JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

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ISSN / EISSN : 2249-782X / 0973-709X
Published by: JCDR Research and Publications (10.7860)
Total articles ≅ 12,084
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Ankita Jain, R Raja, K Santosh Kumar
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/47098.14584

Abstract:
Introduction: Osteoarthritis is a common disease of aged population and one of the leading causes of disability. Key causes include obesity or overweight along with aging. Knee osteoarthritis can cause significant pain and functional loss. As the disease progresses, it can cause chronic knee joint pain, muscle weakness, joint deformity and functional deficiency which leads to decreased quality of life. The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) is a 24-item questionnaire with 3 sub-scales measuring pain (5 items), stiffness (2 items) and physical function (17 items). Health related quality of life is measured using Short Form-36, used to examine health status in following eight domains: Bodily pain, physical function, role limitations due to social problems, physical problems, general health, vitality, social function, mental health, role limitation due to physical problems. Aim: To find the effect of Short Form-36 Health Status Questionnaire versus WOMAC Arthritis Index Questionnaire to measure the pain, Range of Motion (ROM) and disability in subjects with chronic knee osteoarthritis patients treated with Contrast Bath and Knee Exercises. Materials and Methods: This study was a pre and post longitudinal cohort study. A total of 90 patients were divided into two groups of 45 each. Each patient was given treatment for four weeks. Each patient was treated with Contrast bath and Knee Exercises. Group A patients were instructed to fill the Short Form-36 Health Status Questionnaire and Group B patients were instructed to fill the WOMAC Arthritis Index Questionnaire and outcome measures were collected on day 1, at the end of 2nd week and at the end of 4th week. Data from study were analysed using the statistical package SPSS 19.0 (SPSS Inc., Chicago, IL) and level of significance was set at p<0.05. Results: Group B shows a mean of the total score of WOMAC Arthritis Index Questionnaire which was 74.66 (SD 10.01) on Day 1; mean of 49.02 (SD 12.08) at the end of the 2nd week and a mean of 20.68 (SD 12.23) at the end of 4th week. The p-value was found to be 0.0001. The percentage disability evaluated by the WOMAC Arthritis Index Questionnaire shows a mean of 78 (SD 10) on Day 1; mean of 51 (SD 12) at the end of 2nd week and a mean of 22 (SD 13) at the end of 4th week. On day 1 Short Form-36 Questionnaire, total score of group A was 88.24 (SD 6.72) and at the end of 2nd week and 4th week the mean score was 94.06 (SD 5.10) and 98.72 (SD 4.55), respectively with statistically significant difference p-value (0.0001). Conclusion: The present study showed that the WOMAC Arthritis Index Questionnaire had superior sensitivity in reducing pain and increasing range of motion and thus by decreasing the disability.
Hu Hemanth Gowda,
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/47445.14430

Abstract:
Introduction: Variability in the levels of these trace elements may reflect altered insulin metabolism and poor glycaemic control in the background of elevated oxidative stress. Mineral metabolism is another entity that may be disrupted by diabetes mellitus. Conversely, there are studies implicating early imbalances of trace elements in upsetting glucose homeostasis and insulin metabolism. Aim: To estimate and compare serum zinc, copper and magnesium in Type 2 Diabetes Mellitus (DM) patients with non diabetic controls and to correlate the serum zinc, copper and magnesium with Glycated Haemoglobin levels in Type 2 DM. Materials and Methods: This cross-sectional study was conducted at the Sapthagiri Institute of Medical Sciences and Research Center, Bengaluru, Karnataka, India. The study included 30 Type 2 DM patients and 30 healthy, age and gender matched controls without Type 2 DM. Their serum levels of zinc, copper and magnesium were measured and compared. Statistical Package for the Social Sciences (SPSS) version 16 software was used to perform the statistical analysis. The data obtained was subjected to descriptive statistical analysis. Results: Mean±SD of serum zinc in Type 2 DM and controls was 93.44±46.99 μg/dL and 121.74±37.15 μg/dL, respectively. Serum zinc was significantly decreased in Type 2 DM. However, there was no significant alteration with respect to serum copper and magnesium. Pearson’s correlation analysis showed that the association between HbA1c with zinc (r=0.069, p=0.718), copper (r= -0.094, p=0.622) and magnesium (r=0.116, p=0.543) was random. Conclusion: Zinc deficiency noticed in Type 2 DM patients may be due to increased excretion in urine. Zinc oral preparations are cheap and easily available. Considering these, it can be further explored if micronutrient supplementation would help to improve the glycaemic variability in Type 2 DM.
Ghada A Elfadil, Abdelgadir Elmugadam, Rasheeda A Saied,
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/45887.14459

Abstract:
Introduction: An increased Body Mass Index (BMI) has an adverse effect on the socio-economic and healthcare sectors and may influence metabolic status. High sensitivity C-reactive Protein (hs-CRP) is an emerging biomarker. The association between dyslipidaemia and obesity is well established, and has been found to be the risk factors for CVD. Aim: To study the relationship of hs-CRP with BMI, lipid profile and magnesium among obese and overweight non-diabetic non-hypertensive Sudanese women. Materials and Methods: A cross-sectional study was conducted on 90 women in Khartoum state (Sudan), aged between 20 and 43 years, from June to November 2019. The study included three groups of women based on BMI. hs-CRP was measured by using latex immunoturbidimetric method, lipid profile was evaluated using Biosystems colourimetric methods and magnesium by a chemical method. Results were computed using Statistical Package for the Social Sciences (SPSS) version 20.Results: There was significant increase in the mean values of hs-CRP, Total Cholesterol (TC), Triglyceride (TG), Low Density Lipoprotein Cholesterol (LDL-C), and a significant decrease in the mean values of High Density Lipoprotein Cholesterol (HDL-C) and magnesium in obese and overweight women, when compared to normal body weight women. Pearson’s correlation coefficient revealed a positive correlation between hs-CRP, and BMI, Waist-To-Hip Ratio (WHR), TC, TG, and LDL-C (p-value <0.01). Conclusion: Overweight and obese women have increased hs-CRP and atherogenic lipid profile, suggesting obesity to be a state of chronic inflammation. hs-CRP can be used to assess the risk of obesity-related disorders for early intervention.
, Krishna Gopal, Abel K Samuel Johnson, Jennie Ann Johnson Samuel, Sherin Susan Abraham, Tribeni Goswami, Marina Thomas, Renu Mathew
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/46815.14432

Abstract:
Introduction: Worldwide, Extrapulmonary Tuberculosis (EPTB) accounts for 15-20% of all cases of TB. The diagnosis of EPTB is a big challenge, as the number of Mycobacterium tuberculosis(MTB) bacilli in the tissues and other organs is often very low. Truenat MTB/RIF (rifampicin) is a novel method, which is battery operated, point-of-care and chip-based Real Time Polymerase Chain Reaction (RT-PCR) micro device. Aim: To evaluate Truenat as a screening test in the diagnosis of EPTB in comparison with microscopy and culture. Materials and Methods: A prospective cross-sectional study was carried out over a year in which samples from suspected cases of EPTB fitting in the inclusion criteria were subjected to Ziehl-Neelsen (ZN) staining for smear microscopy, culture on Lowenstein Jensen (LJ) medium and PCR for MTB by Truenat. Comparisons were made between the tests and the data was presented using summary statistics with 95% Confidence Interval (CI). Results: A total of 248 samples were received from suspected cases of EPTB. Out of the different samples tested, 9 (3.6%) were positive with Truenat MTB. The predominant type of EPTB observed in the study was lymph node Tuberculosis (TB) (66.6%) followed by intestinal, pleural and skeletal TB. Out of the 106 samples tested for culture, four were culture positive for MTB and out of 178 samples tested for microscopy, three were positive for acid fast bacilli. Sensitivity, specificity, Negative Predictive Value (NPV), Positive Predictive Value (PPV), observed agreement of Truenat with culture and microscopy were 100%, 95.1%, 100%, 44.4%, 95.3% and 100%, 96.6%, 100%, 33.3%, 96.6%, respectively. Conclusion: Truenat MTB test is a cost-effective rapid molecular test with good sensitivity and specificity for the diagnosis of EPTB in low resource settings.
Hagera Gulam Ahmed, Gurajala Swathi, Anukolu Reddy Ravishankar, Hrv Raj Kumar,
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/46861.14443

Abstract:
Introduction: Urosepsis is a serious, life-threatening consequence of a complicated Urinary Tract Infection (UTI). It is caused by bacterial infection of the urinary tract or prostate that spreads into the bloodstream. Since urosepsis is associated with a very high mortality rate (20-40%), an early diagnosis and identification of the causative bacteria is important so as to facilitate a prompt treatment with appropriate antibiotics. Nearly 50% cases of urosepsis are caused by the Gram Negative Bacterial (GNB) pathogen, Escherichia coli(E. coli). Aim: To determine the bacteriological profile, antimicrobial susceptibility pattern, phenotypic resistance of the organisms associated with urosepsis and to correlate the levels of proinflammatory markers with the clinical outcome of the patient associated with urosepsis. Materials and Methods: This was a prospective observational study including all patients with simultaneously positive urine and blood cultures, with identical bacterial isolate(s). The details of clinical presentation, antibiotic therapy and other relevant information such as C-Reactive Protein (CRP) and Procalcitonin (PCT) values were recorded and analysed using Microsoft office excel 2013. Results:E. coli was the commonest isolate (43/53, 81.1%). Of the total 43 E. coli isolates, 4/43 (9.3%) were Extended Spectrum Beta Lactamase (ESBL) producers and 23/43 (53.49%) were Carbapenemase producers. Significant rise of the proinflammatory markers (PCT>10 ng/mL) and (CRP>100 mg/l) were associated with high mortality (49%). Out of the 53 patients, 43.4% (23/53) patients had more than one risk factor associated with severe sepsis and poor prognosis. conclusion: Early recognition of symptoms followed by accurate diagnosis and early goal directed therapy is essential to decrease morbidity and mortality from urosepsis.
Smita Singh, Jyoti Garg, , Kiran Agarwal
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/46644.14411

Abstract:
Intra-abdominal masses in children are usually malignant. Benign tumours at this location are not seen frequently. It is even rarer to find solitary myofibromas intra-abdominally as these tumours are known to have predilection for the head and neck region. We present an unusual case of solitary myofibroma with abdominal localisation in a six-year-old male child who presented with abdominal distension since six months. Computed Tomography (CT) abdomen revealed a complex solid-cystic mass extending from umbilicus to right iliac fossa and measuring 9×6×4 cm. Histopathological examination revealed a tumour displaying biphasic nodular pattern with the presence of lighter staining fascicles of mature myoid cells along with darker staining and more cellular areas of smaller primitive cells. On Immunohistochemistry (IHC), tumour cells were positive for vimentin and Smooth Muscle Actin (SMA) with variable reactivity for desmin while these were negative for CD34 and Anaplastic Lymphoma Kinase 1 (ALK). Based on the histopathological and immunohistochemical findings, final diagnosis of myofibroma was made. Recognition of these lesions is extremely challenging owing to their rare presentation intra-abdominally and also because of their close morphological overlap with other spindle cell tumours commonly found at this site. This case highlights the combined role played by histopathology and IHC in making a clear distinction between different entities. It is imperative for both clinicians and histopathologists to establish the correct diagnosis as excision of the solitary myofibroma is curative in most cases and offers better clinical course than the more commonly found malignant tumours at this site.
, Arvind Bhake, Anil Agrawal, Sophia Thomas
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/43521.14458

Abstract:
Introduction: Numerous red cell indices are in practice for surveillance of Microcytic Hypochromic (MCHC) anaemia in determination of their aetiology to the Iron Deficiency Anaemia (IDA) and Beta Thalassaemia Trait (BTT). The studies have revealed that there exists the discrepancies for Sensitivity (SN) and Specificity (SP) for any single index conclusive to classify them to the categories of IDA and BTT. A comparative review is needed as to know which index is suitable to discriminate between above two major entities under MCHC anaemia, which can be put to the practice in resource poor laboratories. Aim: A systematic review was planned for diagnostic reliability of red cell indices that segregates IDA from BTT in a morphological classification of MCHC anaemia. Materials and Methods: A systematic literature search was conducted in a database that yielded 36 studies dealing with one or more of the five included indices (Mentzer index, Bessman index, Green and King index, Srivastava index and Sirdah index) in the present analysis. The data for SN and SP of these indices were collected and compared from their performance at discrimination between IDA and BTT and Youden index was calculated to compare the performance of individual index. Results: Of these five indices, the comparative statistics has shown Green and King index works well at the SN of 79.37% and SP of 82.54% as compared to the rest of the indices. The second closest index that is practicable at discriminating IDA from BTT is Mentzer index. Conclusion: None of the indices can be completely relied upon to achieve a conclusive segregation. However, Green and King and Mentzer indices can be used for screening the suspected population to identify patients which may need the specialised tests to confirm the diagnosis to bring this population under proper treatment either for IDA or BTT.
Rama Das, Parna Basu, , Debasish Guha
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/45220.14439

Abstract:
Introduction: Breast cancer continues to be the most common cancers among women in India. The Triple Negative Breast Cancer (TNBC) is a heterogeneous group of malignancy which is often aggressive and has a worse prognosis. Aim: The aim of this study was to assess the hormone receptor and HER2/neu status with platinum based chemotherapy in TNBC. Materials and Methods: The study was analysed retrospectively in a tertiary care centre of West Bengal from Januay 2017 to December 2019. Forty TNBC patients of Locally Advanced Breast Cancer (LABC) cases who received carboplatin along with neoadjuvant chemotherapy (study group) were compared with other group of 64 TNBC patients (control group) who did not receive any chemotherapy making a total of 104 cases of TNBC patients who were selected for the study. All the patients in both the groups had modified radical mastectomy. The study group of 40 TNBC patients who received chemotherapy also showed pathological partial response. Masterchart was prepared comprising patient’s age, menopausal status, family history, therapy history, histo-morphological features, hormone receptor and HER2/neu status after platinum added chemotherapy. Oestrogen Receptor (ER)/Progesterone Receptor (PR) were considered positive, if >1% tumour cell nuclei were immunoreactive and negative, if it was otherwise. HER-2/neu score of 3+ was taken as positive by Immunohistochemistry (IHC) method. Statistical analysis for descriptive purposes, percentages and mean were calculated. Comparison of both the groups was done by Pearson’s Chi-squared and Fisher’s-exact test. Significance level was considered at p-value <0.05. Results: TNBC patients (NACT group) showed hormone receptor positivity of 21 cases (52.50%) after chemotherapy along with carboplatin. HER2/neu positivity was detected in 9 (22.5%) cases. Non-NACT (64) cases were considered as control group for comparison. The effect of NACT in TNBC patients was found to be statistically significant with respect to change in HER2/neu (p=0.033, p<0.05) and ER status (p<0.05) while change in PR status was found to be statistically insignificant. Conclusion: The study showed significant alteration in hormonal and HER2/neu receptor status in TNBC patients receiving platinum added neoadjuvant chemotherapy. This study found statistical significance and justifies re-evaluation of these Hormone Receptor (HR) and HER2/neu markers in residual tumour after chemotherapy.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/47319.14431

Abstract:
Introduction: N-Acetylcysteine (NAC) is a direct precursor in the synthesis of intracellular Glutathione (GSH). NAC protects the liver by restoring the GSH levels or by acting as an alternate substrate for conjugation and hence, detoxification of the reactive metabolite of hepatotoxic drug. Aim: To evaluate the effects of oral NAC on the haemato-biochemical and histopathological changes on the liver of albino rats. Materials and Methods: The study was carried out in animal house located at Sumandeep Vidyapeeth, Piparia. The healthy albino rats of either sex weighing 150-400 gm body weight were grouped into two for the experimental study and were housed in animal house for duration of 24 hours. Before initiation of any procedures; after overnight fasting; the albino rats belonging to Group I Control Group (n=6) were administered distilled water 10 mL/kg orally; Group II NAC treated (n=6) were administered NAC 450 mg/kg as a single oral dose. Blood samples were collected after 24 hours of treatment, to evaluate the effect of NAC on the haemato-biochemical and histopathological changes on the liver. All results were expressed as Mean±SEM. Results: NAC as a single oral dose of 450 mg/kg does not caused statistically significant changes in the serum enzymes levels. Moreover, histopathology showed normal appearance of the liver was similar to that of the control treated rats, with no change in the texture and liver tissue showed normal morphology. Conclusion: NAC as a single oral dose of 450 mg/kg body weight has no toxic effect on the liver in albino rats.
, Andràs Molnàr, Làszló Tamàs, Àgnes Szirmai
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH; https://doi.org/10.7860/jcdr/2021/45056.14434

Abstract:
Introduction: Ménière’s Disease (MD) is associated with rotatory vertigo, unstable levels of hearing, tinnitus, along with vegetative symptoms and postural instability. Progressive hearing loss can be treated in part successfully with Intratympanic Steroid (ITS) (dexamethasone) injection. Aim: To investigate the effects of ITS treatment on vestibular system in MD. Materials and Methods: This retrospective case-control study, was conducted at Semmelweis University, Department of Otolaryngology and Head and Neck Surgery during the period of January 2018 to March 2020.Study involved 120 patients data suffering from advanced MD. Thirty-eight patients suffering from advanced stage of MD received ITS treatment along with 82 patients with advanced MD that were treated with conservative treatment based on international guidelines. The results of vestibular function tests using ultrasound-computer-craniocorpography (US-COMP-CCG) before and after administration of ITS injection were compared, using Mann-Whitney U test and Logistic Regression. To analyse the baseline characteristic of the control and treated groups, Mann-Whitney U test and Chi-square test were applied. Results: Based on the comparison between the baseline characteristic of the control and ITS groups, there was no significant difference detected in case of the US-COMP-CCG parameters, nor was it when the distribution of age groups and gender were contrasted. When the distribution of US-COMP-CCG parameters before and after the steroid treatment were contrasted using boxplots, there was no obvious difference between the parameters, which was also strengthened by the non-significant statistical difference. In case of the parameters of stepping test the same outcome was detected. Comparing the boxplots of the parameters of both tests after the treatment and of the control group, no significant difference was detected. Long-term follow-up data analysis was carried out using Kaplan-Meier curve and Logistic Regression, and there was no statistically significant difference between the treated and nontreated groups {p=0.445; Odds ratio: 1.654 (95% CI: 0.166-0.197)}. Conclusion: Based on US-COMP-CCG, the ITS injection seems to have no impact on the vestibular system, although seems to be efficient in the management of some cases of MD.
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