Long-term Outcome of Coronavirus Disease-associated Mucormycosis: 1-year Follow-up Study from India.

IMPORTANCE: Invasive fungal infections have recently become a public health problem, particularly in India following the second wave of coronavirus disease 2019 (COVID-19). India harbors the world's largest population of patients suffering from diabetes. What prompted the sudden spike of mucormycosis infections in the COVID pandemic needs investigation. OBJECTIVE: To determine if COVID-19 infection prompted the spike in invasive fungal infections in diabetic population. To determine the long-term outcome of COVID-associated mucormycosis. To determine if COVID-19 infection causes diabetes mellitus transiently. DESIGN: The study was a prospective cohort study comprising patients suffering from mucormycosis. The study was planned from 20 May 2021, until 30 November 2022, to investigate the long-term follow-up (1 year) of mucormycosis patients. SETTING: The study setting was a referral hospital. PARTICIPANTS: All the consecutive patients admitted to this hospital for treatment of mucormycosis were included in the study who consented to it. Intervention(s) (for clinical trials) or exposure(s) (for observational studies): All patients suffering with mucormycosis underwent treatment at this hospital with surgery and injectable systemic antifungal drugs alongside diabetes management. MAIN OUTCOME(S) AND MEASURE(S): Primary outcome measurement was in the form of survival with cure of mucormycosis. Hypothesis being tested was formulated during data collection. RESULTS: The data of 98 participants was collected, but analysis was done after excluding the case of cutaneous mucormycosis (infant patient). Mean age for patients was 55.5 years, varying from 28 to 88 years. In our study, 63.3% of patients with mucormycosis were males and 37.8% were females, of which 55.7% (34) and 58.3% (21) were known diabetics, respectively. Previous history of diabetes mellitus was identified as an underlying comorbid condition in 56.7% of patients, while the rest were diagnosed with new-onset diabetes mellitus. Sugar levels ranged (on admission) from 112 to 494 mg/dL (median 212 mg/dL) for known diabetics and from 132 to 356 mg/dL (median 204 mg/dL) for newly diagnosed diabetics. Other comorbidities included hypertension (19.5%), ischemic heart disease (8.2%), chronic renal illness (3.09%), and one case (1.03%) of postoperative renal cell carcinoma (disease-free). The majority of cases (91.8%) were not vaccinated for COVID-19, while only two patients reported a history of vaccination with two doses, and six others had received only a single dose. At the 1-year follow-up, 57.7% of cases were disease-free, 30.9% had expired, and 11.3% were lost to follow-up. The mean glycated hemoglobin (HbA1c) at the time of admission was found to be statistically significant when compared between known diabetics and newly diagnosed ones [confidence interval (CI)-95%, p ≤ 0.01]. A total of seven patients from the newly diagnosed diabetic group no longer required medicines for diabetes at the end of 1 year (CI-95%, p ≤ 0.01). CONCLUSIONS AND RELEVANCE: Diabetes mellitus, particularly with poor glycemic control, was the single most important factor associated with and predictor of outcome. Contrary to the popular hypothesis, industrial oxygen and oxygen masks were not the reasons for the mucormycosis pandemic. Additionally, immunization against COVID provided protection not only from severe COVID but also from COVID-associated mucormycosis. It is recommended that patients with mucormycosis be followed for longer periods as a few patients could be suffering from transient diabetes, particularly against the backdrop of a pandemic.

A Comparative Study of Quantitative Smartphone Usages among Controlled and Uncontrolled Type 2 Diabetes Mellitus Population.

BACKGROUND: Smartphones has significantly changed the lifestyle of people and considered as basic need for day to day work. But its usages beyond certain limits adversely affects physical and mental health. Aim of this study is to analyzes the quantitative usages of smartphone among controlled and uncontrolled type 2 diabetes patients. Objective is to correlate the pattern and duration of smartphone usages with the level of glycemic control. METHOD: "RealizD" is a mobile application that observes the pattern of mobile phone usages like 'screen time' (total duration of time spends watching mobile screen for any purpose) and number of times phone picked in a day. It graphically displays the hourly usages and longest duration of phone use in a single stretch. Subjects were patients of type 2 diabetes mellitus(T2DM) divided into 50 "case" with poor glycemic control and 50 "control" with good glycemic control. This application was installed in their smartphones to collect all above data. Subjects were observed for period of 3 months. Demographic data, blood glucose levels and HbA1c was recorded at first and again at second visit 3 months after. Data from application was recorded at second visit as described above. FINDINGS: The average screen time of cases was 160 ± 50.9 minutes per day whereas of controls was 107 ± 22.5 minutes. This difference in the screen time was statistically significant. Higher the screen time more was the HbA1c. The average of number of times a case picked his/her phone in a day was 70.2 ± 20.1 whereas by the controls was 57.3 ± 22.2. The difference was statistically significant. Also, Cases spend 37.3 % versus controls who spend 19.9 % of total screen time between 5 AM to 9 AM. The difference was statistically significant. This indicates that uncontrolled T2DM patients spend more time on phone in morning hours. INTERPRETATION: Smartphones could be best companion if used judiciously. Their unrestricted use adversely affects the health. Among diabetes patient unregulated smartphone usages leads to poor glycemic control and thus could be considered an important factor that need to be addressed.

Effects of Canagliflozin on Abnormal Liver Function Tests in Patients of Type 2 Diabetes with Non-Alcoholic Fatty Liver Disease.

INTRODUCTION: Canagliflozin, a second line OHA is well known to reduce weight. Patients of type 2 diabetes with non-alcoholic fatty liver disease (NAFLD) frequently have abnormal liver functions. We evaluated role of canagliflozin in reducing weight and improving liver function tests (LFT) in type 2 diabetes with NAFLD. AIMS: Effects of canagliflozin on abnormal liver function tests in patients of type 2 diabetes with non-alcoholic fatty liver disease. METHODS: We selected type 2 diabetes patients who were having comorbid NAFLD with abnormal LFT. Subjects were prescribed canagliflozin in dose of 100mg/ day for 6 months. Dose adjustments of other drugs (oral hypoglycemics agents and insulins) was done to monitor glycemic target. Effects of canagliflozin was observed on LFT, vitals and HbA1c. It was an observational study. Subjects who developed major side effects were excluded and managed. RESULTS: One subject was lost to follow up during study and 31 completed the study successfully. Average HbA1c and weight differences were -0·46% and -1·86% respectively. Average ALT reduction was 36 U/L; t= -9·153623, p is < 0·00001. Average AST reduction was 19·0 U/L; t= -8·153600; p is <0·00001. Average GGT reduction was 5·87 U/L; t= -3·286677, p=0·002588. Average ALP reduction was 1·68 U/L; t= -1·295661. p=0·204973. Serum Bilirubin was elevated by 0·04%; t=0·912, p=0·368. With 0·46% reduction in HbA1c there is 37·5% reduction in ALT levels (R=0·1424) and with 1·86% weight reduction there is 37·5% ALT reduction (R=0·3448). CONCLUSIONS: Canagliflozin controls HbA1c and reduce weight in type 2 diabetes. It also significantly improves LFT in co-morbid NAFLD.

Teneligliptin: An Economic and Effective DPP-4 Inhibitor for the Management of Type-2 Diabetes Mellitus: A Comparative Study.

CONTEXT: Increasing diabetic burden worldwide is creating an alarming situation for the management and development of economic resources for it's treatment. Progressive nature of the disease requires allocation of a higher proportion of expenditure on health care initiative of any country. AIM: Present study is designed with an aim to determine the effectiveness of cost-effective DPP-4 inhibitor, Teneligliptin, over the other agent of the same class. MATERIAL AND METHOD: The study was carried out in Postgraduate Department of Medicine, S.N. Medical College, Agra and 112 patients were selected as subjects with a selected inclusion criterion. STATISTICAL ANALYSIS USED: Independent student's t-test was applied to compare the means. Mean standard deviation was calculated for quantitative data. All p values were two-tailed and values p<0.05 were considered statistically significant. RESULT: There was no significant difference in the levels of blood sugar or glycosylated hemoglobin (HbA1c) before and after the treatment of Teneligliptin. CONCLUSIONS: Teneligliptin offered an efficient second line treatment for the management of type-2 Diabetes Mellitus at a reduced average price of INR 39 per day, when compared to other DPP-4 inhibitors.

Role of percutaneous cerclage wire in the management of subtrochanteric fractures treated with intramedullary nails.

PURPOSE: Cerclage wire application has emerged as a potential therapeutic adjunct to intramedullary nailing for subtrochanteric fractures. But its popularity is plagued by the concern of possible negative effect on fracture zone biology. This study was intended to analyze the clinico-radiological outcome and complications associated with cerclage wire application. METHODS: Retrospective analysis was performed on all the subtrochanteric fractures operated with intramedullary nailing between January 2012 and January 2016. After exclusion, 48 patients were available with an average follow-up of 20.8 months. Long oblique, spiral, spiral wedge or comminuted fracture configurations with butterfly fragments were particularly considered for cerclage wire application, which was employed by percutaneous cerclage passer in 21 patients. Assessment was done in terms of operation time, blood loss, quality of reduction, neck-shaft angle, follow-up redisplacement, union time, complications, and final functional evaluation by Merle d'Aubigne'-Postel score. RESULTS: Average operation time and blood loss were significantly higher in cerclage group (p < 0.05). However, cerclage use substantially improved quality of reduction in terms of maximum cortical displacement (p = 0.003) and fracture angulation (p = 0.045); anatomical reduction was achieved in 95.23% of cases as compared to 74.07% without cerclage. Union time was shorter, although not statistically different (p = 0.208), in cerclage group. Four patients in non-cerclage group developed non-union, 2 of them had nail breakage. No infection or any other implant related complications were reported with cerclage use. CONCLUSION: Minimally-invasive cerclage wire application has proved to be beneficial for anatomical reconstruction in difficult subtrochanteric fractures, whenever applicable, without any harmful effect on fracture biology.

Modified Thoracolumbar Interfascial Plane Block Versus Erector Spinae Plane Block in Patients Undergoing Spine Surgeries: A Randomized Controlled Trial.

BACKGROUND: Lumbar spine surgery is associated with significant postoperative pain. Interfascial plane blocks, such as erector spinae plane (ESP) and thoracolumbar interfascial plane (TLIP) blocks, can play a significant role in multimodal analgesic regimens. METHODS: Sixty patients aged 18 to 60 years undergoing elective single or double-level lumbar discectomy or primary lumbar laminoplasty were recruited into this randomized double­blind study. All patients received general anesthesia and were randomly allocated to either modified TLIP (mTLIP) block (group M) or ESP block (group E). Postoperative and intraoperative fentanyl consumption, and postoperative pain scores, were recorded. RESULTS: Total 48 h postoperative fentanyl consumption was higher in Group M (189.66±141.11 µg) than in Group E (124.16±80.83 µg; P =0.031). In the first 24 postoperative hours, fentanyl consumption was higher in Group M (150.3±120.9 µg) than in group E (89.9±65.3 µg; P =0.01) but was similar between groups in postoperative hours 24to 48 (39.0±20.2 µg versus 34.7±17.1 µg in group M and group E, respectively; P =0.37). Additional intraoperative fentanyl requirement was 57.66±21.76 µg in group M compared with 40.33±21.89 µg in group E ( P <0.01). Postoperative pain scores were higher in group M than in group E at 1, 2, 4, 6, 12, and 24 hours postoperatively ( P <0.001), but similar at 48 hours ( P =0.164). CONCLUSION: Compared with the mTLIP block, the ESP block was associated with lower pain scores and a small decrease in perioperative fentanyl consumption in patients undergoing lumbar spine surgeries. Both blocks could form a part of a multimodal analgesic regimen in spine surgery patients.

Utility of three-dimensional proton density-weighted sequence MRI in knee for the assessment of Anterolateral complex in Anterior cruciate ligament injury.

OBJECTIVES: To assess the proportion and pattern of injury of the anterolateral ligament (ALL) and the Kaplan fibre (KF) complex in knees with anterior cruciate ligament (ACL) injuries on MRI using three-dimensional (3D) proton density (PD) sequences. METHODS: A total of 88 patients having ACL injury were included in this cross-sectional study. 3D PD sequences were used to assess injury of ALL and the KF complex and were graded on a scale of 0 to 3. MR images were evaluated by two radiologists. Interobserver agreement was determined using Cohen Kappa. RESULTS: Femoral, meniscal, and tibial portions of ALL were visualized in 90.9%, 92%, and 94.3% of the study subjects, respectively. Proximal and distal KF were visualized in 92% and 93.2% of patients, respectively. Injury to ALL and KF was seen in 63.6% and 17% of the patients, respectively. Excellent interobserver agreement was noted for the identification and grading of ALL and KF complex injuries. CONCLUSIONS: Oblique reformatted 3DPD MRI reliably detect ALC; however, ALL injury is better characterized than KF injury using this sequence. ADVANCES IN KNOWLEDGE: Given the potential role of anterolateral complex (ALC) in maintaining the rotational stability of the knee, ALC assessment using the 3D PD sequences and their oblique reformatted images should be incorporated as routine review area of the knee MRI, particularly in the setting of ACL tear.

Anatomical correlates for the newly discovered meningeal layer in the existing literature: A systematic review.

The existence of a previously unrecognized subarachnoid lymphatic-like membrane (SLYM) was reported in a recent study. SLYM is described as an intermediate leptomeningeal layer between the arachnoid and pia mater in mouse and human brains, which divides the subarachnoid space (SAS) into two functional compartments. Being a macroscopic structure, having missed detection in previous studies is surprising. We systematically reviewed the published reports in animals and humans to explore whether prior descriptions of this meningeal layer were reported in some way. A comprehensive search was conducted in PubMed/Medline, EMBASE, Google Scholar, Science Direct, and Web of Science databases using combinations of MeSH terms and keywords with Boolean operators from inception until 31 December 2023. We found at least eight studies that provided structural evidence of an intermediate leptomeningeal layer in the brain or spinal cord. However, unequivocal descriptions for this layer all along the central nervous system were scarce. Obscure names like the epipial, intermediate meningeal, outer pial layers, or intermediate lamella were used to describe it. Its microscopic/ultrastructural details closely resemble the recently reported SLYM. We further examined the counterarguments in current literature that are skeptical of the existence of this layer. The potential physiological and clinical implications of this new meningeal layer are significant, underscoring the urgent need for further exploration of its structural and functional details.

Sheehan's Syndrome in India: Clinical Characteristics and Laboratory Evaluation.

Background: Sheehan's Syndrome (SS) is an important cause of hypopituitarism especially in developing countries though it remains underdiagnosed to a great extent. Torrential bleeding after delivery followed by lactation failure and amenorrhoea gives a clue to the diagnosis which is usually made after several years of delivery. Materials and Methods: It was a retrospective observational study conducted by reviewing the case records of 38 cases of SS. The age, anthropometric measurements, signs and symptoms, biochemical parameters, hormone levels and imaging reports were examined and analyzed. Results: The mean age at presentation was 36.5 years because there was a delay of 8.4 years from last delivery before diagnosis could be made. Ninety percent patients presented with lactation failure. Anaemia, hypotension, hypogonadism, hypothyroidism, and altered lipid profile were the most common findings. The mean systolic blood pressure (BP) was 80.95 mm and diastolic BP was 51.6 mm of Hg at the time of presentation. Hyponatremia was the most common electrolyte abnormality noted and low HDL was the commonest lipid abnormality. Conclusion: A large percentage of patients presented with amenorrhea, lactation failure, and decreased or absent axillary/pubic hair. Shock, anemia, and hyponatremia were also common symptoms among the patients studied. The diagnosis of SS rests upon a thorough history taking of the postpartum events in cases presenting with hypopituitarism irrespective of the age at presentation. Proper antenatal care with exclusive institutional deliveries can reduce the prevalence of SS in developing countries.

A study report on the effect of COVID-19 pandemic in providing in-and-out-patient psychiatric services in a level-3 COVID hospital.

Background: COVID-19 pandemic disrupted all routine and emergency hospital services, including our out-and-in-patient psychiatric services. Aim: To study the effect of the COVID-19 pandemic and subsequent lockdown in providing in-and-out-patient psychiatric services and the experience of tele-consultation services in our level-3 COVID hospital. Materials and Methods: We conducted a retrospective observational study using an administrative database at psychiatry in-and-out-patient department. All the cases that were reported to us, through emergency Out-Patient Department (OPD) and tele-consultation OPD, from April 2020 to October 2020, were included in the study. Data, thus obtained, were compared with the out-and-in-patient data during the same period on the previous year. Results: During the study period, there was a decline in out-patient registration of patients by 94.5%, and a reduction in admission rate was 75.5%, in comparison with the previous year. During 3 months of tele-consultation service provided, 23.5% of patients had the diagnosis of depression, 21.4% of them had various types of headaches, 15.9% of patients had psychosis, 15.3% had anxiety disorders, and 8.8% had a bipolar-affective disorder. Conclusion: Being a level-3 COVID hospital, our hospital suffered significantly in relation to psychiatric in-and-out-patients attendance and service recipients during the study period of COVID-19 pandemic.

Sharing of proximal fibers by the anterolateral and lateral collateral ligaments in the human knee: a cadaveric study.

Literature is highly inconsistent in describing the proximal attachment of the anterolateral ligament (ALL) and its relationship with the lateral collateral ligament (LCL) in human knees. This observational study aims to investigate that lacuna. The gross dissection was performed in the lower limbs (n = 83) from the donated adult-age (> 18 years) embalmed cadavers from medical institutions in the north and east India. The dissected knee specimens were first examined macroscopically. Further routine and special staining and microscopic examinations were performed. The ALL was absent in approximately 20.4% of the studied knee specimens (17/83). In remaining, the sharing of ALL and LCL proximal fibers was observed as a consistent finding (~ 97%) with rare exceptions. The mean length of the tibial and meniscal limbs of ALL was 1.57 ± 0.8 cm [Range (R) 0.5-4 cm] and 0.73 ± 0.47 cm [Range (R) 0.1-1.6 cm], respectively. In addition, multiple variations in its presentation were observed. We propose that the proximal sharing of LCL-ALL fibers is a dominant feature in the studied population. The sharing of the fibers may impact the biomechanics and injury mechanisms for both ligaments. The possibility of ethnic variations in the ALL morphology should be a concern during reconstruction surgery.

Assessment of determining factors for severity of NeoCOVIDiabetes in India: A pan India multicentric retrospective study.

BACKGROUND AND AIMS: There is a bidirectional relationship between COVID-19 and diabetes. The primary objective of this study was to estimate the prevalence of patients newly detected to have diabetes (NDD) who recovered from COVID-19 in India whilst comparing NDD with patients without diabetes (ND) and those who have known to have diabetes (KD) in terms of glycemic status pre- and post-COVID with disease severity. MATERIALS & METHODOLOGY: There were 2212 participants enrolled from 15 sites, with 1630 active participants after the respective execution of selection criteria. Data collection was done using a specialized Case Record Form (CRF). Planned statistical analysis and descriptive statistics were concluded for significance between patient groups on various parameters. RESULT: The differences in age between the study groups were statistically significant. The average blood glucose at COVID-19 onset was significantly higher in KD than in NDD. Significantly more proportion of NDD (83%) had been hospitalized for COVID management when compared to KD (45%) and ND (55%). The NDD group received higher doses of steroids than the other two groups. On average, patients in the NDD group who received at least one vaccination (one dose or two doses) had a higher High-Resolution Computed Tomography (HRCT) score. Patients who had not been vaccinated in ND and KD groups experienced a higher HRCT score. CONCLUSION: Prospective metabolism studies in post-acute COVID-19 will be required to understand the etiology, prognosis, and treatment opportunities.

Metabolic derangements with olanzapine and risperidone in schizophrenia spectrum and other psychotic disorders: A 24-week prospective study.

Background and Aims: Schizophrenia spectrum and other psychotic disorders are common disorders often requiring long-term treatment with atypical antipsychotics, which might cause metabolic dysfunctions. We aimed to study the metabolic dysfunctions with olanzapine and risperidone in patients with schizophrenia spectrum and other psychotic disorders. We also explored the incidence of new-onset metabolic syndrome and its predictors. Methods: This was a 24-week prospective observational study conducted at a teaching hospital in North India. The patients were prescribed olanzapine or risperidone. Anthropometric measurements (waist circumference, weight, body mass index, blood pressure) and biochemical investigations (triglycerides, high-density lipoproteins, fasting plasma glucose) were recorded at baseline and after 24 weeks. Metabolic syndrome was defined using the International Diabetes Federation definition. Statistical tests used were Fisher's exact test, paired t-test, unpaired t-test, and logistic regression. Results: A total of 45 patients, 30 on olanzapine and 15 on risperidone completed the study. Statistically significant changes occurred in all variables with olanzapine while with risperidone statistically significant changes occurred in all variables except waist circumference and fasting plasma glucose. Statistically greater changes in mean values between the two were noted only for high-density lipoprotein with olanzapine. 20% of patients developed metabolic syndrome with non-significant between drug differences. Baseline triglyceride predicted the development of the metabolic syndrome. Conclusions: Olanzapine and risperidone cause metabolic derangements and statistically significant differences may not exist between them. Baseline triglyceride levels might predict subsequent metabolic syndrome.

Glimpse into the Lifestyle of Doctors.

Background: Lifestyle disorders are on rise world over. Also, the role of doctors as leaders in propagating healthy lifestyles needs to get a reality check. Aims and Objectives: This study aimed to investigate the prevalence of lifestyle disorders, eating habits, nutrition patterns, and lifestyle of doctors by assessing health-related behaviours considering gender and other relevant demographic parameters. The objectives of the present study are to find out the relationship of lifestyle disorders among doctors and to study lifestyle disorders and related behaviour among male and female doctors and other subgroups. Materials and Methods: Online survey was conducted using Googledoc in June to August 2021. Descriptive statistical analysis has been carried out in the present study. The student's t-test (two tailed, independent) has been used. Results: About 50% rated a happiness quotient of 7 and 8. Surgeons had more diabetes and hypertension than physicians. Prevalence of hypertension was more in self-employed males versus males in job. About two-third participants scored ≥ 80% on healthy lifestyle score. Conclusion: Our results call for a well-thought strategy to overcome the financial and technological hindrances to accurately identify health risk factors and plan corrective interventions. A healthy lifestyle both in terms of diet and exercise should be incorporated into the schedules of doctors.

Erythema annulare centrifugum in a case of chronic myeloid leukemia.

Chronic myeloid leukemia (CML), BCR-ABL1-positive, is classified as a myeloproliferative neoplasm predominantly composed of proliferating granulocytes and determined to have the Philadelphia chromosome/translocation t (9;22)(q34;q11.2). Skin is said to be the mirror to systemic diseases, with skin manifestations ranging from nonspecific cutaneous lesions to specific lesions. The cutaneous manifestations of CML are generally reddish-brown to violaceous papules and nodules, indurated or hemorrhagic plaques, perifollicular acneiform papules, bullae, and palpable purpura. Other unusual manifestations could be erythema nodosum, pyoderma gangrenosum, erythema annulare centrifugum, and so on. Here we present a case of a 50-year-old woman with a history of recurrent pruritic skin lesions and erythema annulare centrifugum as the presenting complaint of CML.

Two-level bilateral ultrasound-guided erector spinae plane block for kyphosis corrective surgery - A case report.

BACKGROUND: Ultrasound-guided erector spinae plane (ESP) block has been used to provide lumbar analgesia. The craniocaudal spread of local anesthetic in this block can be unpredictable in patients with kyphosis due to backward curvature of the spine, which might prevent longitudinal spread. CASE: This is a case of a 33-year-old male (60 kg) diagnosed with type 3b kyphosis of the thoracolumbar region at the level of L1 who underwent extended pedicle subtraction osteotomy. ESP block was administered at two different levels, one at T12 (above the angle of the kyphosis L1) and another at L3 (below the angle of kyphosis L1), as the curvature of kyphosis can hinder the longitudinal spread of local anesthetic. CONCLUSIONS: Two-level ESP block results in better craniocaudal spread of local anesthetic in a patient undergoing kyphosis correction surgery.

Assessing the SpO2 in a random population - Looking for the best among fingers.

Context: Pulse oximetry is one of the most revolutionary methods used to monitor the patients in the clinical setting, particularly intensive care and anesthesia. We usually use the index or middle finger to measure SpO2 values, but little is known about the inter-digital differences that exist between the fingers. Aim: We aim to compare the peripheral capillary oxygen saturation among fingers of both hands. A total of 93 healthy volunteers aged between 18 and 50 years participated in the study. Materials and Methods: Their SpO2 values were recorded from each finger with at least 1 minute of resting interval. Their blood pressure, heart rate, and body temperature were recorded as well. Result: A total of 930 measurements were obtained from 93 volunteers. The highest average SpO2 value of right-handed volunteers was measured from the left little finger (98.48 ± 0.62) of right-handed volunteers, and it was statistically significant when compared with the right ring finger, right little finger, left thumb, left index, left middle finger, and left ring finger. The highest average SpO2 from left-handed volunteers was obtained from the right index finger, but it was statistically insignificant. Conclusion: We assume ethnic and climatic differences to play a role in contradictory results noted from previous studies conducted, and this needs to be investigated further. It is recommended that multiple readings may be obtained from other fingers as well before coming to any conclusion as inter-finger variability cannot be ignored.