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   Table of Contents - Current issue
Coverpage
January-March 2018
Volume 13 | Issue 1
Page Nos. 1-77

Online since Monday, September 10, 2018

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ORIGINAL ARTICLES  

Galactocele ultrasonography and elastography imaging with pathological correlation Highly accessed article p. 1
Suresh Vasant Phatak, Gulam Bashir Marfani
DOI:10.4103/jdmimsu.jdmimsu_51_18  
Objective: The objective of the study is to study the sonographic and strain elastographic features of galactocele in patients presenting in our hospital. Materials and Methods: This is a prospective observational study of all patients visiting our hospital with breast problems. This study was conducted at AVBRH hospital, Sawangi, Wardha, from March 2016 to July 2018. Most patients visiting the hospital with a clinical diagnosis of galactocele included in the study. Results: A total of 15 patients were included in the study. Sixty percent of patients belonged to the third decade of life (age between 21 and 30 years) followed by 20% from the fourth decade (age between 31 and 40 years). In our study, pregnancy and lactational period related galactoceles were more common than galactocele not related to pregnancy and lactation. Most galactoceles showed features of benign lesion on sonography. Conclusion: Galactoceles commonly appear on ultrasound as cystic or multicystic lesions with posterior acoustic enhancement. Blue-green-red appearance is seen in all cases on strain elastography.
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A comparative study of equipotent doses of intrathecal clonidine and dexmedetomidine on characteristics of bupivacaine spinal anesthesia p. 4
Rahul Rajan, SN Gosavi, Vinay Dhakate, Sanjot Ninave
DOI:10.4103/jdmimsu.jdmimsu_59_18  
Background: We compared the onset and duration of sensory block, onset and duration duration of motor block, analgesia time, and adverse effects along with the hemodynamic changes, following intrathecal administration of dexmedetomidine or clonidine with bupivacaine. Materials and Methods: A total of 120 ASA Grade I or II patients, aged between 18 and 60 years, were enrolled in the study. The patients were randomly allocated to three equal groups: Group B received hyperbaric bupivacaine (0.5%) 15 mg with normal saline as a placebo, Group D received bupivacaine with 5 μg of dexmedetomidine, and Group C received bupivacaine with 50 μg of clonidine. All solutions were made up to 3.5 ml with addition of normal saline and injected at L3–L4 using a 25G spinal needle. The onset and duration of sensory and motor blockade and the sensory and motor regression times were recorded and the sedation level was also calculated. Hemodynamic changes and time to use first rescue analgesia, diclofenac sodium 75 mg IM, were also recorded. In postanesthesia care unit, pain scores were recorded using visual analog scale. Analysis of variance test was used to compare the quantitative variables in between the three groups which were independent of each other. Chi-square test was used to compare categorical variables. All the data were analyzed using SPSS (SPSS Inc., Chicago, IL)versus 17. P < 0.05 was considered statistically significant. Results: There was no significant difference in patients' demographics or duration of surgery. The time to onset of sensory block and motor block was early in Group D and Group C as compared to Group B. Duration of sensory and motor blockade was prolonged in Groups C and D, compared with Group B. Two-segment regression time was prolonged in Group C and Group D as compared to Group B. Intraoperative hemodynamics and level of sedation were clinically not significant in all the groups. Conclusion: The addition of clonidine or dexmedetomidine to intrathecal bupivacaine prolongs the motor and sensory block and postoperative analgesia when compared to bupivacaine alone with preserved hemodynamic stability in lower abdominal and lower limb surgeries.
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A comparative study on peripapillary retinal nerve fiber layer thickness in patients with iron-deficiency anemia to normal population p. 9
Shreya Jateen Jaiswal, Shashank Banait, Sachin V Daigavane
DOI:10.4103/jdmimsu.jdmimsu_82_17  
Aims: The aim is to study the retinal nerve fiber layer (RNFL) thickness in patients of iron-deficiency anemia (IDA) and compare with healthy controls. Settings and Design: This study was conducted in the Department of Ophthalmology and Department of Medicine, Sawangi (Meghe), Wardha. This was a cross-sectional, observational study. Subjects and Methods: Eighty patients with IDA, i.e., hemoglobin: <10 g/dl, serum transferrin saturation: <15%, serum iron: <50 mg/dl, serum ferritin: <15 mic/dl, and total iron binding capacity (TIBC): >300 mic/dl and age- and sex-matched healthy individuals between 20 and 50 years of age were included in the study. All the cases and controls underwent detailed ophthalmic evaluation including optical coherence tomography (OCT). Hemoglobin, serum iron, serum transferrin saturation, serum ferritin, TIBC, and RNFL thickness by OCT were determined for both the groups and compared. Statistical Analysis Used: Descriptive and inferential statistics using Chi-square and students paired t-test. Analysis was done using the SPSS software (version 17.0) and GraphPad Prism 5.0 version software. Results: The RNFL thickness in all the four quadrants is lesser in patients of IDA. There is a positive correlation of RNFL thickness with hemoglobin, iron, and ferritin and negative correlation with TIBC. Conclusions: The difference in the average RNFL thickness in both the groups was statistically significant, with a decreased RNFL thickness in all the four quadrants was observed in the patients with IDA. It may greatly impact on the assessment and management of many ophthalmic disorders that affect RNFL thickness as glaucoma and other neuro-ophthalmological disorders.
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Sonographic evaluation of painful shoulder and its comparison with clinical diagnosis Highly accessed article p. 12
Sanjay V Deshpande, Suresh Vasant Phatak, Gulam B Marfani, Nipun A Gupta, Sakshi S Daga, Samida S Samad
DOI:10.4103/jdmimsu.jdmimsu_52_18  
Objective: To study sonographic findings in cases of painful shoulder and to compare this with the clinical diagnosis made by physical examination.Materials and Methods: This is a prospective observational study of all patients visiting our hospital with painful shoulder. This study was conducted at AVBRH hospital, Sawangi, Wardha, from March 2016 to July 2018. Results: Sensitivity of physical examination with respect to ultrasonography was low with overall sensitivity, specificity, positive predictive vaue, and negative predictive value found were 65.38%, 77.78%, 89.47%, and 43.75%, respectively. Conclusion: Sonography of shoulder joint is more sensitive than clinical examination in cases of painful shoulder.
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Mentolabial sulcus: An esthetic-based classification p. 16
Dinesh Rokaya, Bishwa Prakash Bhattarai, Kanokwan Suttagul, Dashrath Kafle, Manoj Humagain
DOI:10.4103/jdmimsu.jdmimsu_80_17  
Objectives: The objectives of this study were to study the mentolabial sulcus in Nepalese, to compare the sulcus between male and female, and to classify the sulcus according to the angle. Materials and Methods: This study was conducted in 160 university students (65 males and 95 females) between April and September 2016. Photographs of all the students were taken using a digital camera. Mentolabial sulcus angles were measured from the lateral photographs using an angle instrument. The data were analyzed using SPSS 22. The comparison of sulcus between male and female was done using two-sample t-test at 95% confidence interval. Results: The mean mentolabial sulcus angle in Nepalese was 118.19° ±12.28° (male: 119.43° ± 9.99° and female: 117.61° ± 13.23°). There was no statistically significant difference of sulcus angle between males and females (P = 0.098). The sulcus was classified as deep, average, and shallow in males and females. In total students, the average was more predominant followed by deep and shallow. Conclusions: The mean mentolabial sulcus angle in Nepalese was 118.19° ± 12.28°, in male was 119.43° ± 9.99°, and in female was 117.61° ± 13.23°. The sulcus was classified as deep, average, and shallow. There was no statistically significant difference of sulcus angle between males and females. The average type of sulcus was more predominant in Nepalese.
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A study on superficial skin infection and their risk factors among rural population of West Bengal p. 20
Anubrata Karmakar, Bijit Biswas, Aparajita Dasgupta, Aritra Bhattacharyya, Nazrul Mallick, Ayon Ghosh
DOI:10.4103/jdmimsu.jdmimsu_47_17  
Background: Superficial skin infections (SSI) are quite common but often avoidable public health problem which requires early diagnosis and prompt treatment to prevent complications. Despite the high prevalence of certain skin diseases in developing countries, they have so far not been regarded as a significant health problem in the development of public health strategies. Methodology: This was a cross-sectional clinic-based study conducted from December 2016 to January 2017 among 160 study participants attending a rural health facility in Singur block of West Bengal using a predesigned structured schedule and clinical examination. Data were collected regarding sociodemographic profile, occupational details, housing condition, personal hygiene practices, and history of any skin diseases. Data were analyzed using appropriate statistical methods using SPSS (version 16). Results: A total of 27 (16.9%) of 160 study participants were suffering from SSI. Tinea corporis and tinea cruris were the two most prevalent types of SSI. Nature of work adjusted odds ratio ([AOR]-4.88 [1.38–17.20]), water source for bathing (AOR-4.27 [1.15–15.80]), persons/room (AOR-3.22 [1.26–8.21]), poor personal hygiene (AOR-1.67 [1.18–2.36]), and diabetes (AOR-3.34 [1.08–10.31]) were found to be significant predictors of SSI. Conclusions: Superficial fungal infection is the most prevalent type of SSI in the present study. More emphasis should be given to improving hygiene practices, living conditions, controlling diabetes, and creating awareness to reduce the risk of skin infection.
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Transabdominal and transvaginal ultrasonographic evaluation in the measurement of endometrial thickness in patients with abnormal uterine bleeding p. 25
Amandeep Singh, Kamlesh Gupta, Sirat Toor, Madhu Nagpal
DOI:10.4103/jdmimsu.jdmimsu_47_18  
Background: Abnormal uterine bleeding is a common complaint in women of all ages for which they consult their gynecologist and is the direct cause of a significant health-care burden for women. It affects 10%–30% of reproductive age women and 50% of perimenopausal women. The most probable etiology of abnormal uterine bleeding relates to the patients' reproductive age, as does the likelihood of serious endometrial pathology. Imaging plays a pivotal role in resolving these common complaints in practice. Study Design: This study is of 50 women presenting/referred with abnormal uterine bleeding in the department of radiodiagnosis of our hospital. They underwent both transabdominal and transvaginal ultrasonography for the evaluation of endometrial thickness and also to look for the presence of other pelvic pathologies. Results and Conclusion: In our study of 50 patients, transabdominal and transvaginal ultrasonography did not yield a significant difference in the measurement of endometrial thickness. However, both had a complimentary role in better diagnosing pelvic pathologies and eliminating the use of invasive procedures for diagnosing cases of abnormal uterine bleeding.
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Retrospective analysis of incidence of central nervous system tumors in a tertiary care centre: A 3-year study p. 30
Neha Yadav, Sant Prakash Kataria, Jyoti Sharma, Sunita Singh, Nisha Marwah, Sanjay Kumar, Gajender Singh
DOI:10.4103/jdmimsu.jdmimsu_45_18  
Introduction: Tumors of the central nervous system (CNS) are rare neoplasm constituting <2% of all malignancies. In India, CNS tumors constitute about 1.9% of all tumors. The objective of this study is to have an insight into the pattern of CNS lesions over a period of 3 years in a tertiary care hospital retrospectively. Materials and Methods: A retrospective study was conducted at the Department of Pathology, Pandit Bhagwat Dayal Sharma, Postgraduate Institute of Medical Sciences (PGIMS), Rohtak, a tertiary care hospital, over a period of 3 years. Two hundred and thirty-nine cases of CNS lesions reported during this period comprised the patients of the study. All data and information were archived from the case records maintained in the histopathological division of the Department of Pathology. Results: The age of the patients ranged from 2 to 65 years, with the mean age of 43.28 years. Majority of the cases were seen in the age group of 28–58 years (70%). Overall, males slightly outnumbered females; however, meningioma is an exception with higher rates in females. Majority of tumors were intracranial (96.2%) and remaining (3.76%) were spinal. Of the intracranial cases, frontal lobe was the most common site (25.5%) followed by temporoparietal lobe (13.2%). Astrocytomas comprising 84 (35.2%) cases constituted the largest group of the present study, followed by meningioma constituting 22.2% of all CNS tumors and glioblastoma forming the largest subtype of astrocytic tumor (35.7%). Among 16 pediatric cases, astrocytomas (6 cases) were more common as compared to medulloblastoma (4 cases). Conclusion: The most frequent type of CNS tumor in the present study was astrocytoma, followed by meningioma. The ratio of male: female for all CNS tumors was 1.06:1. Females outnumbered males in meningioma (2.8:1).
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Assessment of dentition status and treatment needs among children with disabilities attending special schools in Karad City, India p. 34
KM Shivakumar, Snehal Patil, Vidya Kadashetti, Yojiri Rajmane, Vaishali Raje
DOI:10.4103/jdmimsu.jdmimsu_35_17  
Introduction: There are a number of individuals suffering from various disabilities in this society. The parents, caretakers, and family members have a grievous effect due to the psychological reactions associated with deformity. This leads to apprehensive behavior in the life of these disabled individuals. Objectives: The objectives of this study were to assess the dentition status and treatment needs among 7–12-year-old children with disabilities at special schools in Karad city, Maharashtra India. Materials and Methods: A cross-sectional study was conducted among 7–12-year-old children attending specials school in Karad city, India. A total of 50 children (30 males and 20 females) were examined. The dentition status and treatment needs were assessed using dentition status and treatment needs index. The caries experience was assessed using decayed, missing, and filled teeth/surface (dft/s/DMFT/S) index. Information on intelligent quotient, disability status, and systemic diseases was also recorded. Results: The mean age of the study population was 8.98 ± 3.15 years. There were 30 (60%) males and 20 (40%) females in the study population. Among the total children examined, 52% of the children suffering from mental retardation (MR), followed by MR with cerebral palsy (20%). The overall mean dft and DMFT scores were 2.99 ± 0.92 and 3.91 ± 1.43, and decayed component had the highest score in both the groups. There was a statistically significant difference has been observed between gender (P < 0.01). Conclusion: Dental treatment needs in these individuals are very high, which reflect the barriers to access and utilize oral health care among these children. As dentists, we should emphasize on health education, periodic recall, and monitoring among these individuals.
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Role of hypoxia in malignant transformation of oral submucous fibrosis p. 38
Alka Harish Hande, Minal S Chaudhary, Amol R Gadbail, Prajakta R Zade, Madhuri N Gawande, Swati K Patil
DOI:10.4103/jdmimsu.jdmimsu_40_18  
Context: In the Indian subcontinent and Southeast Asia, habit of chewing areca nut has been recognized as one of the most important risk factors leading to a ubiquitous oral potentially malignant disorder (OPMD), oral submucous fibrosis (OSMF).In OSMF, owing to fibrosis in the connective tissue, there is narrowing of blood vessels which further results in compromised blood supply to the local tissue milieu. This tissue hypoxia elicits the activation of the transcription factor Hypoxia-inducible factor 1-alpha (HIF-1 α). In OSMF, its expression shows significant correlation with degree of epithelial dysplasia. Aim: This study aims to evaluate the expression of HIF-1 α in OSMF. Settings and Design: Seventy-five histopathologically proven cases of OSMF were included in the study. The tissue sections were studied for histopathological evaluation and HIF-1α expression. Statistical Analysis Used: Descriptive and inferential statistics using one-way ANOVA and multiple comparison using Kruskal–Wallis test were used. Results: Comparison of HIF-1α expression in different grades of OSMF was done. There were 47 cases without dysplasia, whereas 16 and 12 were of low-risk and high-risk dysplasia, respectively. On comparison of HIF-1α expression in different grades of OSMF, it was found to increase significantly from normal oral mucosa (1.43 ± 0.89) to no dysplasia (3.97 ± 2.75) to low-risk epithelial dysplasia (4.93 ± 1.76) to high-risk epithelial dysplasia (5.66 ± 2.01). Conclusion: The altered expression of HIF-1α can signify the disturbed epithelial-mesenchymal interaction which indicates progression toward the malignant transformation of OSMF. Thus, HIF-1 α expression showed good correlation with increase in grades of epithelial dysplasia and thus can assist for grading/quantifying oral epithelial dysplasia in OSMF.
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Prevalence of dental caries and gingivitis among pregnant and nonpregnant women p. 44
Swati Patil, Rajul Ranka, Minal Chaudhary, Alka Hande, Preethi Sharma
DOI:10.4103/jdmimsu.jdmimsu_5_18  
Objective: The aim of this study was to find the occurrence of dental caries and gingivitis among pregnant women and to compare it with those in nonpregnant women. Materials and Methods: A total of 303 pregnant and 238 nonpregnant women were recruited from the Department of Obstetrics and Gynaecology, Acharya Vinoba Bhave Rural Hospital, Sawangi (M), Wardha. Dental caries and gingivitis were defined clinically according to the World Health Organization (WHO) diagnostic criteria. Results: Over 63.3% of pregnant women had caries, and 71.9% had gingivitis. A significant difference came out between pregnant women and nonpregnant women with regard to dental caries (P = 0.0001) and gingivitis (P = 0.0007). The pregnant women were 2.2 times more likely to suffer from dental caries and 1.94 times more from gingivitis compared to nonpregnant women. Dental caries was significantly seen in pregnant women above 25 years of age, illiterate, and homemakers. Poor oral hygiene, poor dental care knowledge, and poor attitude were all important risk factors for dental caries and gingivitis. Conclusion: Proper dental healthcare programs should be conducted to improve the dental health and to increase the awareness of hygienic practices in pregnant women.
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Comparison of effectiveness of hyaluronic acid in combination with polylactic acid/polyglycolic acid membrane and subepithelial connective tissue graft for the treatment of multiple gingival recession defects in human: A clinical study p. 48
Jayshri Nandanwar, Manohar L Bhongade, Sneha Puri, Prasad Dhadse, Mangesh Datir, Akash Kasatwar
DOI:10.4103/jdmimsu.jdmimsu_39_18  
Background: The patients today are increasingly conscious of personal appearance, and much attention has been focused on denuded roots that are exposed during smiling which look unesthetic. These concerns have given rise to numerous approaches for covering denuded root surfaces; however, difference of opinions is prevailing among the clinicians. Objectives: Therefore, the present study was undertaken to compare the effectiveness between hyaluronic acid (HA) in combination with polylactic acid/polyglycolic acid (PLA/PGA) membrane with that of subepithelial connective tissue graft (SCTG) for the treatment of multiple gingival recession defects. Material and Methods: Twenty-four systemically healthy patients were randomly assigned to the test guided tissue regeneration (GTR-HA) and control SCTG groups. Clinical measurements, including probing pocket depth, relative attachment level, and relative gingival margin level, were measured at baseline and at the 6-month follow-up. Result and Conclusions: After 6 months, the mean reduction in gingival recession in the test group was 2.55 ± 0.45 mm whereas in the control group, it was 2.11 ± 0.58 mm. The test group showed mean root coverage of 92.93%, and the control group showed 84% at 6 months postsurgery. When HA in combination with bioresorbable PLA/PGA membrane was compared with SCTG group; there was signifi cantly greater root coverage, clinical attachment level gain, and increased width of keratinized gingiva in the test group.
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CASE REPORTS Top

Askin's tumor in adult: A rare clinical entity p. 54
Shailendra D Anjankar
DOI:10.4103/jdmimsu.jdmimsu_36_18  
Primitive neuroectodermal tumors are classified into peripheral and central subtypes on the basis of its embryological origin and not the anatomical location. Peripheral primitive neuroectodermal tumor (pPNET) that occurs within the thoracopulmonary region is named an Askin's tumor. Seventeen cases of epidural thoracopulmonary region pPNET in adult patients are reported in the literature till date. We report two more cases from a rural hospital, and relevant literature is reviewed.
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Timely recognition and nonsurgical retrieval of a lost guidewire during central venous catheter placement p. 58
Anurag Yadava
DOI:10.4103/jdmimsu.jdmimsu_22_18  
Central venous cannulation is a common procedure used in the intensive care setting. This procedure is known to cause a number of complications, if not carefully performed. We report a case of a lost guidewire during central venous cannulation through the left internal jugular vein approach which was retrieved successfully nonsurgically.
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Management of endodontically treated teeth with endocrown p. 60
Nikita Oswal, Manoj Chandak, Rajesh Oswal, Manali Saoji
DOI:10.4103/jdmimsu.jdmimsu_38_17  
With multiple options available to restore an endodontically treated tooth, endocrowns represent a simple, conservative, and esthetic alternative to conventional crowns. Endocrown is a one-piece restoration, usually indicated in cases with decreased crown height. The preparation comprises “sidewalk” as the cervical margin and a preparation into the pulp chamber that may or may not extend into the root canals. It prevents interferences with periodontal tissues, due to the presence of supragingival position of the restoration margins. The rationale of this technique is to use the surface area available in the pulpal chamber to assume the stability and retention through adhesive procedures. Principally, endocrowns are full ceramic restorations. A case report is presented here, where a porcelain-fused-to-metal endocrown was fabricated using the similar protocols and clinical procedures.
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Pleomorphic adenoma of the cheek: Report of a rarity p. 63
Murtaza Zahid Fidvi, Anendd A Jadhav, Akash P Kasatwar, Rajiv M Borle
DOI:10.4103/jdmimsu.jdmimsu_108_17  
Pleomorphic adenoma (PA) is the most common tumor of the salivary glands. Approximately, 90% of these tumors occur in the parotid gland and 10% in the minor salivary glands. The buccal mucosa or cheek is a rarely affected site by PAs of the minor salivary glands. Herein, we report a case of PA of the cheek, presented with intraoral swelling, and conclude that complete surgical excision can be a curative treatment for this benign tumor with 5-year follow-up.
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UPDATES IN MEDICAL RESEARCH Top

Methylation pattern of retrotransposons: Biomarker for human cancer p. 66
Prajakta Deshpande, Vivek Gupta, Arvind Bhake
DOI:10.4103/jdmimsu.jdmimsu_3_18  
Transposable elements (TEs) comprise almost 45% of the human genome. There are DNA transposons and RNA transposons. Retrotransposons like long interspersed nuclear element 1 (LINE 1) is abundant among all the TEs and present in 17% of the genome. These elements have repetitive sequences. Retrotransposons are regulated by epigenetic modification like methylation alteration of which leads to aberrant expression of LINE1. The literature says that loss of methylation of global DNA is associated with the imitation and progression of cancer. LINE 1 methylation status can be considered as a biomarker for cancer. The hypomethylation of LINE 1 causes transcriptional deregulation, genomic instability, chromosomal recombination, activation of oncogenes, and repression of tumor suppressor genes. There is less evidence on genomic instability and the mechanism underlying the cancer progression due to hypomethylation of LINE 1 elements. Hence, the methylation of LINE1 could be the possible marker for the prognosis of cancer.
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REVIEW ARTICLE Top

Microbiota, biofilm, and chronic rhinosinusitis: A transitory general idea of writings p. 71
Muhamad Bin Abu Bakar, Mainul Haque
DOI:10.4103/jdmimsu.jdmimsu_2_18  
Chronic rhinosinusitis is one of the highly prevalent multifactorial inflammatory disorder of the paranasal sinuses and a public health problem in the developed and developing countries, which reduces the patient's quality of life. The membranes of the nasal and paranasal sinuses' mucosa are the motherland of numerous type of microorganisms such as fungi, bacteria, and viruses causing diseases or not. Furthermore, these complex polymicrobial microbiota families exist in within the nasal and paranasal sinus cavities of both patients without chronic rhinosinusitis and patients with chronic rhinosinusitis; the latter group was observed with minimum diversity when compared with controls. Biofilms are typically defined “as surface-associated microbial communities, surrounded by an extracellular polymeric substance matrix.” Nevertheless, if the microbes get ahead in establishing a biofilm within the human host, the infection frequently becomes fatal and difficult to treat and progresses into a chronic state. Multiple chronic infections such as cystic fibrosis pneumonia, chronic otitis media, chronic rhinosinusitis, and recurrent urinary tract infections, are linked to biofilm formation. S. aureus and P. aeruginosa are major delinquent in the growth of obstinate severe airway disease in chronic rhinosinusitis and cystic fibrosis patients. Moreover, the rapid development of resistant microorganism throughout the planet, jeopardizing the efficacy of antimicrobials, which have once changed medicine and protected millions of lives. Antimicrobial resistance has been currently identified as most dangerous threats to human health.
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LETTERS TO EDITOR Top

Nevus comedonicus at a rare site p. 75
Uddhao S Zambare, Vijaya S Shriramwar, Swagata A Tambe, Chitra S Nayak
DOI:10.4103/jdmimsu.jdmimsu_46_17  
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Knowledge and awareness about the ebola virus disease among the medical undergraduate students p. 77
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/jdmimsu.jdmimsu_68_17  
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