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   Table of Contents - Current issue
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January-March 2022
Volume 17 | Issue 1
Page Nos. 1-217

Online since Monday, July 25, 2022

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CASE REPORTS  

Monkeypox and lupus Highly accessed article p. 1
Rujittika Mungmunpuntipantip, Pathum Sookaromdee, Viroj Wiwanitkit
DOI:10.4103/jdmimsu.jdmimsu_251_22  
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ORIGINAL ARTICLES Top

Nail Changes in the Chronic Kidney Failure – A Cross-Sectional Study Highly accessed article p. 2
Ruchita Kabra, Sourya Acharya, Samarth Shukla, Sunil Kumar
DOI:10.4103/jdmimsu.jdmimsu_90_22  
Background: Nail manifestations observed in chronic renal failure (CRF) patients are multifarious and heterogeneous in nature. The prime objective of the study is to evaluate the prevalence and features of various kinds of nail manifestations in the patients of CRF. CRF causes heterogeneous pathology of nail which may be or may not be associated with renal condition itself, complications related to it and its therapy. Objective: To study nail changes in the patients of CRF whether managing conservatively or on maintenance hemodialysis (HD). Patients and Methods: The study consists of 100 patients suffering from CRF. Nails of these 100 patients suffering from CRF were examined and different kinds of nails were appreciated and frequencies of the same type of nails in different patients were noted. Results: Nail changes found in chronic kidney disease are longitudinal ridges, half and half nails, leukonychia, pitting nails, onychomycosis, absence of lunula, splinter hemorrhage, and onycholysis as decreasing trend they observed. Conclusions: Nail changes that are seen on examination of patients with CRF managing on HD are very frequent and nail changes if found earlier can be an indicator for early diagnosis of systemic diseases.
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Prediction of preeclampsia and adverse pregnancy outcome on the basis of uterine artery doppler Highly accessed article p. 7
Prerna Anup Patwa, Gaurav Vedprakash Mishra, Rohan Kumar Singh, Megha Manoj, Rajasbala Pradeep Dhande, Sonal Singh, Aditi V Goyal, Bhagyashree Yewale
DOI:10.4103/jdmimsu.jdmimsu_36_22  
Background: Hypertensive disorders complicating pregnancy are common. Preeclampsia and eclampsia are major causes of maternal morbidity and mortality, particularly in developing countries. With prompt recognition of symptoms and early diagnosis of preeclampsia can lead to improved maternal and neonatal outcome. Numerous tests have been proposed for the prediction of preeclampsia, their results have been inconsistent. We focused to investigate the uterine artery by conducting Doppler ultrasound study in predicting the preeclampsia in women with a high-risk pregnancy. Methods: This prospective cross-sectional observational study was conducted on 195 pregnant women referred to Acharya Vinoba Bhave Rural Hospital, Wardha (India). Uterine artery Doppler was conducted on all women with raised blood pressure referred to the radiology department. The patients were followed up and outcomes such as eclampsia, chronic hypertension, death, neonatal intensive care unit (NICU) admission, low birth weight, and preterm labor association with preeclampsia were measured. Results: The mean age of pregnant women was 26.47 ± 4.96 years old. Preeclampsia was seen in 68 (34.9%) of the women. In the study, maternal outcome such as eclampsia and maternal high blood pressure (HTN) was significantly associated with preeclampsia. Similarly, neonatal outcomes such as low birth weight, NICU admission, and intrauterine growth restriction were significantly associated with preeclampsia. Pulsatility Index (PI) at >1.2 had the highest sensitivity of 64.71%, specificity of 71.65%, positive predictive value of 55%, and negative predictive value of 79.1% to predict preeclampsia than any other Doppler indices. Conclusion: The findings of this study suggest that PI at >1.2 had better validity in predicting preeclampsia compared to resistive index (RI) and Standard deviation.
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Role of transrectal ultrasound and elastography in the diagnosis of prostate lesions Highly accessed article p. 14
Rishabh Gupta, Suresh Vasant Phatak
DOI:10.4103/jdmimsu.jdmimsu_80_22  
Background: The incidence of malignancy of prostate gland has displayed a rapid rise over recent times. Transrectal ultrasound (TRUS) has brought revolution to radiologist's human prostate imaging methods. Information regarding elasticity of suspicious or abnormal lesions provided by strain elastography can enhance the detection rate of prostate malignancies as well as serve as a reliable visual guide for biopsy from these sites. In this prospective study, we aim to appraise the use of TRUS for diagnosing prostatic lesions, both benign and malignant, and compare it to the utility of strain elastography to precisely locate and guide biopsies of lesions while referring to the pathological diagnosis as the reference standard, wherever possible/needed. Materials and Methods: This was a prospective, cross-sectional study involving 82 male patients who were clinically suspected to have prostate malignancy. The patients were referred to the Department of Radiodiagnosis, AVBRH, where they underwent transrectal ultrasonography and elastography with Hitachi Aloka ultrasound (USG) Machine Arietta S70 with biplane high-frequency transrectal probe (6–10 MHz) with elastography. Results: TRUS had high sensitivity (92.45%) and specificity (78.38%) for cancer detection. Strain elastography had a sensitivity of 96.23%, specificity of 81.08%, positive predictive value (PPV) of 70.83%, and negative predictive value (NPV) of 97.83%. Based on our findings, real-time elastography had more sensitivity and higher NPV than TRUS for the identification of prostatic cancer. Hence, it can be concluded that elastography is an effective assessment tool for ruling out the possibility of malignant tumors, helping to reduce redundant biopsies. Conclusions: Transrectal ultrasonography (TRUS) is an effective tool for the assessment of prostatic lesions. TRUS has high specificity, sensitivity, NPV, and PPV when assessing lesions for prostatic cancer. Elastography has high sensitivity, high specificity, high PPV, and reliable NPV when detecting for prostatic cancer. The combination of TRUS and elastography can help more efficiently assess lesions and guide biopsies to increase the identification rate of prostatic cancer.
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Age and gender differences in morphometric measurements of brain stem using magnetic resonance imaging in healthy Indian adults p. 21
Amrutha Ranganath, Anil Kumar Saklecha, Aasish Singh, E Vineela
DOI:10.4103/jdmimsu.jdmimsu_238_22  
Background: Morphometric changes in the brain stem can be an early indicator for ongoing physiological or pathological changes. Establishing age- and gender-matched linear morphometric values of the brain stem serves as a useful reference for comparison. Aims and Objectives: This study aimed to determine normal measurements of brain stem structures in healthy Indian adults and to establish age and gender differences in brain stem measurements if any. Materials and Methods: This hospital-based cross-sectional study was conducted from November 2020 to January 2021 on patients referred to the department of radiodiagnosis for magnetic resonance imaging (MRI) of the brain. Baseline data and linear midsagittal measurements on MRI were recorded. Results: A total of 142 patients were included in the study. The average measurements for midbrain, pons, medulla at pontomedullary (PM), and medulla at cervicomedullary junction are 1.67 ± 0.17 cm (mean ± standard deviation [SD]), 2.16 ± 0.18 cm (mean ± SD), 1.39 ± 0.16 cm (mean ± SD), and 1.08 ± 0.13 cm (mean ± SD), respectively. Significant reduction in brain stem measurements at all levels with P < 0.05 were recorded with increase in age except for the medulla at the PM junction which remained constant. There was no significant difference in brain stem measurements between males and females. Conclusion: Normal reference value for AP diameter of the brain stem in healthy Indian adults showed statistically significant reduction at various levels with advancing age. There were no statistically significant gender differences in sagittal diameter of the midbrain, pons, and medulla.
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Study of gram-positive isolates from cases of septicemia and their antibiotic sensitivity pattern with special reference to methicillin-resistant Staphylococcus aureus p. 25
Shital Moreshwarrao Mahajan
DOI:10.4103/jdmimsu.jdmimsu_210_22  
Background: Infections of the bloodstream are a leading source of illness and mortality in all types of communities. Bacteremia is the presence of bacteria in the bloodstream for long or short periods. Aim and Objectives: Dissemination of the bacteria throughout the body with evidence of systemic responses toward microorganisms is septicemia. Many organisms including Gram positive such as Coagulase negative staphylococci, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, and Enterococcus faecium can cause septicemia. Many precipitating factors such as presence of intravenous catheters, immunocompromised state, and use of cytotoxic drugs may lead to increase in cases of septicemia. Isolation of the offending pathogens and knowledge about sensitivity and resistance pattern of the isolates remain the mainstay of the diagnosis. This study was conducted to cite the bacteriological etiology of septicemia in adults as well as in neonates and to decide the strategy for the cure of septicemia cases along with their antibiotic susceptibility profile. Materials and Methods: Duration of this study was 3 months. In this duration, 100 blood samples from suspected cases of septicemia were processed. Results: Gram positive organisms isolated from the specimens were collected and identified by standard protocols. Antibiotic sensitivity and detection of methicillin resistant Staphylococcus aureus were done by using Kirby Bauer disc diffusion method. Conclusion: Various causative agents were isolated from blood samples. Some of them are resistant to the drugs that are commonly used for the treatment of septicemia. Hence, isolation of the etiological agent along with the detection of its antibiogram pattern is important for early diagnosis and treatment of cases of septicemia.
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A research protocol of an observational study on efficacy of microsoft kinect azure in evaluation of static posture in normal healthy population p. 30
Tamanna Nurai, Waqar Naqvi
DOI:10.4103/jdmimsu.jdmimsu_176_21  
Background: Recognition of human pose is very significant in studies involving human-computer interactions (HCIs). Microsoft's Kinect II or Microsoft's Kinect azure sensor in three-dimensional motion capturing systems shows a growing interest in vision-based HCI as they are low-cost. In this research, we introduced and ruled out the efficacy of Microsoft Kinect Azure in the evaluation of static coronal Posture in normal healthy population. Methodology: The research has been structured as an observational study. The total of 132 participants will be taken from AVBRH, Sawangi Meghe for study as per inclusion and exclusion criteria. With intervention the period of the study will be 6 months. It holds single period, concurrent validity evaluation comparing normal posture derived from the Kinect system. Discussion: This study protocol aims to evaluate the validity of the evaluation of normal human posture using Microsoft Kinect Azure. The study's expected outcome will concert on the evaluation of coronal Posture using Microsoft Kinect Azure in normal healthy population.
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A research protocol of foot posture in traffic policeman p. 34
Tamanna Nurai, Waqar Naqvi
DOI:10.4103/jdmimsu.jdmimsu_178_21  
Background: Traffic police officers have a high-risk job as said by Driscoll. They also have many health-related issues due to their occupation. Mostly, their physical health is affected because of their long hours of standing duty on the road, exposure to sun and cold, constant travelling on bike throughout the day. In this research, we used foot posture index (FPI)-6 a novel method of rating foot posture using the set criteria and a simple scale. It is a clinical tool used to quantify the degree to which a foot is pronated, neutral, or supinated. Materials and Methods: The study has been structured as a cross-sectional survey. The total of 132 participants will be taken from traffic department policemen of Wardha city unit excluding policemen who were on leave or suffering from foot injuries. The study procedure will involve permission to conduct medial arch assessment for traffic policemen through DCP, Wardha. Demographic details such as gender and age will recorded and also weight and height will be taken to calculate body mass index for each individual. Weight will be taken with and without gadgets. Discussion: This study protocol aims to evaluate the foot posture evaluation of policeman of Wardha City. The study's expected outcome will concert on the evaluation of foot posture using FPI in traffic police officers of Wardha City.
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Sexual dimorphism in cervical spine – A magnetic resonance imaging study p. 38
Anita R Gune, Swati Sarjerao More
DOI:10.4103/jdmimsu.jdmimsu_327_21  
Background: Morphometric measurements of the spinal cord provide important clues regarding neural and spinal injuries. They are also of forensic importance and can be used to determine sex of an individual. These parameters have been shown to vary across age groups and ethnicity. Currently, there is a paucity of data regarding these parameters in Maharashtra, India. Therefore, studies are required to provide reference values for spinal canal parameters for this population. Aims: To study the cervical spinal canal morphometric differences in males and females in the west Maharashtra population. Materials and Methods: A comparative, retrospective study was conducted on 70 subjects aged between 18 and 70 years (36 males, 34 females). The sagittal vertebral body diameter, the sagittal spinal canal diameter, and the sagittal spinal cord diameter were measured at the C3–C7 level by magnetic resonance imaging. The space available for the spinal cord and Torg's ratio were determined. Statistical Analysis Used: Mann–Whitney U-test and unpaired t-test were used to calculate significant difference at P < 0.05. Results: Mean age of the patients was 48.53 ± 14.67 years. There was significant difference in the sagittal spinal canal diameter and spinal cord diameter (P = 0.000107 and P = 2.20e−16, respectively) from C3 to C7. In all the cases, the Torg's ratio of females (0.97–1.04) was higher than in males (0.89–0.95) and varied significantly (P < 0.05). Conclusions: The study provides reference morphometric values for combined Torg's ratio and individually in males and females in the Kolhapur population.
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Bacteriological profile of gram-negative organisms from cases of septicemia and their antibiotic sensitivity pattern with special reference to beta-lactamase and carbapenemase production p. 43
Shital Moreshwarrao Mahajan, Sonaakshi Khushwah
DOI:10.4103/jdmimsu.jdmimsu_359_21  
Background: Blood stream infections are amongst the most important causes of morbidity and mortality throughout the world. Septicemia is a serious bloodstream infection and a biggest challenge for the clinicians in selection of appropriate antimicrobial agents. Presence of intravascular catheters, immunosuppression and use of cytotoxic drugs are some precipitating factors for antibiotic resistance which is a global problem. Reports of multi-resistant bacteria causing septicemia in developing countries are increasing. Extended-spectrum beta-lactamases (ESBL) and Carbapenemase-producing Enterobacteriaceae (CRE) has caused a major public health concern. Aim and Objectives: To determine the bacteriological profile of septicemia and their antibiotic susceptibility profile with special references to β-lactamase and carbapemase productionin gram negative bacilli. Material and Method: During the 3 month period of study total 100 blood samples from suspected cases of septicaemia are collected. Isolates were processed and identified by standard protocols. Detection of extended spectrum β-lactamase (ESBL), inducible AmpC and MBL (Metallo β-lactamases) was done by using screening test and then confirmatory tests. Results: Out of 100 samples 68 gram negative organisms were isolated. Maximum growth was of Pseudomonas aeruginosa i.e. 34 , followed by Klebsiella pnemoniae i.e. 19 and Acinetobacter sps and E.coli. From all isolates 4.4% were ESBL, Metallo –beta-lactamases (MBL) production were seen in 5.9 %. 40% and 10.5% were MBL-E.coli and MBL-Klebseilla pnuemoniae respectively. Conclusion: Many of the isolates from cases of septicaemia were resistant to most of the recently used antibiotics. So, Detection of the etiological agents and their antibiotic sensitivity will definitely help in effective prophylactic measures, prompt and accurate diagnosis of septicaemia. Simple methods like disc potentiation test for ESBL, disk antagonism test for inducible AmpC producers and Combined disk potentiation test for MBL production are relatively inexpensive and less cumbersome, so it can also be performed as a part of routine sensitivity testing. High degree of antibiotic resistance is an alarming sign for development of antibiotic policies and protocols for treatment of septicaemia.
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Evaluation of effectiveness of management of excessive gingival display (Gummy Smile) with lip reposition procedure: A case series p. 47
Sneha S Puri, Priyanka G Jaiswal, Akhilesh Shewale
DOI:10.4103/jdmimsu.jdmimsu_17_21  
Background and Aim: Excessive gingival display can be managed by a variety of treatment modalities, depending on the specific diagnosis. Lip repositioning surgery is a largely unknown and underutilized treatment modality for excessive gingival display. The aim of the present study was to minimize gingival display with a lip reposition procedure. Materials and Methods: A total of three patients with a gummy smile were selected for the study. This case report demonstrates the successful management of excessive gingival display with a lip-repositioning procedure. This is accomplished by removing a strip of mucosa from the maxillary buccal vestibule, then suturing the lip mucosa to the mucogingival line. Results: The procedure resulted in a narrower vestibule and restricted muscle pull, thereby reducing gingival display during smiling. Conclusion: The lip repositioning technique to decrease the amount of gingival display proved to be more conservative and provided a good esthetic outcome.
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Awareness of dental health in competitive and recreational swimmers: A comparative survey-based study p. 51
Sachet Engineer, Sandhya Tamgadge, Nikita Rijhwani, Nidhi Choudhary, Geet Shukla
DOI:10.4103/jdmimsu.jdmimsu_469_21  
Background: Swimming is an exercise globally popular due to its beneficial effects. It is a well-known fact that chlorine is added to pool water for disinfection, although the repercussion of the same is not prominently described in the literature. Aims: (1) This study aims to establish the presence of symptoms of dental erosion in swimmers who swim competitively as well as recreationally and (2) to compare the gradient of symptoms experienced by the two groups. Materials and Methods: This cross-sectional prospective study was carried out to establish the correlation between dental erosion in swimmers who swim competitively (n = 250) – 6 or more than 6 h a week and recreationally (n = 250) – lesser than 6 h a week. A questionnaire was distributed both online and manually across India and feedback was received. All the findings were correlated and statistically analyzed. Observation and Results: The results showed the distinct presence of the phenomenon among a majority of swimmers who experienced an array of symptoms of dental erosion such as chalkiness of teeth in 58.2% of subjects, roughness of teeth in 54.4%, generalized sensitivity in 38.2%, sensitivity to hot and cold foods/drinks in 52%, discoloration in 37.6%, and staining in 36.6% subjects. A remarkable finding of this study was the lack of generalized awareness with respect to the phenomenon among competitive and recreational swimmers Conclusion: This study highlights the prevalence of the phenomenon and the general lack of awareness among swimmers with respect to dental erosion associated with exposure to the chlorinated pool water.
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Knowledge, attitude, and practice related to alcohol use among undergraduate students p. 59
Kudupudi Punyavathi Poojitha, Syam Kumar Addepalli
DOI:10.4103/jdmimsu.jdmimsu_443_21  
Background: The increasing production, distribution, and promotion of alcohol have seen drink-related problems emerging as a major public health concern in India, especially in college-going young adults. The percentage of the population drinking alcohol aged less than 21 years has increased from 2% to more than 14% in the past 15 years as revealed by Alcohol and Drugs Information Centre India. Objective: The objective is to evaluate knowledge about alcohol intake, attitude and practice methods toward alcohol consumption in undergraduates. Materials and Methods: A total of 500 undergraduates from engineering and medical streams were included in the study. Undergraduates were given a validated Student Alcohol Questionnaire. Information given by the students was analyzed. Results: 93% of students believe that many people drink to escape from problems, loneliness, and depression. 54% of students think that responsible drinking can result in relaxation, enhanced social interactions, and feeling of well-being. 74% of students' opinion is that many people drink because of peer group pressures and to gain adult status. About 76% of students agreed to the statement that approximately 10% of fatal highway accidents are alcohol related. Only 22% of students are aware of the fact that blood alcohol content of 0.1% is the legal definition of alcohol intoxication in driving. Alcohol was consumed by 31% of males and 17% of females at least once in their lifetime. 70% of boys and 64% of girls of those who consumed alcohol had experienced vomiting and hangover. Twenty (4%) students reported that they drove car after having several drinks or involved in a fight at least once in their lifetime. Conclusion: There is a necessity for more studies to evaluate the reason for increasing inclination of students toward the consumption of alcohol.
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Prevalence of nomophobia and use of social networking sites and applications – A cross-sectional study among undergraduate students in a medical college of Eastern India p. 69
Arijit Kundu, Lipilekha Patnaik, Sumitra Pattanaik, Trilochan Sahu
DOI:10.4103/jdmimsu.jdmimsu_125_19  
Background: Nomophobia (NMP) refers to the discomfort or anxiety caused by the nonavailability of a mobile phone, computer, or any other virtual communication device. It is considered as a modern age phobia due to interaction between people and communication technologies, especially smartphones. Objectives: The objective was to know the prevalence of NMP and to study the pattern and dependence on most popular social networking sites and applications among medical undergraduates. Materials and Methods: A cross-sectional study was conducted among undergraduate students of a medical college. Data regarding sociodemographic characteristics, use and addiction to smartphones, Internet, social networking sites, and messaging applications were collected and analyzed by SPSS software. Results: Among 338 students, 87.6% were using their smartphones most of the time in a day. About 56.6% of the students liked to come back to get their smartphone if they had forgotten while going out. All had access to Wi-Fi and 96.2% had their own Internet connection. About 47.6% used Internet immediately after waking up in the morning. Common symptoms seen with loss of contact with their smartphone were loneliness (40.6%), panic attacks (10.4%), depression (5.7%), etc., All students had NMP and among them, 22.1% had mild, 61.5% had moderate, and 16.4% had severe NMP. Conclusion: The concept of NMP is doubtful to be considered as a disorder, but it has become a serious modern-day problem and should be intervened at the earliest.
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Exploring the experiences of maternal-fetal attachment among primigravida women p. 73
Memchoubi Keithellakpam, Suresh Ray
DOI:10.4103/jdmimsu.jdmimsu_273_20  
Background: In India, in which the mortality rate for women is 130 per 100,000 live births and the neonatal mortality rate at 25.4 deaths per 1000 live births that makes it 12th worst among the 52 lower middle-income countries. Healthy maternal–fetal attachment (MFA) may serve to allow women to adopt optimal health practices earlier, thereby on a larger scale contribute toward the reduction of obstetric maternal and child morbidity and mortality. The objective of the study was to explore the experience of MFA among primigravida women. Materials and Methods: Qualitative approach was used and the research design adopted was hermeneutic phenomenology. Data were collected from six samples. The sampling technique used was the nonprobability purposive sampling technique. The tool consisted of demographic profile and a guiding questionnaire. The data were collected through one-to-one in-depth interview and field notes. To ensure the trustworthiness of the data credibility, transferability and dependability were done. The data collected were analyzed using descriptive statistics, i.e., frequency and percentage for demographic variables, and thematic analysis for determining essential codes, subthemes, and themes through content analysis was used to analyze the data gathered through interview. Results: Out of six samples, 50% were in the age group of 18–25 years, 33.3% each studied up to secondary and graduation education, 83.3% were homemaker, no one with significant past medical and surgical history, 83.3% of them were in 36–40 weeks of gestation, all had a history of nausea and vomiting, and all women taken antenatal care information from health personnel. A total of 8 themes, 28 subthemes, and codes were generated. The themes emerged were experience as ready for change, feeling of life, social and family support, self-awareness, embracing motherhood, health promotional practices, hopeful anticipation, positivity, and gratitude.
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Comparison between biomarkers high-sensitivity C-Reactive protein and N-Terminal probrain natriuretic peptide in patients with myocardial infarction p. 78
Dharmveer Sharma, Vivek Kumar Jain, Vidyanand Pandit, Manish Kumar Verma
DOI:10.4103/jdmimsu.jdmimsu_382_21  
Background: Elevated inflammatory markers have been associated with an increased risk of future cardiovascular events, acute myocardial infarction (MI), and illness in patients with stable or unstable coronary artery disease. Aim: The present study was comparison between high-sensitivity C-reactive protein (hsCRP), NTproBNP, TnT, and creatine kinase MB (CK-MB) in patient groups and control group. Materials and Methods: The diagnostic test blood glucose and lipid profile biochemical parameter were assessed using endpoint method. hsCRP kits for human were assessed using turbidimetric immunoassay method. Serum N-terminal probrain natriuretic peptide (NT-proBNP) levels were measured by automated immunoassay. Both cardiac TnT and CK-MB mass were measured with highly specific monoclonal antibodies in a sensitive chemiluminescence assay. Results: Comparing marker levels of the two groups, Mann–Whitney U test and independent sample t-test were used. The mean NT-proBNP (pg/ml) and hsCRP (mg/L) were found significantly different and almost 24- and 8-fold higher in cases as compared to controls (610.69 ± 25.28 vs. 25.28 ± 11.76, and 4.47 ± 1.62 vs 0.52 ± 0.23; all P < 0.01). Further, the CK-MB (IU/L) and TnT (pg/ml) (mean ± standard deviation) were also high in the case group than control (166.83 ± 27.8 vs. 98.03 ± 3.05; P < 0.01 and 135.44 ± 8.79 vs 96.46 ± 2.91; P < 0.01). Conclusion: Elevated level of NT-proBNP is a strong independent prognostic predictor in patients with myocardial infarction and positive correlation between NTproBNP with TnT and CK-MB with TnT and consumption of alcohol, smoking, and tobacco may be also a risk factor for myocardial infarction.
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Vascular access for dialysis - A choice between brachiobasilic versus brachiocephalic arteriovenous fistula p. 84
Chandrashekhar Mahakalkar, Suhas N Jajoo, Meghali Kaple, Shivani Kshirsagar
DOI:10.4103/jdmimsu.jdmimsu_233_22  
Aim: The study aims to compare the vascular access of brachiobasilic arteriovenous fistula (AVF) to that of brachiocephalic AVF for hemodialysis in patients of end-stage renal diseases (ESRDs), in terms of patency, maturation, and the time of cannulation. Objectives: (1) To analyze the patency, maturation, and surgical outcomes of two autogenous upper arms' arteriovenous accesses: brachiobasalic and brachiocephalic AVF. (2) To analyze the factors responsible for patency and maturation of the AVF. (3) To define a criterion for vascular access maturation of the AVF. Methodology: It was a randomized controlled trial done on patients of ESRD on maintenance hemodialysis. Patients were randomized into Group A – brachiobasilic AVF and Group B – brachiocephalic AVF. They were either subjected to brachiocephalic or brachiobasilic AVF according to standard surgical guidelines. Follow-up was taken at day 30, day 90, and 6 months via clinical examination and color Doppler. Results: The patency of brachiobasilic fistula was statistically significant compared to brachiocephalic (patent: −85% vs. 71%, respectively, not patent: −15% vs. 29%, respectively) (P ≤ 0.05) at 6-month follow-up. In fistula used successfully for hemodialysis, significant difference of 73% and 56%, respectively, for brachiobasilic and brachiocephalic was observed. Conclusion: From the above study, it can be concluded that brachiobasilic AVF is superior to brachiocephalic AVF in terms of patency, rate of complications, and surgical outcomes. The factors responsible for the patency and maturation of AVF were identified.
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Assessment of knowledge about nanotechnology in dentistry amongst dental post graduate students in India: An online cross-sectional survey p. 89
Shweta Dharmatti, Seema Bargale, Bhavna Dave, Anshula Neeraj Deshpande, Jayesh Rupesh Khandelwal, Sejal Jain
DOI:10.4103/jdmimsu.jdmimsu_442_21  
Introduction: Nanodentistry is one of the most emerging and widely expanding branches in the field of dentistry. The maintenance of near perfect oral health through the use of nanomaterials, biotechnology, including tissue engineering, and nanorobotics can be made possible. Aim: The present study aimed to assess the knowledge about nanotechnology in dentistry among postgraduate dental students in India on the basis of questionnaire. Materials and Methods: A structured 20 questionnaire was validated by subject experts in the field of dentistry. The postgraduate students in the field of dentistry in India were approached and were provided with the validated questionnaire for an online survey. The questionnaire was randomly distributed among various postgraduate dental students across India, which evaluated 328 students in total. Descriptive and inferential statistical analyses were carried out in the present study. Results: On assessing the data statistically, out of 328 participants, 44.80% were from I MDS, 35.40% were from II MDS, and 19.80% were from III MDS. The postgraduate dental students in India had adequate knowledge regarding fourteen out of twenty questions. The students, however, did not have adequate knowledge regarding six questions which comprised history, tools, and techniques about nanotechnology in dentistry. Conclusion: The study was able to assess that postgraduate dental students in India had adequate knowledge regarding nanomaterials used in dentistry; however, knowledge regarding techniques and tools in nanotechnology was not satisfactory.
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Indian rural lands and shortages of healthcare professionals: A burning issue p. 95
Abhishek Singh Nayyar
DOI:10.4103/jdmimsu.jdmimsu_100_21  
Context and Aim: The shortage of healthcare professionals in rural areas contributes toward discriminatory healthcare delivery. The present study was planned with similar intent and aimed to evaluate the perception of dental students regarding their future in rural areas. Materials and Methods: The present study was designed as a cross-sectional study comprising a 30-item questionnaire survey instrument distributed among a total of 550 dental students, while the results obtained were subjected to statistical analysis. Statistical Analysis Used: Statistical analysis was done using SPSS version 12.0 (SPSS Inc., Chicago, IL, USA). Independent Student's t-test and one-way analysis of variance were used for comparison among the variables, while Chi-square test was used to determine the association between the variables. P < 0.05 was considered statistically significant. Results: No significant difference was observed in the attitudes based on gender (P = 0.43), though a statistically significant difference was observed in the attitude of students based on the year of their education with a positive attitude toward rural dental practice generally noted in the 1st-year Bachelor of Dental Surgery students, which significantly declined with the increasing level of education (P = 0.01). Conclusions: Dental students are more influenced by the negative aspects of rural dental practice though they have, in their mind, a positive approach to the same at the beginning of their education, this significantly declined with the increasing level of their education.
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Sonography, color doppler, and power doppler evaluation of palpable breast masses with pathological correlation p. 103
Soumya Jain, Suresh Vasant Phatak
DOI:10.4103/jdmimsu.jdmimsu_83_22  
Background: The study was performed to analyze the accuracy of each of the techniques used in ultrasonography of breast in differentiating benign and malignant masses of the breast. The techniques under evaluation were B-mode, color Doppler, and power Doppler. Materials and Methods: It was a prospective, cross-sectional study involving 240 female patients who were clinically suspected to have a breast mass. The patients were referred to the Department of Radiodiagnosis, AVBRH, where they underwent ultrasonography with Aloka Hitachi USG Machine Arietta S70 with high-frequency linear probe (12–15 MHz) followed by Doppler assessment. Results: Of 240 patients that were included in the study, histologically, 73 (30.4%) patients were diagnosed with breast carcinoma, 167 (69.6%) were diagnosed with benign breast lesions. Gray scale ultrasonography had the highest accuracy with sensitivity of 90.4%, specificity of 92.8%, positive predictive value (PPV) of 84.6%, and negative predictive value (NPV) of 95.68%, followed by color Doppler having sensitivity of 89%, specificity of 87.1%, PPV of 87.69%, and NPV of 88.5%. Power Doppler had sensitivity of 82.19%, specificity of 89.22%, PPV of 76.9%, and NPV of 91.98%. The combined sensitivity and NPV of sonography, spectral color Doppler and power Doppler were found to be more, i.e., 91.78% and 95.97%, respectively. Conclusions: Breast malignancy is a very prevalent and common issue in India as well as in the rest of the world. Sonography has proven to be more accurate in differentiating benign from malignant masses of the breast. Color Doppler and power Doppler findings in conjunction with gray scale ultrasonography findings can help in early detection and give a better understanding of the type of lesion based on the tissue vascularity. This could also be used as an effective first-look screening tool to assess patients who are at high risk for breast carcinomas.
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CASE REPORTS Top

Hearing loss with pneumolabyrinth posttransverse temporal bone fracture p. 110
Rohan Kumar Singh, Gaurav Vedprakash Mishra, Rajasbala Pradeep Dhande, Suresh Vasant Phatak, Prerna Anup Patwa
DOI:10.4103/jdmimsu.jdmimsu_346_21  
Head injury caused by high force can lead to severe complications if fracture of the temporal bone is present. It is rare that temporal bone fracture causes pneumolabyrinth; there is an entry of air into the vestibulocochlear system due to the fracture line communicating inner ear to the middle ear. Vestibular pneumolabyrinth is more common than cochlear pneumolabyrinth. For initial evaluation of polytrauma patients with fracture of the temporal bone, multidetector computed tomography (CT) with high resolution and multiplanar reformation play an important role in the identification of important structures lying in close relation to the temporal bone that may lead to severe complications if fracture line is traversing through them. We herein present an interesting case of a 39-year-old man who underwent a road traffic accident leading to transverse temporal bone fracture and cerebral contusion. After discharge from the hospital, the patient complained of decreased hearing in the ipsilateral ear and difficulty in maintaining balance. On CT, otic capsule violating fracture was noted with pneumolabyrinth. First, the patient was treated conservatively, following no improvement in his condition, he was surgically treated and gained full recovery. Early detection of otic capsule involvement in cases of temporal bone fracture can provide effective treatment which will further lead to decrease in complications which if left untreated could have resulted in drastic consequences contributing to irrecoverable hearing loss. One should always pay attention while reporting for CT scans and always look for the location of air bubbles in the otic capsule as the line of fracture is not visualized properly in the presence of mastoid collection.
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Acceleration of orthodontic tooth movement using two different distraction techniques p. 114
Neetu Dabla, Arjun Vedvyas, Geetanjali Gandhi
DOI:10.4103/jdmimsu.jdmimsu_243_21  
A shortened orthodontic treatment period is the demand of the modern era. Various methods, namely corticotomy, micro-osteoperforation, distraction, etc., have been implored to achieve a quicker tooth movement. Our report presents a comparison of periodontal and dentoalveolar distraction techniques done using a modified HYRAX as distractor in contralateral arches of the same patient. Results showed that the canine was retracted in 13 days on the periodontal distraction side and in 16 days on the side of dentoalveolar distraction. Hence, it can be concluded that the distraction technique significantly reduces the treatment time duration.
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Dumbbell type large prostatic urethral calculus: Sonographic diagnosis p. 118
Bhavik Unadkat, Suresh Vasant Phatak, Nishant Raj, Pratik Bhansali
DOI:10.4103/jdmimsu.jdmimsu_418_21  
Massive calculi in the prostatic urethra are even more unusual than calculi in the urethra. The size, form, and location of the calculus, as well as the state of the urethra, all impact the therapeutic method. If the stone is big and obstinate, it can be removed using perineal or suprapubic methods. A case report of a patient who had difficulty in passing urine and burning during micturition is presented. Two calculi were found in the urinary bladder: One was vesical calculus, and the other was vesicourethral (prostatic) dumbbell-shaped calculus, as observed on ultrasonography.
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Modified lip repositioning technique to improve the smile harmony: A 3-year follow-up p. 122
Anitha Vijayarangan, Adline Vadhana, Shanmugam Muthukali, Ashwath Balachandran
DOI:10.4103/jdmimsu.jdmimsu_423_21  
Excessive gingival display (EGD) is a highly prevalent condition and poses esthetic concerns. Lip repositioning is a simple technique for the treatment of EGD due to vertical maxillary excess (VME) and hypermobility of the upper lip. Various modifications have been proposed to the original technique to improve the predictability and stability of the results over the long term. This article presents the long-term results of the modified lip repositioning technique.
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Bilateral masseter muscle hypertrophy p. 126
Pragati Anupkumar Bhargava, Rahul R Bhowate, Simran D Badki, Mrunal Ghusaji Meshram, Ravikant Vijayrao Sune
DOI:10.4103/jdmimsu.jdmimsu_252_22  
Masseter muscle hypertrophy is due to oral parafunctional habits, occlusal disharmony, altered emotional and psychological status, and at times congenital factors. Masseter muscle hypertrophy occurs usually at puberty involving unilateral or bilateral masseter muscles and affects functional quality in a severely hypertrophied muscle. This presents a report of a 14-year-old girl with bilateral masseter hypertrophy which compromised the esthetic value of the face. The diagnosis was made using clinical examination, conventional radiography, and magnetic resonance imaging.
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Hassle faced with induced mania in elderly female while treating for obsessive-compulsive symptoms p. 129
Poonam Bharti, Angad Harshbir Singh
DOI:10.4103/jdmimsu.jdmimsu_288_20  
Obsessive-compulsive disorder (OCD) is one of the most frequently associated comorbidities in bipolar disorder. While this presents a challenge in understanding the phenomenology and also the treatment aspect of cooccurrence of mania with OCD. The index case is of an elderly female who presented with obsessive-compulsive (OC) symptoms and while on treatment had mania episodes. The mania episodes presented challenges while managing underlying OC symptoms. The common neurobiological mechanism for the comorbid illness and treatment lacunae are discussed.
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Acquired melanocytic nevus in head-and-neck region – A case series p. 132
Jigna Pathak, Priyadarshani Sarkate, Adil Gandevivala, Rashmi Hosalkar, Niharika Swain
DOI:10.4103/jdmimsu.jdmimsu_266_21  
Acquired melanocytic nevus (AMN) is the most common benign proliferative lesion of melanocytes occurring on the skin after birth. Nevi can occur under the genetic influence or certain environmental factors. Histopathologically, they are categorized as an intradermal, compound, and junctional nevus. The significance of nevi lies in their relation to melanoma with malignant transformation rate being 4%–9%. We, hereby present an institutional case series of AMN in the head-and-neck region.
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IMAGES Top

A congenital melanocytic hairy nevus of the face and conjunctival nevus: A real management dilemma for the pediatrician? p. 137
Mahaveer Singh Lakra, Keta Jayant Vagha, Jayant Vagha, Ashwini Lakra
DOI:10.4103/jdmimsu.jdmimsu_70_22  
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REVIEW ARTICLES Top

Methicillin resistant Staphylococcus aureus infection among orthopedic patients in South-East Asia region: A systematic review and meta-analysis p. 140
T Latha, Leena Sequira, Saraswathi Hebbar, Baby S Nayak, N Ravishankar
DOI:10.4103/jdmimsu.jdmimsu_447_20  
Hospital Associated infections are on the rise globally. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the common pathogens resulting in increased morbidity and mortality among orthopedic patients. Though individual reports are available, no systematic review on the prevalence of MRSA infection among orthopedic patients in South-East Asia Region (SEAR) is accessible and hence, the systematic review and meta-analysis is conducted. We systematically searched eight databases (Scopus, PubMed-Medline, IndMed, CINAHL, Proquest, Web of Science, Ovid-Medline, and Google-Scholar) and included the articles published from 2006 to 2019 from SEAR. A total of 22 studies were eligible for the review. STATA 13.0 with metaprop package in STATA was used to find the rate of MRSA infection. Among 1135 orthopedic patients, the pooled prevalence of MRSA infection was 27% (95% confidence interval 17%–38%; P = 0.001, I2 95.99%). Based on this infection rate, the policymakers are recommended to develop guidelines to effectively manage infection in healthcare settings to reduce the burden of MRSA infection among orthopedic patients.
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Utilizing digital technology in the public health system during an epidemic p. 146
Poonamchand Parmar, Krishnaba Vaghela
DOI:10.4103/jdmimsu.jdmimsu_76_21  
The people-centric public health measures and an integrated model of health service delivery can be obtained through the efficient utilization of digital technologies during the epidemics. The classical epidemic control measures like contact tracing, social distancing, and quarantine should be supported by the efficient analytical digital tools. This paper aims to explore the feasibility of digital interventions during a pandemic situation such as COVID-19 to enhance monitoring, surveillance, detection, and prevention of the spread of disease, along with to mitigate the impact on health services. The accessible health services can be ensured with the effective use of digital tools; web-based and cloud-based services, Internet of things, smartphones mHealth, data analytics, etc., to support an emergency public health response, real-time tracking, data monitoring, virtual clinics, and telemedicine/teleconsultation during a disease outbreak. Digital technologies to advance the management of public health services and to balance between data privacy and of public health measures should be considered for the effective management of an epidemic.
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Patient education strategies for coronary heart disease in a cardiac rehabilitation setting: A scoping review p. 152
Varoon Chandramohan Jaiswal, Lata Parmar, Snehal Ghodey
DOI:10.4103/jdmimsu.jdmimsu_93_21  
Coronary artery disease is the leading cause of death and disability globally. Comprehensive cardiac rehabilitation has been proved to be beneficial in reducing death and disability for patients with coronary artery disease. Patient education is an integral part of comprehensive cardiac rehabilitation and its benefits are well documented. The objective of the scoping review is to map the strategies of patient education in a cardiac rehabilitation setting. A total of 31 published scientific articles (24 research studies and 7 reviews) were included in the review based on the inclusion criteria. 23 varied patient education strategies for coronary heart disease patients were identified from the included studies and 20 different delivery formats of education have been reported in the literature. This scoping review provides a brief insight to various patient education strategies and delivery format used in a cardiac rehabilitation setting.
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Possible link between acidic interstitial fluid and various mineralization disorders of teeth: Evidence-based hypothesis p. 166
Sandhya Tamgadge, Avinash Tamgadge
DOI:10.4103/jdmimsu.jdmimsu_468_21  
Effects of pH fluctuation of blood and interstitial fluid have a tremendous effect on bone which leads to osteoporosis. This evidence has been widely mentioned in dental and medical literature. However, the same interstitial fluid enters teeth too through the apical foramen and periodontal space. Thus, it will have a similar effect in teeth too. This article is about the effect of interstitial fluid and its effect on teeth on the basis of evidence mentioned in the literature. Various databases have been researched such as PubMed, MEDLINE, and Google for literature search.
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Cancer-associated fibroblasts and FAP-Alpha: Its applications in odontogenic tissues p. 170
Sandhya Tamgadge, Treville Pereira
DOI:10.4103/jdmimsu.jdmimsu_467_21  
Cancer has always been a mystery for researchers, health-care providers and even patients. The entire journey of a cell from physiological to pathological form has been incompletely explored. Everyday new research articles have been updated on various platforms where researchers have been making an attempt to find out the various causes of carcinogenesis. Cancer-associated fibroblasts and its one of the prime proteins FAP (FIBROBLAST ACTIVATION PROTEIN ALPHA) alpha found in the normal-appearing tumor microenvironments have been investigated by many researchers and showed a positive correlation with advanced tumor grade. It has been found highly expressive in oral squamous cell carcinoma. Odontogenic lesions too are highly destructive and show recurrence. There is a need to evaluate FAP-alpha expression in these lesions too.
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WASH practices in childhood stunting – A narrative review article p. 175
Neha Gurbani, Abhilasha Dhyani, Sana Ammarah, Prerna Baghel
DOI:10.4103/jdmimsu.jdmimsu_451_21  
Childhood stunting, malnutrition, and WASH practices censure millions of people around the globe to a life of drawbacks and physical impairment. Diarrhea and weak development which have interminable effects on well-being of a child are mostly due to malnourishment, dietary deficiency, and exposure to contamination. Stunting is a composite challenge with reactions of those who got affected because of it and the community as a whole. To fasten the process in removing stunting, the efforts required should be broad to reach the level of the sector in nutrition to gear the underlying reasons of malnutrition. To make faster progress in eradicating stunting, more initiatives are required that go beyond dietetics to label the fundamental sources of malnourishment. According to the research reviewed, inadequate WASH situations have a significant detrimental influence on child development and growth, owing to long-term exposure to intestinal pathogens as well as larger social and economic causes. To fully realize the promise of WASH to reduce stunting, attempts to attain a universal approach to these facilities, as envisioned by the Sustainable Development Goals, must be redoubled. It can also necessitate new or converted WASH techniques that can go past typical treatments to target exposure routes in the first 24 months of life when the stunting process is mostly absorbed. The interest is increasing in whether water, sanitary practice, and hygiene (WASH) interference can help plans in reducing stunting and it may also need new and upgraded WASH techniques and plans that should work above the traditional plans in reducing the divulgence of child's early 24 months of life when the procedure of stunting is evaporated.
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Robotics in orthodontics p. 180
Rashmi Rukshana, Geetanjali Gandhi
DOI:10.4103/jdmimsu.jdmimsu_173_21  
The successful application of robotics in the medical field has paved way to explore their scope in dentistry. Their goal was to increase precision of the present appliances in use. A literature review was performed using electronic searching methods for the applications of robots in dentistry. From the gathered data, this review article was compiled. This article summarizes some of the promising researches done and developed in dentistry with regard to robotics. A brief about what the future research can focus has been put into account.
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Role of ultrasonography and strain elastography findings in peripheral nerve sheath tumor: A narrative review p. 187
K B Harshith Gowda, Gaurav V Mishra, Suresh Vasant Phatak, Asish Pavanan, Rajasbala Pradeep Dhande
DOI:10.4103/jdmimsu.jdmimsu_266_22  
Peripheral nerve imaging science is rapidly advancing, for early and robust diagnosis of many ill-health conditions, especially in detection of tumors. Radiological imaging techniques provide dynamic, real-time assessment of anatomy which either can help in diagnosis or prognosis in peripheral nerve disorders. Peripheral nerve tumors are often evaluated with magnetic resonance imaging, although there are many advantages offered with ultrasonography (USG). Strain elastography (SE), another technique, is well known for the diagnosis of soft-tissue tumors and is used to evaluate tissue stiffness. Hard lesions are more resistant to extrinsic compression and show smaller strain, whereas soft lesions show larger strain. The narrative review provides insight in functioning and utility of USG and SE techniques in peripheral nerve sheath tumor diagnosis.
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SYSTEMATIC REVIEWS Top

Machine-Assisted irrigation systems for smear layer removal in root canal treatment: A systematic review p. 196
Kajol Relan, Manoj Chandak, Pooja Chandak, Akshay Jaiswal
DOI:10.4103/jdmimsu.jdmimsu_453_21  
Objectives: The objective was to evaluate the efficacy of three machine-assisted irrigation systems in smear layer removal from apical one-third of the root canal system. Data Source: A comprehensive search of last 10 years was performed in the following systematic electronic database: PubMed/Medline and Scopus. Data Selection: We included in-vitro studies that compared Endoactivator, Endovac, and Passive ultrasonic irrigation system's clinical success of smear layer removal in apical one-third of the root canal systems. Data Synthesis: A total of 72 nonduplicated studies were retrieved in the systematic search. Seven studies included in the study assessed the success rate of smear layer removal in the apical third of the root canal system of three irrigation systems through scanning electron microscopic evaluation. These studies were classified as low risk of bias. The studies evaluating the scanning electronic microscopy of smear layer removal in the apical one-third of the root canal comparing the Endoactivator and Passive ultrasonic irrigation showed no statistical difference (P < 0.05). The studies evaluating the scanning electronic microscopy of smear layer removal in the apical one-third of the root canal comparing the Endoactivator and Endovac showed statistical difference (P > 0.05). Conclusion: Based on the findings, Endovac irrigation system was found to be effective in smear layer removal from apical one-third of the root canal system. Further in-vivo studies and clinical trials are required for more conclusive results.
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Psychological distress and its associated risk factors among health-care professionals of India during Coronavirus Disease 2019 Pandemic: A systematic review and meta-analysis p. 203
Dhiraj Bhambhani, Suresh Bhambhani, Garima Bhambhani, Anjali Bhoyar, Ankit Pachori, Manu Kulshrestha
DOI:10.4103/jdmimsu.jdmimsu_269_22  
Introduction: Millions of lives have been impacted by coronavirus disease 2019 (COVID-19) infection worldwide. The world's health-care system is overburdened and, in some places, in disarray, which has an effect on medical workers' physical and psychological well-being. The psychological impact has more negative effects on people's general well-being. The goal of this review was to ascertain how the COVID-19 pandemic affected these populations' levels of stress, despair, and anxiety. Until March 2022, PubMed, Google Scholar, and journal online databases were searched for articles focusing on stress, anxiety, and depression in Indian health-care professionals. “Psychological distress,” “COVID-19,” and “Health professionals” were utilized as search phrases. The quantitative study was performed using R Software version 4.1.2. Using Cochran's Q test, the studies' heterogeneity (I2) was evaluated. We found 12 studies in the search results. Stress prevalence as a whole was 0.2721 (95% confidence interval [CI] - 0.1336–0.4754). Depression had a combined prevalence of 0.3941 (95% CI - 0.2698–0.5338). Anxiety's pooled prevalence was 0.4158 (95% CI - 0.2790–0.5670). Young age and longer work hours were considered the main risk factors for psychological distress. The COVID-19 had a significant impact on India's medical sector. The critical goal is to recognize psychological issues at an early stage and to use the right technique and intervention to deal with them.
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LETTERS TO EDITOR Top

Concomitant occurrence of inguinal hernia and scrotal varicocele in a diabetic patient: Ultrasonography and doppler evaluation p. 209
Megha Manoj, Suresh Vasant Phatak, Prasanthi Ghanta, Vaishali Bodhraj Dhawan, Roohi Gupta
DOI:10.4103/jdmimsu.jdmimsu_273_21  
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Postintercourse extraalbugineal penile hematoma: Ultrasound and elastography appearance p. 211
Nishant Raj, Suresh Vasant Phatak, Shivesh Pandey, Vaishali Bodhraj Dhawan, Roohi Gupta
DOI:10.4103/jdmimsu.jdmimsu_279_21  
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Hepatofugal flow versus hepatopetal flow in portal vein on doppler: Its significance p. 213
Prasanthi Ghanta, Suresh Vasant Phatak, Vaishali Bodhraj Dhawan, Roohi Gupta, Megha Manoj
DOI:10.4103/jdmimsu.jdmimsu_301_21  
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Adult penoscrotal edema as manifestation of chronic renal failure: Ultrasonographic evaluation p. 215
Shivesh Pandey, Suresh Vasant Phatak, Rishabh Surendra Gupta, Pratik Jayprakash Bhansali, Vaishali Dhawan
DOI:10.4103/jdmimsu.jdmimsu_248_21  
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Role of tomography in the setting of traumatic submacular haemorrhage leading to choroidal rupture - letter to the editor p. 217
Rohan Kumar Singh, Prerna Anup Patwa
DOI:10.4103/jdmimsu.jdmimsu_222_21  
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