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   Table of Contents - Current issue
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April-June 2017
Volume 12 | Issue 2
Page Nos. 85-160

Online since Friday, September 8, 2017

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ORIGINAL ARTICLES  

Comparative study of type I tympanoplasty with or without mastoidectomy in tubotympanic type of chronic suppurative otitis media patients p. 85
Disha Amar Methwani, Prasad T Deshmukh
DOI:10.4103/jdmimsu.jdmimsu_8_16  
Objectives: The aim is to compare the results of type I tympanoplasty alone and tympanoplasty with cortical mastoidectomy in safe chronic suppurative otitis media (CSOM) patients in terms of graft uptake, improvement in hearing and clinical improvement. Study Design: This was prospective study. Materials and Methods: Sixty cases of safe type of CSOM were included in the study. Type I tympanoplasty was done in thirty cases and tympanoplasty with cortical mastoidectomy was done in another thirty cases. Patients were followed up postoperatively at 3, 6, and 12 weeks for graft uptake and any complication. Pure-tone audiometry was done at 6th and 12th week postoperatively to note the hearing improvement. Results: Graft uptake was 76.67% in tympanoplasty alone group and 83.33% in tympanoplasty with cortical mastoidectomy group. In the present study, pre- and post-operative pure-tone average was compared and the statistical difference between tympanoplasty group and tympanoplasty combined with cortical mastoidectomy group was not statistically significant. Recurrence of discharge was seen in 6 cases of tympanoplasty alone group. Although tympanoplasty combined with cortical mastoidectomy is better in hearing yield, graft acceptance rate, and clinical benefit, but the difference in two groups is statistically insignificant. Conclusion: Hearing outcome, graft acceptance rate, and clinical benefit were statistically unequalled in two groups. Tympanoplasty combined with cortical mastoidectomy will not give an additional advantage in terms of hearing gain, disease clearance, and graft uptake.
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Evaluation of knowledge and awareness about the ebola virus disease among the medical undergraduate students: A cross-sectional study p. 89
P Abhinitha, Camelia Putri Binti Yusof, Shaktesh Shanmugam Muthusamy Sinniah, Naveen Kumar
DOI:10.4103/jdmimsu.jdmimsu_48_17  
Introduction: Ebola virus disease (EVD), also known as Ebola hemorrhagic fever, is a fatal illness and it can be transmitted to people from wild animals and spreads in the human population by human-to-human transmission. Proper awareness of viral infection is necessary for both general population and medical professionals in minimizing the rate of mortality of the infected individual. The current cross-sectional study has been undertaken to evaluate the level of awareness about EVD in medical undergraduate students at their early academic curriculum. Materials and Methods: A total of 282 MBBS students of Malaysian origin studying in India were included in the study. Faculty-validated close-ended questionnaire was designed which comprised the questions related to general and medical-related aspects of Ebola virus. Results: Overall knowledge on EVD was moderate (score 2) with a majority of students (59%) followed by 35% of students having a low level (score 1) of awareness and only minimal number (6%) of students having an adequate level of awareness (score of 3). Conclusion: Overall knowledge about EVD among the medical undergraduate students at their preliminary curricular stages was in a satisfactory range with a score of 2. Nevertheless, their awareness of medical perspectives of EVD is comparatively more than that of general aspects.
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Study of serum interferon gamma in tubercular pleural effusions p. 93
Saood Ali, Babaji Ghewade, Ulhas Jadhav, Smaran Cladius
DOI:10.4103/jdmimsu.jdmimsu_53_17  
Background: Pleural effusions (PEs) are a common reason for admission in Acharya Vinoba Bhave Rural Hospital, and in developing countries like India, tuberculosis (TB) is the most common cause of exudative PE. The diagnosis of tuberculous PE with standard analysis of pleural fluid is often inaccurate. Pleural tissue histopathology and culture for Mycobacterium tuberculosis are considered the gold standard, but the procedure is invasive, requires skilled clinicians, and does not provide immediate results. To address these limitations, we evaluated whether serum interferon gamma (IFN-γ) can be used as a diagnostic aid for tubercular PEs and to compare its efficacy with adenosine deaminase (ADA) and cytology of pleural fluid. Materials and Methods: The sample size was 86 patients aged 16 years and above and who were diagnosed having tubercular PE either on the basis of ADA or cytology or by both methods, and serum IFN-γ levels were evaluated in these patients. Results: Serum IFN-γ was significantly raised in patients with tubercular PE. Conclusion: Pleural fluid ADA and IFN-γ are almost equally sensitive in diagnosing tubercular effusion; however, in cases where obtaining pleural fluid or other diagnostic material is difficult, serum IFN-γ can be considered as aid in diagnosing TB.
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A comparison between intrathecal dexmedetomidine with hyperbaric bupivacaine and intrathecal fentanyl with hyperbaric bupivacaine in lower abdominal surgeries: A prospective double-blinded study p. 99
Lyba Ann Varghese, Karuna Taksande
DOI:10.4103/jdmimsu.jdmimsu_55_17  
Background: The aim of this study is to compare the efficacy and safety of injection dexmedetomidine 5 μg and injection fentanyl when given intrathecally as adjuvant to injection bupivacaine in patients undergoing total abdominal hysterectomy in terms of the following parameters: (1) Characteristics of onset of sensory and motor block. (2) Characteristics of regression of sensory and motor block. (3) Level of sedation (4) Hemodynamic stability as assessed by pulse rate, systolic, and diastolic blood pressure (BP) and requirements of vasopressors. (5) Quality of postoperative analgesia as assessed by visual analog scale. (6) Evaluation of complications associated with injection dexmedetomidine and injection fentanyl when used as an adjuvant to injection bupivacaine. Materials and Methods: Ninety patients of the American Society of Anesthesiologists Class I and II posted for lower abdominal surgeries were allocated randomly into three groups of thirty patients each. C group: (n = 30) received 0.5 mL normal saline with hyperbaric bupivacaine 17.5 mg in 3.5 mL to make 4 mL. D group: (n = 30) received dexmedetomidine 5 μg with hyperbaric bupivacaine 17.5 mg in 3.5 mL diluted with 0.4 mL normal saline to make it 4 mL. F group: (n = 30) received fentanyl 25 μg with hyperbaric bupivacaine 17.5 mg in 3.5 mL to make 4 mL. Results and Conclusion: We observed that the groups were comparable with respect to demographic data (age, weight, height and duration of surgery) and onset time of sensory and motor blockade. The onset of sensory and motor block was slightly delayed in both groups. Two segment regression time of sensory blockade and time to reach Bromage scale 0 was greatly significant in dexmedetomidine and fentanyl. However, in comparison of the two, dexmedetomidine was clearly superior. The groups were comparable in terms of hemodynamic parameters, oxygen saturation, and respiratory rate, though there had been a statistically significant fall in BP and heart rate when compared to baseline. Sedation scores were found to be statistically significantly higher in group dexmedetomidine as compared to Fentanyl. The results showed statistically significant increase in the duration of postoperative analgesia in group using dexmedetomidine as compared to group fentanyl. The requirement of first rescue analgesic was greatly significant. The group using fentanyl had an postoperative pain free period of unto 4 h and dexmedetomidine had analgesia period unto 7 h. We found some adverse effects such as hypotension, bradycardia, nausea and vomiting with dexmedetomidine and fentanyl; however, the results were statistically insignificant. To conclude, the addition of dexmedetomidine prolonged the sensory and motor block significantly when used with hyperbaric bupivacaine intrathecally, to a much greater extent to the addition of fentanyl without increasing the incidence of significant adverse effects.
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Ultra-fast-tracking in cardiac anesthesia “Our Experience” in a rural setup p. 110
Manisha Taware, Manish Sonkusale, Rashmi Deshpande
DOI:10.4103/jdmimsu.jdmimsu_56_17  
Background: Fast-track cardiac anesthesia refers to extubation within 6 h of the end of surgery, whereas ultra-fast-track anesthesia (UFTA) refers to extubation within 2 h of the end of surgery. Objectives: We have tested a protocol for early extubation to see safety, efficacy of ultra-fast tracking, and its cost containment in the present study of forty patients in cardiac surgery department in a tertiary care rural center. Materials and Methods: We have observed in our study the outcome of UFTA on a set of forty patients posted for cardiac surgery, using a protocolized approach and have prospectively noted the duration of mechanical ventilation, extubation time, length of Intensive Care Unit (ICU) stay, rate of re intubation, and other complication. Results: Extubation could be achieved within 30 min in 29 patients (72.5%). Mean length of ICU stay could be cut to 1.6 days (39 h). 55% patients could be mobilized on postoperative day 1, With approximate cost savings of 5000 rupees/patient/day. No cases of reintubation or serious complications noted. Conclusion: Ultra-fast-tracking is found to be feasible in our cardiac surgical setup. It is safe in all age groups, with proper selection of cases and rational utilization of available resources, besides it is found to be cost-effective.
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Comparative evaluation of efficacy and effectiveness of profile rotary instruments in conjugation with solvent for retreatment of resilon and gutta-percha: An In vitro study p. 115
Manoj Chandak, Avinash Salgar, Pradhnya Nikhade, Shilpa Shrivastava, Aditi Sahni, Rakhi Chandak
DOI:10.4103/jdmimsu.jdmimsu_57_17  
Aim: The aim is to determine the effectiveness of rotary instrumentation (ProFile 0.06 tapered rotary NiTi instruments) in conjugation with solvent (chloroform) in the removal of resilon compared to gutta-percha during root canal retreatment. Materials and Methods: Sixty recently extracted human mandibular permanent premolars with straight roots with single canals were used. Decoronation of samples done at cementoenamel junction using the diamond disk. The length of each canal was determined with a size 15 K file and canals were instrumented using a crown down technique with ProFile 0.06 tapered NiTi rotary instruments. Irrigation done followed by obturation. Result and Conclusion: Statistical evaluation was done using paired t-test (P < 0.05) which showed that the samples obturated with resilon showed significantly better results at the apical third when compared to samples obturated with gutta-percha and the time required for Group 2 is significantly less than Group 1.
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Comparison between magnesium sulfate (50 mg/kg) and lignocaine (2 mg/kg) for attenuation of intubation response in hypertensive patients p. 118
Nikhil S Bhalerao, Anjali Modak, Virendra Belekar
DOI:10.4103/jdmimsu.jdmimsu_58_17  
Aims and Objective: The aim and objective of this study was to compare between magnesium sulfate and lignocaine for attenuation of intubation response in hypertensive patients. Materials and Methods: This prospective, randomized, double-blinded study was conducted in an operating room of Jawaharlal Nehru Medical College Institute, in which 60 adult American Society of Anesthesiologists 1 and 2 controlled hypertensive patients undergoing elective surgery under general anesthesia and requiring endotracheal intubation were selected. Patients were randomized into two groups: Group I with thirty patients who received MgSO4 50 mg/kg half an hour before induction of anesthesia and Group II with thirty patients who received lignocaine 2 mg/kg intravenous bolus. Laryngoscopy and intubation were performed to see response in both the groups. Heart rate (HR) and blood pressure (BP) were recorded before, during, and after endotracheal intubation for 10 min. Results: The changes in the HR and mean arterial pressure (MAP) were compared, and the results showed that Group I patients had minimal response to any changes after intubation while Group II patients showed changes in HR and MAP toward baseline after laryngoscopy and endotracheal intubation. Discussion: Magnesium sulfate developed hypotension at various points, though it is associated with good control of adrenergic response during intubation, while lignocaine developed rate pressure changes which were not so good, also showing cardiac instability. Conclusion: Magnesium sulfate 50 mg/kg has a better control of BP during intubation in hypertensive patients with some incidence of hypotension when compared with lignocaine 2 mg/kg.
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Prevalence and risk factors – Hemoglobin A1c, serum magnesium, lipids, and microalbuminuria for diabetic retinopathy: A rural Hospital-based study p. 121
Prerana Phadnis, Mala A Kamble, Sachin Daigavane, Pravin Tidke, Siddharth Gautam
DOI:10.4103/jdmimsu.jdmimsu_59_17  
Objective: To study the risk factors responsible for diabetic retinopathy (DR). Material and Methods: One hundred and six cases of DR were included for the study. Detailed history including age and sex of the patient, duration of diabetes, anterior segment, and detailed fundus examination was carried out. Fasting blood sugar (FBS), postmeal blood sugar (PMBS), hemoglobin A1c (HbA1c), serum magnesium, lipid profile, and microalbuminuria were performed. Results: Of 106 patients of DR, 69.81% were males and 30.18% females. Average duration of diabetes was 7.67 years. Average age was 57.16 years. Nonproliferative DR (NPDR) was present in 87.73% and proliferative DR (PDR) in 12.26%. Raised FBS was present in 78.30%, raised PMBS in 69.81%, raised HbA1c in 77.35%, hypomagnesemia in 22.64%, and microalbuminuria in 7.55% patients. Raised low-density lipoprotein was present in 32.11% NPDR, 3.67% PDR, 19.81% clinically significant macular edema (CSME). Raised triglycerides were present in 37.74% NPDR, 1.88% PDR, and 21.70% CSME. Raised total cholesterol was present in 28.30% NPDR, 1.88% PDR, and 18.87% CSME. Conclusion: Risk factors for developing DR were duration of diabetes, uncontrolled blood sugar, raised HbA1c, hypomagnesemia, presence of microalbuminuria, and raised serum lipids. Therefore, good glycemic control with early diagnosis and management is required to prevent DR.
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Comparative evaluation of effectiveness of surgical blade, electrosurgery, free gingival graft, and diode laser for the management of gingival hyperpigmentation p. 133
Pooja P Suryavanshi, Prasad V Dhadse, ML Bhongade
DOI:10.4103/jdmimsu.jdmimsu_60_17  
Aim and Objectives: To compare effectiveness of surgical blade, electrosurgery, free gingival graft (FGG), and diode laser for the management of gingival hyperpigmentation. Materials and Methods: Forty patients who were concern for the unesthetic anterior gingival due to melanin hyperpigmentation were treated in this study. Of 40 patients, 10 patients were treated using surgical blade, 10 by electrosurgery, 10 using FGG, and 10 patients using diode laser. The gingival hyperpigmentation was recorded preoperatively and 3 months postsurgery by measuring area of hyperpigmentation in square millimeters and severity of hyperpigmentation using Dummet's oral pigmentation index. Results: Healing was uneventful and required no supportive therapy. No patients experienced severe pain during or postsurgically. Mild discomfort was more common in FGG during the 1st week. At 3 months localized area of repigmentation was seen in group treated by surgical blade and electrosurgery. However, no repigmentation was noticed at 3 months in diode laser group and free gingival group. Conclusion: Depigmentation of gingival hyperpigmentation using diode laser and FGG were found to be effective procedures. However, diode laser yields esthetically acceptable results along with patient satisfaction.
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Study and correlation of clinical, radiological, cytological, and histopathological findings in the diagnosis of thyroid swellings Highly accessed article p. 138
Anuja Raniwala, DD Wagh, Ashwini Dixit-Shukla, Ninad Shrikhande, Mangesh Padmawar
DOI:10.4103/jdmimsu.jdmimsu_61_17  
Objectives: To study the clinical profile of patients with thyroid swellings. To study the radiological findings of these patients. To study the histopathological outcome. To correlate these factors in order to make diagnosis of malignant thyroid swellings in patients more accurate. Study Design: The present study: 'Study and correlation of clinical, radiological, cytological with histopathological findings in the diagnosis of thyroid swellings' was carried out in Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Sawangi Wardha from July 2013 to October 2015 It was carried out as a cross sectional observational study involving OPD based patients requiring further management. The sample size was fixed at 60 patients. All the patients of any age and either gender having goitre requiring surgery were included. Every patient was evaluated in terms of detailed history, thorough examination and relevant investigations. Results: Out of 60 patients, 51 (85%) were female and 9 (15%) were males. Maximum i.e. 22 (36.67%) cases belonged to the age group 41-60 years. More than half i.e. 34 (56.67%) of the patients came with a swelling on one side of the neck. 11 (18.33%) patients came with complains of Solitary nodule of Thyroid. The main complaint was anterior neck and was of grade 3 as per WHO Grading in 28 patients (46.67%). The duration of swelling was between 1-7 years in 30 (50%) patients followed by < 1 year in 17 (28.33%) patients. On clinical examination, 53 (88%) were diagnosed as benign and remaining 7(22%) as malignant swellings. Later on FNAC (done under ultra sound guidance), 8 (13%) patients were diagnosed with malignant swellings. Malignancy was noted in 13 (21.67%) cases on histopathology. A correlation between the diagnosis made pre-operatively on clinical examination, USG and FNAC was made with the Gold Standard for diagnosis of malignant thyroid swellings i.e. Histopathology. Conclusion: Goitre was common in females of middle age and majority had single lobe enlargement. Most of them presented with large goitres which were present since many years. On clinical evaluation, the symptoms suggestive of malignancy were pressure symptoms and lymph node enlargement. Multinodular goitre and colloid cysts were the commonest findings on FNAC. FNAC is a reliable tool of investigation for thyroid nodule. Using a thorough clinical examination, ultrasound and FNAC, a surgeon can reliably diagnose malignancy in thyroid glands and choose appropriate surgery for the treatment of the same. Histopathology is gold standard for confirmation of the diagnosis of malignancy post operatively.
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Study of diabetes mellitus in association with tuberculosis p. 143
Smaran Cladius, Ulhas Jadhav, Babaji Ghewade, Saood Ali, Tilak Dhamgaye
DOI:10.4103/jdmimsu.jdmimsu_62_17  
Background: Nanda and Tripathi (1967) stated that influence of diabetes on tuberculosis is as harmful as the impact of tuberculosis on diabetes. The present study was undertaken to determine the incidence of diabetes mellitus in tuberculous patients and to study the clinical profile and therapy of this association. Materials and Methods: The present cross-sectional study was carried out on tuberculosis patients registered at AVBRH, Sawangi, Meghe, Wardha, between July 2014 and June 2016. The patients diagnosed as tuberculosis were subjected for the diabetic status by detailed clinical history and investigations. Results: Of 200 cases the incidence rate of pulmonary tuberculosis with diabetes mellitus was 7% and 5% in extrapulmonary tuberculosis with diabetes mellitus. Far advanced, exudative, and cavitary lesions were higher in frequency in diabetics. All seven cases of extrapulmonary tuberculosis with diabetes had pleural involvement. Conclusion: All patients of tuberculosis should be screened for the presence of diabetes especially those above 40 years of age. Insulin should be given initially till the diabetes is stabilized. Short course antitubercular chemotherapy is highly effective in the management of tuberculosis with diabetes provided that the blood sugar level is adequately maintained throughout the duration of the treatment.
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An evaluation of field cancerization in patients with oral cancer by “Mirror Image” biopsy p. 148
Ravikant V Sune, Atul D Indurkar, Rahul R Bhowate, Shirish S Degwekar, Vidya K Lohe
DOI:10.4103/jdmimsu.jdmimsu_63_17  
Aim: The present study was conducted with the aim to define the incidence and type of field change in clinically apparent normal mucosa of new patients with unilateral oral squamous cell carcinoma (OSCC). Materials and Methods: Biopsy was carried out from clinically apparent normal oral mucosa on the contralateral site (mirror image site) in 38 consecutive newly diagnosed patients with unilateral OSCC. The mirror image tissue was analyzed histologically for abnormal features of dysplasia by two oral pathologists. Results: According to observer 1, 22 (57.89%) mirror image biopsies showed dysplasia of which 19 (50%) mirror image biopsies showed mild dysplasia and 3 (7.89%) mirror image biopsies showed moderate dysplasia. According to observer 2, 17 (44.74%) mirror image biopsies showed dysplasia of which 16 (42.11%) mirror image biopsies showed mild dysplasia and 1 (2.63%) mirror image biopsy showed moderate dysplasia. Conclusions: Histological observation of dysplasia at mirror image site was noted in about half of a sample of cases. Results displayed vulnerability to field change of oral mucosa chronically exposed to carcinogens. It acknowledges the risk for development of second or multiple primary tumors.
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CASE REPORTS Top

Large right ventricular fibroma p. 154
Sachin Kuthe, Manish Sonkusale, Anil Wanjari, Prasad Panbude
DOI:10.4103/jdmimsu.jdmimsu_51_17  
Primary cardiac tumors are extremely rare in infants and children. They are generally benign histologically, but clinical spectrum varies from asymptomatic patient to ventricular arrhythmia, sudden cardiac death. This report describes the case of a 6-year-old girl with a large cardiac fibroma in the right ventricle. Surgical resection was indicated because of the right ventricular outflow tract obstruction caused by progression of the tumor and symptoms to patient. The fibroma was successfully completely resected and further follow-up evaluation was uneventful.
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A case of phenytoin induced multiple toxicities p. 157
Khalid I Khan, PD Jalgaonkar, Sachin Agrawal
DOI:10.4103/jdmimsu.jdmimsu_50_17  
Phenytoin (PNT) is a commonly used sedative antiepileptic medication in many countries. It is used in generalized tonic-clonic (grand mal) and complex partial (psychomotor, temporal lobe) seizures and prevention and treatment of seizures occurring during or following neurosurgery. Adverse effects of PNT may occur even at therapeutic doses and may involve any system.
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IMAGES IN MEDICINE Top

Images: Emphysematous cystitis p. 159
Suresh Phatak, Tejas Sadavarte, Gaurav Mishra, Sanjaykumar Yadav, MD Ali Jiwani, Neeraj Patange
DOI:10.4103/jdmimsu.jdmimsu_52_17  
Emphysematous cystitis is a rare disease caused by severe urinary tract infection. Imaging findings are discussed with demonstration of classical images.
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