Search

Introduction: Molecular docking facilitates the exploration of interactions between bioactive alkaloid compounds and target proteins, offering insights into potential binding modes and affinity, crucial for drug discovery and understanding molecular mechanisms. Catharanthus roseus (C. roseus), renowned for its bioactive alkaloid compounds, emerges as a promising candidate for novel agents in diabetes management. Aim: To study the computational methods, including in-silico molecular docking, to elucidate the interactions between bioactive alkaloids from C. roseus and a Type-2 diabetic target protein. Materials and Methods: In this in-vitro study conducted in 2022 at the Department of Research, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Tamil Nadu, India. The research took place from July to October 2022. Computational techniques, particularly in-silico molecular docking, were utilised to analyse the binding affinities and potential mechanisms of action of bioactive alkaloids from C. roseus against a target protein associated with Type-2 diabetes. The study employed established computational protocols and software tools to predict and evaluate the binding interactions between the alkaloids and the target protein. Results: The analysis suggests Vinblastine, Ajmalicine, and Vindolinine from C. roseus as potential diabetes therapeutics. Vinblastine binds strongly to Human Pancreatic Alpha-Amylase (HPA), hinting at glucose metabolism regulation. Ajmalicine and Vindolinine also interact significantly with HPA, implying antidiabetic potential. Additionally, the present study findings suggest a potential role of Reserpine in modulating HPA activity and supporting its antihypertensive effects. Conclusion: In conclusion, the analysis highlights the potential of C. roseus compounds like Vinblastine, Ajmalicine, and Vindolinine in managing diabetes by interacting with HPA, indicating their potential as antidiabetic agents. Additionally, Reserpine’s effect on HPA activity suggests a role in hypertension management. These findings emphasise the therapeutic potential of natural compounds from C. roseus for diabetes and related conditions, warranting further clinical investigation.

Introduction: Laparoscopic cholecystectomy is considered the gold standard for benign gallbladder disease due to its minimal invasiveness, reduced bleeding, and rapid recovery. Enhanced Recovery After Surgery (ERAS) protocols, recognised for lowering surgical stress and complications, are increasingly adopted for their postoperative benefits. Aim: To assess and compare postoperative outcomes in laparoscopic cholecystectomy patients undergoing ERAS versus conventional approaches. Materials and Methods: This prospective interventional study was conducted at the Surgery Department of Mahatama Gandhi Medical College and Research Institute, Puducherry, India from January 2021 to June 2022. All patients above 18 years of age undergoing laparoscopic cholecystectomy with American Soceity of Anaesthesiologists (ASA) I and II were included. A total of 90 subjects, 45 subjects in the Group A (ERAS protocol) and 45 subjects in the Group B (Conventional approach), were included based on computer-generated random numbers with concealment of allocation. Key parameters, including length of hospital stay, morbidity, postoperative pain, and protocol compliance, were evaluated between both groups. Continuous variables were presented as means with standard deviations and analysed using unpaired t-tests. Categorical variables were expressed as percentages and compared using chi-square tests. Results: The mean age of the study population in ERAS and conventional was 41.3±7.9 years and 41.6±9.6 years, respectively. Similarly, 17 male participants were from the ERAS group and 15 were from the conventional group, whereas among female participants 28 were from the ERAS group and 30 were from the conventional group. The ERAS group demonstrated significant advantages: shorter hospital stays (91.2% vs. 73.4%, p=0.0274), lower Grade 1 morbidity (p=0.0213), and reduced postoperative pain (p=0.0001). Conclusion: The ERAS group exhibited notable benefits, including a shorter hospital stay, reduced morbidity, and lower postoperative pain. These findings suggest the potential for enhanced recovery outcomes with ERAS protocol implementation in laparoscopic cholecystectomy patients.

Neurofibromatosis 2 (NF2) is characterised by numerous tumours in the central and peripheral nervous systems due to NF2 gene abnormalities that cause the tumour suppressor protein, Merlin, to disappear. Often referred to as Multiple Inherited Schwannomas, Meningiomas, and Ependymomas (MISME), a distinctive characteristic of NF2 is bilateral vestibular schwannomas manifesting in late adolescence with symptoms such as sensorineural hearing loss, tinnitus, and balance issues. Two distinct phenotypes, Wishart and Feiling-Gardner, characterise NF2. This case report discusses the case of a paediatric patient who presented with bilateral hearing loss, giddiness, and blurring of vision and sought a Magnetic Resonance Imaging (MRI) examination which revealed bilateral vestibular schwannomas, non vestibular schwannomas, left sphenoid wing meningiomas, multidirectional spinal schwannomas, spinal nerve sheath tumours, and lesions in the retroperitoneal region. Despite an absent family history, significant involvement of cranial nerves strongly indicates classical NF2. Management focuses on preserving function, and surgery is contemplated for symptomatic lesions and tumours causing cord compression. Gamma Knife radiosurgery and targeted therapies have been investigated.

Introduction: Transfusion of blood Group O and its components with high ABO antibody titers to non O recipients has been shown to cause acute transfusion reactions, especially in platelet transfusions, as platelets contain significant amounts of ABO antigen on their surface as well as Anti-ABO alloisogglutinins in plasma. Aim: To estimate the ABO Anti-A and Anti-B agglutinin titers among blood donors at a tertiary care referral teaching hospital blood centre. Materials and Methods: This cross-sectional observational study was conducted at the Immunohaematology laboratory of the Department of Transfusion Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India, from March 2021 to June 2022. All blood donors presenting to the blood centre were screened for eligibility for blood donation. Donors who fulfilled the eligibility criteria as per the Drugs and Cosmetics Act, 1940, and Rules, 1945 were included. Anti-A and Anti-B titers were determined by the conventional tube method with dilutions of 1 in 2, 1 in 4, 1 in 8, 1 in 16, 1 in 32, 1 in 64, 1 in 128, 1 in 256, 1 in 512, and 1 in 1024. A titer of 64 was considered as a high titer. Results: A total of 399 donors were included in the study, with 393 (98.5%) being males and 6 (1.5%) being females. The mean age of the study population was 28.49 years. Among blood group A, the percentage of individuals with an IgM anti-B titer of 64 was 14.56% (15), whereas in blood group B, IgM anti-A titers of 64 were 34.5% (49). In blood group O, the percentage of individuals with 64 titers of IgM anti-A were 52.60% (81) and 47.40% (73), respectively, whereas for anti-B, 64 titers were 77.92% (120) and 22.08% (34), respectively. Conclusion: It is recommended that a database be maintained in all institutes by estimating antibody titers for every A, B, O blood group donors. Whole blood or platelets from group O donors with IgM Anti-A and Anti-B antibody titers

Introduction: Botulinum toxin injection has become ubiquitous in the treatment of wrinkles. It is less invasive and easy to perform, with almost immediate effects. Although it is the most common non surgical cosmetic procedure performed in many parts of the world, accurate figures of its increasing trend in India need to be unraveled as well. Aim: To analyse the clinical profile, outcomes, indications, and nature of revisits among patients seeking Botulinum toxin injections for cosmetic indications. Materials and Methods: A cross-sectional observational study was conducted at a tertiary care centre, Department of Dermatology, Cutis Academy of Cutaneous Sciences, Bengaluru, Karnataka, India, for six months between November 2018 and April 2019 among 80 consecutive patients who received Botulinum toxin injection A for cosmetic purposes. The collected data included age, gender, indication, the number of units of Botulinum toxin used, and the profile of patients seeking revisits. The data was recorded and analysed using Statistical Product and Service Solutions (SPSS) version 23.0. Results: The average age for treatment among females was 38 years, while among males, it was 35.5 years. Females, comprising 61 (76%), outnumbered men by a factor of three. The single most common indication for Botulinum toxin injection among females was Crow’s feet, accounting for 26 (43%), and among females below 40 years, it was Masseter hypertrophy in 13 (21%). The most common indication among men was Glabellar line correction in 10 (53%). Other indications included the Nefertiti lift, Marionette lines, Popply chin, Brow lift, and Gummy smile. Women revisited the clinic three times more often than men. Among women, Crow’s feet correction was the most common reason for revisits. The number of units of Botulinum toxin needed was found to be higher in males for Glabellar lines and in older individuals for Masseter Hypertrophy. Conclusion: Women are more receptive to cosmetic facial Botulinum toxin injections and revisit more frequently than men. Adverse effects were mild and self-limiting. Upper-face Botulinum toxin injections appear to be the preferred indication in both genders. More epidemiological studies detailing the profile of patients seeking aesthetic Botulinum toxin injections are needed to better understand patients’ needs and concerns, offer preprocedure counselling, manage their expectations, and provide customised services.

Introduction: The accurate diagnosis of thyroid disease relies on the sensitivity and specificity of laboratory tests, which require specific reference intervals. Thyroid hormone levels can be influenced by factors such as age, gender, iodine intake and geographical region. Therefore, it is recommended for clinical laboratories to establish their own reference intervals. Aim: To establish reference intervals for Thyroid Stimulating Hormone (TSH), Free Thyroxine (FT4), Anti-thyroglobulin antibody (anti-TG), and Anti-Thyroid Peroxidase Antibody (antiTPO) in males and and females. Materials and Methods: A cross-sectional study was conducted in the Department of Biochemistry, Amrita Institute of Medical Sciences (AIMS), Kochi, India, from December 2021 to July 2022. The study included 217 apparently healthy subjects aged between 18 years and 60 years. TSH, FT4, anti-TPO, and anti-TG levels were analysed to establish reference values for males and females in the two age groups: 18-40 years and 41-60 years. Reference intervals for thyroid parameters were expressed as mean±Standard Deviation (SD), median, 2.5th and 97.5th percentiles. The Mann-Whitney U test was used to assess the statistical significance of thyroid parameters between gender and age groups. Results: The mean age in the female population was 38.24±11.64 years, while in the male population, it was 39.24±10.98 years. The reference intervals and cut-offs for TSH, FT4, anti-TG and anti-TPO in females were determined as 0.80-4.12 μIU/mL, 0.99- 1.57 ngm/mL,

Introduction: Due to their susceptibility to mental health problems, medical students should have their prevalence of stress, anxiety, and depression checked before their final examinations. Aim: To assess the prevalence of stress, anxiety, and depression among medical students at a private medical college in Tamil Nadu, India, four weeks before their final examinations. Materials and Methods: A cross-sectional study was conducted at a private medical college, Tamil Nadu, India, including 297 Bachelor of Medicine and Bachelor of Surgery (MBBS) students, using Depression, Anxiety, and Stress Scale-21 (DASS-21) questionnaire in December 2022 The survey was completed independently by the students with verbal agreement obtained; the response rate was 68.2%. The short form and history of usage of the DASS-21 in comparable medical student research led to its selection. Results: The mean age of the study participants was 20.48±1.23 years. The DASS-21 revealed prevalence rates of 60.9% for depression, 72.7% for anxiety, and 40.4% for stress among 297 first- to third-year medical students. There was no discernible effect of gender on these rates. With a depression frequency of 69% and significantly higher rates of severe depression (18.6%), first-year students demonstrated the highest scores, which were statistically significant (p

Introduction: The incidence of candidiasis can vary across various subsites within the head and neck region and is associated with various co-morbidities and risk factors. The increase in the incidence of resistant Non-albicans Candida (NAC) species among these patients and the limited number of available antifungal agents make treatment difficult. A better understanding of the subsite-specific prevalence of candidiasis and its antifungal susceptibility is crucial in enhancing effective control and treatment. Aim: To determine the subsite-specific prevalence of candidiasis among Head and Neck Cancer (HNC) patients undergoing radiotherapy. Materials and Methods: A cross-sectional study was conducted on patients undergoing therapy for head and neck malignancies at the Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur, Kerala, India over a four-year period (January 2019 to December 2022). A total of 276 patients aged 18 to 85 years with squamous cell carcinoma were included. Oral samples were collected from patients who developed candidiasis, and co-morbidities and risk factors were documented. Candida species were isolated and identified. Antifungal susceptibility was determined using the VITEK system, and fluconazole susceptibility was compared with the standard disc diffusion method. Data were entered into an Excel sheet and analysed using Statistical Package for the Social Sciences (SPSS) software. Results: Pharynx was the most frequent site of head and neck malignancy, accounting for 104 cases (37.7%), followed by the oral cavity with 83 cases (30.1%). Among patients with malignancies in the pharyngeal region, a high rate of Candida infection was observed in 42 (43.3%) out of 97 cases. Candida species isolated included C. albicans (56, 57.7%), C. tropicalis (26, 26.8%), C. krusei (8, 8.3%), C. glabrata (3, 3.1%), and C. parapsilosis (4, 4.1%). Sixty-five patients (23.5%) had diabetes, which was statistically significant (p-value

The incidence of Invasive Aspergillosis (IA) is increasing. Early diagnosis and treatment are very important to improve patient survival, especially in immunocompromised patients. The diagnosis of IA is challenging as clinical indicators are limited, and early microbiological confirmation of the infection is infrequent. Here, the authors present the case of a 43-year-old male who was undergoing radiotherapy along with concurrent chemotherapy for carcinoma supraglottis. He developed Invasive Pulmonary Aspergillosis (IPA) along with candidiasis within two weeks of therapy. Voriconazole remains the recommended therapy for patients with IA, which also acts against fluconazole-resistant Candida species.

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

Introduction: Rotator Cuff Injuries (RCIs) are common shoulder injuries, and the supraspinatus muscle, which is part of the rotator cuff, plays a crucial role in shoulder abduction. The mini-open repair technique offers several advantages, including being less invasive, leading to reduced postoperative morbidity, and shorter operative times. Aim: The aim of this prospective interventional study was to assess the functional consequences of open microscopic repair and the functional implications of supraspinatus tendon repair following the procedure and during the postoperative healing period. Materials and Methods: The study was conducted at the Department of Orthopaedics at Great Eastern Medical School and Hospital in Srikakulam, Andhra Pradesh, India. The study duration was one year, from July 2020 to July 2022. A total of 120 patients aged between 20 and 60 years were included, and all surgeries were performed by the same surgeon. Patients were followed up for one year and evaluated with ConstantMurley Score (CMS) system. Patient data were analysed based on gender, age, degree of tears, clinical test results, and postoperative scores. Levene’s test was used to determine variance homogeneity, and the Student’s t-test (two-tailed, dependent) was used to determine the statistical significance of study parameters on a continuous scale within each group. Results: The study included 120 patients (84 males and 36 females), and the majority of them had traumatic tears. When data was analysed based on patient age, the majority were between 46 and 50 years (33 patients, 27%), followed by the age group of 41-45 years. At the end of one year, the outcomes were excellent in 68 patients, good in 24 patients, satisfactory in 16 patients, and poor in 12 patients. Conclusion: Based on the results of the mini-open technique, the authors concluded that mini-open rotator cuff repair resulted in superior repair integrity and shoulder function.

Acute Mesenteric Ischaemia (AMI) is a group of disorders characterised by a sudden occlusion of blood supply to varing portions of the small intestine, eventually progressing to ischaemia and peritonitis. The present case series highlights a total of seven cases, three of which are classified as acute superior mesenteric artery thrombosis and four as acute superiormesenteric vein thrombosis. The typically symptoms reported were sudden onset of abdominal pain, distension, and melena (a late finding). Among the seven cases, four patients who received early intervention had favourable outcomes. All patients presented late with peritonitis symptoms, except for one patient. Emergency laparotomy was performed on all patients, except for one who underwent diagnostic laparoscopy. Therefore, although abdominal pain is an uncommon symptom, physicians need to exercise a high level of diligence. If left untreated, the overall mortality rate consistently exceeds 70-90%. This case series emphasises the importance of timely diagnosis, early intervention, and immediate postoperative heparinisation, which significantly decrease morbidity and mortality.

Introduction: Renal Cell Carcinoma (RCC) is the 9th and 14th most common cancer in men and women, respectively, and among the most lethal urological cancers. Upto 30% of patients experience recurrence within five years postnephrectomy. Therefore, the predictors of disease survival and molecular markers associated with clinical prognostic parameters should be identified. Aim: To examine the histopathological features of RCC and investigate the association of Tumour protein p53 (p53) and Cluster of Differentiation 44S (CD44S) expression with prognostic factors. Materials and Methods: The present prospective crosssectional study was conducted in the Department of Pathology, M.S Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India, from June 2017 to May 2019. Radical and partial nephrectomy specimens of RCC patients were obtained for the study. In each case age, tumour histologic type, tumour size, Fuhrman nuclear grade, rhabdoid features, necrosis, tumour stage and p53 and CD44S status were evaluated through immunohistochemistry. The Chi-square test was used to evaluate differences in CD44S and p53 expression among different groups. Data were entered in Microsoft (MS) Excel version 11 and was analysed using International Business Machines Statistical Package for the Social Sciences (IBM SPSS) software version 20.0. Results: The study included 50 RCC patients with a mean age of 56.64 years and male:female ratio was 2.8:1. CD44S and p53 positivity were noted in 33 (66%) and 27 (54%) patients, respectively. Weak, moderate, and strong CD44S expression were observed in 13 (26%), 8 (16%) and 12 (24%) patients, respectively and those of p53 in 9 (18%), 14 (28%) and 13 (26%) patients, respectively. Patients with higher Fuhrman nuclear grades exhibited stronger CD44S (n=24, 85.71%) and p53 (n=19, 67.85%) expression than did those with lower grades. Conclusion: The clear cell carcinoma is the most common histologic subtype. Presence of rhabdoid features and necrosis is seen with advanced Tumour, Nodal and Metastasis (TNM) stage. A significant association between p53 and CD44S immunohistochemical expression and higher Fuhrman nuclear grade suggests increased expression of p53 and CD44S and indicates an aggressive clinical course that can be used as a marker of poor prognosis.

A 62-year-old man reported to the Outpatient Department (OPD) with the chief complaint of a skin growth in the lower left back tooth region for the past three years. He complained that the growth was initially small and gradually increased in size. He had no history of tenderness but had discomfort on mastication. Medical history was non significant, and his dental history revealed that the patient underwent restorations in the past and had his teeth extracted. Upon clinical examination, no extraoral abnormalities were detected

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

Introduction: Hepatitis is a major public health concern. The social media platform, allows for the unregulated dispersion of information related to many public diseases, even by unverified accounts that are easily accessible to the population. Dispersion of unverified and unregulated information about major health conditions like “Hepatitis” by Instagram, an easily-accessible and popular social media platform, can put public health at risk. Aim: To evaluate the type and authenticity of the information available on Instagram related to the disease “Hepatitis”. Materials and Methods: A cross-sectional observational study was conducted virtually over a period of ten days in August 2022. Top four “Hepatitis” related hashtags on Instagram identified by the maximum number of posts- (#hepatitis, #hepatitisawareness, #hepatitistreatment, and #hepatitisa) were taken into this study. Posts in language “English” or “Hindi” and containing information about the disease “Hepatitis” were included in the study. A questionnaire was made for assessment of these posts based on various pre-determined categories- type of post, type of information circulated and to assess if it is “true”, “false” or “cannot be determined” using World Health Organisation (WHO) factsheet on hepatitis and Centers for Disease Control and Prevention (CDC) guidelines. Results: Out of the top 400 posts analysed, 388 (97%) were found relevant to the study. These posts had information related to the description {274 (70.62%)}, prevalence {95 (24.48%)}, aetiology {233 (60.05%)}, prevention {172 (44.33%)}, treatment {75 (19.33%)} and mortality {72 (18.56%)} of the disease “hepatitis.” A large number of posts {314 (80.93%)}, had authentic information about the disease. Conclusion: Although a large number of Instagram posts related to the disease “ Hepatitis” has authentic information and were posted by doctors and the health and wellness industry, these accounts could not be verified. Government and the national medical association should join hands to create a platform to deliver authentic information to the population related to “Hepatitis” and verify the already available information.

Introduction: The credibility of the published scientific literature is dependent on various dynamic factors like the type of research, type of journal, journal indexing, impact factor which are subjected to constant changes. Calculating publication points, as a form of performance measure to award promotions for postgraduate faculty is used in many developing and in some developed countries. Aim: To determine the knowledge of the Dental Council of India (DCI) point system among orthodontists associated with a Dental College and to develop a colour-coded guide of Orthodontics journals. Materials and Methods: This cross-sectional study was conducted in the Department of Orthodontics, of an Educational Institution from July 2021 to December 2021, and a structured questionnaire was self-designed and made available in Google forms. This cross-sectional epidemiological study was conducted among the orthodontic faculty. A total of 428 complete responses were obtained and all the responses were evaluated using one way analysis of variance with Tukey’s Post-hoc tests and Independent sample t-test. A survey of all the journals that related to the field of orthodontics was performed in various databases. Journals that are included in the DCI categories were listed and colour-coded. Results: Majority of study participants in this study were professors (53.3%) followed by readers and senior lecturers (15.9% each). Significant differences (p-value=0.021) were noted in participants’ knowledge on the DCI points system based on designation. Almost all the respondents reported indexing of the journal to be the basis for selecting a journal. Only 8.4% responded that, they were not aware of the DCI’s points system for publications. Subjects with self-reported awareness on the DCI points system showed a significantly higher mean knowledge score compared to their counterparts. Conclusion: Subjects with self-reported awareness on the DCI points system showed a significantly higher mean (2.412±0.793) knowledge score compared to their counterparts. A colour-coded guide was developed to eliminate the bias in point calculation completely and help academicians select a journal suitable for academic promotions.

Introduction: Orphan children are usually abandoned by their parents and these children are more vulnerable to oral health problems due to lack of knowledge and psychological support. These children do not receive adequate preventive health care and often suffer from oral health diseases. Oral Health Education (OHE) is the paramount of health promotion and prevention of oral health disease and also it throws some light on unattended oral health problems. Aim: To assess the knowledge, attitude and oral hygiene practices among 10 to 15 year-old orphanage children and to compare the effectiveness of OHE using video (child model) vs conventional method (Dentist) on knowledge, attitude and oral hygiene practices. Materials and Methods: This prospective interventional study was conducted among 120 orphanage children of 10-15 years in Puducherry, India. OHE using dentist and child model OHE video intervention was given to group I and group II, respectively. Knowledge, attitude and practice scores of both the groups was assessed at pre-test, post-test and 15 days follow-up using a prevalidated questionnaire. The data thus collected were statistically evaluated using repeated measures of Analysis of Variance (ANOVA), independent t-test, percentage. Results: When compared with baseline, a significant increase in knowledge, attitude and practice scores were seen in post-test and follow-up of child model video group when compared to conventional dentist led OHE group (p≤0.001). The results of this study indicate that knowledge, attitude and practice regarding oral health were improved in OHE using child model video group. Conclusion: From the results of this study it was found that incorporation of video in imparting OHE using child model can be an effective tool in improving oral health knowledge and it is evident that these children will be more confident, comfortable receiving instructions from children of their age group.

Introduction: Endodontically treated tooth reinforced with posts should restore its lost structural integrity, as well as withstand the various masticatory forces. Choosing the appropriate post, so that a durable prosthesis can be given, is often a challenge to a restorative dentist. Aim: To compare the resistance to fracture, of endodontically treated teeth restored with the various posts when subjected to compressive loads, and analyse the different types of fractures and cracks which are visible under normal eye, microscope and radiograph. Materials and Methods: An in-vitro study was conducted in the Department of Dentistry, Pondicherry Institute of Medical Sciences, Puducherry, India, from February 2019 to March 2020. Study was done with four types of posts namely cast post, stainless steel, fibre and titanium on seventy extracted teeth, which were randomly allocated into five groups with one group as control without any post. The teeth were subjected to increasing compressive loads with universal testing machine and the loads at which fracture occurred was recorded. The data was analysed statistically with one way Analysis of Variance (ANOVA) and the groups were compared with Tukey’s HSD test. The types of fractures that occurred were also analysed. Results: The loads at which the teeth reinforced with various posts fractured, showed significant difference (p-value

Introduction: A quality night sleep is essential for physical, cognitive, and emotional well-being. The amount of sleep may have an effect on both weight and metabolism. In India, for the last few years, decline in sleep duration has been noted with an average sleep duration of 7 hours per night and one-third sleeping less than 7 hours per night. Televisions and smartphones which came into households as remarkable source of information and entertainment has caused the voluntary sleep restriction. Aim: To evaluate the sleep quality, Body Mass Index (BMI) and Blood Pressure (BP) of the healthcare students and also to find the correlation of sleep quality with BMI and BP. Material and Methods: The present cross-sectional study was conducted on 138 healthy males and females healthcare students residing in hostel premises of Yenepoya (Deemed to be University), Karnataka, India from November to December 2021. Pittsburgh Sleep Quality Index (PSQI) questionnaires administered to assess the sleep quality by adding the seven components of PSQI score ranging from 0 to 21. A weighing scale, sphygmomanometer, and stadiometer instruments were used to record the weight, BP, and height. Data were computed in International Business Management (IBM) Statistical Package for Social Sciences (SPSS) software version 23.0 to analyse descriptive and inferential statistics. Results: The mean age in present study was 23±0.72 years and 71 (51.4%) belonged to 22-23 years, majority 112 (81.2%) were female students. In present study, moderately obese students (33.15±0.72) and severely obese (35.39±0.10) had mean sleep score of 6.00±3.46 and 11 respectively indicating poor sleep quality. The underweight (16.91±1.17), normal weight (21.49±2.04) and overweight (26.49±1.48) had mean sleep score of 3.08±1.62, 3.08±1.12 and 4.66±3.05 respectively, which indicated good sleep quality. Students with hypotension, normal BP and hypertension stage-1 showed mean sleep score of 3.52, 2.71 and 4.77 respectively, showing good sleep quality. A statistically significant positive correlation of BMI was found with SBP (r-value 0.273, p-value 0.001) and DBP (r-value 0.181, p-value 0.033). Conclusion: BMI and BP were positively correlated with sleep quality. Therefore, creating awareness among healthcare students on healthy lifestyles such as exercise, healthy sleep and regular health supervision is essential to prevent pre-hypertension and maintain normal BMI status.

In treating mandibular fractures, accurate anatomical reduction and reconstruction remains quite challenging and arduous for the oral maxillofacial surgeon using traditional devices and methods. Therefore, advanced techniques have become essential to simplify and achieve safe and desirable anatomical reduction with lesser operative time. Introduction of 3 Dimensional (3D) printed guides helps to achieve bony consolidation in the correct anatomic position to facilitate standard mouth opening and restore the pretrauma occlusion. In the following case reports (7-year-old male, 35-year-old male), the preoperative surgical planning began with the construction of 3D imaging in both the cases after radiographic examination. For virtual reconstruction, the images from the multiplanar Computed Tomography (CT) scan were converted into Digital Imaging and Communications in Medicine (DICOM) format. The present reports have proposed using an inexpensive customised 3D printed cast metal surgical guide in the treatment of two cases of mandibular fracture. A customised 3D printed surgical guide and an occlusal stent were designed and fabricated to assist in placing screws and plates for approximation of fractured segments and to guide the occlusion during surgery. They also highlight the efficacy and functionality of a customised 3D printed cast metal surgical guide in increasing the reduction accuracy, reducing surgical difficulties, and improving clinical outcomes with a lesser operative time in treating mandibular fractures.

Introduction: Physical models are being used in embryology lectures along with PowerPoint presentations to improve the spatial orientation of students. But the demonstration of the sequence of changes is not possible with commercial models due to nonavailability and high expenses. The latest audio-visual aids including three-dimensional projections like simulation-based screens, or virtual reality enhance the visual-spatial ability of the students but are very costly and not affordable for all institutions. Aim: To compare the effectiveness of hand-made physical models with the PowerPoint presentation mode of teaching in understanding the 3D concept of embryology, among first-year MBBS students and to assess the students’ perception of this model-based teaching. Materials and Methods: The study was conducted using a quasi-experimental study design, on 218 phase 1 medical students of Government Medical College, Thiruvananthapuram, Kerala, India, from February 2020 to August 2020. The students were divided into two equal groups. Group B was taught the topic “Second week of embryonic life” with a PowerPoint lecture session (n=109) and the Group A had in addition a demonstration with the handmade models (n=109). Pretest and post-test were conducted with an internally validated questionnaire. Feedback on the student’s acceptance of teaching/ learning with models were also collected. The improvement of the test scores was analysed using paired t-tests in both the test and control groups. Results: Statistically significant improvement in knowledge score was obtained while comparing the post-test scores of the intervention group (mean score was 4.83±2) with that of the non intervention group (mean score was 3.99±2.06) (student’s t-test, p-value

Introduction: Non Alcoholic Fatty Liver Disease (NAFLD) in the absence of overweight and obesity has been defined as ‘lean NAFLD’. Metabolic syndrome associated diseases in low and middle income countries have variable phenotypes and clinical outcomes. Hypothetically, ‘Lean NAFLD’ can be a part of the spectrum of classical obesity related NAFLD or separate entity with different pathophysiology. Aim: 1) To characterise the NAFLD in lean/non obese subjects; 2) To explore how it differs from classical ‘obese phenotype’ of the NAFLD; 3) To explore how these lean/non obese subjects with NAFLD are different from healthy lean/non obese subjects in terms of metabolic profile. Materials and Methods: The present study was a crosssectional observational study conducted over a period of six months. Forty subjects were categorised into four groups (1. Lean NAFLD without Diabetes; 2. Lean NAFLD with Diabetes; 3. Obese NAFLD with Diabetes; 4. Lean healthy subjects). Clinical history, examination, anthropometry, biochemical data including insulin resistance by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) were analysed. Results: Mean Body Mass Index (BMI), Fasting Blood Glucose (FBG) and HbA1c (Glycated haemoglobin) of group 2 and group 3 were significantly higher than that of group 1 and group 4 subjects (p0.05) and also of group 2 and group 3 subjects (p>0.05). Conclusion: Lean NAFLD subjects have a different metabolic profile than overweight-obese patients with NAFLD, particularly in relation to diabetes. On the basis of all metabolic parameters and insulin resistance, authors propose a spectrum of insulin resistance ‘Non obese Control - Non obese NAFLD without Diabetes Mellitus (DM) - Non obese NAFLD with DM - Obese NAFLD with DM’.

Introduction: Diabetes is a common disorder that is prevalent in the general population. As it advances, it causes a multitude of consequences, some of which are fatal. Diabetic Neuropathy (DN) is one such illness that causes nerve damage, and it is quickly recognised and diagnosed using a technique known as biothesiometry. Aim: To create an assessment tool based on an Artificial Neural Network (ANN) that evaluates diabetic foot based on Vibration Perception Threshold (VPT) values. Materials and Methods: This experimental and predictive study was done using VPT values for 696 controlled and diabetic groups selected by purposive sampling. The VPT was measured by a biothesiometre. A metal probe was placed under the foot of the person and the voltage was increased gradually from zero and the transition from no vibration to the point of vibration is marked as VPT. Average of three measurements were taken to calculate the VPT value of the given patient. This involves the VPT value which helps in the assessment of severity of the condition. The recorded data was fed as an input to the ANN model which predicted the average VPT value of the left and right foot. Furthermore, the ANN model was assessed my means of statistical measures and parameters. Results: The results of the study confirmed the correlation between the values of VPT acquired at different points of the foot and the coefficient for the left and right foot was found to be 0.99549 and 1.0000 respectively. Furthermore, the efficiency of the proposed ANN model was assessed using statistical measures like Mean Square Error (MSE), Mean Absolute Error (MAE), Square Sum Error (SSE) and Coefficient of determination (R2). The predicted values were very close to the experimental VPT results, and the correlation coefficient R are 0.99549 and 0.99975 for the left and right foots respectively, which shows the best settlement. Conclusion: The study concluded that VPT acquired from the foot of diabetic patients is useful in categorising the level of severity of DN. Furthermore, the results of ANN model proved that there exists a strong correlation between the average VPT values of left and right foot and those that are acquired from different points of the foot such as Great Toe, First metatarsal, Third metatarsal, Fifth metatarsal, In step and heel which concluded the study to be effective in the assessment and diagnosis of DN.

Celiac axis compression syndrome is an uncommon entity of abdominal vascular compression syndrome which results from the compression of the proximal celiac artery by the hypertrophied median arcuate ligament. The patients present clinically with postprandial abdominal pain predominantly in the epigastric region and weight loss. The use of thin-section Multidetector Computed Tomography (MDCT) and 3-Dimensional (3D) image reconstruction has greatly improved the ability to obtain detailed images and helped to assess the abdominal vascular system non invasively. Five cases of celiac axis compression syndrome with its characteristic MDCT imaging features like hooked appearance, thickened median arcuate ligament more than 4 mm, poststenotic dilatation and posterior and inferior displacement of celiac artery with indentation on aorta have been described in the present case series and the imaging findings described by other authors in their reported studies have also been compared.

Introduction: Intravenous thrombolytic therapy has become the standard of care in patients with acute ischaemic stroke. The success of this therapy depends on achieving the shortest time between the onset of stroke and reperfusion. Many clinical tasks like neurological assessment, imaging and its interpretation, exclusion of contraindications and informed consent must be taken care of, prior to administration of thrombolytic therapy. As this is a time sensitive intervention, it may have variable outcomes in different settings. Aim: To evaluate the immediate and 90-day neurological outcome of the patients who had received intravenous thrombolytic therapy in acute ischaemic stroke and to evaluate its association with stipulated critical time intervals. Materials and Methods: This was an ambispective observational study conducted for a period of 18 months (April 2018-October 2019) in the Emergency Department of Pushpagiri Institute of Medical Sciences, Thiruvalla, a tertiary care hospital in central Kerala, India. For the prospective arm of the study, data were collected from the patients who came to the Emergency Department with acute ischaemic stroke in the window period (three hours) or in the extended window period (3-4.5 hours). Onset to door time, door-to-imaging time, door-to-needle time and onset-to-needle time were assessed and recorded. National Institute of Health Stroke Scale (NIHSS) score at presentation and at 24 hours post-thrombolysis was noted. Magnetic Resonance Imaging (MRI)/Computed Tomography (CT) brain report 24 hours post-thrombolysis was followed-up. The functional outcome at 90 days was assessed using Modified Rankin Scale (MRS) score. For the retrospective arm of the study, the relevant data were collected from the hospital records and the patients were followed-up. The association between the stipulated critical time intervals and 24 hours post-thrombolysis NIHSS score, as well as MRS score at 90 days were calculated using the statistical analysis tool STATA v.14. Statistical comparisons were performed between subgroups using the Chi-square (χ2) test, Fischer’s-exact test, Wilcoxon signed-rank test, and Mann-Whitney U-test as indicated for dichotomous or continuous variables. For all statistical analyses, a p-value of

Introduction: Neck braces are commonly used to immobilise and support the neck and spinal cord. Even though neck brace has given significant assistance for proper management of cervical spine injuries, it offers a false sense of security where it might prevent additional and further spinal cord injury. Customised neck brace can provide additional comfort. Furthermore, doctor’s views and opinions were taken into consideration and the design has been altered and also can be made customisable to suit every patient, ensuring their comfort at the same time. Aim: To design a 3D printable neck brace and to evaluate it numerically by means of Finite Element Modelling (FEM). Materials and Methods: The model was designed in Autodesk Fusion 360 software and then was imported into HyperWorks for further analysis. Polylactic Acid (PLA) was assigned as a material to the model and it was analysed under two conditions after assignment of materials properties such as young’s modulus, density and Poisson’s ratio. HyperView was utilised to visualise the results of the linear static analysis to further enhance the model. Results: The maximum displacement, stress and strain of the model was observed in the posterior and interior segments which was found to be 1.813E-06, 1.109E+0, 4.805E-02, respectively upon application of a force of 20 N and 1.656E-06, 1.202E+03, 2.286E-07 respectively when a force of 100 N was applied. Conclusion: The study found varying stress, strain and displacement values upon application of an external force which was used in the evaluation of the model. It was also found that PLA material led to better alignment and strength of the overall model and a mixture of PLA and natural rubber can be used as a viable 3D printing filament.

Introduction: Tuberculosis is a major public health problem in majority of the developing countries. Pleural effusion develops when fluid accumulates between the parietal and visceral pleura. Aim: To evaluate the efficiency of corticosteroids in rapid clinical and radiological resolution of Tubercular Pleural Effusion (TPE). Also to study the recurrence of pleural effusion and find incidence of pleural fibrosis in patients treated with corticosteroids. Materials and Methods: This prospective interventional study was conducted at Government Chest Diseases and TB hospital (tertiary care teaching hospital), Telangana, India, from October 2014 to October 2016. Total 80 patients with TPE were divided into two groups. Steroid group (n=40), patients received standard Antitubercular Treatment (ATT) that was alternate day regimen along with prednisolone 0.75 mg/kg body weight per day for two weeks there after tapering of the dose done every second weekly in next four weeks. Non steroid group (n=40), patients received standard ATT alone that was alternate day regimen under Directly Observed Treatment Short course (DOTS) therapy based on Revised National TB Control Programme (RNTCP) guidelines respectively. All patients were followed in the Outpatient Department at the end of second, fourth, sixth, 24th week. At every follow-up visit, history obtained from patients regarding symptoms and chest radiographs for comparison of reabsorption of pleural fluid between two groups. At the end of treatment ultrasound of the chest was performed to confirm the presence of pleural thickening seen on chest radiograph. Descriptive measures obtained included as mean and standard deviation. The association between two categorical variables done by using Chisquare test. The p-values

Introduction: Surgical management differs for different cystic lesions of liver. Various clinical, biochemical and radiological features are specific to a particular cystic liver lesion pathology and it’s associated complications. Preoperative diagnosis helps to select appropriate surgical approach and tailoring appropriate management. Aim: To evaluate the clinical, biochemical, radiological predictive factors to differentiate between hydatid diseases, simple cyst of liver and biliary cystadenoma. Also to evaluate appropriate management for hydatid disease with cystobiliary communication. Materials and Methods: A retrospective study was conducted at Institute of Surgical Gastroenterology, Madras Medical College, Chennai, Tamil Nadu, India. Data were collected from 65 patients including 44 patients of hydatid disease, 13 patients of simple cyst, and 8 patients of biliary cystadenoma using a maintained database from January 2014 to December 2019 with a follow-up period up to December 2020 (mean follow-up of 47.06±24.37 months). Various parameters like presence of cholangitis, deranged liver function test, number of cystic lesion, presence of calcification, presence of septation with or without enhancement were assessed. Data were statistically analysed using Analysis of Variance (ANOVA) and Chi-square test. Results: There were 44 (67.69%) females and 21 (32.31%) males in this study with mean age of 50.44±12.23 years. Though multiseptation was associated with 27 (61.36%) of hydatid cysts and 1 (7.69%) of atypical simple cyst, it was more specifically present in biliary cystadenoma 8 (100%). Presence of daughter cyst (n=24, 54.55%) in hydatid disease and multilobulated appearance (n=5, 62.5%) in biliary cystadenoma were strong predictors of diagnosis. Radical surgery was associated with significantly less postoperative bile leak than conservative surgery in patients of hydatid disease with cystobiliary communication. Conclusion: Predictive factors can help to make preoperative diagnosis correctly. Radical surgery reduces postoperative bile leak in patients of hydatid disease with cystobiliary communication.

Introduction: Misoprostol is a synthetic prostaglandin E1 analogue widely used for cervical ripening and labour induction. However, optimal dose of misoprostol required to induce labour is still controversial. Aim: To determine the efficacy and safety of 25 μg and 50 μg of intravaginal misoprostol for induction of labour at term and to evaluate maternal and neonatal complications. Materials and Methods: The present study was a prospective, randomised, double blind, single centre study carried out during March 2019 to December 2020. The present study was conducted at Department of Obstetrics and Gynaecology, Maharaja Institute of Medical Sciences, Vijayanagaram, Andhra Pradesh, India. All the selected participants were randomised (1:1) to group 1 which received 25 μg of intravaginal misoprostol (n=70) and group 2 received 50 μg of intravaginal misoprostol (n=70). Based on the Bishop’s score, misoprostol was chosen as labour inducing agent. Number of misoprostol doses, mode of delivery, vaginal delivery duration, maternal and neonatal complications was recorded. Statistical significance among study groups were analysed by using Chi-square test. Results: Postdatism was most frequently reported indication in both the study groups (57.1% and 52.9%). A total of 14 and 4 participants in group 2 and group 1 received only single dose of misoprostol (p

Solitary Bone Cyst (SBC) are the bony cysts which lack epithelial lining. They are also known as simple bone cysts or pseudocyst. This fluid filled lesions, lies in an intact bony wall. These lesions are not a common clinical finding and are frequently discovered by chance in radiographs during routine examinations. The aetiopathogenesis has not been studied in depth, and the management remains controversial. When presented in oral cavity, the most common site of occurrence is body of mandible with 75% occurrence among jaw bones while prevalence in maxilla is only 1% in the jaw bone. In this case report, solitary bone cyst is presented in a 12-year-old male patient, who came with chief complaint of bony enlargement on buccal aspect of maxilla in the posterior region. The lesion presented as a painless swelling for three months gradually increasing in size. The patient was treated with surgical excision and there was no sign of regional recurrence at three months of postoperative follow-up. In this paper, the authors presented a rare case report of solitary bone cyst in maxilla in a paediatric patient.

Introduction: Haemolysis in Autoimmune Haemolytic Anaemia (AIHA) is a result of Immunoglobulin G (IgG) or Immunoglobulin M (IgM) auto-antibodies with or without complement components binding to the Red Blood Cell (RBC) surface and initiating its destruction. Serologic evidence is provided by autocontrol or Direct Antiglobulin Test (DAT). Diagnostic work-up is essential as the management depends on the antibody type. Characteristics of the bound antibody and the target antigen determine the degree of haemolysis. Serological characterisation in AIHA helps to differentiate into its various types which help the clinician to decide on the treatment to be given. Aim: To serologically characterise the auto-antibodies in patients with DAT positive AIHA at a tertiary care teaching hospital. Materials and Methods: This cross-sectional study was carried out in the Department of Transfusion Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India, from March 2019 to February 2020. A 40 consecutive patient samples were included in the study. Characterisation of antibody was done using polyspecific Anti-Human Globulin (AHG) reagent followed by mono-specific AHG reagent by gel method. If antibody was of IgG type, then the subclass was determined by a mono specific anti-IgG1 and anti-IgG3 gel card. Association between antibody types, subtype, and strength of DAT with severity of haemolysis were compared using Chisquare/Fisher’s-exact test. A p-value of less than 0.05 was considered statistically significant. Results: The total study population was 40 patients. The mean age of the study population was 45 years (range 13-78). Out of 40 patients, males were 30 (75%) and females were 10 (25%). The primary and secondary causes for AIHA include 4 (10%) and 36 (90%) respectively. Among 40 patients, 22 (55%) patients had IgG antibody alone, 17 (42.5%) patients had IgG antibody with combination of other antibodies and 1 (2.5%) had only complement (C3d). IgG1 was identified in 7 (18%) of patients, combination of IgG1 and IgG3 in 3 (7.7%). There was a significant association with IgG+combination (p-value=0.03), IgG1+IgG3 (p-value=0.029) and strength of reaction (p-value=0.003) with respect to severity of haemolysis. Conclusion: Presence of multiple antibodies, presence of IgG1 and IgG3 and with complement combination and presence of higher grading of reaction in gel column were associated with severity of haemolysis. We recommend that serological characterisation of auto-antibody in AIHA would help the clinician in assessing the severity of haemolysis so that management can be done appropriately.

Introduction: Estimation of stature is important in the process of identifying unknown and co-mingled human remains in mass casualties and natural disasters. Forensic experts are asked by the investigating officer to help to identify the person from dismembered parts of the body and skeletal remains. Estimation of stature is based on a principle that every body part bears more or less a constant relationship with height of an individual. Literature have documented that the hand parameters can be successfully used for stature estimation. Aim: To determine the relevance of hand parameters in the estimation of stature and also to derive a regression formula for stature from the hand parameters. Materials and Methods: This cross-sectional study was conducted in the Department of Forensic Medicine, Government TD Medical College, Alappuzha, Kerala, India, from June 2017 to June 2018. A total of 210 postmortem cases aged above 20 years were included in present study for the comparison of stature, hand length and hand breadth based on age were measured using standard methodology. Average of measurements of right and left hands were taken. Descriptive statistics were used to summarise height, hand breadth and hand length. Categorical and continuous variables were expressed as mean±SD. Correlation was done using Analysis of Variance (ANOVA) and t-test and predictive equations obtained using Karl Pearson’s correlation coefficient. Results: A total of 210 included 157 males and 53 females, and maximum subjects (78,37.1%) belonged to the age group 41-60 years. Hand length and hand breadth showed significant correlation with stature in both males and females with a significant p-value

Introduction: Online teaching is a crucial challenge in the current pandemic situation. Choosing the right modality for teaching and delivering the information in a very effective manner is critical. Self-paced learning is an important modality that moulds the students into adult learners. Aim: To compare the effectiveness of teaching modalities like self-paced learning and instructor-led live online lecture class based on performance in assessments. Materials and Methods: A cross-sectional study was conducted on phase I medical students over a period of three months where they were given self-paced learning and online instructor-led lecture sessions. Topics and reading materials for self-paced learning were provided to the participants through Telegram. After one week they were evaluated using objective-based assessments. Instructor-led live online lecture classes also were taken for them through Impartus followed by assessments. Independent t-test was done to assess the difference between the both performances based on the scores attained. Results: Total of 86 subjects were included in which 54 were females with mean age 18.75 years and 32 males with mean age 18.84 years. After online lecture sessions, 93.02% (n=80) of students came in the high performers group, while only 65.12% (n=56) of students belonged in self-paced learning sessions. There was no significant difference in performance in both modalities between gender (p>0.05). Conclusion: Instructor-led live online methods are more effective than self-paced learning. Self-paced learning is also important in education as it enhances the quality of adult learning. Implementing e-learning into the current syllabus can be more productive as it augments student teacher interaction.

Introduction: The main issue with the morbidity and mortality of type 2 diabetes is its associated health complications. In the last decade Glycated Albumin (GA) emerged as an extinguished marker for short-term glycaemic control. Aim: To Quadrate the association of Body Mass Index (BMI) along with HDL-cholesterol to GA in Type 2 diabetic cases. Materials and Methods: Total of 50 diabetic cases (Group 1) and 50 healthy non-diabetic control subjects (Group 2) recruited for the study between November 2017 to December 2018, which includes both males and females. Serum samples of both the groups were analysed to assess the lipid profile to GA levels along with BMI. Variations among groups was compared using student t-test by calculating r-values of the parametres and the pearson coefficient was calculated with significant p value at

Introduction: Empathy is a social skill that exerts influence on the quality of social relationships. An empathetic person is able to understand the emotions of others, accurately express their feelings, comprehend other’s situations and act appropriately. Added to the volatile nature of the age, the youth face challenges from social exclusion, gender based violence and the lack of access to rights and opportunities. Aim: To measure empathy levels among college students aged 18-28 years in Kerala and to find out the factors associated with individual variations in Empathy levels among them. Materials and Methods: A cross-sectional survey was conducted among 610 college students of both gender randomly selected from Pathamthitta, Kottayam, Alappuzha, Kollam, and Trivandrum districts in South Central Kerala, India. Interpersonal Reactivity Index (IRI), short version of MalachPines (2005) and Burnout Measure was used for collecting information from study participants. Data was analysed using IBM Statistical Package for the Social Sciences (SPSS) version 20.0 (Chicago, USA). Results were expressed as percentages and proportions. Results: The mean age of the study participants was 21±1.6 years. The mean empathy score and burnout score of study participants were 58±11.9 and 41.03±12.3, respectively. The empathy score among study participants was found to be significantly associated with age of study participants and burnout. Conclusion: The present study revealed a good prevalence of empathy and humanistic values among college students in Kerala. However, certain factors like burnout that can affect total individual empathy scores need to be addressed.

Introduction: In complete denture fabrication, the common denture base material used is heat activated Polymethyl Methacrylate (PMMA). Considering various advantages, still there are some disadvantages like poor flexural strength and poor wear resistance. The flexural strength of any material reflects its potential to resist catastrophic fracture under a flexural load. Another property that influences the surface characteristics of acrylic resins is the surface hardness, which indicates the ease of finishing a material and its resistance to in-service scratching during cleaning procedures and exposure to various oral fluids. Thus an ideal denture base material should exhibit greater flexural strength and high surface hardness for the longevity of the dentures. Aim: To evaluate the effects of adding different percentages of silanised aluminium oxide (Al2 O3 ) nanoparticles on the flexural strength and surface hardness of a conventional heat-polymerised acrylic resin. Materials and Methods: The in-vitro experimental study was conducted between October 2020 to Janaury 2021 at Drs. Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Vijayawada, Andhra Pradesh, India. A total of 120 samples were fabricated and were grouped into four groups coded A to D (n=30). Group A was the control group (without adding Al2 O3 ). Specimens in the other three groups (B to D) were reinforced with silanised Al2 O3 at loadings of 1%, 2.5% and 5% w/w. Flexural strength was assessed with a three-point bending test using a universal testing machine. Surface hardness test was conducted using a Vickers Hardness (VH) tester. Data was analysed using Analysis of Variance (ANOVA) and Tukey’s post-hoc test. Results: Among all the reinforced groups highest flexural strength value was seen in Group C- PMMA+2.5% w/w silanised aluminium oxide nanoparticles reinforced group (88.33 Mpa) and highest surface hardness value was seen in the Group D- PMMA+5% w/w silanised Aluminium oxide nanoparticles reinforced group (29.44 VH). Conclusion: Reinforcement of the conventional heat cured acrylic resin with 2.5% w/w silanised Al2 O3 nanoparticles significantly increased its flexural strength and hardness.

Introduction: The occurrence of invasive fungal infections has increased significantly worldwide, premature infants in Neonatal Intensive Care Unit (NICU) along with other risk factors are at particular risk of these invasive fungal infections which lead to fungal septicaemia in newborns. Candidaemia is the most common form of invasive candidiasis associated with an unacceptably high mortality rates. Candida colonisation in neonates is considered the first step towards developing neonatal sepsis. Aim: To determine the prevalence of Candida colonisation and its characterisation among neonates admitted in NICU. Materials and Methods: The present study was a prospective cross-sectional study with 150 neonates included in the study. Swabs were taken from four different sites of each neonate and inoculated on Chocolate agar and Sabouraud’s Dextrose Agar (SDA) and incubated at 37°C for seven days. Candida species isolated were confirmed by gram stain, germ tube test, growth on Chromogenic (CHROM) agar and cornmeal agar. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 11.0. Results: A total of 32 (21.3%) neonates had Candida colonisation. Twenty two (68.7%) were low birth weight and 24 (75%) were born premature. Perineum was the most common (56%) site of colonisation. Among Candida isolates, Candida tropicalis (63%) was the commonest followed by Candida parapsilosis (25%) and Candida glabrata and Candida albicans (6%). The risk factors identified were low birth weight, premature birth, use of antibiotics. Conclusion: Colonisation of preterm and low birth weight neonates by Candida species is a major risk factor and needs attention to avoid dissemination and life threatening infection.

Introduction: The deformity and imbalance in an osteoarthritic knee undergoing Total Knee Arthroplasty (TKA) are the result of a combination of bony and soft tissue changes locally. Proper and ideal balancing of ligaments is considered essential to the success of a TKA. There are numerous techniques to achieve soft tissue balance in varus knee. More recently, Medial Tibial Reduction Osteotomy (MTRO) has been described as an adjuvant to soft tissue release. Limited data exists on the outcomes of patients requiring a MTRO. There are not many Indian studies available regarding the radiographic and clinical outcomes of medial reduction osteotomy in severe varus deformity in TKA. Aim: To find out the radiological and functional outcome of MTRO for severe varus deformity in patients undergoing TKA. Materials and Methods: This study was Prospective Cohort study conducted at the Department of Orthopaedics, Rajagiri Hospital, Chunangamveli, Aluva, Kerala from December 2018 to November 2019. Twenty patients 15 females and 5 males (30 knees), in the age group 55-80 years with osteoarthritis of knee with severe varus deformity, were enrolled in the study. Preoperative and postoperative standing leg Antero-posterior radiographs were taken for all patients and hip- knee- ankle angle was measured and amount of deformity correction was calculated. Postoperatively, radiographs were taken on the 5th day and 3rd month. Knee society scores were also recorded preoperatively and on the 5th postoperative day, postoperative visits on 6 weeks, 3 months and clinical outcome was assessed. The statistical analysis was performed by SPSS version 25 using Analysis of Variance(ANOVA) and Wilcoxon Signed Rank test. Results: The median knee score improved from 47±9 to 93±3 postoperatively. Similarly, median function score improved from 50±5 to 80±0. The improvement in function score and knee score were statistically significant (p-value 0.001). The correction of varus between preoperative, postoperative (p-value 0.001) day 5 & 3 months postoperatively was statistically significant. No patient required a release of the superficial Medial Collateral Ligament (MCL). The MTRO was associated with statistically significantly improved Knee Society scores and varus deformity correction. Conclusion: In patients with fixed varus deformity of the knee, the MTRO is found to be safe and adequate to achieve coronal alignment.

Introduction: Supracondylar Humerus Fracture (SCHF) is frequently encountered in paediatric age group and constitutes nearly three fourth of all upper extremity fractures. Most commonly used technique for surgical treatment in the displaced SCHF in children is closed reduction and stabilisation with percutaneous pins. Aim: To find out the outcome and safety of percutaneous pinning techniques in terms of functional and radiological outcome and to note the associated complications with this method of fixation. Materials and Methods: This was a cross-sectional study, conducted on patients admitted to Department of Orthopaedics, Hassan Institute of Medical Sciences, Hassan, between January 2017 to December 2019. Thirty paediatric cases were retrospectively reviewed. These were admitted with a supracondylar fracture and had reported to the hospital over a three-year period. All fractures were treated with closed reduction and fixation with percutaneus K-wire followed by immobilisation in above elbow slab for three weeks. K-wires were removed at three weeks and mobilisation with physiotherapy was advised. Outcome was measured by Flynn’s Criteria. The results were analyzed as per appropriate descriptive statistical tests. Results: The mean age of the patients was 7.4 years (range 3-15 years). Males outnumbered females. Total 22 (73.3%) patients had left-sided fracture and 8 (26.6%) had fracture on right side. Fracture union was seen in all the patients at a mean interval of 4.2 weeks (range 3-5 weeks), in a follow up of 12 weeks. Most (90%) of the injuries were the result of trauma, including fall. 70% of the fractures were Gartland Type III supracondylar fracture. Cross K- wire fixation was done in 21 patients and lateral-only pin in 9 patients. Among the 21 patients, who had type III fracture, 4 of them were fixed with 2 Lateral K- wire pinning and 17 of them with crossed K-wire pinning configuration. The commonest post-operative complication observed was a superficial pin tract infection, seen in 4 (13.3%) patients. Outcome according to the Flynn’s criteria 25 patients (83.3%) had excellent result, 3 (10%) patients had good result, 1 (3.3%) had fair result and 1 (3.3%) patient had poor functional result. Conclusion: The present study concludes that close reduction and percutaneous k-wire pinning techniques give a favorable outcome in displaced supracondylar fractures of the humerus in children, without any serious complications.

Introduction: Shoulder joint is a highly mobile joint but is prone for rotator cuff injuries and dislocations. It is necessary to accurately diagnose rotator cuff and labral injuries so that appropriate plan of action for treatment can be taken. Magnetic Resonance Imaging (MRI) can be used to diagnose and describe the extent of rotator cuff tendon and labral injuries and any secondary rotator cuff muscle abnormalities. Aim: To study the demographic profile of patients presenting with shoulder pain and instability, identify the various rotator cuff injuries causing shoulder pain, identify the rotator cuff interval lesions causing microinstability, identify the various labral and bony pathologies in instability, describe the MRI features of the rotator cuff, rotator cuff interval, labral and bony injuries. Materials and Methods: This study was a cross-sectional study of patients with symptoms of either shoulder pain or instability who underwent MRI evaluation of the shoulder in the Department of Radiodiagnosis, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India, from July 2018 to December 2020. The study population consisted of 54 patients with either shoulder pain or instability who underwent MRI of shoulder. All the MRI scans of the shoulder in this study were performed using 1.5 Tesla Siemens Magnetom Avanto (Tim 76x18) MR machine using a flex coil. Results: The study population consisted of 54 patients comprising of 38 males and 16 females. The age of the patients ranged from 20-77 years. Majority of the patients were older than 50 years constituting about 33.33% of the total study population. Rotator cuff injury was the commonest cause of pain. Tendinosis was the commonest type of rotator cuff injury followed by partial-thickness and full-thickness tendon tears. The commonest grade of tendinosis was mild or grade 1. Supraspinatus tendon was the most commonly affected tendon followed by subscapularis and infraspinatus tendons. Teres minor tendon was normal in all the cases. Anterior instability was the commonest type of instability with equal prevalence of soft tissue Bankart, bony Bankart and Perthes lesions. Biceps pulley lesions resulted in long head of biceps tendon instability, microinstability and internal impingement. Conclusion: Rotator cuff injuries are the commonest cause of shoulder pain and are seen more frequently after the fifth decade. Shoulder instability is most commonly seen in young male adults. Tendinosis is the commonest type of rotator cuff injury. Supraspinatus tendon is the most commonly injured tendon. Anterior instability is the commonest type of shoulder instability. Biceps pulley lesions result in long head of biceps tendon instability, microinstability and internal impingement. MRI can diagnose interstitial or intrasubstance tendon tears which are not visualised on arthroscopy. MRI description of tendon and labral tears, tendon retraction and muscle atrophy can guide the orthopaedician during arthroscopy and in treatment planning.

Introduction: Polycystic Ovarian Syndrome (PCOS) is the most frequent gynaecological endocrinopathy characterised mainly by anovulation and hyperandrogenism. Women with PCOS are at higher risk of developing Cardiovascular Disease (CVD) due to a number of risk factors associated with this disease. Obesity, especially central adipose tissue accumulation, plays a major role in the pathophysiology of this disease. Lipid Accumulation Product (LAP) is a simple, inexpensive index to estimate cardiovascular risk and is based on fasting triglyceride and Waist Circumference (WC). Aim: To find out the association between LAP and cardiovascular risk factors in women with PCOS. Materials and Methods: This case-control study was conducted in the Department of Biochemistry and Department of Gynaecology, Government Medical College, Thiruvananthapuram, Kerala, India. Study subjects included 48 women with PCOS and 48 age and Body Mass Index (BMI) matched controls. Clinical and demographic data and medical history were evaluated. Duration of the study was six months. Anthropometric measurements, Blood Pressure (BP) and biochemical parameters like Fasting Plasma Glucose (FPG), lipid profile were recorded. LAP was calculated using the formulaFemale LAP= {waist (cm) -58} × Triglyceride (TG) concentration (mmol/L). The quantitative variables were expressed as mean and standard deviation. Comparison of continuous variables between two groups was analysed by unpaired t-test. Categorical variables were analysed by Chi-square test. Correlations between continuous variables were tested using the Pearson correlation or Spearman correlation coefficient (r) analysis. The p-value

Introduction: Mantle Cell Lymphoma (MCL) is a relatively rare Non-Hodgkin Lymphoma (NHL) of mature B cells forming 5-7% of NHL. SOX11 has emerged as a useful antibody in the diagnosis of MCL with prognostic significance. Aim: To evaluate the immunomorphologic features and significance of SOX11 expression in MCL at a tertiary care cancer institute. Materials and Methods: This was a descriptive study which was conducted at a tertiary care cancer centre in Southern India over a period of five years from January 2013 to December 2017. Seventy six cases of newly diagnosed MCL with paraffin blocks were included in the study. Immunohistochemistry (IHC) with a panel of antibodies including SOX11 was carried out on Formalin Fixed Paraffin Embedded (FFPE) sections. Morphologic, immunologic findings were analysed and correlated with clinical data and survival, using Chi-square and Independent sample t-test to compare data and Kaplan-Meir method with Log Rank test for survival analysis. Results: Mantle Cell Lymphoma (MCL) formed in 5.8% of NHL with a striking male predominance (M:F ratio, 4.4:1), with mean age of 58 years at presentation and females at a younger age. Nearly 80% of patients presented at an advanced stage. Cervical lymphadenopathy was the most common presenting feature, followed by involvement of the gastrointestinal tract. There were 59 cases of classic and 17 cases of blastoid and pleomorphic MCL, with diffuse pattern being the most common in 36 (47.4%) cases. In the present study, 64 (92.8%) cases expressed SOX11 and showed heterogeneous staining with high expression in 34 (53.1%) cases and low expression in 30 (46.9%) cases. Ki-67 proliferation of more than 30% was seen in 52 (68.4%) cases and 30% or less in 24 (31.6%) cases. None of these findings had statistically significant correlation with survival, though high Ki-67, high MCL International Prognostic Index (MIPI) and blastoid/pleomorphic cases had relatively worse Overall Survival (OS). Conclusion: MCL is a disease of the elderly and in the present study it affected females at a slightly younger age as compared to males. SOX11 expression was heterogeneous in neoplastic cells and was complementary to cyclin D1 for diagnosis of MCL however, the staining intensity had no effect on survival.

With rising demand of surgical interventions post-lockdown due to Coronavirus Infectious Disease (COVID)-19, surgeons all over the country have restarted their surgical practice. To increase caution and safety, seven scenarios in which surgeons in a Tertiary Care Centre in North India encountered COVID-19 patients during lockdown are being highlighted in the present case series. The main aim was to encourage prompt recognition and isolation of positive patients along with establishment of a clear institutional protocol for surgical practice to keep our system resilient and useful for the population we serve. Clinical and radiological records of eleven patients admitted from 22.3.2020 to 31.5.2020 (period of lockdown) in a Tertiary Care Hospital in India were studied separately and concluded consensually by two surgeons and seven unique scenarios in which a surgeon may encounter a COVID-19 patient were identified. First was the COVID-19 positive patient with concurrent symptomatic surgical pathology, second was COVID-19 positive patient incidentally diagnosed with additional surgical pathology and third was a solely surgical patient mimicking COVID19 positive symptomatology. Fourth was a COVID-19 negative surgical patient acquiring nosocomial COVID-19 infection, fifth was COVID-19 positive surgical patient with false negative COVID-19 test report, sixth was COVID-19 suspected by intraoperative unusual intestinal findings and then, getting postoperative COVID-19 test positive for the patient and last was COVID-19 patients requiring elective surgical procedures.

Salmonella Newport is a major cause of food-borne infection which occurs due to consumption of contaminated food items. Stool sample from a suspected case of enteric fever was received in the Central Microbiology Laboratory of a tertiary care teaching hospital in Southern India. The bacterial isolate was identified on the basis of Gram Staining, cultural characteristics and biochemical reactions as Salmonella species. Agglutination for serotyping was done and it was found to be agglutinable by only Polyvalent O antiserum. For further speciation, the isolate was sent to the National Institute of Cholera and Enteric Diseases (NICED), Kolkata, West Bengal, India and was identified as Salmonella enterica serotype Newport. The patient responded well to ciprofloxacin therapy. As the diagnosis of Non-Typhoidal Salmonellosis (NTS) is often challenging, patients with suspected Salmonella infections are usually given empirical antibiotic therapy which can cause an increase in drug resistant NTS.

Introduction: Acute injury to the optic nerve resulting in vision loss is known as Traumatic Optic Neuropathy (TON). Optical Coherence Tomography (OCT) documents the progression of damage of axons over time. Aim: To assess visual outcome of patients diagnosed with TON after management with intravenous (IV) steroids and to study Retinal Nerve Fiber Layer (RNFL) using OCT in patients with TON. Materials and Methods: An observational prospective study was conducted in a tertiary care centre, including 29 TON patients. IV steroids, methylprednisolone was administered in indirect TON patients. RNFL was assessed using OCT on the day of discharge. Follow-up for one week and one month after discharge. Paired t-test/Wilcoxon sign rank test was applied to test the mean differences of the study. Results: Patients treated with IV, steroids showed significant improvement over time. Patients with just Perception of Light (PL) or Hand Movements (HM+) did not show much improvement. Another factor for visual recovery was timing of steroid administration. The time limit was within 24 hours after the injury before full-fledged inflammation sets in. RNFL study using OCT showed reductions in circumpapillary RNFL thickness and Retinal Ganglion Cell (RGC) complex began to decrease at two weeks after trauma and plateaued at 20 weeks in all cases. Conclusion: IV steroids can be considered as a treatment of TON rather than wait for spontaneous recovery. But baseline visual acuity played a crucial role in recovery. OCT is a useful follow-up tool to analyse axonal loss. But a standard protocol is still lacking.

Introduction: Accommodation is the ability to see over a range of distances by changing the power of the natural lens. With cataract surgery, this ability is partially or completely abolished. Apparent accommodation or pseudo-accommodation is the potential of pseudophakic eyes to sustain a good amount of near vision. Aim: To measure near vision in children with pseudophakia unaided, with distance vision correction alone (mono focal lens) in-situ and to measure the minimum near add (bifocal near segment power) required to read 1M (normal reading print size) at 30 cm and 40 cm. Materials and Methods: A cross-sectional study was conducted among children between 5-15 years of age with pseudophakia. Vision assessment was done using Lea symbol chart, at 3 metres for distance and at 30 cm and 40 cm for near. Near vision assessment was done unaided and with distant vision correction alone in place. Minimum spherical power needed to read 1M and child’s class textbooks were also assessed. Results: Sixty-four children were included in the study. Mean age was 10.5 (±3.12) years. Refractive status showed spherical power ranging from -7.00 DS to +1.00 DS (-0.8 Mean, (±1.33 SD), astigmatism ranging from -4.50 DC to +3.00 DC (-1.29 mean, ±1.37 SD). Unaided near vision assessment showed that 41 (64%) could read