiac Troponin T (cTnT), CRP and echocardiographic RWMA in patients with acute STEMI. Materials and Methods: Fifty patients of STEMI were evaluated from January 2017 to July 2017 by Troponin-T (positive >0.18 ng/mL), CRP (positive >3 mg/l) and echocardiography (positive with presence of RWMA) on day one. The patients were divided into three groups: Group 1: patients with all the three parameters positive, Group 2: patients with all three parameters negative, Group 3: patients with one or two parameters positive. The end points observed were heart failure Left Ventricular Ejection Fraction (LV EF) class II by Lown’s classification) and mortality at day 30 in the groups. Chi-square test for equality of proportions was used to analyse the difference in outcome in the groups. Results: The mean age of patients was 54 years. There were 25 (50%) patients in group 1, 14 (28%) patients in group 2 and 11 (22%) patients in group 3. Twelve (24%) patients had heart failure with 9 (18%) in group 1 and 3 (6%) in group 3 (p<0.05). 9 (18%) patients had significant ventricular ectopics with 8 (16%) patients in group 1 and 1 (2%) patients in group 3 (p<0.05). Mortality was found in 9 (18%) patients with 8 (16%) patients in group 1 and 1 (2%) patients in group 3 (p<0.05). Conclusion: Acute STEMI with high cTnT, CRP and presence of RWMA on echocardiography at admission need more aggressive management and close follow-up.
Amit Hemant Pathak, Ajit Kamalakar Joshi,
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/49305.14957

Abstract:
Introduction: Posterior Capsular Opacification (PCO) is a condition which develops months or years after cataract surgery. The Neodymium Yttrium Aluminium Garnet (Nd:YAG) laser capsulotomy is the procedure of choice for PCO and its adverse effects include intraocular pressure elevation, cystoid macular oedema, corneal endothelial cell damage, retinal detachment and Intraocular Lens (IOL) pitting. Aim: To assess the corneal endothelial structure and function before and after Nd:YAG laser capsulotomy in patients with PCO using specular microscopy. Materials and Methods: This was a prospective observational study carried out in Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Sangli, Maharashtra, India on 50 eyes of 50 patients having PCO. This study was conducted in the time period between October 2020 to February 2021 for four months. Patients were subjected to Nd:YAG laser capsulotomy in the affected eye and were followed-up at one week and one month postprocedure. Specular Microscopy was used to evaluate the Endothelial Cell Density (ECD), Coefficient of Variation (CV) and Hexagonality of endothelial cells before and after laser capsulotomy. Statistical Package for Social Sciences (SPSS) version 26.0 was used for the statistical analysis. Chi-square test and ANOVA test are the tests of significance applied in this study. Results: Forty-five patients (90%) gained Best Corrected Visual Acuity (BCVA) of >6/18 after one week and 47 patients (94%) gained BCVA of ≥6/18 after one month postprocedure. Mean ECD prelaser was 2356.76 cells/mm2, which decreased to 2231.8 cells/mm2 at one week and 2199.2 cells/mm2 at one month follow-up. The difference between prelaser ECD and at one week and one month was 124.96 cells/mm2 and 157.56 cells/mm2, respectively, which was statistically significant at one month (p<0.0001). The mean CV prelaser was 33.74, at one week was 35.58 and at one month it was 37.22. The difference in CV from prelaser status to one month was statistically significant (p<0.0001). The mean hexagonality at baseline was 65.34% which decreased to 62.02% at one week and 60.42% at one month follow-up. The difference in hexagonality between one month and baseline was statistically significant (p<0.0001). Conclusion: Nd:YAG laser capsulotomy is a safe, effective and non invasive method for the treatment of PCO. However, it causes structural and functional corneal endothelial cell damage.
Sergei Egorovich Khalchitsky, Marina Vanikovna Sogoyan, Alexei Nicolaevich Kozhevnikov, Sergei Valentinovich Vissarionov, Alexei Georgievich Baindurashvili
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/46429.14990

Abstract:
Introduction: Rheumatoid Arthritis (RA) is a chronic autoimmune disease with unknown pathogenesis. The disease is multifactorial, however, the exact causes of the occurrence, as well as the targets of the autoimmune process, are unknown. Genes candidate for a predisposition to RA are cytokine genes. Of the cytokines, IL-6 is considered a key mediator of systemic and localized inflammation in RA. Aim: The comparative analysis of the frequency distribution of alleles and genotypes IL-6 -174G/C polymorphism in patients with RA and in the control group to determine the genotype most characteristic of this disease. Materials and Methods: This case-control study was conducted in a group of 136 children with RA aged 14 to 18 years. In the control group, there were 143 practically healthy children of similar age without RA and orthopedic pathology. Both groups were tested for polymorphism IL-6 -174G/C using real-time Polymerase Chain Reaction (real-time PCR). The results were statistically processed using the Pearson's Chi-square test. Results: The distribution of -174G/C genotypes in the IL-6 gene is significantly different in patients with RA when compared with the control group. In patients with RA, heterozygous carriers of -174G/C (52.94%) prevail, while in the control group the most numerous group are homozygous carriers of -174G/G (40.56%). Conclusion: As a result of this study, it was possible to identify significant differences in the distribution of the genotypes -174 G/C polymorphism in the IL-6 gene between patients with RA and subjects of the control group. In relation to the European population of the Russian Federation, this polymorphism can serve as a diagnostic marker in the study of the pathogenesis of RA.
Irene Jose Manjiyil,
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48444.15079

Abstract:
Introduction: Hepatitis B Virus (HBV) infection remains a significant global health concern that may cause acute or chronic hepatitis. Chronically infected patients are at risk for cirrhosis and hepatocellular carcinoma. The disease causes a problem in the tribal communities. There are lack of studies on the prevalence of HBV among the tribal population. Aim: To assess the seroprevalence of HBV infection among the tribal population of Attapady, Kerala. Materials and Methods: This was a community based cross- sectional study conducted on serum samples collected from 269 subjects among the tribal population of Attapady. Serum samples were tested for quantitative antibody to HBsAg (anti-HBs), Hepatitis B surface antigen (HBsAg) and Hepatitis B envelope antigen (HBeAg) Enzyme Linked Immunosorbent Assay (ELISA). Total hepatitis B core antibody (anti-HBc) and IgM antibody to hepatitis B core antigen (anti HBc IgM), frequencies were obtained using proportion and 95% Confidence Interval CI. Results: The seroprevalence of HBsAg was 10.4%. HBeAg was detected in 7.1% of HBsAg positive patients. 21.2% had protective anti-HBs titer. Anti-HBe was detected in five patients. Anti-HBc total and anti-HBc IgM were positive for 26.7% and 2.6%, respectively. Anti-HBc IgM alone and isolated anti-HBc were detected in 1.5% and 5.9 %, respectively. Anti-HBs and anti-HBc total both became positive in 8.6% cases. Conclusion: HBV infection poses a huge burden on tribal health. All HBsAg positive patients should be tested further to determine the stage of the disease. There is need to explore high HBV prevalence areas with studies on associated risk factors to bring out the ongoing transmission process and focus on preventive measures. HBV vaccination, antenatal screening, and health awareness should be given priority to tackle the burden.
Mohan Kumar Mili, Tanushree Ghosh, , Jyotirmoy Phookan, Nabajyoti Saikia
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48199.14913

Abstract:
Introduction: Epistaxis whether spontaneous or acquired is one of the most common ENT emergencies. Its management can be challenging depending on the origin of bleeding and presence of precipitating factors. Aim: To find out the seasonal variation in epistaxis according to age, gender, region and aetiological factor. Materials and Methods: This cross-sectional study was conducted from June 2019 to June 2020 in a tertiary care centre in Upper Assam. In this study, the seasons were divided according to weather atlas as follows: Winter- December, January, and February; Spring- March and April; Summer- May and June; Rainy season- July, August and September; and Autumn- October and November. Outcome was to find the seasonal variation in epistaxis according to age, gender, region and aetiological factor. The data collected was tabulated in Microsoft Excel Worksheet and the categorical variables were summarised as proportions and percentages. Results: Out of 313 patients, 221 (70.6%) were males and 92 (29.4%) were females. High male preponderance with male to female ratio of 2.4:1 was noticed. Maximum number of patients were seen in month of October 66 cases (21%). Minimum male patients were seen in month of June 2020 (0.6%) 2 cases and minimum number of female patients were seen in the month of February and April (0.3%). Conclusion: The major cause of epistaxis in this region is hypertension, therefore peripheral health facility should be ready for giving treatment.
Rajesh Kumar Gupta, Manoj Bansal, Mahendra Chouksey, , Sasmita Mungi
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48841.14966

Abstract:
Introduction: Children living in urban slums are vulnerable to malnutrition due to lack of basic health facilities and poor environmental conditions. These make children susceptible to infectious diseases. Data on the correlates of stunting, underweight and wasting specifically among under-five children in central India remain limited, hence the need of this study. Aim: To study the prevalence of underweight, stunting, and wasting with its predictors in under-five children living in slum area. Materials and Methods: It was a community-based cross-sectional study, carried out from March 1, 2018 to February 28, 2019, slum area of Gwalior City, using multistage sampling. Study subjects were under-five children residing in urban slums. Data collection was done by conducting house to house survey and information was recorded in pre-designed questionnaire. Mean, Standard Deviation (SD), frequency and percentage were calculated. Logistic regression was applied to calculate Odds Ratio (OR, 95% CI). Data was analysed using version Statistical Package for Social Sciences (SPSS) -16. Results: A total of 550 children (257 boys, 293 girls) under-five years of age were included in the study. The overall prevalence of underweight was 49.1%, stunting was 58.2% and wasting was 23.5%. The risk of underweight, stunting and wasting was less among others caste category (OR:0.42,0.27,0.49). The risk was higher among children living in nuclear family (OR:1.86,1.78,1.72), with illiterate mother (OR:6.47,4.87,3.53), with Illiterate father (OR:4.60,3.65,1.99) and also among people living in kuccha house and using wood as medium of cooking food. Duration of breastfeeding, complementary feeding only, timing of initiation of complementary feeding and birth weight emerged as other significant predictors for underweight, stunting and wasting. Conclusion: Children with low birth weight, belonging to lower socioeconomic class, living in nuclear families and having illiterate parents require special attention and focus. Parents should also be careful in reference to their children’s complementary feeding and duration of breastfeeding.
Mithun S Acharya, Narayana Keertish, Harsha T Gowda,
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/46349.15042

Abstract:
Introduction: Colour has a potential influence on learning by improving Short Term Memory (STM) in different settings. Background colours of study materials can have an impact on STM in healthy student population. Enhanced memory can improve academic performance in students. In this study background colour between chromatic/yellow and achromatic/white colours were compared. Aim: To compare the effect of white background black text with yellow (preferential colour chosen via voting by students) background black text of study materials on STM. Materials and Methods: A cross-over study design was conducted in a tertiary care hospital of southern India with an interval of two weeks in October 2018. Two groups of 27 students each were assessed for visual STM using word list recall in a cross-over design study with an interval of two weeks duration. Data was collected as number of words and correct number of words recalled, from the word list. The obtained data was then put to statistical analysis using statistical software IBM Statistical Package for the Social Sciences (SPSS) version 25.0. Results: Out of total sample of 54 students, 13 were males and 41 were females. The males and females were comparable with age with p-value of 0.25 which was not statistically significant. The analysis showed that there was no statistically significant difference in the number of words and number of correct words recalled between white and yellow colour backgrounds in both the sessions. There was an overall improvement in the recall of words in both test materials from first session to second session. Conclusion: Chromatic/yellow background colour was no better than the standard achromatic/white background colour. Improvement in the number of words recalled from first session to second session with both colours appeared to be due to carry over effects.
, Kuldeep Dmello, Jitesh Wadhwa, Mora Sathi Rami Reddy, Atul Singh
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/29808.14959

Abstract:
Introduction: Information regarding the adhesion of bacterial species and plaque accumulation to bracket material is limited. Adequate information is needed in order to offer patients orthodontic treatment without significantly increasing their risk of developing white spots, caries, or gingival inflammation. Aim: To determine the levels of the caries-inducing S. mutans species on metallic, self-ligating and ceramic brackets and to compare the total bacterial counts and counts of species present on these bracket materials. Materials and Methods: By means of an in-vitro study, six commercially available bracket systems {3M Gemini (A), American Ortho (B), Ormco (C), Begg (D), Ceramic (E) and Self-ligating (F)} were compared. The brackets were bonded in the cell well culture plate and the agar plates were prepared. Brain heart infusion medium including bacteria and artificial saliva was introduced to each bracket system containing 10 premolar brackets and were incubated. After 72 hours, the adherent bacteria were then detached by sonication and the Colony-Forming Units (CFU) of Streptococcus mutans were calculated on each bracket and were analysed using Statistical Package for the Social Sciences (SPSS) software version 17.0 for Windows. Results: Between the different bracket types, significant differences were found in terms of biofilm formation. The Begg brackets showed the least bacterial adhesion and the self-ligating brackets showed the highest bacterial adhesion and was statistically significant among all the groups (p0.05). Conclusion: Different orthodontic brackets serve as different loci for biofilm formation showing that the Begg brackets are the most hygienic among all the brackets taken in this study.
S Girija, N Naresh Kumar, N Natis Prasannaa, S Sarumathy, R Nanda Kumar
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48404:15035

Abstract:
Drug Induced Parkinsonism (DIP) can be described as reversible development of Parkinsonian syndrome in patients treated with drugs which impair dopamine function. It includes symptoms such as tremor, muscular rigidity and bradykinesia. Gastrointestinal prokinetics, calcium channel blockers, modern atypical antipsychotics, and antiepileptic drugs may cause DIP. This report is about a 40-year-old female patient who developed a DIP after taking the antipsychotic medication combination (chlorpromazine and trifluperazine) for insomnia after being prescribed from a psychiatric clinic. After four weeks of initiation of treatment, she developed tremors, muscular rigidity and slowness in movements. The patient was admitted with the following complaints and then the drugs chlorpromazine and trifluperazine were stopped. The patient was then treated with tablet levodopa and carbidopa 110 mg, trihexiphenidyl 2 mg and tablet alprazolam 0.25 mg after which she gradually improved and was feeling better after a week. Atypical antipsychotics indicated for psychiatric disorders have high potential to cause extrapyramidal symptoms. Hence, for the treatment of insomnia newer drugs such as zolpidem and zaleplon can be used to minimise the chances of occurrence of DIP.
C Sreekanth,
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48163.14989

Abstract:
Introduction: Hypotension remains one of the most common problems associated with subarachnoid blockade. A number of strategies have been developed for its prevention, of which administration of fluids prior to subarachnoid block holds the importance. Gelatin is a colloidal plasma volume expander obtained from degraded gelatine. It is as effective as albumin solution in the treatment of spinal induced hypotension. Aim: To compare the incidence and frequency of hypotension after subarachnoid block in patients receiving colloid (polymerised gelatin) or crystalloid (0.9% normal saline) as prehydration and compare side-effects of colloid and crystalloid prehydration. Materials and Methods: A total of 60 patients scheduled for elective Transurethral Resection of Prostate (TURP) surgery were selected to participate in this prospective randomised double-blind study for a period of two years from April 2006 to April 2008. Patients were randomly allocated into two groups of 30 patients each. Group H received 500 mL of polymerised gelatine (Haemaccel) solution and group N received 1000 mL of 0.9% normal saline15 minutes prior to subarachnoid block. Intraoperative monitoring includes SBP, DBP, MAP and HR for 30 minutes. Incidence of hypotension and number of mephentermine boluses were noted.Statistical analysis of data was determined with Mann-Whitney U test and analysis of variance for repeated measures (ANOVA). Chi-square test was used to find out possible associations. Result: After spinal anaesthesia mean systolic blood pressure decreased in both the groups and was lower in group N compared to group H (97±18.9 vs 102±9.26 mmHg). There was fall in diastolic blood pressure in both the groups and was maximum at 20th minute in group N and group H (66.37±5.47 vs 64.67±10.30). There was highly significant (p<0.01) fall in mean arterial pressure in group N. The change in the heart rate was highly significant (p<0.01) at different time interval in both the groups. Vasopressor was required in 90% and 60% patients in group N and group H, respectively. No statistical difference in the incidence of nausea and vomiting in both the groups. Conclusion: The present study showed that preloading of fluids either with colloids or crystalloids prior to subarachnoid block reduces the incidence of hypotension but not completely eliminating it, also showed that colloids offset hypovolemia and hypotension more effectively than crystalloids in patients undergoing TURP surgery.
Pir Dutt Bansal, Deepika Garg, Priyanka Bansal, Bhavneesh Saini
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/49515.15078

Abstract:
Introduction: Migraine is the most common cause of vascular headache with a one-year prevalence as high as 6-14.3%. Having various pathophysiological theories, it occurs in much co-morbidity with several medical as well as psychiatric disorders like mood disorders, phobia, anxiety spectrum, etc. Migraine, especially when co-morbid with psychiatric illness stands markedly burdensome economically, diagnostically, therapeutically and prognostically. Hence, needs even further research. Aim: To study patients with migraine versus other types of headache and to study psychiatric co-morbidity among patients with migraine. Materials and Methods: This cross-sectional study was conducted on total 100 patients presenting with headache, meeting the criteria were taken up for the study and divided into two groups. Patients meeting International Headache Society (IHS) criteria for migraine were enrolled under group A and patients suffering from headache other than migraine under group B. Having subjected to detailed history and evaluation, patients were subjected to Symptom checklist-80, Hamilton’s Anxiety Rating Scale (HARS) and Montgomery Asberg Depression Rating Scale (MADRS), International Classification of Diseases (ICD)-10 criteria. The data so collected was subjected to statistical analysis and association of psychiatric morbidity with migraine patients was assessed. Results: Patients with migraine (group A) and among those too, patients having psychiatric morbidity had significantly (p24 hours compared to the other groups. Patients having migraine had significantly (p<0.01) higher psychiatric morbidity, more SCL-80 symptoms (mean score 83.05); more depressive symptoms (mean MADRS score was 31.9±9.2) and more anxiety with the mean Hamilton Anxiety score was 23.3 than in patients without psychiatric morbidity. Conclusion: A thorough evaluation of psychiatric disorders in migraine is important so as to propose a non segregated model of care to direct the burden and deterioration associated with psychiatric co-morbidity in migraine.
Sanam Rasool Wani, , Danish Zahoor Pandith, Mohammad Maqbool Dar
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/49191.15016

Abstract:
Introduction: Drug addiction one of the greatest challenges face across the glob. The parenterally transmitted viruses like Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) occur more frequently in this high-risk group of population as compared with the general population. Aim: To find the prevalence of HBV, HCV and HIV in People Who Inject Drugs (PWIDs) attending a tertiary care hospital in Kashmir valley, India. Materials and Methods: A prospective descriptional study was conducted from October 2017 to October 2020 in the Department of Microbiology of a tertiary care hospital in Kashmir. Subjects included 200 (PWIDs) who voluntarily presented themselves at the drug clinic. Participants were tested for HBV, HCV and HIV infections. For HBV, surface antigen was detected using Enzyme-linked Immunosorbent Assay (ELISA), HCV was detected by HCV antibody test using ELISA and HIV was detected using combination of three rapid kits, COMBAIDS-RS ADVANTAGE ST, MERISCREEN HIV 1-2 WB and TREDRO HIV 1-2 Ab. Demographic data was collected from all the PWIDs. Results: Among 200 PWIDs,138 (69%) were in the age group of 16-25 years and none of them was more than 35 years of age. The mean age of PWIDs was 22.9 years. Out of 200, 20(10%) PWIDS had HCV antibodies, 7 (3.5%) were positive for HBV, and 1 (0.5%) had anti-HIV antibodies. A 73.5% of PWIDs belonged to urban Kashmir and majority of them (62.5%) were college going students. Conclusion: From present study, authors report a high prevalence of hepatitis C and B in PWIDs of Kashmir. It is also the fact that these figures are just the tip of the iceberg. Targeted intervention programs should make HBV/HCV testing, prevention and care more accessible for PWIDs.
Helder Fernandesde Oliveira, Brunno Santos De Freitas Silva, Rogerio Ribeiro Paiva, Carolina Cintra Gomes, Orlando Aguirre Guedes
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/49324.15006

Abstract:
Radicular Dens Invaginatus (RDI) represent a rare form of dens invaginatus which develops in the root of the tooth after the crown development is completed that can sometimes cause complex pathological conditions that are difficult to diagnose. This case report describes a case of a RDI associated with an inflammatory periapical cyst. A 17-year-old female complained of mobility in tooth 22. The tooth showed gyroversion and colour change and no evidence of caries or root fracture. Axial slices and tridimensional reconstruction of the cone-beam computed tomography revealed the presence of a RDI on the distal surface of the root that extended from cervical to the apical third. The diagnostic hypothesis was symptomatic infectious apical periodontitis, and conventional root canal treatment was performed. Subsequently, it was opted for a complementary surgical approach, which involved an aspiration puncture bulletin with a collection of yellow-citrus liquid, periapical curettage, apicectomy, retro-preparation and retrofilling with Mineral Trioxide Aggregate (MTA). Histopathological examination revealed was inflammatory periapical cyst. After 3-years, repair of the area was evident. Surgical management of this rare condition can be favourable for resolving endodontic infection related to this dental anomoly.
, Samim Ahmad Aldabbagh, Zana Qadir Omer
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/46760.15049

Abstract:
Introduction: Many variables affect tooth eruption time. Eruption time and sequence of teeth is important as part of dental treatment planning in paediatric dentistry, orthodontics treatment, and forensic dentistry to estimate age of the child. Aim: The aim was to study the effect of different socio-demographic and anthropometric variables on eruption time of permanent teeth among Kurds aged 5-15 years in Duhok governorate-Kurdistan Region-Iraq. Materials and Methods: A cross-sectional study was conducted on 1418 randomly selected healthy Kurdish students aged 5-15 years of both genders in Duhok governorate. All were clinically examined for tooth emerging through the oral mucosa. Normally and delayed teeth eruption time was correlated to different variables such as gender, residency, socioeconomic status, Body Mass Index (BMI), parents’ job, smoking habits, education, consanguinity, nutritional details, feeding pattern, birth weight, and pregnancy outcomes. Data were analysed using the Statistical Package for Social Sciences (SPSS, version 22.0). Numerical variables were presented and summarised as means and standard deviations. Categorical variables were presented as frequencies and percentages. Chi-square test was used to test association between categorical variables. A p-value of ≤0.05 was considered statistically significant. Results: There were a statistically significant differences with p-value0.05) among eruption time and socioeconomic status, residence, parent’s (education, job, smoking habit), several nutritional details, pregnancy outcome, birth weight, nursing at first year, and finally the introduction of supplementary food for the child. Conclusion: Normal and delayed Eruption time and factors affecting it will be useful in treatment planning in paediatric and orthodontic dentistry as well as in forensic dentistry.
Lalithambigai Arumugasamy, Hetal G Patel
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48085.15100

Abstract:
Introduction: Diabetic Kidney Disease (DKD) is a chronic complication in Type 2 diabetes. The Chronic Kidney Disease (CKD273) peptide classifier has been found to predict development of DKD even before microalbuminuria develops. Seventy four percent of peptides in the CKD273 classifier are Collagen degradation fragments. The Beta-CrossLaps (β-CTx) Enzyme Llinked Immunosorbent Assay (ELISA) assay detects the specific collagen degradation product, C terminal telopeptide of Type 1 collagen. In light of the Capillary Electrophoresis/Mass Spectrometry (CE-MS) findings, linking collagen degradation fragments excretion to early detection of DKD, the significance of urinary β-CTx levels as a DKD biomarker needs to be evaluated. Aim: To study the urinary excretion of β-CTx in type 2 diabetes patients and to evaluate its relation to Microalbuminuria status and estimated Glomerular Filtration Rate (eGFR) of the patients. Materials and Methods: This descriptive cross-sectional study was undertaken at a tertiary care hospital, with enrollment of 82 type 2 diabetes patients from the diabetes Out Patient Department (OPD) Participants were divided into groups based on their Urinary Albumin Creatinine Ratio (UACR) and eGFR levels. The study participants were tested for Urinary β-CTx level, UACR and eGFR. Mean or median was calculated for the parameters with normal and non-normal distribution, respectively. All statistical testing was performed on online calculators available at the site; https://www.socscistatistics.com/. Results: The median urinary β-CTx level observed was 100.6 ng/mmol of creatinine. Among the 82 participants, 15 participants had urinary β-CTx level 15pg/mL, the sensitivity of the kit. Among the remaining 67 participants, the minimum Urinary Beta-CrossLaps: Creatinine ratio observed was 2.6 ng/mmol and the maximum value observed was 2071 ng/mmol (i.e., 2.1 μg/mmol). The median urinary β-CTx level was highest (100.6 ng/mmol creatinine) in the patient group with eGFR in the normal range. The urinary β-CTx level was found to decline with decline in eGFR, with median urinary β-CTx 65.5 ng/mmol creatinine in the patient group with mildly decreased eGFR and 7.2 ng/mmol creatinine in the patient group with moderately decreased eGFR. Conclusion: The Urinary β-CTx concentration in type 2 diabetes patients is dispersed over a wide range. The Urinary β-CTx concentration correlates with the eGFR of the patient and is not influenced by age, gender or duration of diabetes. This parameter is a potential early DKD biomarker.
Rajeev Gandham, , Sr Sheela
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/46243.14403

Abstract:
Introduction: Pre-eclampsia is a pregnancy specific disorder, characterised by the onset of hypertension and proteinuria. Pre-eclampsia is the leading cause of maternal, perinatal morbidity and mortality. The exact cause of pre-eclampsia is not known clearly and needs to be explored. Aim: To evaluate the maternal serum apelin 13 levels among pre-eclampsia and healthy pregnant women and also, to find the association between apelin 13 and blood pressure. Materials and Methods: A case-control study was conducted between Department of Biochemistry and Department of Obstetrics and Gynaecology, RL Jalappa Hospital and Research Centre, Kolar, Karnataka, India. After approval from the Institutional Ethics Committee and written informed consent from study subjects, a total of 270 pregnant women were recruited for this study. Among them, 135 pre-eclamptic women were considered as cases and 135 normotensive healthy pregnant women served as controls. According to the pre-eclampsia severity, cases were grouped into mild (n=47) and severe pre-eclampsia (n=88). Blood samples were collected from all the study subjects and was analysed for apelin 13 by Enzyme Linked Immunosorbent Assay (ELISA) method. Maternal and foetal adverse outcomes were recorded. Results were expressed as mean±Standard Deviation (SD). Categorical variables were expressed in percentages. Spearman’s correlation was applied and p<0.05 was considered significant. Results: The mean gestational age was 36.66±3.69 weeks which was, significantly low in pre-eclamptic women compared with healthy pregnant women. BMI (26.94±3.81 kg/m2), systolic (157.82±15.14 mmHg), diastolic (101.68±11.02 mmHg) and Mean Arterial Pressure (MAP) (120.20±11.12 mmHg), pulse rate (88.14±5.82 bpm), Aspartate Transaminase (AST) (25.25±12.49 IU/L) and Alanine Transaminase (ALT) (19.01±10.95 IU/L) were significantly increased in pre-eclamptic women when compared with control group. Mean maternal serum apelin 13 (341.44±218.63 pg/mL) concentrations were significantly lower in pre-eclampsia compared with healthy pregnant women. Maternal serum apelin 13 concentrations were negatively correlated with Systolic Blood Pressure (SBP) (r = -0.196), Diastolic Blood Pressure (DBP) (r = -0.172) and MAP (r =-0.204). Adverse maternal outcomes such as epigastric pain 75 (55.55%), oedema 62 (45.92%) and persistent headache 35 (25.92%) were higher in pre-eclamptic group. Additionally, adverse foetal outcomes were more in pre-eclamptic cases including significantly decreased birth weight (2.40±0.65), babies requiring Neonatal Intensive Care Unit (NICU) admission were 54 (40%), preterm birth (≤37 wks) in 50 (37.03%), Respiratory Distress Syndrome (RDS) 31 (22.96%), Small for Gestational Age (SGA) in 4 (2.96%) and Intra Uterine Death (IUD) in 11 (8.14%) babies. Conclusion: It was concluded from the present study that there was low maternal serum apelin 13 concentrations in pre-eclampsia and had negative correlation with blood pressure, suggesting its potential role in the pathophysiology of pre-eclampsia.
, Sushmita Banerjee, Pranab Roy, Apurba Ghosh
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/46262.14409

Abstract:
Introduction: Lipoprotein a {Lp(a)} increases in Nephrotic Syndrome (NS). Although the majority of paediatric NS are steroid sensitive, relpase and steroid dependence are commonly seen in this cases. Lp(a) is an LDL-like lipoprotein that consists of an LDL particle to which the glycoprotein apolipoprotein(a) {apo(a)} is attached. Aim: To evaluate the potential of Lp(a), measured on admission, for the prediction of relapse/steroid dependency. Materials and Methods: Children (n=36) with first episode NS were recruited in this prospective observational case-control study and followed up for one year. They were tested at presentation for Lp(a) (mg/dL) and standard tests such as haemoglobin, albumin, protein, cholesterol, triglyceride, and urine protein. Children received standard therapy for NS, and were followed for a period of one year from diagnosis to record days to initial remission, relapse episodes, steroid dependence etc. Patients were categorised as: no relapse (NR), Infrequent Relapse (IFR), frequent relapse (FR) and Steroid Dependent (SD) as per standard definitions. Fifteen healthy volunteers were also tested for lipid profile and Lp(a) levels. Results: Of 36 cases (median age 3 years, 19 males), there were 15NR, 7IFR, 2FR and 12SD. The mean Lp(a) of the NS group (165.2±120.4 mg/dL) was higher than controls (30.52±21.9 mg/dL) (p<0.0001). All the lipid parameters except HDL-cholesterol were significantly higher in the NS group. Within the NS group, Lp(a) showed significant correlation (Spearman-rho) with albumin (p=0.0062,r=0.47), but no correlation with lipid parameters or urine protein. Comparison of Lp(a)levels in the NS groups revealed that the SD patients had a high Lp(a)(222.0±115.7 mg/dL) compared to NR (129.7±120.1 mg/dL) (p=0.02). Conclusion: Concentration of plasma Lp(a) in patients with SDNS was higher compared to patients who did not suffer any relapse, and this concentration may serve as a marker for prediction of SDNS.
Am Anusha, Pa Sherena, , Jk Mukkadan
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/46322.14446

Abstract:
Introduction: Green leafy vegetables are important sources of polyphenols and carotenoids which possess both antioxidant and anti-inflammatory activities. Aim: To study the anti-inflammatory activity of oxycarotenoid extracts isolated from coriander leaves (Coriandrumsativum) and curry leaves (Murraya koenigii) in carrageenan induced acute paw oedema in rats. Materials and Methods: Oxycarotenoid extracts were isolated from the coriander leaves (Coriandrum sativum) and curry leaves (Murraya koenigii) and they were assessed for anti-inflammatory activities by in-vivo methods. The in-vivo anti-inflammatory activity was evaluated in carrageenan induced acute paw oedema model. Indomethacin at a dose of 20 mg/Kg body weight was used as standard anti-inflammatory drug. Results: The results revealed that oxycarotenoids extracted from coriander leaves administered at a dose of 40 mg/kg body weight showed an inhibition of 53.33% whereas the oxycarotenoids extracted from curry leaves showed an inhibition of 60% at the sixth hour after carrageenan injection. The results are comparable with those of indomethacin (20 mg/Kg body weight) administered group which showed an inhibition of 55.53% Conclusion: These findings suggest that oxycarotenoid extracts isolated from leafy vegetables (coriander leaves and curry leaves) have significant anti-inflammatory activities.
G Ramya, Chandra Sekara Guru, Gagan Kumar Banodhe, Dobson Dominic,
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/46392.14448

Abstract:
COVID-19 pandemic has severely affected sports worldwide. Usual practice can’t be done due to high viral transmission, yet prolonged inactivity leads to detraining and deconditioning and threatens ending of sporting career. Depending on the present guidelines of the government, a safe and evidence based gradual resumption of training and sports is essential. The cardiorespiratory- neuromuscular system involvement among others in COVID-19 directly affects exercise-sports performance and health, and the possibility of sub-clinical transmission poses immense challenge. Like other games, swimming is also heavily affected. Although COVID-19 is transmitted by droplets, the prolonged presence of virus in the air currents, commonly-touched surfaces and in stool of those infected should be kept in mind. Importance of hand hygiene, cough and sneeze etiquette, social distancing, use of mask while not exercising hard, other good public hygiene practices, staying home if sick, frequent cleaning and disinfection of pool and frequently touched surfaces, early detection, isolation and adequate treatment for the positive cases and strictly following government guideline should be compulsory. Awareness program and continued education for athletes, parents, coaches, support staff and other management team should be done. This review is intended to understand the course of COVID-19 and to formulate guidelines for resumption of swimming in India, based on recommendations by various organisations like WHO, CDC etc. The aim being to act as a key support for safely resuming swimming yet reducing the risk of COVID-19 infection.
J Lakhani Sucheta, , J Lakhani Som
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/47351.14424

Abstract:
Introduction: In developing countries, immunosuppressive patients are at greater risk of parasitic infection which may cause morbidity and mortality. Socio-economic and environmental factors including lack of health hygiene in close contact with infected reservoir animal which plays an important role. Aim: To determine the prevalence of parasitic infections and their association with socio-demographic status. Materials and Methods: This was a cross-sectional study which was carried out at tertiary care hospital located in Central East India. Total 120 stool samples were collected from the immunosuppressive patients and were processed using direct wet mount preparation with saline and Lugol, formalin-ether concentration and Modified Ziehl-Neelsen stain. Different socio-demographic parameters were recorded. Statistical analysis was done using Graph Pad Prism version 8 Chi-square test. The p-value ≤0.05 was considered as statistically significant Results: Out of total 120 patients, 20 (16.7%) were found to be infected. Majority of the population were males (66.7%). Among the total positive samples, 75% (15) showed the presence of Protozoa in which 10 samples had Entamoeba histolytica. The presence of Helminths was found in 25% (5), in which three samples showed Ascaris lumbricoides and two had Taenia species (10%). Conclusion: The prevalence of parasitic infection among immunosuppressive patients in the present study was 16.7%. Entamoeba histolytica was the most commonly observed parasite. There was no significant association between prevalence of parasitic infections and socio-demographic data variables.
Harsha Sreedharan, Kb Asha Pai
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/46121.14442

Abstract:
Introduction: Methicillin-Resistant Staphylococcus aureus(MRSA) infection is a major global healthcare problem, the prevalence of which varies from 25-50% in India. It is known to cause Skin and Soft tissue Infections (SSI), endovascular infections, endocarditis, pneumonia, septic arthritis, osteomyelitis, and sepsis. Vancomycin is the drug of choice for treating severe MRSA infections. Ceftaroline, a fifth-generation cephalosporin has been approved by the United States Food and Drug Administration (US FDA) for treating acute bacterial SSI caused by susceptible micro-organisms including MRSA, Community acquired respiratory tract infection, MRSA bacteremia and endocarditis. Aim: To assess the susceptibility of clinical isolates of S. aureusto ceftaroline, in a Tertiary Care Hospital. Materials and Methods: This prospective study was conducted in the Department of Microbiology of a Tertiary Care Hospital over a period of two months from June 2019 to July 2019. S.aureus isolates from various clinical samples were screened for methicillin resistance by disc diffusion method using cefoxitin disc and ceftaroline susceptibility of these isolates was assessed by E-strip method. The isolates were classified as ceftaroline susceptible, Susceptibility Dose Dependent (SDD) and ceftaroline resistant respectively as per CLSI guidelines. A descriptive analysis of the data was done and the results were presented as frequencies and percentages. Results: All the S.aureus isolates were found to be susceptible to ceftaroline. Methicillin Sensitive Staphylococcus aureus(MSSA) isolates had lower Minimum Inhibitory Concentration (MIC) when compared to MRSA. The highest MIC among MRSA was 0.5 μg/mL. Conclusion: Ceftaroline can be considered as an effective alternative for treatment of infections caused by MRSA.
, Shivangi Patel, Rajvi Patel, Urvi Patel, Sheel Patel, Ujval Patel, Sanket Patel
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/47399.14450

Abstract:
Introduction: Oral squamous cell carcinoma (OSCC) contribute to 90% of cancer cases in head and neck region and entails remarkable morbidity and mortality inspite of immense research and advances. Amongst other causes, infection with Helicobacter pylori is an emerging cause of OSCC. There is still perplexity in the exact etiopathogenesis of H. pylori related oral cancer. Aim: In order to explore this much unattended area, present study was aimed to find out the association between H. pylori in premalignant disorders and OSCC. Materials and methods: A Prospective case-control Pilot study of 35 patients (11 confirmed cases of Oral squamous cell carcinoma and 24 with oral potentially malignant disorders along with 15 age and sex matched healthy control) from June 2018 - September 2018 was conducted in the Department of Microbiology, Smt. B. K. Shah Medical Institute, Piparia, Gujarat. H. pylori was detected by methods like Rapid urease test, Gram’s staining and Serology. Results: H. pylori was detected in five cases with OSCC with male predominance and mean age 45.6 yrs. All the five positive patients were severely addicted to tobacco and betel quid since decades. Tobacco was found to be the major risk of OSCC with the OD of 16.19, followed by betel quid (OD-4.56) and H. pylori infection (OD-0.83). Conclusion: The results of this pilot study do not establish a definite causal relationship between H. pylori and OSCC due to the low sample size. Study definitely offers an avenue for further work on larger populations to confirm this possible association.
, Jagan Nadipelly, Vijaykumar Sayeli, Viswanathan Subramanian, JaiKumar Shanmugasundaram, Binoy Varghese Cheriyan
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/46023.14416

Abstract:
Introduction: Therapy with anticancer drugs like paclitaxel, platinum complexes and vincristine result in severe peripheral neuropathy. Very few treatment options are available to overcome this debilitating side effect. Flavone and its monohydroxy derivatives have been proved to possess anti-nociceptive and anti-inflammatory effects in animal models. Aim: To investigate flavone, 5-hydroxy flavone, 6-hydroxy flavone and 7-hydroxy flavone for their effect on neuropathy induced by vincristine and oxaliplatin in mice. Materials and Methods: In this experimental animal study, neuropathy was induced in mice by multiple doses of vincristine or a single dose of oxaliplatin. The manifestations of mechanical allodynia, cold allodynia and thermal hyperalgesia were measured by von Frey’s hair aesthesiometer, acetone spray test and hot water tail immersion test. The data was subjected to ANOVA followed by Dunnett’s test for multiple comparison and paired t-test at appropriate places. Results: Flavone and monohydroxy flavones significantly reduced the paw withdrawal response scores due to mechanical allodynia and cold allodynia resulting from vincristine or oxaliplatin administration (p<0.05). The tail withdrawal latency due to thermal hyperalgesia was also significantly increased by different flavone derivatives (pthermal hyperalgesia>mechanical allodynia. Opioid mediated antinociceptive effect, interaction with cation channels and anti-inflammatory effect of the investigated flavones may be suggested as possible mechanisms for their beneficial effects in neuropathy due to chemotherapeutic agents. Conclusion: Various neuropathic manifestations induced by vincristine and oxaliplatin were effectively attenuated by flavone and monohydroxy flavones.
Rajlaxmi Upadhyay, Trupti Rekha Swain, Sabita Mohapatra, Manas Ranjan Upadhyay
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/47663.14461

Abstract:
Introduction: Osteoarthritis (OA) is commonly prevalent disorder seen in Indian population. Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) are used as primary drugs for its symptomatic treatment. However, its use is limited by its long-term adverse effects. Many clinical studies have shown that diacerein reduces clinical symptoms of OA. Aim: To evaluate whether diacerein has beneficial anti-arthritic property when used prophylactically in Freund’s Complete Adjuvant (FCA) induced arthritis in rats. Materials and Methods: An experimental study was conducted over a period of about two months in the Department of Pharmacology, SCBMC, Cuttack. Thirty albino rats of Wistar strain was divided into 5 groups with 6 animals in each group. The basal body weight and the hind paw volumes of both right and left paw of all the animals was noted in day 0 and then on 4th, 8th, 14th and 21st day. Arthritis was induced in all animals by injecting FCA on day 0 into the plantar surface of right hind paw. Normal saline, diclofenac 5 mg/kg, three doses of diacerein (50 mg/kg, 100 mg/kg, 200 mg/kg), was administered orally once daily to groups I, II, III, IV and V respectively. Paw volumes and body weight was measured for arthritic parameters. On day 22 radiological and histopathologic evaluation was done. Results: Maximum inhibition of Freund’s adjuvant induced arthritic paw volume was on the 21st day with 100 mg/kg of diacerein and with diclofenac 5 mg/kg was from 8th to 14th day. There was a decrease in body weight due to freund’s adjuvant in normal saline group from 4th to 21st day, still greater decline with diclofenac 5 mg/kg group, but in diacerein treated group there was an increase in body weight from 4th to 21st day in all the three doses. Radiologically and histopathology maximum benefit was noted with 100 mg/kg of diacerein. Conclusion: Three weeks treatment of oral diacerein can significantly inhibit arthritic swelling of the injected paw at all the 3 doses in adjuvant induced arthritis model in rats and can be a promising disease modifying drug for OA.
Manoj Prathapan, Namrata Pambavasan, Smrithi Sony Thampi, Smriti Nair, , Minu Maria Mathew
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/45805.14414

Abstract:
Introduction: Cataract is the leading cause of preventable blindness worldwide. It is caused by the degeneration and opacification of the lens fibres. Phacoemulsification is the current treatment modality available for cataract. However, there is a possibility of an increase in the anterior chamber depth after phacoemulsification. This occurs as a result of the removal of the bulky lens matter and implantation of a thin intraocular lens, thereby reducing the intraocular pressure. Aim: To compare the preoperative and postoperative Intraocular Pressure (IOP) changes and the factors associated with intraocular pressure changes among patients who underwent phacoemulsification in a Tertiary Care Centre in Kerala. Materials and Methods: A retrospective cohort study was carried out among 610 patients, who underwent phacoemulsification surgery from January 1st, 2017 to December 31st, 2017. Using a checklist, the following data such as age, sex, Date of Surgery, Last recorded preoperative intraocular pressure of both eyes, First recorded Postoperative intraocular pressure of both eyes any time after 3 months, Axial length, Grade of cataract and comorbidities like diabetes, hypertension, dyslipidaemia, glaucoma and Coronary Artery Disease (CAD) was obtained from the hospital Information System. Data collected was entered into an MS Excel and was analysed using SPSS version 20. Frequency and percentages were calculated and association assessed using Chi-square test. Paired t-test was applied to find the mean changes in the IOP levels and p-value was ≤0.05, thus significant. Results: It was observed that there was a mean reduction of 7.907 mmHg in ocular hypertensives when compared to ocular normotensives following phacoemulsification. This finding was found to be statistically significant (p-value <0.001). There was association between grade of cataract and change in IOP which was significant with a p-value of 0.031. Conclusion: Phacoemulsification is the treatment of choice in patients with cataract. In the study, it was found that ocular hypertensives who underwent phacoemulsification had a significant drop in intraocular pressure post-surgery. Phacoemulsification can be employed in patients who have both ocular hypertension and cataract. This procedure can improve vision and in addition to having a positive effect on IOP reduction.
Gurupada Das, Bibhu Prasad Behera, Purna Chandra Karua,
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/46620.14433

Abstract:
Introduction: Acute Kidney Injury (AKI) occurs most commonly in Plasmodium falciparum infection. Next to cerebral malaria and anaemia, AKI is the third most common complication of falciparum malaria. N-Acetylcysteine (NAC) has been shown to decrease serum creatinine without affecting the Glomerular Filtration Rate (GFR) by activating creatinine kinase and possibly by increasing tubular secretion. Aim: To study the effect of NAC on improvement and deterioration of falciparum malarial AKI. Materials and Methods: This prospective observational study was undertaken on 100 patients of falciparum malaria with AKI who were admitted to the Department of General Medicine ward, VSSIMSAR, Burla, Odisha from November 2014 to October 2016. Patients who were treated with NAC were considered as NAC group (n=50) and those who were not given were considered as Non N-Acetylcysteine (NNAC) group (n=50). In both the groups serum creatinine level and urine output were compared on day 1, day 3 and on day 5 of the study. Graph pad instat version-3 for windows was used for various statistical analyses. The numerical value was compared by Chi-square test. The comparison of mean values among the NAC and NNAC groups was performed by student t-test. The p-value less than 0.05 was considered statistically significant. Results: A total of 63 males and 37 females were included in the study. Most of the cases were present in 15-34 years age group in both NAC and NNAC groups. The mean age of the patients for NAC group was 33.3±12.8 years and for NNAC group was 33.2±12.1 years with majority being males in both the groups. Out of 50 cases who were given NAC 600 mg twice daily for five days, 28 (56%) cases improved in AKI on day 5 as compared to day 1 of the study in NAC group. Similarly, out of 50 cases who were not given NAC, 26 (52%) cases improved in AKI on day 5 as compared to day 1 of the study in NNAC group. There was no difference in patients showing improvement in AKI after NAC therapy compared to patients with NNAC (χ2, 0.04; p=0.841). Conclusion: In NAC group, improvement of falciparum malarial AKI after five days was found to be little bit more as compared to the NNAC group, though it did not reach statistically significant difference.
, D Chandini, Jigisha Mehta, TejasH Sharma
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/47496.14620

Abstract:
Idiopathic Thrombocytopenic Purpura (ITP) is a rare auto-immune disorder that causes low platelet levels. In this condition, platelets are prematurely destroyed by reticuloendothelial system. Here, authors report a case of 27-year-old primigravida of 38 weeks pregnancy with history of ITP was posted for elective caesarean section. Her platelet count was 25000/mm3 which increased to 78000/mm3, after treatment with 30 gm Intravenous (IV). immunoglobulin for three days and three units of pooled platelet suspension. Thereafter, caesarean section was conducted under general anaesthesia without any complication. Regional anaesthesia is a relative contraindication in obstetric patients with thrombocytopenia. To avoid the complications of neuraxial blockade, general anaesthesia was preferred and is safer in a patient with ITP during pregnancy with low platelet count.
Sridevi Sivarama Krishnan, , Bhagavatham Meenakshi, Chitraa R Chandran
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/46990.14743

Abstract:
Introduction: Gingival Crevicular Fluid (GCF) has been referred to as a promising medium for detection of markers for periodontal disease activity. Analysis of GCF shows minute changes in biomarker levels well before the onset of clinical signs and symptoms; which helps to even predict a person’s predisposition towards periodontal disease occurrence. The elemental analysis of human blood serum is noteworthy in routine clinical practice as well as in medical research. Aim: This study was done to determine the changes in calcium and iron levels in GCF and serum in human subjects with normal periodontal health and those with disease. Materials and Methods: This was a cross-sectional study conducted from March 2019 to December 2019. Eight study subjects (4 healthy subjects and 4 periodontitis cases) were selected from the patients reporting to the Department of Periodontics at Tagore Dental College and Hospital, Chennai. The subjects were chosen based on inclusion and exclusion criteria and all patients were subjected to a clinical examination wherein the Probing Depth (PD) and Clinical Attachment Level (CAL) were recorded by a single examiner using William’s Periodontal probe. The GCF samples were collected by Capillary Tubing method. Blood was collected by venipuncture and centrifuged to provide serum samples. Dual viewing Inductively Coupled Plasma Optical Emission Spectrometry (ICP-OES) was used to estimate Calcium and Iron in GCF and serum. SPSS version 21.0 was used for statistical analysis. Mann Whitney U test was used for comparing the groups. p-value less than 0.05 was considered statistically significant. Results: Serum iron levels were significantly less in periodontitis patients than healthy subjects (p-value 0.043). GCF iron level (p-value 0.386), GCF calcium level (p-value 0.149) and serum calcium level (p-value 0.564) did not show any major variation among subjects with normal periodontal health and those with disease. Conclusion: The findings of this study showed that iron and calcium are present in GCF and serum samples of healthy persons and patients with chronic periodontitis which can be detected using ICP-OES. A significant difference in serum iron levels between health and disease could indicate a patient’s predisposition towards developing periodontitis. Calcium levels in GCF and serum do not point towards periodontal disease activity.
, Nayef H Felemban, Yousef Althomali, Puneet Gupta
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48275.14638

Abstract:
Introduction: Diagnosis and treatment planning in orthodontics determines the treatment outcome and long term stability. Cephalometric radiography is an essential diagnostic aid in orthodontics and hence numerous studies have been carried out in the past. Aim: To determine the Combination Factor (CF) through evaluation of the mean Overbite Depth Indicator (ODI) and Anteroposterior Dysplasia Indicator (APDI) values in western region of Saudi Arabian young male patients which would act as an aid in orthodontic treatment planning. Materials and Methods: A retrospective cephalometric study was conducted on 80 Saudi Arabian young male patients ranging in age from 7 to 14 years. Data was collected from records derived from the University Dental Hospital. Patients (n=80) were divided into four age groups: ages 7 (n=20), 8-9 (n=20), 10-11 (n=20), and 12-14 (n=20) years. Lateral cephalometric images were hand-traced and measured by one standardised and calibrated investigator. Statistical analysis was done with significance level set at 0.05, assuming that the length of the 95% confidence interval was two. One-way analysis of variance, followed by the Tukey test used to compare the mean ODI and APDI values of different groups. The statistical data were analysed through SPSS version 24 for Windows (IBM SPSS, Chicago, IL, USA). Results: The mean ODI value was 69.2688° and standard deviation 4.66670°, respectively. The overall APDI mean value was 81.7063° and standard deviation 4.18987°, respectively. There were no significant differences in the mean ODI and APDI values among different age groups (p>0.05). Conclusion: This retrospective cephalometric study determined the CF for western region of Saudi Arabian young male population to be 150.96°. This factor can be used as a diagnostic aid for planning orthodontic treatment. When the CF, is under the norm (150.96°), the skeletal pattern tends to improve with dental extractions. A CF higher than the norm (150.96°) will maintain a better relation with a non-extraction treatment.
, Maninder Singh Sidhu, Seema Grover, Ashish Dabas, Namrata Dogra, Archana Jaglan
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/48361.14750

Abstract:
Introduction: Coronavirus Disease (COVID-19) pandemic is not the first one which the globe has faced but never came across a health crisis that moved so quickly across continents. COVID-19 outbreak presently posed a very serious threat to the existence of mankind on earth. The massive impact of COVID-19 pandemic was evident in all aspects of life-personal, social as well as professional. The field of dentistry including orthodontics was no exception to this. Aim: To describe the impact of COVID-19 pandemic on orthodontic practice, exploring the basic sterilisation protocols being followed during COVID-19 pandemic and to predict the future of orthodontics in post-COVID era. Materials and Methods: The Department of Orthodontics and Dentofacial Orthopedics, Faculty of Dental Sciences, SGT University, Gurugram, Haryana, India, conducted this questionnaire based cross-sectional survey in May 2020 over a time span of 20 days. A web-based questionnaire of 15 multiple choice questions in English was created as a Google Form in Google Documents. The link to this form was shared online with the orthodontists and postgraduate students (Orthodontics) of dental colleges situated in the National Capital Region (NCR) through WhatsApp groups and e-mails. A total of 254 responses were received. Results: A 97.6% of respondents agreed that COVID-19 affected their orthodontic practice. The odds ratio between those not likely to resume practice and those likely to resume practice taking educational qualification as the significant predictor was calculated to be 8.976 at 95% confidence intervals. There was wide variation in the selection of the safety protocols by the orthodontists in the present study (p<0.01). Increased digitalisation in orthodontics (45.7%) followed by less demand of orthodontic treatment (18.5%) were opted as the future in post-COVID era (p<0.01). Conclusion: The present survey found that orthodontic community as a whole was affected greatly by COVID-19 pandemic and is quite apprehensive. The future of orthodontics in the post-COVID era is unpredictable presently. Digitalisation in orthodontics is the key option to have minimum physical contact with the patients. The study suggested the need and importance of basic sterilisation protocols and a training program for dental settings during COVID-19 for patient’s as well as clinician’s safety.
Ashish Wasudeorao Bele,
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/45595.14597

Abstract:
Introduction: Urinary Incontinence (UI) is the involuntary loss of urine with social alienation, loss of sexual activity and other psychosocial issues which may affect the Quality of Life (QOL) and psychosocial well-being of patients. Electrotherapy may play an important role in the treatment of incontinence by means of stimulating the weakened structures which helps in control of micturition. Various electrotherapeutic currents including Faradic, Galvanic, Inferential Therapy (IFT), Russian currents along with the pelvic floor muscles strength training may be helpful in UI. Aim: To find the impact of electrotherapy or training of muscle on QOL in male geriatric population of incontinence of urine. Materials and Methods: This randomised controlled trial will be carried out on geriatric male patients attending Acharya Vinoba Bhave Rural Hospital, Sawangi (Meghe), Wardha as well as on patients from geriatric homes and nearby PHCs. They will be screened for UI. The participants will be divided into three groups each of which will receive Faradic stimulation, Russian current stimulation and Pelvic Floor Muscle Training (PFMT) exercises respectively. The study will be carried out between October 2020 to October 2022. The data will be collected and analysed utilising inferential and descriptive statistics by using Chi-Square test and student’s t-test (unpaired and paired) and software for analysis will be SPSS 22.0 version and Graph pad prism 6.0 version and level of significance will be considered as p<0.05 and results will be obtained. Conclusion: In male geriatric population, muscle strength training or electrotherapy can reduce urine incontinence.
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