Medical Sciences Institute Research Articles

Tibial Tuberosity Fixation in Complex Proximal Tibia Fractures Using Thin Profile Distal Fibular Plate: A Prospective Study with 12-month Outcomes

Introduction: Proximal tibial plateau fractures are common intra-articular injuries that result from either direct axial compressive trauma or indirect coronal trauma. The standard fixation method is bi-columnar dual plating. In cases with additional tibial tuberosity fractures, a thin-profile distal fibular plate can be used for repair. Aim: To assess the clinical outcomes of a combined posteromedial, anterolateral, and thin distal fibular plating of the tibial tuberosity fractures, and also to assess the radiological outcome in complex proximal tibia Schatzker type 5 and 6 fractures with additional tibial tuberosity fractures. Materials and Methods: This prospective study was carried out at the Orthopaedics Department of Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India from January 2017 to January 2022, on 18 patients with tibial plateau fractures (Schatzker type V or VI) associated with tibial tuberosity avulsion fractures. These fractures were fixed with thin-profile distal fibular plates. The functional outcome of the knee joint was assessed after one year, using the Knee Society score. Descriptive statistics were used to compute means, Standard Deviations, and ranges. Student’s t-tests and One-way Analysis of Variance (ANOVA) were used to compare the means. The p-value of ≤0.05 was considered statistically significant. Results: The average age of the study population was 39.4±5.6 years. Road traffic accidents were the most frequent mode of injury in 14 (77%) individuals. No perioperative complications were noted. The average duration of surgery was 114±10.4 minutes, and the average blood loss was 146±40 mL, throughout the procedure. The Knee Society score at 12 months postoperatively was excellent at 93.6 (range 92 to 98). Radiographic bone union was observed after an average of 12.4 weeks. Conclusion: Multiplanar complicated proximal tibia Schatzker type V and VI fractures with tibial tuberosity avulsion fractures may be effectively treated using a novel technique of thin-profile distal fibular plating. The bi-columnar plates combined with open reduction and internal fixation through two incisions with thin distal fibular plates showed satisfactory results.

Spectrum of Radiological Findings in Pulmonary Tuberculosis- A Tertiary Care Hospital-based Retrospective Descriptive Study

Introduction: Tuberculosis is a worldwide public health problem associated with high morbidity and mortality. Tuberculosis can manifest in active and latent forms. Improving the diagnosis, treatment, and screening of tuberculosis is crucial for effective tuberculosis control. Chest X-ray and Computed Tomography chest play a vital role in diagnosing and screening for tuberculosis. Aim: To analyse the spectrum of radiological findings in pulmonary tuberculosis. Materials and Methods: The present retrospective descriptive study was conducted at a teritary care hospital in the Department of Radiodiagnosis, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India. The data of 160 patients diagnosed with pulmonary tuberculosis between January 2019 and December 2020 were accessed and analysed. The recorded variables included forms of pulmonary tuberculosis, age/gender distribution, co-morbidities, Acid-fast Bacillus (AFB) smear status, and radiological findings and distribution. Descriptive statistics are presented in frequency and percentage. Results: Among the 160 cases of pulmonary tuberculosis, 30 (18.75%) cases were active primary tuberculosis, 105 (65.63%) cases were active post-primary tuberculosis, and 25 (15.62%) cases were inactive tuberculosis. Among the 30 cases of active primary tuberculosis, 14 (46.67%) cases had consolidation with air bronchogram, and 6 (20%) cases had consolidation without air bronchogram. Among the 105 cases of active post-primary tuberculosis, 65 (61.9%) cases had consolidation, 50 (47.62%) cases had cavities, and 56 (81.9%) cases had centrilobular nodules with a tree-in-bud appearance. Among the 25 cases of inactive tuberculosis, 18 (72%) cases had fibrosis with bronchiectasis, while 4 (16%) cases had fibrosis without bronchiectasis, and 3 (12%) cases had calcified granulomas. Conclusion: The study conclusively demonstrates the diverse radiological manifestations of pulmonary tuberculosis in different patient demographics. It highlights a higher incidence of active post-primary tuberculosis, especially in patients above 45 years, with varying radiological findings such as consolidation, cavitation, and fibrosis.

Assessment of Mechanical Properties and Antimicrobial Effects of Hyaluronic Acid Coating on Absorbable Suture Material: An In-vitro Study

Introduction: The use of absorbable suture materials in surgical procedures is a critical aspect of wound closure and tissue repair. In recent years, there has been growing interest in exploring the potential benefits of incorporating Hyaluronic Acid (HA), a naturally occurring biopolymer, into these sutures. By shedding light on the interactions between HA and absorbable sutures, the present study seeks to provide valuable insights that could enhance the quality of surgical wound management. Aim: To assess the mechanical properties and antimicrobial effects of HA-coated and uncoated absorbable suture material. Materials and Methods: The in-vitro study was conducted at Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India in a year 2022. A total of 70 samples of HA-coated and uncoated Vicryl 4-0 suture material were tested for tensile strength using an Instron machine. An anti-bacterial effect against Pseudomonas aeruginosa and Streptococcus mutans was assessed using a Mueller Hinton agar (MHA) plate, and the zone of inhibition was measured. Additionally, both the uncoated and HA-coated Vicryl 4-0 suture materials were analysed under the Scanning Electron Microscope (SEM) to determine the surface characteristics. An independent t-test was used to compare the tensile strength of coated and uncoated suture materials. Results: The mean tensile strength of uncoated and HAcoated suture material was 6.47±0.23 MPa and 3.78±1.02 MPa, respectively. The difference between both groups was statistically significant (p<0.05). For Pseudomonas aeruginosa and Streptococcus mutans, the zone of inhibition was 8.0±0.5 mm in diameter and 9±0.5 mm in diameter, respectively, around coated Vicryl 4-0 suture material, whereas no zone of inhibition was observed for both Pseudomonas aeruginosa and Streptococcus mutans around uncoated suture material. SEM analysis showed superior surface characteristics of HA-coated suture thread when compared to uncoated suture thread. Conclusion: HA-coated suture material does not exhibit superior tensile strength when compared to the uncoated suture material. However, HA-coated suture material has potent antibacterial effects against Pseudomonas aeruginosa and Streptococcus mutans. Additionally, SEM analysis showed improved surface characteristics in favour of the coated suture material.

A Cross-sectional Study on Neuroimaging in Epilepsy: Diagnostic Value of T2 Relaxometry in Mesial Temporal Lobe Epilepsy

Introduction: The use of Magnetic Resonance Imaging (MRI) T2 relaxometry and spectroscopy has added new dimensions to the imaging of Temporal Lobe Epilepsy (TLE). Advanced techniques like MRI diffusion and MRI perfusion are new additions to the MRI protocol for epilepsy. Aim: To study the diagnostic value of T2 relaxation time in Electroencephalogram (EEG) confirmed seizure cases. Materials and Methods: A single-centre, cross-sectional study was conducted at Department of Radiodiagnosis, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India, from December 2020 to November 2022 at a tertiary care hospital. All patients were subjected to MRI with a special epilepsy protocol and T2 relaxometry. Hippocampal T2 relaxation values for each slice were measured by placing a Region of Interest (ROI) on the representative image obtained from the T2 relaxometry sequence, focusing on the hippocampus in both the control and study groups. The control group (n=30) consisted of healthy volunteers, whereas the case group (n=36) comprised patients presenting with a history of seizures with positive MRI and EEG findings. Mean T2 relaxation time was calculated in each ROI, and an average was derived. Mean and Standard Deviation (SD) were calculated for the continuous variables, while ratios and proportions were calculated for the categorical variables. To determine the association of T2 relaxometry values in the study and control groups, an unpaired t-test was used. Results: The mean age of participants was 25.14±9.35 years (ranging from 9 to 51 years). The male-to-female ratio was 1.25:1. Hippocampal atrophy (32 out of 36 cases) and T2 signal alteration (30 out of 36 cases) were the most commonly identified features in Mesial Temporal Sclerosis (MTS). MRI without T2 relaxometry had a sensitivity of 94%. In two cases, where only mild hippocampal atrophy was identified in the conventional MRI sequence, making the diagnosis dubious, T2 relaxometry revealed increased T2 relaxation time in the head of the hippocampus and guided a proper diagnosis. EEG was able to lateralise seizures in 8 out of 13 right MTS cases (61.5%), 10 out of 17 left MTS cases (58.9%), and 5 out of 6 cases of bilateral MTS (83%). Conclusion: T2 relaxometry allows quantification of hippocampal signal intensity, allowing the detection of even subtle changes in signal intensity that are difficult to perceive by visual assessment.

Effectiveness of Lymph Node Revealing Solution in Estimation of Lymph Nodes Yield in Radical Specimen of Oral Squamous Cell Carcinoma: A Preliminary Histomorphometric Observational Study

Introduction: Oral cancer poses a serious health challenge globally, particularly for nations undergoing economic transition. The number and size of lymph nodes obtained, along with nodal involvements, are crucial for proper diagnosis, treatment, and prognosis. Aim: To assess the number of lymph nodes obtained before and after treating the specimens with the Lymph Node Revealing Solution (LNRS) along with staining characteristics. Materials and Methods: The present prospective observational study was conducted at the Department of Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India, over a period of six months from January 2023 to June 2023 in a tertiary oral healthcare centre in Chennai. Six histologically confirmed Oral Squamous Cell Carcinoma (OSCC) cases with neck dissection were included in the study, involving 32 lymph node levels. Lymph nodes were grossed using both routine procedures of palpation and visualisation and after treatment with LNRS for two days. The number of nodes obtained through both methods was compared along with the staining characteristics. The data were analysed using Statistical Package for Social Sciences (SPSS) software version 26.0. Chi-square and paired t-tests were used to compare the two groups, and any value less than or equal to 0.05 was considered statistically significant. Results: Out of 134 lymph nodes, 21 were positive with conventional fixation, whereas after the application of LNRS, an additional 41 lymph nodes were retrieved. Two nodes showed metastatic deposits; fortunately, the additional positive nodes did not affect the staging. No statistically significant difference was found before and after immersion in LNRS regarding staining characteristics. The mean area of the yielded nodes was 84.71±4.85 mm2 . There was a statistically significant difference between the size of lymph nodes between the manual grossing method and after immersion in LNRS (p-value <0.001). Conclusion: The study confirmed that the LNRS technique identified very small lymph nodes in oral cancer patients, which may contain metastatic deposits. This might change the stage of the disease and influence the mode of treatment.

Diagnostic Performance and Accuracy of Ovarian-Adnexal Reporting and Data System Ultrasound Risk Score- A Prospective Cohort Study

Introduction: Adnexal malignancies are a leading cause of mortality in gynaecologic cancers, posing significant diagnostic challenges. Ultrasonography (USG) is the primary imaging modality, and the development of the Ovarian-Adnexal Reporting and Data System Ultrasound (O-RADS US) aims to provide standardised interpretations to assist in management decisions. Aim: To evaluate the effectiveness of using the O-RADS classification system in diagnosing and characterising adnexal lesions. Materials and Methods: This single-centre prospective cohort study was conducted at the Department of Radiodiagnosis, Sri Guru Ram Das Charitable Hospital attached to Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India from January 1, 2023, to March 31, 2024. The study included 50 patients with adnexal mass lesions from all age groups. All participants underwent transabdominal/ transvaginal ultrasonographic examinations, with Colour Doppler assessment included. The O-RADS classification system was employed to assess and characterise the adnexal mass lesions. The diagnostic accuracy of the O-RADS US risk score was determined. Statistical analysis was conducted using Statistical Packages for Social Sciences (SPSS) version 24.0 to calculate the sensitivity, specificity, accuracy, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) for O-RADS US results in diagnosing ovarian masses. Results: The patients’ ages ranged from 18 to 83 years, with a mean age of 41.68±15.51 years. The cohort included 35 premenopausal and 15 postmenopausal individuals. The most common indication for USG was pelvic pain, observed in 15 out of 50 patients, representing 30% of the study cohort. The O-RADS sensitivity for the detection of ovarian cancer was 88.89%, with a specificity of 93.75%, NPV of 93.75%, and PPV of 88.89%, with an accuracy of 92%. These results were achieved by keeping O-RADS score of 4 as the cutoff for malignancy. Conclusion: The O-RADS US is effective in the risk stratification of ovarian lesions and has a high diagnostic performance. Implementing these guidelines in clinical practice could be beneficial for managing adnexal lesions.

Declining Effect in the Immunogenicity of Covishield Vaccine among Healthcare Workers Postvaccination- A Prospective Cohort Study

Introduction: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic had a severe impact on global healthcare systems and the economy. The introduction of Coronavirus Disease 2019 (COVID-19) vaccines has provided a solution for the disease. However, with mutations in the strains of COVID-19, there is a need to understand the immunogenicity and duration of protection provided by the vaccines. Aim: To assess the immunogenicity of the covishield vaccine among Healthcare Workers (HCWs) postvaccination following the administration of the second dose of the covishield vaccine. Materials and Methods: This was a single-centre prospective cohort study in the Department of Microbiology, Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India, from January 2022 to June 2022. Study included HCWs who had received the first and second doses of the Covishield vaccine and were willing to participate in the study. Only 30 HCWs who had received two doses of the COVID- 19 vaccine (Covishield) at least two weeks before registration were enrolled in the study. The serum was tested to determine the qualitative detection of COVID-19 Immunoglobulin G (IgG) antibody in HCWs using the Enzyme-linked Immunosorbent Assay (ELISA) method using COVID Kawach IgG Microlisa kit. The P/N ratio is the Optical Density (OD) value of the sample tested/average OD value of the negative control. The P/N ratio was calculated and the participants were divided into different groups based on the months after receiving the second dose of the vaccine. The non parametric Kruskal-Wallis test was applied to test the difference between the P/N ratio based on the months of vaccination since the second dose. Results: In the present study, the majority of HCWs, 20 (66.6%), were uninfected by the SARS-CoV-2 virus, while 10 (33.3%) became infected after receiving two doses of the covishield vaccination. Out of 30 samples, 29 (96.6%) samples had crossed the cut-off OD value of 0.3970, and the P/N ratio was greater than 1.5, suggestive of the presence of antibodies against SARS-CoV-2. Only 1 (3.3%) sample had an absorbance value lower than the cut-off, and the P/N ratio was <1.5, suggestive of the absence of antibodies against SARS-CoV-2. The P/N values of the participants were compared between different groups, which were divided based on the months since the second dose of the covishield vaccine. Participants who had completed five months since the last vaccine dose showed the highest P/N value (median 13.9), followed by median values of 7.1, 4.8 and 3.3 on completion of 6, 7 and 8 months and beyond, respectively. A steady decline in the median P/N ratio was observed from 5 to 8 months. Conclusion: The immunogenicity of the covishield vaccine among HCWs Postvaccination after the second dose of the covishield vaccine showed a steady decline in the subsequent months.

Seroprevalence and Co-infections of Different Infectious Aetiologies in Blood Culture Negative Febrile Patients Seeking Healthcare at a University Hospital in Northern India: A Cross-sectional Study

Introduction: The burden of acute febrile illness remains underestimated in many low- and middle-income countries. The rationale of this study revolves around the gaps in diagnostics for acute febrile illnesses in these regions. Aim: To highlight the seroprevalence and co-infections of different infectious aetiologies in blood culture negative febrile patients. Materials and Methods: This cross-sectional study was conducted at Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India from October 2021 to July 2022, involving 153 serum samples from patients presenting with fever for less than two weeks duration during outpatient and emergency visits. The blood culture negative samples were further tested for other aetiologies such as Leptospirosis, Dengue NS1 antigen, Dengue IgM antibody, Chikungunya, Scrub typhus IgM, and Widal, respectively. Convalescent sera were also tested for all positive Widal results. All statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) statistical software (IBM SPSS version 26.0, Armonk, N.Y.). Results: Out of the 153 patients enrolled, 120 patients were tested for a panel of serological tests. The majority 52 (43.3%) were aged between 21 and 40 years. Fifty-five patients (45.8%) exhibited positivity, among which Scrub typhus was the most common aetiology with 21 (17.5%) case, followed by Leptospirosis 19 (15.8%), Dengue 10 (8.3%), Chikungunya 3 (2.5%), and Enteric fever 2 (1.7%), with no cases of malaria reported. Overall, co-infections reported in present study included 7 (5.8%) cases, of which scrub typhus and Leptospirosis were the most prevalent in 5 (4.16%) cases. Two patients (1.6%) presented with a co-infection of dengue and chikungunya. Conclusion: The diverse aetiologies causing acute febrile illness necessitate a syndrome-based disease surveillance approach, accompanied by strong clinical acumen, for the betterment of patient outcomes.

Association between Cord Blood Haematocrit and Neonatal Outcome among Neonates of Diabetic Mothers: A Cohort Study

Introduction: The perinatal mortality rate of Neonates of Diabetic Mothers (NDMs) over the years showed a reducing trend. Polycythaemia is common in NDMs, and such neonates have a risk of hyperviscosity, renal vein thrombosis, cardiac failure, metabolic abnormalities, and necrotising enterocolitis. Aim: To assess the association between cord blood haematocrit and neonatal outcomes among NDMs. Materials and Methods:The present study was a cohort study that included 130 neonates, which was conducted at Amala Institute of Medical Sciences (AIMS), Thrissur, Kerala, India, from December 2019 to June 2021. The primary inclusion criteria were singleton neonates of Gestational Diabetic Mothers (GDM) (diabetes detected after 20 weeks of gestation) and Overt Diabetes Mellitus (ODM) defined under White’s classification (known to be diabetic before the onset of pregnancy or detected in the initial visits). The parameters assessed were the frequency of distribution of hypoglycaemia, hypocalcaemia, and hyperbilirubinemia among the neonates of DM. Statistical analysis was done using Fisher’s exact test and Student’s t-test. Results: Among the 130 neonates, the majority of the mothers had GDM 111 (85.4%) than ODM 19 (14.6%). The majority were delivered by normal vaginal delivery 67 (51.5%). 10 (7.7%) of NDMs had a birth weight > 4000 g. Significant associations were noted between cord Packed Cell Volume (PCV) and the presence of hypoglycaemia (p-value=0.003), hypocalcaemia (p-value=0.0001), and Neonatal Hyperbilirubinemia (NNH) (p-value=0.0001) among NDMs. Conclusion: Hypoglycaemia, hyperbilirubinemia, and hypocalcaemia were common complications noted in NDMs.

A comparative evaluation of 0.75% ropivacaine with fentanyl versus 0.75% ropivacaine with dexmedetomidine in intrathecal anesthesia for lower limb surgeries

Background: Anesthesia for lower limb surgeries can be administered locally, regionally (spinal or epidural), or generally. The primary option is still spinal anesthesia because of its quick onset, excellent blockage, low infection risk, low failure rate, and affordability. The most widely utilized method is bupivacaine spinal anesthesia. By extending and strengthening the sensory blockade, an adjuvant not only boosts the effectiveness of a local anesthetic but also lowers the dosage of local anesthetic drugs. Aims and Objectives: The aims and objectives of the study are to assess the synergistic effect and safety of adding dexmedetomidine to ropivacaine 0.75% in the subarachnoid block for lower limb surgeries compared to fentanyl to ropivacaine 0.75%. Materials and Methods: The present study was a prospective randomized control study, carried out at the Department of Anesthesiology and Critical Care, Kempegowda Institute of Medical Sciences, Bangalore, for a period of 2 years. Two groups of 30 subjects each were selected for the study by simple random sampling. Patients with physical status ASA 1 or 2 who underwent elective lower limb surgeries were included. Patients in Group F (n = 30) received 3 mL of isobaric 0.75% ropivacaine and 25 μg fentanyl (0.5 mL) and in Group D (n = 30) received 3 mL of isobaric 0.75% ropivacaine with 10 μg dexmedetomidine (0.5 mL). Sensory testing was assessed by loss of pinprick sensation. The motor block in the lower limb was graded according to the modified Bromage scale. Duration of analgesia was noted. Hemodynamic parameters were recorded every 5 min for 1st 30 min and thereafter every 30 min till the patient complained of pain. Results were analyzed using the SPSS 20.0 version and the association was tested using Student t-test and Chi-square test. Results: The average time for sensory block onset was 2.93 ± 0.25 min in Group D and 2.43 ± 1.14 min in Group F. In both Group D and Group F, the length of the sensory block was 281.33 ± 25.15 and 144.67 ± 19.43, respectively, and was extremely significant both statistically and clinically. When compared to Group F, which had analgesia for 144.67 ± 19.43 min, Group D experienced analgesia for a significantly longer duration, 360.67 ± 16.17 min. There was a statistically significant difference (<0.001). In Group D, the average motor block duration was 339.67 ± 19.21 min, whereas in Group F, it was 92.33 ± 16.95 min. Conclusion: When compared to fentanyl as an adjuvant to ropivacaine, intrathecal dexmedetomidine causes a faster onset of sensory and motor blockade and a longer duration of motor and sensory block, as well as hemodynamic stability, higher sedation, and a longer duration of post-operative analgesia.

Sleep quality, perceived stress, and attention levels: A study on medical students

Background: Sleep is the most important yet least understood function of the brain. It is seen that students usually get lesser duration of sleep, due to academic and social demands. In our study, we are trying to use relatively short-duration tasks, which are software-based and can be easily used in a clinical setting for screening purpose, for the assessment of attention in individuals with poor sleep quality. Aims and Objectives: The aim of this study was to compare the perceived stress levels in students based on the quality of sleep and to compare the attention in students based on the quality of sleep. Materials and Methods: Eighty-four participants were divided into good and bad sleep quality based on the Pittsburgh sleep quality index (PSQI) scores and their perceived stress scores were obtained. All of them were subjected to smartphonebased cognitive function testing using color word and word color Stroop test. Results: Eighty-four subjects were recruited for the study from the Bidar Institute of Medical Sciences, Bidar, of which 34 (40%) were in the good sleep group and 50 (60%) in the bad sleep group. The median PSQI score in the group with bad sleep quality was found to be significantly higher than the median PSQI scores of the group with good sleep. The median word color Stroop score in the good sleep quality was found to be significantly higher than the score of the bad sleep group. Similarly, the median color word Stroop scores were significantly higher in the good sleep group than that of the bad sleep quality group. Conclusion: Sleep quality seems to increase the levels of perceived stress in students. Sleep affects the attention of the subjects in a negative way.

Prevalence, Correlates and Trends in Tobacco Use among Youths: A Retrospective Secondary Data Analysis of Nationally Representative Surveys (NFHS-5) in India

Introduction: Youths are the most vulnerable population to initiate tobacco use. It is the need of the hour to prevent tobacco addiction among young people to reduce the morbidity and mortality associated with it. Therefore, there is a need for necessary data to build an appropriate strategy to combat this epidemic. Aim: To determine the prevalence and trends of tobacco use and to assess the factors associated with tobacco use among youths (age 15-24 years) in India. Materials and Methods: This retrospective secondary data analysis study was conducted at Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, between January 2023 and June 2023, using data from the National Family Health Survey-5 (NFHS-5), 2019-2021, which was conducted across all states of India to estimate the prevalence of tobacco use among the 15-24 age group. Data were compared with NFHS 3 and 4 to observe the trends in tobacco use. The data were analysed using Statistical Packages for Social Sciences (SPSS) software (version 21.0). Multivariate logistic regression was used to identify the significant risk factors associated with tobacco use. A p-value less than 0.05 was considered statistically significant. Results: The prevalence of smoking and smokeless tobacco use was 2109/14525 (14.52%) and 2237/14525 (15.40%) respectively among male youths aged 20-24 years, and it was 374/119043 (31%) and 119/119043 (1.53%) in females of similar age. For males, the prevalence has decreased from 40.07% in NFHS-3 to 27.31% in NFHS-4 and to 22.51% in NFHS-5. For females, the prevalence has decreased from 4.55% in NFHS-3 to 2.38% in NFHS-4 and to 1.33% in NFHS-5. Males and females belonging to the scheduled caste/scheduled tribe, having a poor wealth index, and in the married category had a higher prevalence of tobacco use. Youths residing in rural areas were using more smokeless tobacco. Conclusion: There was a declining trend of tobacco use among youths over NFHS-3 (2005-2006), NFHS-4 (2015-2016), and NFHS-5 (2019-2021). Male gender, higher age, rural area, the northeast region of India, poor wealth index, education upto primary level, being married, and other categories of marriage had higher adjusted odds of using both forms of tobacco. There is a need to implement and enforce evidence-based tobacco control strategies that can substantially improve the health of the young, hence securing India’s future.

Clinico-epidemiological Characteristics and Risk Factors Associated with Multidrug- resistant Bacterial Ear Infections at a Tertiary Care Centre in Northern India: A Retrospective Analytical Study

Introduction: A total of 360 million people worldwide have been reported to suffer from hearing loss. The most common cause of ear infection is otitis media, which can be attributed to bacterial pathogens such as Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus pneumoniae. Aim: To identify the incidence and risk factors associated with multidrug-resistant bacteria causing ear infections at a tertiary care centre in India. Materials and Methods: A retrospective analytical study was conducted in the Bacteriology section of the Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, from January 2021 to January 2023, and analysed in February 2023. A total of 83 ear discharge samples sent to the laboratory were included in the duration of the study and all clinical and laboratory data were extracted from the hospital information system and the laboratory register, respectively. All pathogens were identified using routine biochemicals and Matrix-assisted Laser Desorption/ Ionisation- Time of Flight-Mass Spectrometry (MALDI-TOF-MS) assay, and their antibiotic susceptibility testing was performed using the Kirby Bauer Disc Diffusion method. Statistical analysis was performed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software version 20.0 (SPSS Inc.). The Chi-square test was used for all categorical variables, and the comparison of two means was performed using GraphPad Prism version 9.5.1 (GraphPad Software Inc.), with p-value<0.05 considered statistically significant. Results: The mean age of the participants in the present study was 35.39±20.93 years and majority, 56 (67.47%) participants were males. Among total 83 samples, 69 (83.13%) patients with suppurative bacterial ear infections. Postoperative conditions in 40 (48.19%) samples and respiratory allergies in 36 (43.37%) samples were the most common risk factors associated with ear infections. Postoperative conditions (p-value=0.005) and Diabetes Mellitus (DM) (p-value=0.026) were statistically significant risk factors for developing ear infections. Pseudomonas aeruginosa was recognised as the most common pathogen in 22 acute cases and 10 chronic cases of otitis media. For all the antimicrobial agents tested, the highest resistance was observed towards fluoroquinolones in 51/67 (76.11%) samples, followed by extended-spectrum beta- lactams in 43/67 (64.18%) samples. Conclusion: The current study describes the incidence and risk factors associated with multidrug-resistant ear infections, the spectrum of pathogenic microbial isolates and their drug susceptibility, aiming to prevent morbidity and complications leading to the loss of auditory function.

Clinicohistopathological Features and Immunohistochemical Expression Patterns of p53 in Epithelial Ovarian Tumours: A Cross-sectional Study

Introduction: Ovarian tumours represent 3% of female malignancies, with epithelial tumours constituting more than 90% of all ovarian cancers. Tumour suppressor gene 53 (TP53) mutations play an important role in the prognosis and treatment of ovarian cancer. The tumour suppressor gene Tumour Protein 53 (p53), located on the short arm of chromosome 17, acts by suppressing abnormal cell growth at the beginning of the Synthesis phase (S-phase) of the cell cycle. Previous studies have shown a correlation between p53 mutation or overexpression and patient prognosis in various types of tumours, including breast cancer, rectal cancer, intestinal cancer, lung cancer, and ovarian cancer. Aim: To investigate the clinicohistopathological features and immunohistochemical expression of p53 in Epithelial Ovarian Tumours (EOT). Materials and Methods: A cross-sectional study was conducted in the Department of Pathology at Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh, India. The duration of the study was one year and two months, from September 2021 to November 2022. A total of 80 cases of EOT were included and histopathological diagnosis was performed, and immunohistochemical expression of p53 was evaluated in all cases. The Chi-square test was used to compare categorical data (the number of benign, borderline, and malignant EOT) and determine whether the difference in p53 expression (positive or negative) was statistically significant, using Statistical Package for the Social Sciences (SPSS) version 26.0. Results: The total of 80 cases of EOT in the present study comprised 56 (70%) benign, 5 (6.25%) borderline, and 19 (23.75%) malignant tumours. The p53 expression was statistically significant. Immunohistochemistry (IHC) for p53 showed diffuse strong positive nuclear staining (>60%) of the tumour cells in 14 cases, all of which were malignant epithelial tumours. Focally weak and patchy positive nuclear staining patterns (5%-60%) were observed in 64 cases, including 56 benign cases, four borderline cases, and four cases of malignant epithelial tumours, respectively. p53 positivity (<5% staining of tumour cells) was seen in two cases, one each of borderline and malignant epithelial tumour, respectively. Conclusion: The IHC marker p53 serves as a surrogate marker for p53 gene mutation, and its positivity is observed in serous EOT. Understanding p53 staining patterns can be used in conjunction with a panel of other antibodies to correctly classify morphologically confusing EOT. This can aid in assessing prognosis and understanding the biological behaviour of the tumour, which can be helpful in modifying the treatment plan.

Diagnostic Accuracy of Transabdominal and Transvaginal Ultrasound in Assessing Endometrial Pathologies in Women with Postmenopausal Bleeding: A Cross-sectional Study

Introduction: Postmenopausal Bleeding (PMB) is defined as any spontaneous bleeding occurring after 12 consecutive months of amenorrhoea due to ovarian follicular inactivity. Timely evaluation of PMB is crucial to exclude potential underlying cervical or endometrial malignancies, which are significant causes of mortality. Although endometrial biopsy is considered the gold standard for diagnosis, it is invasive and can be painful. Therefore, a less invasive screening tool is needed, which is where the role of Ultrasound (USG) comes into play to identify candidates for endometrial biopsies. Aim: To evaluate and compare the diagnostic accuracy of Transabdominal Sonography (TAS) and Transvaginal Ultrasound (TVS) in detecting endometrial pathology in postmenopausal women with bleeding and to compare these findings with endometrial biopsy results. Materials and Methods: This cross-sectional study, conducted from November 2020 to October 2022 in the Department of Radiodiagnosis at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation Vijaywada, Andhra Pradesh, India, included 50 adult female patients of menopausal age with atleast 12 months of amenorrhoea. In these patients, endometrial thickness was measured using both TVS and TAS, after which they were referred to the Department of Gynaecology for endometrial biopsy. The patients were divided into two groups: those with endometrial pathology (40 patients) and those with other causes of PMB (10 patients). Quantitative, non normally distributed variables were analysed using the Wilcoxon’s Mann-Whitney U Test and the Kruskal-Wallis Test. Receiver Operating Characteristics (ROC) curve analysis with a >5 mm cut-off for endometrial thickness was performed. Statistical significance was set at p<0.05. Results: The mean age of the study participants was 59±7 years and the endometrial thickness measured using TAS was 4.46±3.05 mm, while the endometrial thickness measured using TVS was 5.28±3.83 mm. Significant differences were observed between the two groups (patients with and without endometrial pathology as a cause for PMB) regarding endometrial thickness, as measured by both TAS (W=446.000, p<0.001) and TVS (W=442.000, p<0.001). The endometrial pathologies identified in the study included endometrial atrophy (26 patients), endometrial hyperplasia (4 patients), endometrial carcinoma (7 patients), and endometrial polyps (3 patients). The strength of association, measured by Point-Biserial Correlation, was 0.69 for TAS and 0.70 for TVS, indicating a large effect size in both cases. Endometrial pathology was predicted with a sensitivity of 77% and specificity of 95% using TAS, and with a sensitivity of 85% and specificity of 89% using TVS. Conclusion: The present study emphasises that PMB is a prevalent concern in gynaecological practice, and ruling out endometrial cancer is critical due to its associated mortality. TVS remains a primary tool for identifying patients who require further evaluation through endometrial biopsy. Although TAS is initially performed for screening other pelvic pathologies and prior to conducting TVS, both modalities should be utilised.

Experience of external quality assessment scheme in hematology at Shantabaa Medical College, Amreli: An observational 5-year study

Background: The complete blood count is one of the most frequently requested tests in laboratory medicine. External quality assessment programs are intended to allow medical laboratories to compare the closeness of their output (test results) to their peers through statistical evaluation against a target value. External quality assessment schemes (EQAS) are accepted around the world as an invaluable tool by laboratories to assess the performance of their testing systems. Results are objectively compared to other laboratories, using the same methodologies for every parameter. Aims and Objectives: To review EQAS results from time to time in an effort to improve the performance of the laboratory. Materials and Methods: An observational study is done for hematology EQAS test results at the hematology laboratory, Shantabaa Medical College and General Hospital, Amreli, from June 2017 to August 2021 (5 years). One ethylenediaminetetraacetic acid whole blood sample for blood cell counts and two slides for peripheral smear examination and reticulocyte count are received quarterly in a year from all India Institute of Medical Science, New Delhi. The test results of all Indices of blood samples and peripheral smears for cell morphology and reticulocyte count were analyzed and documented. Results: Satisfactory results were obtained in all the cycles except once. The discrepancy was observed in RBC, MCH, and reticulocyte count. Root cause analysis was performed and necessary action was taken. Conclusion: This participation in EQAS over the past 5 years has helped us significantly to improve our laboratory services in terms of performance evaluation, patient care, and overall quality of laboratory practices.

Beyond Anxiety: Unveiling the Power of Self-Efficacy in Shaping Academic Performance among Medical Students

Objective: The study aimed to explore the relationship between anxiety and academic performance and discuss a key boundary condition i.e., self-efficacy as a strategy to manage anxiety in the academic setting. Methodology: A quantitative survey design was used employing a cross-sectional time frame. Public sector medical colleges of Lahore affiliated with the University of Health Sciences (UHS) were selected such as Allama Iqbal Medical College, Ameer-ud-Din (PGMI) Medical College, Services Institute of Medical Sciences, and Shaikh Khalifa Bin Zayed Al-Nahyan Medical & Dental College. The duration of the study was from June 2021 to January 2022. A convenience sampling technique was used to collect data from 259 medical students through self-administered questionnaires. The inclusion criteria applied were that the medical institution needs to be recognized by UHS and should be located in Lahore. Medical students included belonged to second to final year MBBS. First-year students were omitted as they had not taken their professional examinations. Results: Hayes PROCESS Macro analysis in SPSS version 22 showed that social media overload and academic performance were significantly related (B=-0.198, p<0.05). Moreover, a significant moderating role of self-efficacy in the relationship between anxiety and academic performance was found. Conclusion: Results suggested that when medical students faced anxiety their academic performance was decreased however this did not apply to medical students with high self-efficacy. Medical students with low self-efficacy who see themselves as incompetent, lose motivation easily when they try to attempt tough tasks and focus too much on potential failure. Key Words: Anxiety, academic performance, self-efficacy.

Prospective study of ABO and Rh blood group frequency and distribution among health-care professional students at Hassan Institute of Medical Sciences, Hassan

Background: The presence of immunologically competent agglutinogens in ABO and Rhesus (Rh) system makes these blood groups clinically important. The distribution frequency of these blood groups in various geographical regions is essential for the maintenance of blood bank records, for research studies, etc. This helps in safe transfusion during emergency. Many population-based research works were conducted on the prevalence of blood agglutinogens. The lack of data on these blood antigens among young health-care professional students prompted the conduct of this study on blood groups. Aims and Objectives: The aims and objectives of the study are to ascertain blood group frequencies among health-care professional students and to obtain prospective group of Rh-negative blood donor database. Materials and Methods: Research was accomplished on 400 health-care professional students of HIMS, Hassan, in department of physiology after going through knowledge, attitude, and practice questionnaire. Blood grouping was done by collecting blood from participants by finger prick method on glass slides. Results: In participants, the most common blood group was O (40.8%) with decreasing prevalence of B (34.3%), A (18%), and AB (7%). The frequency of Rh-positive and negative groups was 95.5% and 4.5%, respectively. Conclusion: Among participants, blood group O and blood group AB was most and least common, respectively. The frequency of Rh positive was far higher compared to Rh-negative groups.

A Prospective Study of Seroconversion Post Covishield Vaccination in COVID-19 Warriors

Introduction: During the Coronavirus Disease 2019 (COVID19) pandemic in India, two vaccinees were predominantly administered to prevent the spread of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The first vaccine introduced in India was ChAdOx1-nCOV (Covishield), followed by BBV-152 (Covaxin). In the first phase, Healthcare Workers (HCW) were prioritised for vaccination, given their crucial role in the healthcare system. Aim: To assess the antibody response post Covishield vaccination at specific time intervals in HCWs and to determine the correlation of antibody response with age, gender, comorbidities and blood group. Materials and Methods: This prospective study was conducted at Dr. Balasaheb Vikhe Patil Rural Medical College, Pravara Institute of Medical Sciences, Loni, Maharashtra, India, over a duration of six months from January 2021 to June 2021. A total of 110 vaccinated HCWs who volunteered were included in this study. SARS-CoV-2 antibodies at specific time intervals were assessed using Ortho Clinical Diagnostic’s VITROS 3600 based on the principle of Chemiluminescent Immunosorbent Assay (CLIA). Assessment of anti-SARS-CoV-2 total and IgG antibodies was performed at 15 days, one month, one and a half months, two months, three months, and four months postfirst dose of vaccination, or in other words, 15 days and one month after the 1st dose, and 15 days, one month, two months, and three months post second dose of vaccination. For analysis, Pearson’s correlation and a regression model were performed using GraphPad Prism 8.0.2 version. Results: Fifteen days post second dose, 110 HCWs (100%) and 109 (99.09%) HCWs turned seropositive for total antibodies and IgG antibodies, respectively. It was observed that the majority of participants (33, 30.27%) with peak IgG levels in the medium range were from the age group of 31-40 years. Overall, there was a negative correlation between age and IgG antibody levels for peak IgG values (r-value=-0.224, p-value=0.019). The peak values were achieved in the majority of participants 15 days post second dose (53.6%). The difference in antibody levels based on gender was not significant (Chi-square value=3.387, p-value=0.184). No significant difference in SARS-CoV-2 IgG levels was observed between participants with co-morbidities and those without co-morbidities. Participants who developed SARS-CoV-2 infection during the study period exhibited robust antibody responses after vaccination. Conclusion: These findings help elucidate Covishield vaccinespecific antibody responses in vaccinees of different age groups, genders, blood groups, and with co-morbid conditions. The vaccine has substantially reduced the burden of disease by preventing serious illness in vaccinated HCWs during the second wave of the COVID-19 pandemic.

Correlation between Neutrophil to Lymphocyte Ratio and Urine Albumin to Creatinine Ratio in Diabetic Nephropathy Patients: A Cross-sectional Study

Introduction: One of the microvascular complications of diabetes is known as Diabetic Nephropathy (DN). The clinical manifestation of DN is an increase in the amount of albumin excreted in the urine. Albuminuria is the inflammatory process that occurs before end-stage renal failure and is a diagnostic marker. The total White Blood Cell (WBC) count is a crude but sensitive measure of inflammation. It is examined as an inflammatory marker in various cardiac and non cardiac disorders, such as acute Myocardial Infarction (MI), stroke, and heart failure. Aim: To find a correlation between Neutrophil to Lymphocyte Ratio (NLR) and Urine Albumin to Creatinine Ratio (UACR) in DN patients. Materials and Methods: This was an analytical cross-sectional study done over a period of 18 months from January 2018 to June 2019 at Vydehi Institute of Medical Sciences and Research Centre in Bengaluru, Karnataka, India. on 104 subjects diagnosed with type 2 Diabetes Mellitus (DM) registered in present study. Spot albuminuria was tested by immune turbidimetry method. Urine creatinine was tested using Jaffe’s kinetic method, from which spot UACR was calculated. The patients with albuminuria and without albuminuria were grouped into cases and controls, respectively. NLR was calculated using complete blood count and correlated with UACR. The estimated Glomerulus Filtration Rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation and correlated with UACR. Cases were further subgrouped into moderately increased albuminuria and severely increased albuminuria groups. Mean and standard deviation, independent sample t-test, Chi-square test, Odds Ratio (OR) were applied to find significance. A p-value of <0.05 was considered statistically significant, and an OR more than one suggests a positive association. Results: A total of 104 diabetic subjects were registered, with 52 subjects having DN and 52 having normal urine albumin. The mean age was 56±11.3 years and 50.6±11.8 years in the case and control groups, respectively. Among the 52 subjects in the case group, 12 (23.1%) were female and 40 (76.9%) were male. In the 52 control group, 30.8% (n=16) were female, and 69.2% (n=36) were male. The mean urine albumin was 75.5±121.2 mg/dL and 1.2±1.2 mg/dL in the case and control groups, respectively (p<0.001). A correlation was calculated between UACR and NLR, with a cut-off value for NLR of 2.92. The cutoff value for NLR was calculated using the Receivers Operating Curve (ROC). The Chi-square test was applied, showing statistical significance (p<0.001), with an OR calculated at 4.34 (OR >1). Conclusion: The present study showed a significant positive correlation between NLR and UACR. Therefore, NLR may be considered a novel surrogate marker of DN, as an alternative to UACR, which is expensive and requires special equipment.