bluuebunny/crossref_metadata_2025 huggingface dataset:
Kitchen garden: Perceived role and utilization among rural households in Mandya, Southern Karnataka
Authors: Sheethal MP  , Shashikantha SK  , Neeta PN  , Shwetha Hariba
Published: January 2025

Background: Diversified diet is the key to combat micronutrient deficiency in India. Kitchen garden is a sustainable approach to provide diversified diet in rural area.
Aims and Objectives: The objectives of this study were to assess the utilization and perception of kitchen garden use among the households in rural area.
Materials and Methods: A community-based cross-sectional study carried out among women in the age group 18–65 years in Nagamangala was asked about the details on awareness and utilization of kitchen garden.
Results: One-third of the study subjects were in the age group 30–40 years. About 18.2% of them were involved in some form of agriculture related work. Around 64% of the households had space available for kitchen garden. About 54% households had kitchen garden and 95% of the subjects used their kitchen garden products for self-use.
Conclusion: Having kitchen garden contributes to household food security by providing direct access to food that can be easily harvested, prepared, and consumed.
Cellular diameter in desquamated cells of smokeless tobacco users
Authors: Sonia Jaiswal  , Pradeep Kumar Sharma  , Tahsin Munsif
Published: January 2025

Background: Tobacco-induced mucosal changes have been identified in exfoliated cells. The morphology of the exfoliated cells depends on the nature of the changes taking place in the epithelial layer; conversely, alteration in cytological pattern may be attributed to the changes occurring in the epithelial layer. Applying this possibility, exfoliative cytological techniques have been applied to examine the effect of tobacco on the oral mucosa.
Aims and Objectives: The study was conducted to study the alterations in the cellular diameter of buccal mucosal cells.
Materials and Methods: In a case controlled study, 240 participants were divided into four groups according to their habit of consumption of tobacco leaves, tobacco with areca nut, participants with oral lesions, and participants without any such habit. The groups were, further, subdivided according to their age. Desquamated cells from the buccal mucosa of were collected and smeared on a slide. The cells were stained with Papanicolou (rapid kit). Fifty cells per slide were studied and photomicrographs were obtained at ×40 magnification. The cellular diameter was obtained using the Leica 1000 software.
Results: The mean cell diameter was found to be highest in the group of normal subjects (49.51±7.31 micron), followed by the group of tobacco users (43.52±1.92 micron) and Gutkha users (39.05±3.57 micron). The mean cell diameter was minimum (24.97±3.13 micron) in the group of oral lesion patients. According to the ANOVA test, the difference in cell diameter among various groups is found to be highly significant (P<0.0001).
Conclusion: Tobacco used in any form can induce changes in the buccal mucosa. In our study, mean cellular diameter decreased from normal-cells to cells affected by oral lesions.
Clinico-demographic and hepatic profile as outcome predictor in scrub typhus in pediatric age group
Authors: Tirthankar Kundu  , Radheshyam Purkait  , Manik Mondal  , Sen Sandipan
Published: January 2025

Background: Scrub Typhus, a Rickettsial disease is an emerging tropical disease mainly in South East Asia. Very few studies are there in pediatric age group and mainly limited to epidemiological and clinical profile only.
Aims and Objectives: The main objective of this study is to assess different clinical, laboratory, and biochemical parameters denoting hepatic function in scrub typhus and their role in measuring final outcome and disease severity.
Materials and Methods: This observational study included 90 children with history of febrile illness for ≥5 days between 1 and 12 years of age, diagnosed to be a case of scrub typhus by positive IgM ELISA test to assess the hepatic involvement by different clinical, laboratory, and radiological parameters and also to find out their role in disease severity and outcome.
Results: Fever followed by vomiting was the most common symptoms with eschar evident in only three patients. Raised aspartate transaminase (AST) and alanine transaminase (ALT) were seen in 71.1% and 64.4%, respectively, with hypoalbuminemia in 78.9%, hepatomegaly in 47.8%, and only 2.2% had altered hepatic echotexture on ultrasonography. All of them had ALT: lactate dehydrogenase (LDH) ratio of <5. Shock was the most important predictor of duration of hospital stay whereas serum AST was an important predictor for final outcome and duration of hospital stay.
Conclusion: Predominant feature of hepatic involvement in scrub typhus resembles that of anicteric hepatitis. Serum ALT: LDH ratio may be an important indicator of scrub hepatitis. Among lab parameters serum AST is the most important predictor of disease mortality and morbidity.
Retaining the epigastric trocar, until rest all ports closed decreases post-operative shoulder pain in laparoscopic cholecystectomy patients
Authors: Leesa Misra  , Navya Teja  , Swastik Mishra  , Manash Ranjan Sahoo
Published: January 2025

Background: Laparoscopic cholecystectomy has become the mainstay of treatment for gallstone disease cases due to its lower morbidity and pain compared to open techniques. Unfortunately, the use of carbon dioxide to insufflate the abdomen is the main contributor to post-operative shoulder pain.
Aims and Objectives: The aim of the study was to evaluate the effectiveness of retaining the epigastric port trocar in position until rest all ports closed after completion of lap cholecystectomy in decreasing the post-operative shoulder pain.
Materials and Methods: A prospective, randomized, and clinical trial was done in AIIMS hospital, Bhubaneswar, on 102 patients who have undergone laparoscopic cholecystectomy. The patients were alternatively selected, one in the study group (52) and the other in the control group (50). For those patients in the study group, after the completion of the surgery, the epigastric port trocar is retained in position until the rest of all ports were closed. In the control group, all trocars were removed and port closure was done. The patients were evaluated for the next 24 h for post-operative shoulder pain. A numerical rating scale (NRS) was used to assess shoulder pain on patient arrival to the ward, at 4, 6, 12, and 24 h postoperatively. One hundred and two patients were included in the final data analysis.
Results: NRS pain scores were significantly lower in the study group at 6, 12, and 24 h post-laparoscopic cholecystectomy compared to the control group with no additional requirement of IV analgesics.
Conclusion: Retaining the epigastric trocar in position is an easy way that is beneficial in reducing post-operative shoulder pain post laparoscopic cholecystectomy surgery.
A case series on post-traumatic facial nerve palsy
Authors: Praveen Kumar J  , Sengottuvelu P  , Semmanaselvan K  , Nerthipriya R
Published: January 2025

Road traffic accidents accounts a for substantial proportion of traumatic facial nerve injuries. Facial nerve paralysis causes considerable facial disfigurement and emotional distress to the patient. It can cause detrimental effect on both voluntary and involuntary actions of facial muscles. Importantly, it can interrupt normal daily functions such as eating and drinking. Therefore, early identification and surgical intervention are of prime importance in the management of traumatic facial nerve palsies, which is described below in this case series. The goal is to find out type of temporal bone fractures in patients with traumatic facial nerve palsy, to find out the common site of facial nerve injury in patients with traumatic facial nerve palsy, and to assess the surgical outcomes in patients who underwent facial nerve decompression. Case series of five patients who are admitted in ENT Wards in Rajiv Gandhi Government General hospital with traumatic facial nerve palsy were included in this study. Thorough history taking, otoscopic examination, audiological evaluation, radiological Imaging (HRCT temporal bone), topodiagnostic tests, and nerve conduction studies were done in all the five cases. All five patients presented with either grade 3/grade 4 facial palsy according to House–Brackmann’s grading system. HRCT temporal bone showed a fracture line in all the five cases. Electroneuronography showed more than 90% degeneration in all the cases. All the patients underwent facial nerve decompression followed by a course of oral steroids and post-operative physiotherapy. All five cases showed remarkable improvement in facial palsy after surgery with leveling up to House–Brackmann grade 2 and grade 1, early identification of facial nerve palsy due to trauma and prompt management by surgical intervention plays a important role in the management of facial nerve palsy.
Validation of two preoxygenation techniques, 3 min tidal volume breath and eight vital capacity breath techniques in tribal and non-tribal population of Eastern India
Authors: Tirtha Ratan Ghosh  , Suman Sarkar  , Debarati Goswami  , Saptaki Majumder  , Debasish Saha
Published: January 2025

Background: Preoxygenation during anesthesia can be done by 3 min tidal volume breath and eight vital capacity breath in 1 min, conventionally. Population of our country is not homogenous.
Aims and Objectives: The present study was conducted to validate preoxygenation processes in people of eastern India.
Materials and Methods: Total 140 patients of ASA grade I and II, age group 20–50 posted for surgeries under GA were allotted in TV and VC group. Every odd number and even number patient was tested for TV method and VC method, respectively, with a Magill circuit and airtight face mask with 100% oxygen flow at a rate of 10 L/min. Time and number of breaths were noted when end tidal oxygen concentration ≥90% in TV and VC group, respectively.
Results: In TV method, the mean time (in minute) was 3.10±0.27 and 3.13±0.24 for tribal and non-tribal sub-group (P=0.80); 3.02±0.37 and 3.10±0.27 for tribal and non-tribal male (P=0.57); and 3.18±0.05 and 3.16±0.21 for tribal and non-tribal female (P=0.57). In VC method, mean number of VC breaths was 8.32±0.60 and 8.43±0.74 for tribal and non-tribal sub-group (P=0.76); 8.75±0.49 and 8.23±0.70 for tribal and non-tribal male (P=0.42); and 8.20±0.60 and 8.60±0.72 for tribal and non-tribal female (P=0.16). Patients completing preoxygenation in TV and VC method – tribal: 22% and 53%, non-tribal: 4% and 62%, tribal male: 22% and 20%, non-tribal male: 8% and 68%, tribal female: 0% and 60%, and non-tribal female: 0 and 57%, respectively.
Conclusion: No significant difference found between tribal and non-tribal groups of both sexes in each method. Completion of preoxygenation was higher in VC group, though not tested statistically.
A cross-sectional study of severe acute malnutrition impact on auditory evoked potentials in children age 6–59 months
Authors: Anju Agarwal  , Virendra Verma  , Prachi Arya  , Neetu Sharma  , Ajit Singh Rajput
Published: January 2025

Background: Malnutrition is a public health concern in India. According to NFHS-5, the number of children under 5 years who are stunted (less height-for-age) and underweight (less weight-for-age) in India, are 35.5% and 32.1%, respectively. Many researchers reported that malnutrition affects myelination and neural maturation of the auditory brainstem pathway.
Aims and Objectives: In this study, auditory evoked potential (AEP) parameters were studied in severly acute malnutrition (SAM) children of 6 months to <5 years of age.
Materials and Methods: Fifty children, with severely malnourished (Their weighted age was 51–60% of the expected weight, and height for age <85% of the expected height) and 50 healthy children (with weight >80% of expected with normal height for their age), aged 6–59 months were included in the study. The parameters of AEPs were recorded using RMS-EMG EP MARK II, a 4-channel machine.
Results: In our study, 30 (60%) males and 20 (40%) females had severe acute malnutrition. There were significant differences in the mean latencies of the waves I to V and the mean interpeak latencies (IPLs) of the waves I-III and I-V on the right and left ears between the study and control groups (P<0.05). The mean IPLs of I-III and I-V on the right side were found to be longer in the SAM group than in the control group (P<0.05. While the mean absolute peak latencies of wave, I found prolonged on both ears in the children with SAM (P<0.05).
Conclusion: In the present study, severely acute malnourished children showed changes in AEPs characterized by absolute wave prolonged latencies and interpeak intervals compared with normally nourished children.
The noise profile and hearing impact of commercial fiberglass reinforced plastic speed boats in Port Blair, Andaman and Nicobar Islands
Authors: Jonathan Lalchawilena  , Lalhmingmawii
Published: January 2025

Background: Hearing impairment may result from tourism-related vehicle engine noise in Port Blair, Andaman, and Nicobar Islands.
Aims and Objectives: Measure noise levels and test commercial fiberglass-reinforced plastic (FRP) speedboat operators for hearing loss.
Materials and Methods: Hearing loss and noise impacts were checked in a total of 145 male crew members and workers exposed to commercial FRP-speedboat outboard engine noise. 18–50-year-olds with 1–20 years of experience participated. To detect hearing loss, noise-induced hearing loss (NIHL) risk indicators that could appear as a 4 kHz noise notch and the existence of high-frequency sloping hearing loss were detected using pure tone audiometry. The level of noise exposure was measured in conjunction with a questionnaire to assess an individual’s general knowledge of the effects of noise and hearing loss.
Results: A 4 kHz noise notch, some high-frequency slope hearing loss, and an overall hearing loss rate of 42.1% were found in 145 participants. Out of these, 15.9% had the most common bilateral notch. Bilateral high-frequency sloping was 10.3%, Unilateral high-frequency sloping was 4.9%, and unilateral 4 kHz notch was 11.0%. According to the questionnaire, research participants are shockingly unaware of noise-induced hearing loss. The FRP Speedboat outboard engine’s measured noise level ranged from 79.7 to 89.4 dB (A).
Conclusion: The FRP Speedboat crews were at risk of hearing loss, specifically NIHL with continuous noise exposure. High frequency sloping hearing loss, mild to moderate hearing loss, and a substantial 4 kHz noise notch are found in noise-exposed employees. Awareness is needed to prevent irreversible hearing loss.
Idiopathic pure red cell aplasia: A case series from India
Authors: Manoj U Mahajan  , Sunil Goel  , Harsh Patel  , Aseem Aasdhir  , Urvansh Mehta  , Kavita Gupta  , Shashi Sujanani  , Jagdish Vishnoi  , Nilesh Patira  , Kalu Ram Sharma
Published: January 2025

Pure red cell aplasia (PRCA) is a rare hematologic disorder characterized by normocytic normochromic anemia with reticulocytopenia and depleted erythroid precursors. It is reported mainly from western countries. We report our experience in two patients of PRCA from India, the clinical characteristics, differential diagnosis, and their management. Our patients showed improvements following treatment with corticosteroids, blood transfusion, and/or rituximab.
Mucinous adenocarcinoma arising from a chronic perianal fistula: A case report and literature review
Authors: Ravindran Chirukandath  , Sharath K Krishnan  , Tinu Sasi  , Sumin V Sulaiman  , Adarsh K Nair  , Nisthar CMT  , Priyanka Mittra
Published: January 2025

Perianal fistula is a common disease affecting the general population but development of mucinous adenocarcinoma (MA) in a chronic perianal fistula is a rare entity. Due to the rare nature of the disease, there are no established guidelines regarding the diagnosis and management of the condition. The aim of this article is to report a case of MA perianal region that we managed surgically with an extra levator abdominoperineal resection and flap reconstruction.
Comparison of CD3 and CD8 immunoscoring with histological grade of the tumor in urothelial carcinoma of bladder
Authors: Sneha M  , Radhika Krishna OH  , Sri Lakshmi Gollapalli  , Vani Padmaja GJ
Published: January 2025

Background: Inflammatory response within transitional cell carcinoma (TCC) bladder is known to be predictive of tumor prognosis. Lower scores are associated with worser outcome and vice versa. Simpler and cost-effective methods of immunoscoring using immunohistochemistry (IHC) have been described. This study uses two easily available T-cell markers CD3 and CD8 and compares their immunoscore with tumor grade and understands the association.
Aims and Objectives: The aims of this study were as follows: (1) To perform immunoscoring for cytotoxic T lymphocytes -CD3+ and CD8+ lymphocytes in urothelial carcinoma and (2) to correlate the immunoscore with tumor grade and calculate its significance in predicting prognosis.
Materials and Methods: A prospective cross-sectional study of 2 years duration from October 2018 to October 2020 was conducted at a tertiary level super specialty government institution. All the transurethral resection of bladder tissue biopsies reported as urothelial malignancies during the study period were included in the research. The tumors were graded histologically into high grade and low grade on histology based on the World Health Organization 2016 classification of Urothelial Carcinomas/International Society of Urological Pathology grading system. They were then subject to IHC with two T-cell markers CD3 and CD8 and immunoscoring was done using the method described by Galon.
Results: A total of 42 cases of urothelial malignancies were diagnosed during the study period. Cases with higher tumor grade were 25 and lower tumor grade were 17. The association between the lower immunoscore and higher tumor grade was statistically significant.
Conclusion: Immunoscoring is a useful adjunct to the routine histological evaluation of TCC. Easily available T-cell markers can be used as simple easy and cost-effective method for immunoscoring.
Clinical spectrum and laboratory profile of scrub typhus in children: A study from tertiary care hospital in Uttarakhand, Northern India
Authors: Bharti Bhandari  , Nitesh  , Sunil Malik  , Ragini Singh
Published: January 2025

Background: Scrub typhus is a mite-born disease scrub. It commonly manifests as an acute febrile illness with multi-system involvement. It is regarded as a life-threatening disease in children, with serious complications usually occurring in the 2nd week of illness.
Aims and Objectives: The aims of this study were to explore the clinical and laboratory profile of children with scrub typhus.
Materials and Methods: All children admitted with scrub typhus over 1-year duration were enrolled in the study. The clinical, laboratory profile, and outcome were observed and analyzed.
Results: A total of 47 children were diagnosed with scrub typhus, 17 (36.1%) children had clinical and laboratory evidence of meningitis. The most frequent presenting features were fever (100%), headache (82.4%), vomiting (82.4%), seizures (41.2%), and altered sensorium (70.6%). The mean duration of fever was 6.57 days, eight children (7%) had persistent fever for >14 days duration. Other complications reported were hepatitis 2 (4.3%), hepatosplenomegaly in 18 (38.3%) acute respiratory distress syndrome 2 (4.3%), and shock 31 (66%). The mean cerebrospinal fluid (CSF) protein, glucose, and cell count was 65.75±9.27 mg/dL, 45.00±7.23 mg/dL, and 65.94±52.72 cells/mm3 of CSF, respectively, with lymphocyte count of more than 96% in all cases. Most patients had lymphocytic pleocytosis and the mean lymphocyte percentage was 96.2%±4.5%. Out of all 47 patients, 45 (84.61%) patients recovered with appropriate antibiotics in both groups, while two (15.38%) patients expired in the group without meningitis.
Conclusion: A high degree of suspicion and knowledge of the geographical distribution of Rickettsial diseases is crucial for its early diagnosis and favorable outcome. Scrub typhus should be considered in the differential diagnosis of aseptic meningitis.
A study of the risk factors and outcome in patients with upper gastrointestinal bleed presenting to a tertiary care center in Kumaon region of Uttarakhand
Authors: Alka  , Subhash Chandra Joshi  , Vivekanand Satyawali  , Yatendra Singh  , Arun Joshi
Published: January 2025

Background: Upper gastrointestinal (GI) bleeding refers to blood loss within the intraluminal GI tract from any location between the upper esophagi to the duodenum at the level of the ligament of Treitz. Bleeding from the upper GI tract may present as hematemesis, melena, hematochezia, occult GI bleeding, and anemia.
Aims and Objectives: The aims of this study were to study the risk factors and outcome in upper GI bleed patients presenting to a tertiary care center in Kumaon region of Uttarakhand. The primary objective was to estimate the proportion of mortality in upper GI bleed patients attending a tertiary care center. The secondary objective was to study the risk factors associated with upper GI bleed and their effect on mortality.
Materials and Methods: This was a hospital-based observational prospective clinical study, carried out in the Department of General medicine, Dr. Susheela Tiwari Memorial Hospital and associated Government Medical College, Haldwani, from January 2020 to September 2021 after obtaining ethical clearance from the Institutional Review Committee and informed consent from the patient or patient relatives. Statistical testing has been conducted with the Statistical Package for the Social Science software (SPSS version 20.0).
Results: The factors associated with mortality using multivariate analysis were high international normalized ratio (INR), low albumin, raised serum glutamic oxaloacetic transaminas, high Child Pugh Score, and high model for end stage liver disease (MELD) score found to be significant.
Conclusion: The mortality rate in our patients was 18% and factors associated with increased mortality were high INR, low Albumin, raised creatinine, high Child Pugh Score, high MELD score, and presence of spontaneous bacterial peritonitis.
Efficacy of intravenous ketamine as premedicant for prevention of intraoperative hypotension after spinal anesthesia in parturients posted for elective cesarean section
Authors: Manjula BP  , Sudeepta Sambrekar  , Girish BK
Published: January 2025

Background: Hypotension following spinal anesthesia (SA) in lower segment cesarean section can be deleterious to the parturient and to fetus. Ketamine acts by stimulating the cardiovascular system leading to high blood pressure and increase in heart rate (HR) and cardiac output.
Aims and Objectives: This study aimed to assess the efficacy of 15 mg of prophylactic intravenous ketamine in elective cesarean section for prevention of hypotension after SA.
Materials and Methods: This double-blinded randomized controlled study was conducted on 98 participating parturients who were American Society of Anesthesiologists term pregnant women. The parturients were randomly divided into two groups (n=49 in each). All the parturients received SA. Ketamine group - Group K received 15 mg of ketamine IV bolus in 3 mL saline and control group - Group C received the same volume of normal saline IV bolus. HR and systolic blood pressure (SBP) were recorded at baseline at 5, 10, 15, and 20 min after the injection and then every 15 min till the end of the operation. Incidences of hypotension were recorded. The total number dose of ephedrine used, APGAR score, and Visual Analog Scale scores were recorded. The Ramsay Sedation Score was also recorded at baseline, then 5, 10, 15, 30, and 45 min after injection, and then at the end of the operation.
Results: This study showed a statistically significant increase in the incidence of hypotension and higher use of intravenous ephedrine 6 mg boluses in the control group when compared to the ketamine group. Forty-two parturients in the control group developed hypotension compared to 23 parturients in the ketamine group with P<0.001. The total ephedrine dose was significantly lower among the ketamine group. Sedation was observed for the first 15 min intraoperatively in the ketamine group with P=0.001. There was no statistically significant difference in APGAR score between the two groups.
Conclusion: There was significantly higher hemodynamic stability in the ketamine group with regard to SBP, diastolic blood pressure, and HR. Hence, low-dose ketamine, when used as a premedicant, is an effective agent that can be used in preventing post-spinal intraoperative hypotension in parturients undergoing cesarean section delivery.
Effect of position - Trendelenburg and horizontal on the height of sensory block in patients undergoing lower abdominal surgery
Authors: Sarmila Guha Banerjee  , Shantanu Hazra  , Akashleena Banerjee  , Ujjwal Bandyopadhyay
Published: January 2025

Background: Subarachnoid anesthesia also known as spinal anesthesia is now considered to be a safe form of anesthesia for lower abdominal and lower limb surgeries. The height of sensory block achieved in spinal anesthesia after drug administration can be altered by changing the position of the patient, and this precisely is the advantage of using hyperbaric local anesthetic drug.
Aims and Objectives: The aim of this study is to compare the effect of position – horizontal and Trendelenburg on the height of sensory block in spinal anesthesia.
Materials and Methods: After obtaining the institutional ethical clearance, total 66 patients scheduled for lower abdominal surgery under spinal anesthesia were selected and divided into two groups – Group A patients were placed in Trendelenburg position with 20° head down for 40 s and then returned to horizontal position and Group B patients were placed in horizontal position after spinal anesthesia. The level of sensory block was compared among the two groups at different points of time up to 30 min of drug administration.
Results: The patients who remained in Trendelenburg position for 40 s after spinal anesthesia achieved a higher level of sensory block earlier as compared to the horizontal group and the maximum block height was two spinal segments higher than that of the horizontal group.
Conclusion: From our current study, we can conclude that Trendelenburg position can be used to achieve a higher level of sensory block as compared to horizontal position after successful neuraxial block.
An observational study comparing ormeloxifene with evening primrose oil for benign breast diseases
Authors: Anupam Banerjee  , Dipan Mukhopadhyay  , Tapati Mondal  , Swarup Chakraborty
Published: January 2025

Background: Fibroadenosis, popularly termed aberrations of normal development and involution (ANDI), is by far the most common female breast presentation to a surgeon. ANDI accounts for the most common breast lumps in women <30 years of age. Mastalgia, a significant spectrum of ANDI, is usually classified as (1) cyclical mastalgia (more common) and (2) non-cyclical mastalgia. Breast nodularity, the other spectrum of ANDI may either present as a predominant feature or coexist with mastalgia.
Aims and Objectives: The aims of this study were to comparatively study ormeloxifene and evening primrose oil with respect to regression of fibroadenosis and mastalgia and evaluate their side effects.
Materials and Methods: This prospective study was conducted in the Department of General Surgery of Calcutta National Medical College and Hospital, Kolkata from February 15th, 2021 to February 14th, 2022, after obtaining prior Institutional Ethical Committee Clearance. Two hundred and eighty patients were equally divided into two groups of 140 in each and screened for inclusion in this study.
Results: At the start of treatment, Group A (Ormeloxifene) presented with a mean visual analog scale (VAS) score value of 5.71, while patients of Group B presented with a similar mean VAS score value of 5. Group B recorded a VAS score of 4.50 at the end of the 6th month, while Group A recorded a significant downhill slope of negligible mean VAS score value of 0.80 at the of the 6th month. In breast nodularity gradings too, Group A showed significant down staging of grades returning, 95% confidence interval at the end of 6th month as 1.144, while 2.280 was recorded for Group B.
Conclusion: Benign breast disease is a common presenting problem in females of reproductive age. Ormeloxifene can be a better alternative to evening primrose oil in both cyclical and non-cyclical types of mastalgia. Larger trials are however required, to finally conclude on.
Immunohistochemical analysis of cytokeratin 7 and 20 expression in colorectal carcinoma and its correlation with histopathological grading of tumour
Authors: Santanu Nandy  , Vandana Maroo  , Gopinath Barui
Published: January 2025

Background: Colorectal carcinoma is a malignant epithelial tumor originating in the large bowel. More than 90% of colorectal carcinomas (CRC) are adenocarcinomas. This being graded morphologically at H&E stain in histopathology as well-differentiated, moderately differentiated, and poorly differentiated.
Aims and Objectives: The aim of this study is to assess any association with different histopathological types and extent of differentiation of CRC with change in expression of CK 7 and Cytokeratin 20 (CK20).
Materials and Methods: In the present study, total 59 patients has been selected by the predetermined sampling techniques. The specimen was collected and the necessary processing was done for H&E stain and for immunohistochemistry for CK 20 and CK 7 profile.
Results: This study showed that most of the well-differentiated colorectal carcinoma are CK20 (+ve)/Cytokeratin 7 (CK7) (-ve) and poorly differentiated CRC are CK20 (+) and/CK7 (+) and also CK20 (−ve)/CK7 (+ve).
Conclusion: Hence, from this study, it is evident that the expression of CK 20 positivity decreasing and CK7 positivity increasing in respect of progression of well differentiated to poorly differentiated colorectal carcinoma, that is, there is a relationship of expression of CK20 and CK7 profile with the histological grading of colorectal carcinoma. Furthermore, the expression profile of CK20 and CK 7 may be of helpful while searching for unknown primary in cases of metastatic deposit.
A rare case of left ventricular thrombus with ischemic MCA stroke in a lady with Crohn’s disease
Authors: Manamita Mandal  , Vasudev S Parashar  , Praveen Kumar Yadav  , Amar Kumar Misra  , Joydeep Mukherjee  , Bijendra Mohanty  , Sanjay Kumar
Published: January 2025

We report a case of Crohn’s disease (CD) presenting as a thromboembolic middle cerebral artery stroke due to a left ventricular (LV) thrombus in a 50-year-old lady. The proinflammatory and procoagulant state reported in CD seems responsible for this. The patient was managed with conservative treatment, but she died quickly. The findings highlight the rare occurrence of LV thrombus in a patient of CD as well as the need for aggressive control of disease activity with disease-modifying drugs at an earlier phase of treatment.
Indian twin registry: A gold mine for genetic studies
Authors: Ruby Dhar  , Arun Kumar  , Subhradip Karmakar
Published: January 2025

Twins are a source of curiosity, both for the family and the scientific community. Genetic similarities between twins have been the preferred choice to study the heritability of traits. The fact that nature and nurture play a significant role in shaping one’s phenotype has prompted Geneticists to use twins as a proxy to address this fact. Based on the similarities, twins are of two types, monozygotic twins (MZ) and Dizygotic twins (DZ). Identical or monozygotic twins are formed when one fertilized egg (ovum), fertilized by one sperm, splits and develops into two embryos with precisely the same genetic information. The combined ratio of MZ and DZ to singleton delivery is approx 1: 100.
On the other hand, fraternal or dizygotic twins are formed when two eggs (ova) are fertilized by two sperm and produce two genetically unique children in the same pregnancy. Monochorionic twins are genetically identical, sharing the same placenta. If more than two twins share the placenta, these are monochorionic multiples. Monochorionic twins occur in 0.3% of all pregnancies. Monozygotic (identical) twins share all their genes, while dizygotic (fraternal) twins only share about 50%. Hence, any similarity seen between identical twins when comparing the similarity between sets of fraternal twins for a trait or condition is most probablydue to genes rather than environment.
TWIN REGISTRIESProgress in twin research worldwide is carried out by establishing Twin registries or consortia based on collaborations of several twin families. These registries are a rich source of materials for Twin research. It is much needed to establish such Twin registries in India. With its 1.5 Billion population, Indian Twin registries can be a source of materials for Twin Research for the whole world.
Morpho-metric study of the facial nerve in the Andaman and Nicobar islands population: A Cadaveric study
Authors: Sanjay Joseph Fernandes  , Chandani Ashok Kumar  , Amar Singh L
Published: January 2025

Background: Facial nerve (FN) is the seventh cranial nerve. It is the only cranial nerve which has a long course in a bony canal. From the brain stem, to its terminal branches, it changes its direction 5 times, to innervate, muscles of the second pharyngeal arch. Hence, it is morphometric study and has great clinical importance.
Aims and Objectives: This study was conducted to ascertain the variations of the length of facial Never at different parts of the crania so that this study could be helpful for neurosurgeon, radiologist, and clinician, to deal with various diseases of FN.
Materials and Methods: Thirty-five (35) male cadaveric temporal bones, were taken out, by removing soft parts attached to it. The FN was exposed. The length of the FN was measured, by digital vernier calliper, in different regions, of the temporal bone.
Results: 7.90 (SD±1.24) in petrous part, 3.7 (SD±0.40) in labyrinthine part, 12.13 (SD±0.36) in tympanic, 12.24 (SD±1.86) mastoid part, 15.76 (SD±0.54) length of nerve to stapedius, and 19.06 (SD±0.66) length of branches of chorda-tympani.
Conclusion: The present cadaveric study has clinical importance, for the ENT surgeon, neurosurgeon, neurophysician, and the radiologist.
Comparative study of analgesic efficacy of levobupivacaine alone and levobupivacaine plus dexmedetomidine in patients undergoing laparoscopic cholecystectomy
Authors: Neha Pareek  , Nikita Badmaliya  , Sweta Bharadiya  , Pramila Soni
Published: January 2025

Background: Instillation of intraperitoneal lignocaine, bupivacaine, levobupivacaine, and ropivacaine has been used, following laparoscopic gynecological and general surgical procedures, to reduce postoperative pain through randomized trials for many years.
Aims and Objectives: Intraperitoneal instillation of 0.25% levobupivacaine provides effective analgesia, and we have added dexmedetomidine 1 mcg/kg to compare the analgesic efficacy of levobupivacaine alone and levobupivacaine plus dexmedetomidine in patients undergoing laparoscopic cholecystectomy (LC).
Materials and Methods: A total of 120 patients of either sex were included in the study. The age range of the included patients was 25–70 years. All the included patients had the American Society of Anesthesiologists physical status I and II and had to undergo LC surgeries. All patients were randomly divided into two groups of 60 patients each.
Results: The mean visual analog scale (VAS) score readings at 4 and 8 h in group A were 21.48±1.80 and 25.41±2.50, respectively, and in group B were 18.14±0.90 and 20.95±1.78, respectively. At 4, 8, and 12 h postoperatively, the mean VAS readings for group B were statistically significantly lower in comparison to the mean VAS readings for group A (P<0.05). Among the A group and B group, the number of patients requiring rescue analgesia was lower in group B in comparison to group A (P<0.05).
Conclusion: It was concluded that intraperitoneal instillation of local anesthetic is an easy, cheap, and noninvasive method, which provides good analgesia in the immediate postoperative period after laparoscopic surgery. Adding dexmedetomidine 1 μg/kg to intraperitoneal levobupivacaine 0.25% in LC decreases the postoperative analgesic needs in the postoperative period compared to levobupivacaine 0.25% alone and improves the quality and duration of analgesia.
Correlation between correctly sized uncuffed endotracheal tube and ultrasonographically determined subglottic diameter in pediatric population
Authors: Urfi Umbreen  , Majid Jehangir  , Syed Mohammad Taha  , Majid Khan  , Showkat Ahmad Gurcoo  , Feroze Shaheen  , Hina Kouser
Published: January 2025

Background: The size of the airway varies greatly in pediatric patients, making it difficult to predict an appropriate size Endotracheal tube (ETT) for securing the airway. Several formulae are used to predict approximate ETT size. With the wider availability of ultrasonography (USG), many clinicians have suggested it as a useful tool for airway management and have used USG to measure tracheal dimensions in adults and children.
Aims and Objectives: The primary aim of this study was to evaluate the usefulness of USG for the selection of correct sized uncuffed ETT in pediatric patients and the secondary aim was to correlate the age-based formula with ultrasound measured subglottic diameter for predicting the size of ETT.
Materials and Methods: A total of 64 patients of either gender in the age group of 2–6 years were enrolled in the study. Standard anesthetic induction was done and transverse subglottic diameter was measured using USG. The minimal transverse subglottic diameter was measured and noted and the patient was intubated with the tube size as determined by modified Cole’s age-based formula.
Results: Out of 64 patients, 33 were male and 31 female. Average age was 3.9 (±1.47) years, 42.2% belonged to the age group of (2–3) years, average weight of the patients was 20.3 (±10.45) kg. The mean ETT outer diameters (OD) based on age-based formula was 6.81 mm compared to 6.91 mm and 6.78 mm by USG based and actual ETT OD, respectively. Both the age based ETT OD and USG-based ETT OD showed good correlation with actual ETT OD used with r-value of 0.891 and 0.876, respectively.
Conclusion: Although USG is a non-invasive, cost-effective, and reproducible technique its routine use for estimating ETT size in pediatric patients could not be justified over age-based formula as both of them have comparable results (statistically insignificant). The success rate of age-based formula and USG in precisely predicting ETT outer diameter is comparable with the size of actual ETT outer diameter (78% vs. 75%, P=0.86).
Intraoperative plethysmography variability index directed fluid management versus standard care during intraabdominal surgery in cancer patients
Authors: Pardeep Kumar  , Asthana Unnati , Shweta Bhardwaj  , Jai Prakash Rohilla
Published: January 2025

Background: During the past 20 years, numerous publications have described the usefulness of systolic pressure variation, pulse pressure variation, stroke volume variation, etc., to guide intraoperative fluid administration. However, we still lack robust noninvasive physiological variables to successfully predict the response to fluid loading.
Aims and Objectives: The present study was designed to evaluate the utility of plethysmography variability index (PVI) to optimize fluid management during intra-abdominal surgery in cancer patients.
Materials and Methods: After the Institutional Ethics Committee approval and consent, 60 patients scheduled for elective lower abdominal cancer surgeries were randomized to receive fluid by either PVI-directed management (2 mL/kg/h) or using central venous pressure (8 mL/kg/h) after standardized technique of general and lumbar epidural anesthesia. The PVI was calculated by measuring changes in the PI during the respiratory cycle (PVI = [(PImax - PImin)/PImax] × 100). Arterial blood samples were taken at the time of incision and after 6 h postoperatively. Instances of intraoperative hypotension and oliguria were recorded.
Results: Among the 60 patients enrolled in the study, demographic data, ASA status, duration of surgery, and hemodynamics were found to be comparable. The amount of crystalloid given was significantly lesser in Group P (984.70±51.16) as compared to Group C (2395.27±209.68) (P<0.001). Four patients in Group P and three patients in Group C required vasopressors.
Conclusion: The use of PVI-guided fluid management was associated with lower lactate levels and crystalloid requirement. Reduced lactate levels in PVI-guided patients suggest that PVI-guided fluid management may be tailored to everyone’s needs.
Effect of Carica papaya raw fruit extract using in vitro rat uterus preparations
Authors: Chaganti Nagesh  , Venkatanarayana Narapogu  , Rajendra Kumar  , Vinay Kumar Ksheerasagar
Published: January 2025

Background: Uterine stimulants are medications used to induce/augment labor, induce abortion, and to prevent postpartum hemorrhage. Currently, available drugs carrying adverse effects, hence the present study is designed to study the effect of Carica papaya raw fruits extract in comparison with oxytocin using in vitro rat uterus preparations.
Aims and Objectives: Primary and secondary aims of the present study were to evaluate the uterine stimulant effect and also the potency of C. papaya fruit extract using in vitro rat uterus preparations in comparison with oxytocin.
Materials and Methods: A total of 6 female rats were taken and anesthetized with ether. By giving midline incision at abdomen from pubic symphysis, two horns of uterus were identified and collected from each rat. Uterus of each rat was subjected to Oxytocin 0.32 IU (standard), alcoholic extract of C. papaya 0.32 mg (AECP), and combination of various doses of AECP (0.64 mg, 1.28 mg, and 2.56 mg) and a fixed dose of Oxytocin (0.32 IU). Using Sherrington’s kymograph, the uterine responses of each drug and combinations were studied in terms of height of the graph.
Results: The mean contraction of uterus was 6.55mm and 2.26 cm, when Oxytocin (0.32 UI) and AECP (0.32 mg) injected, respectively. When combination of Oxytocin and different doses of AECP was injected, the uterus has shown dose-dependent response, i.e., 7.13 cm (Oxytocin 0.32 IU +AECP 3.2 mg), 8.08 cm (Oxytocin 0.32 IU + AECP 6.4 mg), and 9.01 cm (Oxytocin 0.32 IU + AECP 12.8 mg).
Conclusion: AECP has shown dose-dependent uterine stimulant effect. Further studies are required to find out the possible mechanism behind the uterine stimulant activity of AECP.
Determination of serum KIM-1 in patients with chronic kidney injury
Authors: Bansal Abhishek , Shreya Nigoskar
Published: January 2025

Background: Chronic kidney disease (CKD) affects more than 800 million people worldwide and is one of the leading non-communicable causes of death. Despite being a latent issue, once renal damage has started, the disease can rapidly progress to an advanced stage.
Aims and Objectives: Currently, the most commonly used markers for the diagnosis of renal disease are non-specific and insensitive. As a result, the goal of the current study is to investigate whether KIM-1 could be a precise and sensitive biomarker for identifying early kidney injury in CKD patients.
Materials and Methods: This case–control study recruited 155 participants from the Index Medical College Hospital v Research Centre, Indore, Madhya Pradesh, based on inclusion and exclusion criteria. 150 non-CKD subjects matched for age and sex were also taken from the hospital. The levels of KIM-1 were compared between CKD and non-CKD participants. Serum creatinine, urea, and creatinine clearance were also measured.
Results: The levels of KIM-1 were substantially higher in CKD patients than in non-CKD participants. In addition, a negative relationship between KIM-1 and creatinine clearance was observed with a P<0.05.
Conclusion: KIM-1 is a precise and sensitive kidney injury biomarker that can identify early kidney injury in CKD and contribute to the progression of interstitial fibrosis in kidney disease.
To compare the safety and efficacy of intrastromal voriconazole alone and in combination with intracameral voriconazole in intractable cases of fungal keratitis
Authors: Monika Dahiya  , Mohit Dua  , Manisha Rathi  , Sumit Sachdeva  , Ruchi Dabas  , Jitender Phogat
Published: January 2025

Background: Mycotic keratitis is a potential sight-threatening infection and a leading cause of ocular morbidity worldwide. It is inherently difficult to treat due to the delayed diagnosis and fungistatic nature of available topical medications.
Aims and Objectives: The aim is to compare the safety and efficacy of intrastromal voriconazole alone and in combination with intracameral voriconazole in recalcitrant fungal keratitis cases.
Materials and Methods: A prospective, hospital-based, interventional study was conducted in 40 cases of fungal keratitis involving >50% stromal thickness and not showing a good response to conventional antifungal treatment even after 4 weeks. Cases were randomly divided into two groups: group A and group B of 20 each; group A patients received intrastromal voriconazole, while group B patients were given intrastromal+intracameral voriconazole combination in 50 mg/0.1 mL dose. Cases were examined daily for 1 week and then every week for 4 weeks to monitor progression.
Results: Out of 20 cases in group A, 14 (70%) patients got improved, while 18 (90%) patients in group B showed significant improvement after 4 weeks, and the difference was statistically significant (P=0.02). In group A, the average number of injections given to the patients was 3.65±1.56 for 15.2±8.79 days, while in group B, the average number of injections given to the patients was 2.65±1.44 for 13.2±7.768 days, with a statistically significant difference (P=0.033).
Conclusion: Intrastromal and intracameral voriconazole combination is a cost-effective and highly efficacious modality in managing recalcitrant cases of fungal keratitis. It should be recommended in cases with thick hypopyon and Aspergillus as the causative fungi that do not respond to conventional treatment.
Nasal polyps and its histopathological classification: A retrospective study
Authors: Jitendra Pratap Singh Chauhan  , Ritu Gupta  , Abhay Kumar
Published: January 2025

Background: The diagnosis of nasal polyp is made according to clinical and radiological criteria, while histopathologic examination is important for an accurate diagnosis. Histological classification of nasal polyps and its clinical implications are very rarely reported in the literature.
Aims and Objectives: The aim of this study was to study clinical presentation and site of occurrence of nasal polyps and histologically classify nasal polyps in relation to studies published in the literature. We classified the histological changes as described by Davidson and Hellquist.
Materials and Methods: Based on the inclusion and exclusion criteria, the 315 subjects were included in our study, which include eosinophilic polyp, fibro-inflammatory polyp, polyp with sero-mucinous gland hyperplasia, and polyp with stromal atypia.
Results: Sinonasal polyps can be classified in the following way histologically: edematous or eosinophilic polyp 189 cases (60%); fibro-inflammatory polyp: 66 cases (21%); polyp with seromucinous gland hyperplasia: 35 cases (11%), polyp with stroma atypia: no case (0%), and fibrotic 25 cases (8%).
Conclusion: We concluded that the nasal polyps mainly present as an edematous or eosinophilic pattern on histopathological examination. Studies on the histopathology of nasal polyps would help us to understand this disease more appropriately for treatment plan. Further differentiation of nasal polyps may help to develop new therapeutic strategies that are tailored according to the respective group.