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   Table of Contents - Current issue
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January-March 2021
Volume 16 | Issue 1
Page Nos. 1-234

Online since Thursday, July 29, 2021

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ORIGINAL ARTICLES  

Study of intrauterine insemination with hydrotubation in women with infertility Highly accessed article p. 1
Deepti Srivastava, Harsha Shekhawat, Uttara Shelke
DOI:10.4103/1319-4534.322607  
Background: Hydrotubation is the instillation of a solution of medicine through the cervix into the uterus and fallopian tubes under pressure into the peritoneal cavity. It has little value to test whether or not the tubes are blocked in the investigation of infertility and therapeutically to flush or clean the fallopian tubes. Materials and Methods: Sixty women with unexplained infertility were scheduled randomly for hydrotubation either with saline or low-dose lidocaine in saline. Hydrotubation was carried out 1 day before intrauterine insemination (IUI) in clomiphene citrate stimulated cycle. Outcome measures were rates of pregnancy, first trimester abortion, ectopic pregnancy, multiple pregnancy, and procedure-related pain. Results: There were higher clinical pregnancy rates in lidocaine group which had when compared with saline group but statistically no significant difference found. Conclusion: Hydrotubation with low-dose lidocaine in saline 1 day before IUI allowed a significant higher pregnancy rate when compared to saline alone in couples with unexplained infertility.
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A comparative study on the accuracy of SRK/T, holladay II, and barrett universal II formulas in intraocular lens power calculation of axial myopes undergoing cataract surgery Highly accessed article p. 5
Pradeep Sune, Mona Sune, Ritica Mukherji
DOI:10.4103/jdmimsu.jdmimsu_374_20  
Context: Calculation of intraocular lens (IOL) power for extremes of axial lengths (ALs), using classical formulae like Sanders-Retzlaff-Kraff/Theoretical (SRK/T), is unsatisfactory. With the advent of fourth-generation formulae, surgeons are now aiming for better refractive outcomes for such patients postcataract extraction. Aims: The aim of this study was to assess and compare the accuracy of SRK/T, Holladay II, and Barrett Universal II formulae for IOL power calculation in high myopes with cataract by computing the mean absolute error (MAE). Settings and Design: This was a hospital-based prospective comparative study conducted over a period of 1 year. Forty patients with AL ≥26 mm undergoing cataract extraction were included after taking inclusion and exclusion criteria into consideration. Subjects and Methods: After enrolling patients and obtaining informed consent, all patients underwent a comprehensive ophthalmic examination. The power of IOL to be implanted was calculated by SRK/T, Holladay II, and Barrett Universal II with the goal of achieving refraction within ± 1 D postoperatively. Phacoemulsification was performed for all patients and hydrophilic foldable IOLs were implanted. Patients were followed up for 2 months at the end of which MAE was calculated for all three formulae. Statistical Analysis: Statistical analysis was done by descriptive and inferential statistics using Kruskal–Wallis Chi-square test and Mann–Whitney U-test. Software used in the analysis was SPSS 24 version and P < 0.5 was considered as the level of significance. Results: Barrett Universal II formula had the lowest MAE with a mean of 0.06 ± 0.20 and a median absolute error of 0.02. This was followed by Holladay II and SRK/T. While Barrett Universal II outperformed for all powers of IOL, SRK/T had lower MAE for plus power IOLs and Holladay II was better for negative-power IOLs. Conclusions: Barrett Universal II formula is ideal for IOL power calculation in cataract patients with AL >26 mm.
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Anthropometry measurements and nutritional status of children attending anganwadis in rural areas Highly accessed article p. 11
Ansi Patel, Hrutu Gada, Meera Menon, Adithya Panicker, Nikita Patil, Sumer Bora
DOI:10.4103/jdmimsu.jdmimsu_6_19  
Background: The study is regarding the effectiveness of ICDS scheme in India which is for the benefits of children's nutrition and health. Aims: The aim of this study is to determine the assessment of the nutritional status of children attending Anganwadi in Seloo and Deoli. Objective: The objective is to assess the nutritional status of children according to American Association for Health Education in Anganwadi at the village Seloo and Deoli of Wardha district. Materials and Methods: All the students of Seloo and Deoli taken as subject for anthropometric measurements to asses nutritional status. Study type is cross sectional study. Results: In Seloo, almost 56.6% of children are underweight. In Deoli, almost 50% of children are underweight. Conclusion: The overall prevalence of undernutrition in the study population was assessed, and severe undernutrition was found to be present.
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Study of knowledge and attitude about breastfeeding practices and newborn care in rural areas Highly accessed article p. 15
Madhvi Dhamania, Asmeet Chawla, Pranjali Bhagwat, Priyanka Bhalgat, Shivani Sharma, Sheetal Pawar
DOI:10.4103/jdmimsu.jdmimsu_10_19  
Objectives: The objective is to study knowledge and attitude about breastfeeding and newborn care practices and factors affecting initiation and duration of breastfeeding in rural areas. Materials and Methods: Mothers with their babies who came for Oral Polio Vaccine (OPV1) and Diphtheria, Pertussis, and Tetanus Immunization (DPT1) in Acharya Vinoba Bhave Rural Hospital were included in the cross-sectional study after verbal consent. Pretested questionnaire on breastfeeding practices was done. Results: 95% of new-borns cried immediately after birth, meconium passed in 98%,urine passed in 93%, 100% new-borns were immunized. 82% of mothers knew about colostrum. 96 % of mothers knew about immunization, 60% mothers know for which disease immunization is given and all 100% mothers immunized their babies Conclusion: The study emphasizes the need for breastfeeding intervention program in antenatal and postnatal mothers during their checkups. Mothers in rural areas should be encouraged to avail the hospital facilities during their deliveries and postdeliveries.
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Comparative evaluation of masseter and buccinator muscle activity using electromyography in denture wearer and nondenture wearer by fabricating dentures with neutral zone technique – An In vivo study p. 20
Anagha Dafade, Mithilesh Dhamande, Seema Sathe, Anjali Bhoyar Borle, Dipak Shinde, Tanvi Balwani
DOI:10.4103/1319-4534.322598  
Introduction: The objective of this study was to analyze buccinator and masseter muscle activity in previous denture wearer and nondenture wearer wherein dentures were constructed with neutral zone technique; however, complete dentures for patients with no history of previous dentures can be made with a neutral zone technique for improved stability. Methodology: A total of 50 patients were included in this study among which, Group A consisted of a total of 25 patients, who were old denture wearer and for whom a new denture was fabricated with the neutral zone technique. Group B consisted of 25 patients who were first-time denture wearer for whom a new denture was fabricated with a neutral zone technique. Results: The muscle activity does not significantly differ in previous denture and nondenture wearers. However, complete dentures for patient with no history of previous dentures can be made with a neutral zone technique for improved stability. Conclusions: Buccinator and masseter muscle activities significantly differ due to morphological changes that occurred in denture wearers and nondenture wearers.
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Health-related quality of life among medical students p. 25
Joel Thomas, Dhanushree Nair, Preetha John, Rishtha Beeran, Praisil Simon
DOI:10.4103/jdmimsu.jdmimsu_21_19  
Introduction: Medical education appears to perpetuate stress through its intense academic workload, working with patients and grading systems. Various studies show that the stressful life of medical students can attribute to development of various ailments and deterioration of quality of life. The World Health Organization has defined quality of life as “individuals' perception of their position in life in the context of the culture and value systems in which they live and their relation to their goals, expectations, standards and concerns. Aim: To determine the health related quality of life of medical students and assess their mental status. Material and Methods: A descriptive cross sectional study was conducted among the undergraduate students of Jawaharlal Nehru Medical College.A total of 235 students from 2nd year MBBS and Final year part 1 MBBS participated in the survey. The study was conducted after obtaining written consent from the participants and permission from the Head of the Department to conduct the study. Results: The students who participated ranged from the age group of 17 years to 24 years, maximum being 21 years (30%), 164 of them were females. Sixty two percent of the students belonged to 2nd year. According to Beck's Depression Inventory, 23%(53) evaluated to have mild mood disturbances. Overall scores for all 8 domains ranged between 78.2 and 60.2. The maximum score was obtained in the Physical Function domain and the minimum score was obtained in the Role Limitation Due to Emotional Problems domain. Conclusions: The study shows that the quality of life ,health related as perceived by the participants is low. Various factors may be associated with this, including time constraints for social activities, heavy workload and limited contact with family and friends. Deteriorated quality of life may affect the attainment of knowledge by the students, their performances as well as their future competencies as a clinician.
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A formula for estimating the mesiodistal width of permanent mandibular central incisors p. 29
Vikrant Jadhav, Meenakshi Tiwari, Vasudevan Seegavadi, Ranjit Kamble, Pallavi Daigavane
DOI:10.4103/jdmimsu.jdmimsu_121_20  
Introduction: A chieving acceptable occlusal contact during orthodontic treatment is very important. Tooth size ratios play a major role in the prediction of treatment outcomes. Aim: The aim of this study is to determine the mesiodistal width of missing mandibular central incisor. Materials and Methods: The study sample consisted of study casts of 300 participants in the age range of 18–30 years. Samples having a full complement of teeth with Angle's Class I molar and canine relationships, good intercuspation, normal overjet and overbite, and minimal crowding and spacing. Tooth dimensions were measured using a digital Vernier caliper. The data calculated were used for measuring schedule variance (SV) formula. Results: Based on the achieved data, SV formula is derived. Conclusion: For achieving esthetic profile, it is essential to calculate the correct mesiodistal width of the teeth. Ideal tooth proportions play an important role in achieving good occlusion at the end of orthodontic treatment.
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The screening and identification of atypical red cell antibodies by simultaneous LISS/coombs and NaCl/enzyme gel methods prior to blood transfusion p. 33
Purvee Agrawal, Arvind Bhake
DOI:10.4103/1319-4534.322597  
Background: In this retrospective study, we measured the frequency of unexpected antibodies in the blood by Nacl/enzyme gel method or LISS/Coombs method and compared the result and frequency of identification in patients with a history of gestation or blood transfusion. Aims and Objectives: To detect unexpected/atypical red cell antibodies by simultaneous LISS/Coombs and NacL/enzyme gel methods prior to blood transfusion. Materials and Methods: Atypical antibody screening has done in all patients with the history of recurrent blood transfusion or history of gestation by commercially available red cell panel (ID–Dia panel, Diamed–ID Micro Typing System). Results: A total of 30 patients were screened for the presence of atypical antibody. Out of 30 patients, 1 (3.33%) patient showed the presence of alloantibody in the serum. The alloantibody identified was of anti-Lewis system. Conclusion: Screening for the presence of alloantibodies in patients is important to provide compatible blood and avoid adverse transfusion reactions.
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Treatment-seeking behaviors of families for under five children in field practice area of jawaharlal nehru medical college, Wardha p. 36
Abhishek Ingole, Sheela Yadav, Shashank Gotarkar, Sonali Choudhari
DOI:10.4103/1319-4534.322605  
Context: Globally, India had the largest population of under-five (127 million), and the greatest number of under five deaths (2.1 million) in 2006. Nearly about 2 million of cases of diarrhea occur annually in India. An average Indian child below 5 years of age can have 2–3 episodes of diarrhea. It contributes to nearly 2.1 million of the global burden of 9.7 million under five deaths, which is the highest for any nation in the world. The Millennium Development Goal 4 aimed at reducing under-five mortality by two-third till year 2015 which remained unachieved and sustainable development goal 3 aims to ensure healthy lives and promote well-being for all at all ages including under-five children by the year 2030. The health and treatment-seeking behavior of parents and caregivers has direct reflection over child survival statistics of India. The present study has been conducted to study the determinants of treatment-seeking behavior of families for illness of under-five children in the field practice area of Jawaharlal Nehru Medical College (JNMC), Sawangi, Wardha, Maharashtra, India. Aims: A study on the treatment-seeking behaviors of families for illnesses of under-five children in field practice area of JNMC, Wardha, Maharashtra, India. Objectives: The objective of this study is to know the treatment-seeking behaviors of families for under-five children in rural areas. Materials and Methods: This study was carried out in the field practice area of community medicine JNMC, Sawangi Wardha, Maharashtra, India. The present study was carried out in the adopted villages from the field practice area of Wardha district by the JNMC. The present study was a community-based, cross-sectional study, and the study period was 6 months (i.e., from July 2019 to December 2019).The study participants comprised of the caregivers of children under-5 years of age and including mothers and other family members who were primarily responsible for attending the child's health. All children in the age group of 0 to 5 years from the study area were identified for the same (from Anganwadi's in the villages). The study participants, i.e., parents who were ready to participate in the study by signing the written consent were included in the study. Statistical Analysis Used: A predesigned and prestructured questionnaire was prepared and implemented for data collection. Results: The results showed that most of the under-five children were in the age group of 2–3 years. Most of the under-five children were having itching on skin followed by fever and diarrhea. Most of the parents took their under-five children to ANM's or the government hospital situated at their place. Conclusions: The present study concludes that treatment-seeking practices among parents for under-five children in the adopted villages of medical college are satisfactory in terms of qualified treatment provider and compliance to the treatment.
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Clinical study of age-related macular degeneration-incidence, visual acuity assessment, and risk factors p. 42
Sapan Jaiswal, Priyanka Raut, Mala Kamble, Aditi Gadegone
DOI:10.4103/1319-4534.322608  
Background: Age-related macular degeneration (AMD) is an eye disease that can blur the sharp, central vision you need for activities like reading and driving. “Age-related” means that it often happens in older people. “Macular” means it affects a part of your eye called the macula. Settings and Design: AMD is a common condition – it's a leading cause of vision loss for people age 50 and older. AMD doesn't cause complete blindness, but losing your central vision can make it harder to see faces, drive, or do close up work like cooking or fixing things around the house. Methods: AMD happens very slowly in some people. Even if you have early AMD, you may not experience vision loss for a long time. For other people, AMD progresses faster and can lead to central vision loss in one eye or both eyes. Conclusion: The present article aims to summarize the current knowledge on AMD its incidence, visual acuity, and risk factors
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Prevalence of temporomandibular disorders among medical students of Wardha district: A cross-sectional study p. 47
Bhawna Shyamsukha, Sharayu Nimonkar, Vikram Belkhode, Pranali Nimonkar, Alok Pol
DOI:10.4103/1319-4534.322613  
Context: Temporomandibular disorder (TMD) has reached a foremost role within the context of oral health care because of its high prevalence. Although its etiology cannot be exactly interpreted, it is considered to be multifactorial. Aims: The study aimed at evaluating the prevalence of TMD among Medical students with the help of Helkimo's index. Settings and Design: This study was based a cross-sectional in vivo study design. Materials and Methods: Hundred and ten students studying in medical college were evaluated with the help of the Helkimo's index. Anamnestic component of Helkimo was analyzed using the questionnaire and was scaled. Clinical dysfunction component of the Helkimo's index was clinical assessment and was scored. Results: Descriptive statistical analysis was done. The questionnaire answered showed sounds in the temporomandibular joint pain (TMJ) area by 89%, jaw rigidity by 8%, fatigue of the jaw by 2%, and pain in TMJ by 23%. On clinical examination, 17% had mild difficulty in mouth opening, 11% showed mild mandibular deviation, 69% showed clicking sound in TMJ, 18% had mild pain in the TMJ region, and only 8% had muscle pain on palpation. Conclusion: Signs and symptoms of TMD to a varied extent were present among Medical students. Although prevalence was high, the severity was mild. Initial diagnosis may decrease the worsening of the condition in them.
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Utility of mini-CEX in assessing postgraduates competency in orthopedics p. 52
Sanjay Deshpande, Mahendra Gudhe
DOI:10.4103/jdmimsu.jdmimsu_240_20  
Background: Medical education aims at providing quality health care to community, which evidently needs professionally competent physicians. Mini-CEX tool can be employed to assess the core competencies of trainees during their routine clinical practice. This assessment tool offers a reliable measure of trainee's performance through being observed a number of brief encounters over a period, with a number of different assessors and in different clinical settings. So the study was carried out to test utility of Mini-CEX to test competence in postgraduate s in Orthopedics at a rural medical college in central India. Method and Material: Eighteen Orthopedics postgraduates underwent this assessment at an interval of 1 month to a total of 5 encounters. All were examined for seven skills. The timing of these assessments was mostly opportunistic, but the interval was maintained. Various said clinical test / skill was performed on real patient and rated them on the prevalidated checklist and provided feedback. Every skill was observed five times in similar case scenario. Nine point Likert scale was used for assessment. Results: Among the trainees the level of satisfaction was less varied than the supervisors and majority have shown interest with high level of satisfaction with the mean for Mini-CEX ranging from 7.94 to 8.27. And Pair wise analysis between 1st and 5th intervention, 3rd and 4th intervention and 3rd and 5th intervention was found to be significant. Conclusion: Mini-CEX is a method of assessing the clinical skills, which is task focused and quick to perform in a broader set of routine clinical practice administered as multiple encounters with variable patient problems and different examiners. Mini-CEX is a workplace-based assessment of performance, which has been reported to be reasonably reliable and valid to confer structured clinical skills learning in medical education.
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Magnitude of subclinical hypothyroidism in type 2 diabetes mellitus – A hospital-based cross-sectional study p. 57
Kumari Monika, Banait Shashank, Salunkhe Preetam, Jain Jyoti
DOI:10.4103/1319-4534.322621  
Aim: The aim of the present study was to determine the magnitude of subclinical hypothyroidism (SCH) in patients of >35 years of age presenting with type 2 diabetes mellitus (T2DM) to the tertiary care hospital in rural Central India. Settings and Design: This was a cross-sectional study done in a rural tertiary care hospital conducted for a period of 2 years from October 2016 to September 2018. Materials and Methods: We prospectively enrolled all consecutive T2DM in patients aged ≥35 years in this cross-sectional study in rural hospital in central India. Free T4 and thyrotropin estimation have been done by chemiluminescence and the normal range considered was 0.7–1.8 ng/ml and 0.30–5.5 micron IU/ml respectively. Statistical Analysis: Statistical analysis was done using descriptive and inferential statistics using Student's t-test, Chi-square test, and Mann–Whitney test to compare means, proportions, and medians, respectively P < 0.05 will be considered significant. We analyzed the data by STATA software (Version 16, Stata Corporation, Texas, USA). Results: The mean age of the study population (n = 174) was 57.7 ± 10.4 years and 61.5% were male and 51.7% had high body mass index. The magnitude of SCH was 7.5% among study participants with T2DM (9.3% in male and 4.5% in female). The magnitude of SCH was higher in the elderly age group, 9.2% in 61–80 years age group compared to 6.4% in 35–60 years age group. Conclusion: We concluded from this study that SCH is common in T2DM in our study setting. The prevalence of SCH increases with age, especially elderly female.
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Cytomorphometric evaluation of the epithelial cells of buccal mucosa in smokeless tobacco users: An In vivo study p. 63
Mehaksha Batra, Alka Harish Hande, Madhuri N Gawande, Swati K Patil, Archana Sonone, Preethi N Sharma
DOI:10.4103/jdmimsu.jdmimsu_361_20  
Background: Smokeless tobacco (SLT) used in various formulations induces certain oral mucosal lesions commonly known as oral potentially malignant disorders (OPMDs). The prevalence of transformation of OPMD to oral squamous cell carcinoma is high. Thus, early diagnosis and prompt intervention may prevent this progression and further malignant transformation. Aim and Objectives: We aimed to assess the effect of tobacco chewing on epithelial cells of buccal mucosa in SLT users using cytomorphometry. Materials and Methods: The study group comprised 90 patients divided into three groups (A, B, and C). The comparison of the cellular diameter, nuclear diameter, and the nuclear–cellular diameter ratio of epithelial cells of buccal mucosa of control group (A) with tobacco chewing habit but no oral mucosal lesion (B) and tobacco chewing habits and oral mucosal premalignant lesions (C) was carried out. Results: Univariate analysis of variance showed a significant group effect for cellular diameter, nuclear diameter, and ratio of nuclear–cellular diameter. Multiple comparison tests by Tukey's honestly significant difference procedure revealed a significant decrease in the mean cellular diameter, increase in the nuclear diameter, and ratio of nuclear–cellular diameter. Conclusion: Cytomorphometric changes could be the earliest indicators of cellular alterations. There is a progressive decrease in cellular diameter, increase in nuclear diameter, and ratio of nuclear–cellular diameter in epithelial cells of buccal mucosa from all smokeless tobacco users, as compared to normal controls. This indicates that there could be cause–effect relationship between tobacco and quantitative alterations.
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Assessing the change in occlusal vertical dimension in complete dentures prosthesis after processing: A cephalometric study p. 68
Sharayu Nimonkar, Vikram Belkhode, Ram Thombare, Yash Pal Singh, Monika Saini, Jagjeet Singh
DOI:10.4103/jdmimsu.jdmimsu_339_20  
Introduction: Recording of jaw relations is the most important step in complete denture fabrication. One of the main reasons for complete denture failure is the error, in recording the correct vertical dimension of occlusion and its reproduction in final prosthesis. Methods: Thirty completely edentulous participants were selected for the study. The physiologic rest position of the mandible was used to record the vertical dimension of occlusion, and denture was fabricated following all the steps meticulously for all the study participants. A lateral cephalograph for each patient was shooted twice one with adjusted wax rims at determined the vertical dimension and another at denture insertion appointment. The comparative evaluation of both the cephalographs for the change in the angle made by two projection lines drawn by joining the orientation landmarks was carried out using the software of all the participants. Data were statistically analyzed using the Student's paired t-test, and software used in the analysis was the SPSS software version 22.0. Results: Statistically significant difference was observed in the mean occlusal vertical dimension (OVD) recorded at the Jaw relation stage with OVD in processed complete denture (t = 5.84, P = 0.000). Conclusion: The OVD recorded using the physiologic rest position method was found to be increased in the finished complete denture.
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Saliva properties and dental caries prevalence in the South Karnataka population p. 72
Vyapaka Pallavi, Mithra N Hegde, G Kamakshi, Shanthiprasad Indra, Dinapadu Sainath
DOI:10.4103/jdmimsu.jdmimsu_43_20  
Context: The biochemical and physicochemical properties of saliva have multifunctional roles in maintaining oral and general health. This article emphasizes the influence of salivary properties on caries process and caries susceptibility. Aims: The aim of the study was to investigate associations between prevalence and activity of intraoral carious lesions and salivary properties tested using the saliva check kit (GC Corp) in adult South Karnataka population. Subjects and Methods: With ethical approval, 100 healthy adult patients coming to the Outpatient Department of Conservative Dentistry and Endodontics who have decayed, missing, and filled teeth (DMFT) index ≥5 have been selected for the study. Saliva properties tested included hydration, viscosity, resting pH, and for quantity and buffering capacity of stimulated saliva. Statistical Analysis Used: Data obtained were analyzed with Spearman's rank correlation. Results: The resting saliva pH and the buffering capacity of the stimulated saliva were shown to be statistically significant (P < 0.05), whereas resting saliva hydration and stimulated saliva viscosity were not significant. The quantity of the stimulated saliva showed no correlation with DMFT. Conclusions: There appeared to be a correlation between the resting pH of saliva, saliva buffering capacity, and the potential lesion activity of dental caries.
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Association between oral cancer and ABO blood groups p. 76
SR Ashwinirani, Girish Suragimath
DOI:10.4103/jdmimsu.jdmimsu_55_20  
Introduction: Oral cancer (OC) in India accounts for about 40% of all cancers of the body. Since the majority of human cancers are derived from epithelial cell changes in blood group antigens, it is an important aspect of human malignancies. So the present study was designed to evaluate the association between ABO blood group type and OC. Materials and Methods: A total of 63 atients were included in the study after obtaining a written consent and ethical clearance from the Institution. Demographic information including name, age, gender, adverse habits were recorded in a predesigned proforma. The clinically confirmed cases of OC were included and ABO blood grouping was done by routine method using Eryscreen Plus kit. The data was entered in MS excel and subjected to statistical analysis. Results: Most common age group affected in OC was 50-59 years and more in males. The most common site affected by OC was buccal mucosa. Blood group A patients were more common in OC. Conclusion: Based on the results of our study males aged above 50-59 years with blood group A were more prone to develop OC.
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The variation of neutrophil count at different phases of the menstrual cycle in periodontally healthy females p. 80
Aishwarya Hajare, Prashanth Shetty, Varsha Jadhav, Seema Yadav, Preeti Pardeshi, Sabiha Patel
DOI:10.4103/jdmimsu.jdmimsu_60_19  
Introduction: The effect of different levels of sex hormones in the body is to bring out changes in every part of the body. The changes occurring in periodontium under the influence of female sex hormones during menstrual cycle is important from the perspective of periodontal health. Aim: The purpose of this study is to compare the neutrophil count at different time points during menstrual cycle in GCF and to compare the neutrophil count with clinical parameters. Materials and Method: Fifty five periodontally healthy women with regular menstrual cycle were included in the study. Clinical parameters recorded were Gingival bleeding index (GBI) and the Modified Gingival index (MGI) at each phase of menstrual cycle(Ovulatory phase OP, Menstrual phase MH and Premenstruation phase PMP). Gingival crevicular fluid (GCF) was collected at each study phase for analysis ofneutrophil count. Results: Both the GBI and the MGI increased remarkably during the menstrual cycle, and were significantly higher during ovulation than in menstruation and premenstruation phase. The level of neutrophils increased during the different phases of menstrual cycle, highest count being observed during the ovulatory phase. Conclusion: It was concluded that periodontal health is altered during different phases of menstrual cycle.
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Prevalence of hepatic alveolar hydatid in a nonendemic region of North India in hospital-based population: Emerging trend or improved diagnostic workup p. 86
Irshad Ahmad, Mohd Ilyas, Aabid Ashraf, Ajaz A Rather, Tariq A Gojwari
DOI:10.4103/jdmimsu.jdmimsu_86_19  
Objective: The objective of this study was to calculate the prevalence of hepatic alveolar hydatid disease in hospital-based population in North India, a nonendemic region for alveolar hydatid disease. Materials and Methods: This study was conducted at a tertiary care center in North India between April 2017 and March 2019. Patients with suspected hepatic alveolar hydatid on ultrasonography were evaluated with further imaging studies based on classical radiological findings and then confirmed by histopathology. Results: Twenty-five cases of hepatic alveolar hydatid were diagnosed primarily based on the classical imaging/radiological findings with histopathology confirmation, with a 2-year period prevalence of 0.207 cases/1000 population. Majority of the cases were in the age group of 41–60 years, with a mean age of 53.04 years. Fifty-two percent of the cases were female. Majority of them were from hilly areas and working with livestock animals. Abdominal pain was the most common presenting symptom. Conclusion: Hepatic alveolar hydatid is considered as a rare disease in India; however, the increased number of cases been diagnosed in our study could be either due to increased diagnostic modalities or due to actual increase in the number of cases. Therefore, hepatic alveolar hydatid should be considered in the differentials of suspicious liver mass in nonendemic regions.
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Comparative evaluation of interleukin-17 in gingival crevicular fluid of patients with aggressive periodontitis and healthy gingival sites p. 90
Anand Narayanrao Wankhede, Prasad Vijayrao Dhadse, Priyanka Ganesh Jaiswal, Vidya Sudhindra Baliga
DOI:10.4103/jdmimsu.jdmimsu_105_19  
Background: Aggressive periodontitis (AgP) is a severe form of periodontitis with rapid bone loss and clinical attachment loss. Many investigations aimed to understand its etiology and pathogenesis, however there is inadequate literature available regarding the level of interleukin-17 (IL-17) at sites of periodontal inflammation in AgP. Aim: The purpose of this study was to compare the levels of IL-17 in gingival crevicular fluid (GCF) of AgP patients with healthy sites of gingiva. Materials and Methods: GCF samples were obtained from individuals with clinically healthy gingiva (n = 15) and from AgP patients (n = 15). Clinical parameters including probing pocket depth (PPD), clinical attachment level (CAL), Papillary Bleeding Index (PBI), and Plaque index by Turkesy– Gilmore–Glickman Modification Of Quigley-Hein (PI) were measured. The level of IL 17 was measured by using enzyme linked immunosorbent assay (ELISA). Results: The level of GCF IL-17 was found to be statistically significantly increase in AgP (1.12 ± 0.29) as compared to healthy gingiva (0.64 ± 0.23). Clinical parameters such as modified PI, PPD, and PBI were significantly higher in AgP as compared to healthy clinical sites. Conclusion: The result of this study had shown that GCF IL-17 level was found to be elevated in AgP compared to healthy gingiva.
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Effectiveness of education program on knowledge about organ donation p. 94
Mangesh Vilinikaran Jabade, Sheelas Upendra
DOI:10.4103/jdmimsu.jdmimsu_121_19  
Background: Organ donation is when a person allows an organ of their own to be removed and transplanted to another person, legally, either by consent while the donor is alive or dead. To understand organ donation, it is first important to understand organ transplantation. A transplant is a medical procedure where one person's dysfunctional organ or tissue is replaced by that of a healthy person, thus restoring its function. The organ donation and transplantation system strive to honor the gift of donated organs by fully using those organs to save or improve the quality of the lives of transplant recipients. Objectives: The objectives are as follows: (1) to assess the knowledge regarding organ donation among nursing students studying at selected nursing colleges in Pune City and (2) to evaluate the effectiveness of education program on knowledge regarding organ donation, among nursing students studying at selected nursing colleges in Pune. Methodology: The design of the study is quantitative-one group pre-test and posttest design. The data of this study were collected by a self-structured questionnaire using the purposive sampling method. The questionnaire had two sections, namely to gather information regarding demographic variables and knowledge on organ donation. Results: Assessed the knowledge and perception regarding organ donation and result were found as follows: the pretest knowledge score of the students includes 16% had good, 70% had average, and 14% had poor score. The posttest knowledge score of the students includes 57% had good knowledge, 40% had average, and 3% had poor knowledge score. Conclusion: This study revealed that education program is effective to increase the knowledge on organ donation among nursing students.
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Evaluation of morphological alteration in human mandible: A prospective cross-sectional panoramic radiographic study p. 97
Ankita Bohra, Aditya Harsh
DOI:10.4103/jdmimsu.jdmimsu_126_19  
Background: The aim of the study is to evaluate the morphological alterations of the mandiblebetween different age groups, gender, and dentition status. Materials and Methods: A total of 1000 patients (500 males and 500 females), panoramic radiographs, were included in the study out of 57,640 patients in the outpatient department for 1 year. The patients were categorized according to age, gender, and dentition status that were assessed. Results: Statistically significant relation was observed between the mean antegonial angle, depth, gonial angle, and mandibular cortical index (MCI) with respect to the age, gender, and dentition status. The value of antegonial angle decreased with age and edentulousness, while antegonial depth increased with age and edentulousness. Females had higher values of antegonial angles as compared to males for antegonial angle, while the opposite is true for antegonial depth. Conclusion: There is an inherent asymmetry in the antegonial regions between the right and left sides. The gonial angle can serve as an adjuvant and additional forensic parameter, which guides for age group assessment and gender identification. MCI can be used as a diagnostic tool for screening patients with or without osteoporotic changes.
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Utility of fine-needle aspiration cytology in diagnosis of lymphadenopathy: Experience from a tertiary care centre from South India p. 102
Panduranga Chikkannaiah, Channaigaramaiah Guruprasad, Srinivasamurthy Venkataramanappa
DOI:10.4103/1319-4534.322596  
Introduction: Abnormal shape, size, and consistency of the lymph node constitute lymphadenopathy. The etiology of lymphadenopathy varies from reactive to malignancy. It is the significant manifestation of local and systemic ailments specially an occult malignancy. Fine-needle aspiration cytology (FNAC) is a simple, reliable initial diagnostic modality. Materials and Methods: This is a retrospective study from January 2005 to December 2017. The lesions were classified into reactive lymphadenopathy, granulomatous lymphadenitis, necrotizing lymphadenitis, suppurative lymphadenitis, lymphoma, and metastatic lesions. Primary organ was identified in available cases of metastatic lesions. Cytological and histopathological correlation was done in available cases. Results: A total of 3676 cases were retrieved constituting 16% of total FNAC performed during the study, females outnumbered the male. Most of the cases were observed in the age of 21–30 years. Cervical lymph nodes were the common site of involvement (88.8%). Among the benign lesions, granulomatous (40%) was most common followed by reactive (39%). Metastatic lymphadenopathy (13%) was the most common malignant lesion. Squamous cell carcinoma was the most common metastatic tumor followed by adenocarcinoma. The lung was the most common primary organ. FNAC is having high sensitivity and specificity for malignant lesions than the benign. Conclusion: FNAC is a rapid, initial diagnostic tool for lymphadenopathy. It is an effective tool to differentiate inflammatory, benign, and malignant lesions.
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A study of neurocognitive dysfunction in HIV-positive patients in a tertiary care center in South India p. 108
Rajendra Prasad Shivaswamy, Aparajitha Ashok, Subhash Chandra Ballekere Jayaram, Varsha Thandure, Jenee Dowerah
DOI:10.4103/1319-4534.322599  
Context: HIV-associated neurocognitive disorder (HAND) is an ongoing problem among HIV-positive patients, irrespective of whether the patients are on antiretroviral treatment (ART) or not. ART has helped in halting the progression of the disease, but still, research needs to be done in reversing the disorder. Patients on ART are still known to have a mild neurocognitive disorder. The prevalence of HAND is estimated in approximately 40%–50% of all cases. Aims: (1) To determine the presence of neurocognitive dysfunction in HIV-positive patients. (2) To determine sociodemographic factors that influence this condition. (3) To determine the relationship between CD4 count and neurocognitive dysfunction. Settings and Design: The sampling technique was purposive sampling. A cross-sectional study was undertaken in a sample size of 162 among patients attending the outpatient department of medicine department using the International HIV Dementia Scale (IHDS). Subjects and Methods: IHDS has the maximum possible score of 12 points. A patient with a score of ≤10 should be evaluated further for possible dementia. Statistical Analysis: Data entry was done in an Excel sheet. Data analysis was done using SPSS. Results: It was found that of the 162 patients who participated in the study, 71% were found to be at risk for the neurocognitive disorder. The factors which had a significant association were age, education, spouse alive or not, and HIV status of the spouse. Conclusion: It was found that out that neurocognitive disorder is common in the ART era and also it can be detected by simple bedside tests.
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Red cell distribution width and platelet volume indices in critically ill patients p. 115
Sunil Joyson, HS Kiran
DOI:10.4103/1319-4534.322600  
Background: Red cell distribution width (RDW) is the quantitative assessment of variation of the size of circulating red blood cells. Platelet volume indices include mean platelet volume (MPV) and platelet distribution width (PDW). Few studies have evaluated RDW and platelet volume indices in critically ill patients. The objective of this study was to assess RDW and platelet volume indices in critically ill patients. Methods: It was a prospective observational study. The study included 260 critically ill patients (irrespective of diagnosis) admitted in intensive care units (ICUs) under the department of general medicine, fulfilling inclusion and exclusion criteria. RDW and platelet volume indices within the first 24 h of admission into the hospital were taken. The critically ill patients admitted to ICUs were classified into two groups based on their Acute Physiology And Chronic Health Evaluation II (APACHE II) score on the day of admission (≥18 and <18) and they were compared with 130 noncritically patients admitted in wards. Results: The RDW values of critically ill patients with APACHE II score ≥18 was significantly higher (with P value 0.05) when compared to those with APACHE II score <18. The RDW values of critically ill patients with APACHE II score ≥18 was significantly higher (with P = 0.0001) when compared to noncritically ill patients in the wards. The RDW values of critically ill patients with APACHE II score <18 was not significantly higher (with P = 0.111) when compared to noncritically ill patients in the wards. The MPV values of critically ill patients with APACHE II score ≥18 was significantly higher (with P = 0.04) when compared to noncritically ill patients in the wards. The MPV values of critically ill patients with APACHE II score ≥18 was not significantly higher (with “P” = 0.58) when compared to those with APACHE II score <18. The MPV values of critically ill patients with APACHE II score <18 was not significantly higher (with P = 0.73) when compared to noncritically ill patients in the wards. The PDW values of critically ill patients with APACHE II score ≥18 was significantly higher (with P = 0.03) when compared to noncritically ill patients in the wards. The PDW values of critically ill patients with APACHE II score ≥18 was not significantly higher (with P = 1.00) when compared to those with APACHE II score <18. The PDW values of critically ill patients with APACHE II score <18 was not significantly higher (with P = 0.22) when compared to noncritically ill patients in the wards. The RDW, MPV, and PDW correlate with the severity of critical illness but not with mortality. RDW and platelet volume indices do not vary between males and females. RDW and platelet volume indices do not vary among various age groups. Conclusion: RDW and platelet volume indices of critically ill patients admitted to ICUs were more when compared with noncritically ill patients. Hence, RDW and platelet volume indices can be considered as indicators of the severity of critical illnesses and could be used in day-to-day practice as markers of severity of critical illness. Among these three indices (RDW, MPV, PDW), RDW appears to be the best with respect to the association with the severity of critical illness. However, RDW and platelet volume indices are not good tools for the prediction of mortality in critically ill patients.
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Reproducibility of sagittal condylar path inclination assessed by protrusive interocclusal record with two different techniques of facebow registration: A clinico-radiographic study p. 121
Ajay Jain, Sridevi Ugrappa, Ooi Jia Hui, Ooi Wan Jun, Pang Siao Ting
DOI:10.4103/1319-4534.322603  
Purpose: The purpose is to validate whether the data obtained for sagittal condylar inclination are correctly reproduced on the semi-adjustable articulator using protrusive interocclusal records for conventional facebow registration method (orbitale (OR) as an anterior point of reference) and facebow registration using bubble leveler (BL) as an anterior point of reference and compared these values with the values obtained by lateral cephalogram (gold standard). Materials and Methods: In total, 30 individuals (20 males and 10 females) with proper teeth alignment, facebow registrations were recorded using OR as an anterior point of reference (Group A, conventional technique) and WBL as an anterior point of reference (Group B). The sagittal condylar path inclination was measured and compared using protrusive interocclusal records for both the groups. These values compared with the values for sagittal condylar path inclination obtained using lateral cephalogram (Group C) using one-way analysis of variance (P < 0.05). Results: There was no statistically significant differences observed in the values of sagittal condylar inclination for all three groups with P = 0.583. Conclusion: This study suggests that BL technique can be used for the orientation of maxillary cast on the semi-adjustable articulator as accurately as the conventional approach, for those practitioners who find difficulty in locating the OR for those patients with deformity in facial region. Lateral cephalogram provides almost the same measurements of sagittal condylar path inclination as obtained using protrusive interocclusal record on facebow registrations using OR and BL as an anterior point of references.
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Impact of quality of life among teachers after nursing strategy intervention – A quantitative study p. 127
R Thephilah Cathrine, S Aruna, R Vijayaragahavan
DOI:10.4103/1319-4534.322606  
Introduction: Teachers are one of the most significant human resources. The qualities and nature of any instructive framework depends generally on their teacher's work. It has been very much reported that educating is one of the most distressing professions in the world. Aims: The aims of this study were as follows: (i) to assess the level of quality of life (QOL) among teachers of private and fully aided schools in posttest for the experimental and control groups and (ii) to determine the effectiveness of nursing strategies on QOL among teachers of private and fully aided schools. Materials and methods: A quantitative research approach with true experimental design including experimental and control groups and pretest–posttest control group design, was adopted for this study. The study focused on the selected schools in Vellore district. Totally 28 participants were selected by consecutive sampling technique with the age of 25–60 years. Based on the inclusion criteria and availability of teachers, they were allocated into control group (n = 14) and experimental group (n = 14). A nursing strategy program by various modules (the nature of stress, cognitive skills, affect skills, and behavioral skills) once a week for 6 weeks was given. Results: We found that the median value in pretest is significantly different from median value in posttest (P = 0.001). This research suggests that nursing strategy interventions are effective and beneficial in all domains of QOL. Conclusion: More help ought to be offered to teachers to improve their QOL and prosperity.
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Effect of home-based exercise program in patients with hip arthroplasty p. 133
Axita Vyas, Neha Mukkamala, Megha Mehta, Lata Parmar, Paresh Golwala
DOI:10.4103/jdmimsu.jdmimsu_207_20  
Background: Physiotherapy has been a routine component of rehabilitation to improve strength and function following hip arthroplasty (HA). Supervised outpatient exercise program can be costly and inconvenient for people who live in the remote areas. Hence, the present study developed Home-based exercise program (HEP) and studied its effect in patients with HA. Materials and Methods: Thirty-six patients with HA were allocated into HEP and control group through the lottery method. Both groups received physiotherapy during hospital stay and were assessed for muscle strength of hip abductors and extensor apparatus with sphygmomanometer, Numerical Pain Rating Scale (NPRS), and Harris hip score (HHS) at discharge. At discharge, HEP group was given a written home program leaflet, record sheet, and telephonic reminder once a week. The control group received all instructions and demonstration of exercises. All patients were assessed at the 1-month follow-up. Results: A total of 36 patients; 18 in HEP group, (12 males and 6 females) with a mean age 39.24 ± 14.59 years and 18 in the control group (11 males and 7 females) mean age 53.44 ± 19.24 years, out of which 35 completed follow-up (18 in HEP, 17 in control group). A statistically significant difference was found in NPRS (P = 0.001), muscle strength-hip abductors (P < 0.001), extensors apparatus (P = 0.008), and HHS in HEP group between discharge and follow-up. No significant difference was found between the two groups. Conclusion: HEP was effective in reducing postoperative pain, improving hip muscle strength, and function in patients with HA. There was no difference found between the groups
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Study of vitamin D supplementation on selected hematological and inflammatory parameters in type 2 diabetes mellitus with vitamin D deficiency p. 138
Deepali Sadashiv Jankar, Kanchan Chandrashekhar Wingkar, Sujata V Kanetkar, Chintamani Dilip Bodhe
DOI:10.4103/jdmimsu.jdmimsu_214_20  
Introduction: Diabetes mellitus (DM) results from decreased insulin secretion and/or increased insulin resistance. Vitamin D deficiency (VDD) is linked with decreased insulin secretion, increased insulin resistance, inflammation, and complications of DM. Few studies have reported association of VDD with anemia or decreased hemoglobin level in diabetic patients. Animal studies have reported some improvement in various blood parameters such as hemoglobin (Hb), hematocrit, red blood cell (RBC) and white blood cell count, and mononuclear cell count after Vitamin D supplementation. Neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) are cheap, easy, reproducible, and dynamic parameters of inflammation with high predictive value. NLR can be associated with DM and its complications. PLR is reported to be associated with cardiovascular disease, diabetic complications, end-stage renal disease, and malignancies. Both have prognostic value. Materials and Methods: Sixty-three Type 2 DM (T2DM) patients on oral hypoglycemic agents aged 30–60 years with VDD (Vitamin D level <20 ng/ml) participated in this comparative and interventional study. Vitamin D, Hb, total leukocyte count (TLC), mean corpuscular volume (MCV), platelet, red cell distribution width (RDW), mean corpuscular hemoglobin (MCH), MCH concentration (MCHC), packed cell volume (PCV), RBC count, NLR, and PLR were determined at baseline. Participants received Vitamin D 2000 IU daily orally for 12 weeks. All the parameters were estimated again after 12 weeks. Results: We found no correlation of Vitamin D with Hb, TLC, MCV, platelet, RDW, MCH, MCHC, PCV, RBC count, NLR, and PLR at baseline. Extremely significant rise in Vitamin D; nonsignificant fall in Hb, TLC, RDW, MCH, NLR, and PLR; and nonsignificant rise in MCV, MCHC, RBC count, and PCV were reported. Conclusion: There was no association of Vitamin D with hematological and inflammatory parameters. Nonsignificant improvement in the parameters was seen with Vitamin D supplementation.
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Disparities in the quality of life among smokers, nonsmokers, and ex-smokers p. 144
V Anu, B Seetha Laksmi, S Sharmila, S Shivani, SM Mahalakshmi
DOI:10.4103/1319-4534.322614  
Introduction: Ill effects of smoking and the advantage of smoking cessation on health are well reported. This study was undertaken with the aim to assess the Quality of Life (QOL) among smokers, non -smokers and ex-smokers which will help clinicians to point out the influence of smoking on quality of life to assist in their everyday work with the patients and to the researchers in more comprehensive evaluation of the respondents' life quality. Materials and Methods: The study was carried out among 234 current smokers, 233 non-smokers and 253 ex-smokers aged above 20 years using WHO- Quality of life- BREF(WHOQOL-BREF). Sociodemographic variables that were recorded includes age, Gender, educational status, marital status. Smoking history was obtained using a closed ended questionnaire. The collected data was entered in Windows Excel and statistical analysis was carried out using SPSS version 11 software. Descriptive statistics, One-way ANOVA test and Tukey's HSD Post hoc test was done. Level of significance was set as 0.05. Results: 103(45.4%)smokers are 'satisfied' with their health, while majority of the ex-smokers,99(39.2%) are 'neither satisfied nor dissatisfied' with their health. Non-smokers reports higher mean values in all domains when compared to smokers and ex-smokers. The smokers showed higher rating in physical(53.39%) and environmental(52.7%) domains when compared to ex-smokers(50.56% and 59.21% respectively) while lower ratings were found in psychological and social domains among smokers than ex-smokers. Statistical test showed a significant difference among all groups based on domains except smokers and ex-smokers in psychological and social relationship. Conclusion: Quality of life among smokers are relatively lower than the non-smokers in the Physical health, Psychological, Social relationships and Environment attributes. Also, the ex-smokers are found to have similar quality of life as smokers when it comes to psychological and social relationship.
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Study of electrocardiographic and two-dimensional echocardiography changes in patients of intracerebral hemorrhage and its outcome in terms of mortality p. 149
Atul S Narayankar, Sachin Kisan Shivnitwar
DOI:10.4103/1319-4534.322615  
Aims of the Study: The aim was to study the electrocardiographic and two-dimensional echocardiography (2D ECHO) changes in patients of intracerebral hemorrhage and its outcome in terms of mortality. Materials and Methods: Patients admitted to medicine ward and intensive care unit selected for the study. Their electrocardiography (ECG), 2D ECHO, and outcome noted. Results: Mortality was higher in patients of intracerebral bleed having ECG and 2D ECHO changes than those with normal ECGs and 2D ECHO. Conclusion: ECG and 2D ECHO abnormalities are common in patients of intracerebral hemorrhage, and these have prognostic significance in predicting mortality in patients of intracerebral hemorrhage. Thus, every patient of intracerebral hemorrhage should undergo ECG and 2D ECHO examination for the evaluation of cardiac dysfunction occurring in these patients.
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Ropivacaine with dexmedetomidine versus ropivacaine alone in ultrasonography-guided supraclavicular brachial plexus block: A comparative study p. 154
LK Dash, K Raghu, G Rajaram
DOI:10.4103/1319-4534.322617  
Context: Supraclavicular brachial plexus block is the most flavored technique for upper limb surgeries in the day-to-day anesthetic practice. Adjuvants are commonly used along with local anesthetics to improve the overall quality of block. Dexmedetomidine is a α2 adrenoceptor agonist, nowadays gaining popularity due to its favorable outcomes. Aims: The aim of this study is to compare the block characteristics of 0.5% 30 ml ropivacaine alone with 0.5% 30 ml ropivacaine combined with 50 mcg of dexmedetomidine. Settings and Design: This was a prospective randomized controlled study. Materials and Methods: One hundred patients in the age group of 20–60 years, of American Society of Anesthesiologists Grade I and II, scheduled for elective upper limb surgeries were included in this study. Patients were divided into two groups of 50 each to receive either ropivacaine alone (Group A) or ropivacaine-dexmedetomidine combination (Group B). Onset and duration of sensory and motor blockade were assessed. Statistical Analysis Used: Standard qualitative and quantitative tests were used to compare data. P < 0.05 was considered statistically significant. Results: The onset of sensory and motor blockade was faster in Group B when compared to Group A (17.32 ± 2.05 min, 24.23 ± 5.83 min vs. 22.58 ± 1.75 min, 28.61 ± 2.78 min), the duration of sensory and motor blockade was longer in Group B when compared to Group A (635.0 ± 27.12 min, 513.21 ± 26.14 min vs. 501.1 ± 33.14 min, 402.17 ± 18.16 min), and the duration of analgesia was also longer in Group B compared to Group A (338.16 ± 10 min vs. 247.20 ± 12 min). Conclusion: Dexmedetomidine as an adjuvant to ropivacaine fastened the onset of block, prolonged the duration of block, and prolonged the duration of analgesia.
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Evaluation of erosive and cariogenic potential of pediatric liquid formulated drugs commonly prescribed in India: A physiochemical study p. 158
Anshula Neeraj Deshpande, Neha Pradhan, KS Poonacha, Bhavna Dave, Rameshwari Raol, Aishwarya Jain
DOI:10.4103/1319-4534.322619  
Context: Many children receive medications for recurrent acute illness and vitamin supplements prescribed by a pediatrician. These medications for young children are in form of syrup and emulsion which are of high sugar content and low pH. These medications make teeth susceptible tooth erosion. Aim: The aim was to evaluate the erosive and cariogenic potential of mid cariogenic potential of pediatric drugs prescribed in India by physicochemical methods. Materials and Methods: The drugs used in this study compromised 96 liquid drug preparations commercially available as oral solution, suspension, elixir, syrup, and drops commonly prescribed for various ailments for children. Tests were performed in triplicate by a calibrated researcher. The endogenous pH of each sample was determined using digital pH meter HI-253. The measurements of the total soluble solids contents were done using the method proposed by the Ayurvedic Formulary of India and the sugar content was determined according to the prescription. Descriptive statistics were employed to compare the results. Results: All drug classes showed acidic pH, and the lowest mean was found for anticonvulsants (4.2 ± 0.20). The variation in the total titratable acidity was from 0.0% to 0.03% among all the drug classes. The highest TSS values were found in bronchodilators 52.75 ± 14.32. Almost all the syrups failed to mention syrup base in their content. Conclusion: It was found that sugar is present in almost all the commercially available pediatric syrups, and a lot of the syrups have their pH close to the critical pH of teeth.
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Comparative evaluation of antibacterial and antifungal efficacy of mineral trioxide aggregate angelus®, mineral trioxide aggregate plus™, and intermediate restorative material – A microbiological In vitro study p. 166
Sourabh Ramesh Joshi, Aparna Umesh Palekar, Gowri Swaminatham Pendyala, Viddyasagar Mopagar, Sachin Deorukhkar, Mukund Singh
DOI:10.4103/jdmimsu.jdmimsu_316_20  
Objective: The study objective was to evaluate the antibacterial and antifungal properties of Mineral Trioxide Aggregate (MTA) Angelus® (MTA-A), MTA Plus™ (MTA-P), and intermediate restorative material (IRM). Materials and Methods: Pellets of MTA-P, MTA-A, and IRM were prepared to test the influence of these cements on the growth of four oral microbial strains, Enterococcus faecalis and Candida albicans, using agar diffusion method. The agar was removed, and the manipulated material was placed in the wells thus formed. The pellets were lodged in the seeded wells and incubated at 37°C for 24–72 h, after which the growth inhibition was measured. The data were analyzed using Student's t-test to compare the differences among the three cements at different concentrations. Results: The test results indicated that the antimicrobial activity of MTA-P, on both the microorganisms tested, was very strong, showing a mean inhibition zone of 3.1 mm, which extends over time toward all the strains. The diameters of the inhibition zones for E. faecalis were statistically significantly larger than that for Candida (P < 0.05) for MTA-P, IRM, and MTA-A. Conclusion: The materials showed antimicrobial activity against the tested strains. IRM showed no antimicrobial activity on Candida. The largest inhibition zone was observed for E. fecalis group. MTA-P created larger inhibition zones than MTA-A and IRM.
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A study on stress distribution at the bone-implant interface in platform switched short dental implants by three-dimensional finite element model p. 169
Sesha Reddy Manchala, S Rajasekar, Hossam Abdelatty Eid Abdelmagyd, Ahmed Atef Aly Shon, Venkataramana Vannala, Shakeel S Khazi
DOI:10.4103/jdmimsu.jdmimsu_322_20  
Aims: The authors carried out this study to analyze the pattern of stress distribution in terms of eqicrestal and subcrestal implant placement at various depths using short platform switched dental implants. Settings and Design: Modeling of the mandibular posterior molar region done with uniformly thick 1.5 mm cortical bone with an inner core of cancellous bone by three-dimensional finite element model (FEM). Implant dimensions used in the study are of length 6 mm, diameter 4.6 mm, and 3.5 mm abutments. Subjects and Methods: The applied force was 100N in an axial and oblique direction (15°, 30°) for realistic simulation. All models created by ANSYS WORKBENCH.von Mises stress is evaluation in both cancellous and cortical bone at various depths. Translations interpreted on x, y, and z-axis with ten noded tetrahedron elements with 3° of freedom per node. Results: All five position of platform switched short osseointegrated implants analyzed by FEM simulations exhibited different stress-based biomechanical behavior, dependent on bone geometry, the direction of force applied as well as on the depth of implant placement. Conclusions: Oblique forces were more deleterious than axial forces. Subcrestal implant placement resulted in reduced stress in the cortical and cancellous bone.
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A cross-sectional survey of community pharmacist's knowledge, behavior and attitude toward antibiotic dispensation, Southern Karnataka, India p. 175
Khyati Bhardwaj, M Suchitra Shenoy, Shrikala Baliga, B Unnikrishnan
DOI:10.4103/jdmimsu.jdmimsu_435_20  
Aim: The study was conducted to determine the knowledge, attitude/perceptions, and behavior of the community pharmacists in the Southern Karnataka district. Settings and Design: The study was a cross-sectional survey conducted with the help of a questionnaire containing open and close-ended questions and Likert-scale-based response items. Materials and Methods: Questionnaires were distributed to pharmacists by simple random sampling. Statistical Analysis: The data were analyzed by Fisher's test and Chi-square test for association between knowledge, attitude, and practices and sociodemographic categories. Results: Majority of the pharmacists considered the use of antibiotics in livestock and agriculture as the reason for antibiotic resistance. All of the pharmacists agreed that refusing to dispense antibiotics without prescription will negatively hit sales. Conclusion: It is imperative to educate pharmacists about rules and regulations regarding antibiotic dispensation. They need to be sensitized about the negative impact of nonprescription antibiotic use on antibiotic resistance and public health.
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Assessment of titles of original research articles published in two peer-reviewed journals of community medicine and public health from India: A descriptive study p. 181
Satish K Wadde, Vijay Kishanrao Domple
DOI:10.4103/jdmimsu.jdmimsu_332_20  
Introduction: Title is the first face of research article which is the mostly read part after publication. Objective: The objective of this study is to assess the titles of original research articles published in two peer-reviewed journals of community medicine and public health from India. Materials and Methods: This descriptive study included 340 original articles from the Indian Journal of Community Medicine and 140 articles the Indian Journal of Public Health published during 2010 to 2018. These articles were downloaded from the official website of the journals. The study was approved by the Institutional Ethics Committee. A predesigned proforma pertaining to fulfill objective consisting of Setting, Population, Intervention, Conclusion, Endpoint and Design (SPICED) criteria, length, typology, punctuation, abbreviations, use of keywords in title, was used. Data were entered in Excel and analyzed by using Epi Info version 7 for frequencies and percentages. Results: Out of 480 original research articles, 48.54% of the articles had title with 16 to 30 words. Four hundred and forty-two (92.08%) titles were of declarative type and 42.08% titles were of topic only type. Out of 200 articles where punctuation or abbreviations were used maximum 83% were with colon. 46.46% articles quoted 5–8 keywords in the articles. Only 9.58% titles were with all the keywords quoted. Only one experimental study had title with SPICED criteria while no observational study had title was with all criteria. Conclusions: Most of the titles were of descriptive type and less use of keywords in titles was there in the formulation of titles along with scarce use of all components of SPICED criteria.
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CASE REPORTS Top

Gas gangrene in a closed pelvic injury p. 186
Antariksh Waghmare, Sandeep Shrivastava, Swapnil Date, Rameez Bukhari, Ajith Nair, Nikhil Deo
DOI:10.4103/1319-4534.322620  
Gas gangrene in a closed pelvic injury is very rare phenomenon and we could not find many reported cases in the literature. Radiographs are not enough for diagnosis and computed tomography (CT) is not widely available yet in primary health center. Basic management includes surgical debridement with incision and drainage of necrotic tissue of the involved area, antibiotic therapy, and surgical intensive care. Delay of the surgical debridement for >12 h is associated with higher overall morbidity. The aerobic and anaerobic bacteria with the indigenous commensal of the pelvis results in the production of exotoxins that leads to severe rapid tissue necrosis and the synthesis of insoluble gases characteristic of subcutaneous emphysema or Fournier's gangrene. Although gas gangrene is often diagnosed clinically, emergency CT can support in early diagnosis with accurate assessment of the disease extent. CT not only helps evaluate the pelvic bony structures but also helps assess the spread of disease in the abdomen and pelvis. The mainstay of the management includes surgical debridement with incision and drainage of necrotic tissue of involved area, antibiotic therapy, and surgical intensive care. Early diagnosis remains the mainstay of the treatment of Gas gangrene. It is important to diagnose these life-threatening conditions and treat them as early as possible. Due to the rarity of such events and the unavailability of gold standard diagnostic and treatment modalities, it is very difficult to prevent the mortality for such patients. There is a need for a better treatment plan to diagnose and manage such patients urgently and not to miss the initial phase of disease progression which is critical for saving the life of the patient.
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Ultrasonography and doppler diagnosis in a rare asymptomatic case of renal cell carcinoma associated with renal vein thrombosis p. 189
Rishabh Gupta, Suresh Phatak, Amruta Varma, Kaustubh Badurwar
DOI:10.4103/jdmimsu.jdmimsu_270_20  
Renal cell carcinoma (RCC) is the primary malignant adenocarcinoma that is derived from the renal tubular epithelium and is the most common malignant renal tumor. The peak age of occurrence is 50–70 year. Cigarette smoking and dialysis-related cystic disease are the most common risk factors. Almost half of all identified RCCs are found incidentally on imaging performed for other purposes. On grayscale ultrasound (US), they appear solid or partially cystic and may be hyper, iso, or hypoechogenic to the surrounding renal parenchyma. The tumor pseudocapsule can sometimes be visualized with US as a hypoechoic halo. Sometimes, the tumor may produce thrombosis of ipsilateral renal vein which on grayscale US show renal enlargement with hypoechoic cortex from edema (early phase) and decreasing size and increased echogenicity (late phase). On Doppler visualization of thrombus within the lumen is possible. Early diagnosis of this tumor with precise localization of thrombus extent is important for planning the further course of management. We present a rare case of RCC, without any symptom of hematuria.
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A rare presentation in horseshoe kidney p. 192
Nilesh Guru, Shyamal Shah
DOI:10.4103/jdmimsu.jdmimsu_349_20  
Horseshoe kidney is the most common congenital fusion anomaly which occurs in 1 in 400–800 live births. Pelvi uretric junction obstruction is the most common abnormality associated with horseshoe kidney. Bilateral PUJ obstruction with renal stones with obstructive uropathy with one nonfunctional moiety is a rare occurrence. We here report such a case, and to the best of our knowledge, there is no such case reported in the literature. We managed the case by initial stabilization followed by left pyeloplasty with pyelolithotomy and partial isthmusectomy. In all cases of horseshoe kidney with renal calculi, there should be high index of suspicion for PUJ obstruction. Thoughtful management in such cases results in prompt recovery and decreases the morbidity of patient
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Submandibular pleomorphic adenoma – Imaging findings on sonography, color doppler, and strain elastography with pathological correlation p. 196
Vadlamudi Nagendra, Suresh Phatak
DOI:10.4103/jdmimsu.jdmimsu_367_20  
Submandibular gland tumors are uncommon. Elastography is a recent addition in ultrasound diagnosis particularly in cases of soft-tissue tumor imaging. In this case report, we are describing ultrasonographic and elastographic imaging findings of submandibular pleomorphic adenoma.
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Recurrence of aneurysmal bone cyst of the mandible and its management: A case report and overview p. 199
Akash Kasatwar, Sandeep Patil, D Durairaj, Shree Bajaj
DOI:10.4103/jdmimsu.jdmimsu_380_20  
Aneurysmal bone cyst (ABC) was first described by Jaffe and Lichtenstein in 1942 characterized by the blow out of the bone seen in radiograph. 12% of the patients had a lesion in the head and neck region, of which only 2% of these pathologies occur in the maxillofacial region. It is most common in those regions of the skeleton where there is a relatively high venous pressure and high marrow content. Mandibular and maxillary molar regions are most commonly involved followed by angle and ascending ramus with preponderance of female patients. In the present case, a 52-year-old female reported to our institute with the chief complaint of swelling. Clinically and correlating radiographically, a large lesion measuring 6 cm × 2.5 cm approximately was involved occupying half of the mandible. This article describes the clinical, radiographical, and histopathological picture, differential diagnosis, and the management of a recurrence of large ABC of the mandible.
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Imaging of congestive hepatopathy ultrasound and doppler findings p. 202
Bhavik Unadkat, Suresh Phatak, Asish Pavanan, Suhasini Pattabiraman
DOI:10.4103/jdmimsu.jdmimsu_381_20  
Congestive hepatopathy has characteristic features on ultrasound and Doppler imaging; we are presenting the case of a 30-year-old female patient a known case of rheumatic heart disease with severe mitral stenosis with severe tricuspid stenosis with tricuspid regurgitation with congestive cardiac failure and anemia. Important ultrasound and Doppler imaging features are described.
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Imaging findings of dextrocardia with situs inversus in covid positive patient: A case to look back p. 206
Rohan Kumar Singh, Gaurav Vedprakash Mishra, Megha Manoj, Bhavik Unadkat, Prerna Patwa
DOI:10.4103/jdmimsu.jdmimsu_132_21  
Dextrocardia is a rare congenital developmental anomaly where the heart is located in the right hemithorax with the cardiac apex pointing toward the right. Dextrocardia may be associated with total situs inversus or can also present as an isolated finding. We present very rare interesting case of situs inversus totalis in a 68-year-old male patient who came with complaints of difficulty in breathing and had a history of fever for 4 days. In view of the COVID-19 pandemic, he got his real time polymerase chain reaction done and he turned out to be positive. On the imaging dextrocardia with total situs inversus was detected. Even though for a common man, dextrocardia with total situs inversus is only heart on the right side of the body with transposition of the abdominal organs, viscera, and vasculature but from a medical point of view, the diagnosis holds a lot of importance as it is useful in the detection of conditions like appendicitis and abdominal organ injuries.
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Chronic myeloid leukemia manifesting as uncontrolled posttooth extraction hemorrhage: A rare case report p. 209
Soumi Samuel, Devyani Bhal, Thara Chandran, Kishan Prasad Hosapatna Laxminarayana
DOI:10.4103/jdmimsu.jdmimsu_272_20  
Postoperative bleeding is one of the common complications encountered in dental practice after routine dental extractions. Preoperative assessment of the patient is an integral aspect of managing and delivering dental care effectively to a patient. However, a patient with unknown and previously undiagnosed systemic illness can further complicate the treatment and result in defective hemostasis postextraction. We report a rare case of a 23-year-old male, who was diagnosed with chronic myeloid leukemia following uncontrolled hemorrhage postsimple dental extraction procedure.
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Defect reconstruction in oral squamous cell carcinoma patient using novel patient-specific polyether ether ketone implant: Report of a case p. 212
Aishwarya Gupta, Nitin Bhola, Rajanikanth Kambala
DOI:10.4103/jdmimsu.jdmimsu_415_20  
Oral squamous cell cancer comprises of one-third of carcinomas of the maxillofacial region. The principle of treatment involves the resection of the lesion with safe surgical margins. However, the rehabilitation of resected soft and hard tissues remains a challenging aspect for the maxillofacial surgeons. In the past few years, the alternatives for maxillofacial rehabilitation have been transmogrified. The profoundness of functional and esthetic significance of the face has led to evolving concepts in the field of reconstruction. With the emerging trends and search for a better reconstruction modality, a novel, biocompatible, and nonmetallic material that is polyether ether ketone (PEEK) was introduced that has shown to have good success rates in the past few years. However, its utility in the reconstruction of mandibular segmental defect is yet to be studied extensively. This case presents our success in reconstructing a mandibular segmental defect in an operated case of oral squamous cell carcinoma using a patient-specific PEEK implant with a follow-up period of 2 years.
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CASE SERIES Top

A case series on imperforate hymen causing hematometra and hematocolpos with unusual presentations p. 216
Prerna Anup Patwa, Rajkiran Rathi, Konika Chaudhary, Ashutosh Charan, Rohan Kumar Singh, Gaurav Vedprakash Mishra
DOI:10.4103/jdmimsu.jdmimsu_130_21  
Obstruction of the uterine or vaginal outlet causes hematometra or hematocolpos. The uterine or the vaginal cavity is distended with blood and its products causing abdominal pain, obstructive symptoms, and discomfort in adolescent patients. A proper diagnosis aids inadequate management through various surgical techniques and not only prevents any further complications but also preserves fertility in such individuals. In this article, we are presenting three cases of hematometra and hematocolpos, discussing their clinical presentations and imaging findings.
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REVIEW ARTICLE Top

Impact of exercises, yoga, and meditation on anxiety and depression during COVID 19 lockdown p. 219
Ashish Bele, Mohd Qureshi, Ajinkya Ghogare, Nivedita Singh, Divya Jethwani, Avanti Gachake
DOI:10.4103/1319-4534.322618  
The COVID-19, coronavirus infective disease 2019, is becoming a major problem worldwide. This situation varies from country to country. This virus spreads among 196 counties. It has been reported that considerable majority of cases are from scattering countries. The coronavirus flare up combined with the lockdown has set off an expansion in the cases of anxiety and stress. Careful meditation and exercise have constructive outcomes as adjunctive intervention for depressive and anxiety episodes. The aim of the study was to review the effect of lockdown in COVID 19 on anxiety and depression and how yoga, exercises, and meditation are beneficial to cope up with anxiety and depression. The data were collected from the electronic databases including Google Scholar, Springer publication, World Health Organization guidelines, PubMed, Cochrane, and Journal of Travel Medicine. All the articles were arranged as per the information they have provided and arranged in a systematic way. Exercises, yoga, and meditation are useful in coping with depression and anxiety including stress during the lockdown period. This study concluded that yoga is more beneficial in depression and anxiety along with regular exercises and meditation.
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LETTERS TO EDITOR Top

The yin-yang sign: Footprint in diagnosis of pseudoaneurysm p. 222
Suvarna Deshpande, Suresh Phatak
DOI:10.4103/1319-4534.322602  
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Proctosigmoiditis characteristic ultrasonography and color doppler findings p. 223
Prerna Anup Patwa, Suresh Vasant Phatak, Kaustubh Madurwar, Varun Singh
DOI:10.4103/1319-4534.322609  
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Papillary projections in ovarian tumors: Ultrasonographic evaluation p. 225
Suresh Phatak, Bhushan Lakhkar, Amruta Varma, Rishabh Gupta
DOI:10.4103/jdmimsu.jdmimsu_285_20  
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Nuchal cord: Gray-scale ultrasound and color doppler imaging features p. 227
Varun Singh, Suresh Phatak, Shivesh Pandey, Vadlamudi Nagendra
DOI:10.4103/jdmimsu.jdmimsu_307_20  
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RESEARCH PROTOCOL Top

A novel research protocol for single-blinded randomized trial for evaluating the impact of gamification on functional independence and health-related quality of life post distal radius fracture p. 229
Waqar Naqvi, Mohd Qureshi, Pratik Phansopkar
DOI:10.4103/jdmimsu.jdmimsu_283_20  
Background: Distal radius fracture (DRF) is the frequently occurring fracture in the upper extremity among all age groups. Physiotherapy is vividly used to optimize recovery and regain functional independence following a distal radial fracture. To date, however, work on virtual reality (VR)-based rehabilitation in patients with DRF is limited. This research aims to evaluate the impact of gamification on functional independence and health-related quality of life in post-DRF. Methodology: In a single-blinded randomized controlled trial, the participants (n = 40) with DRF will be recruited. The participants will be enrolled into either an experimental or control group with 1:1 allocation ratio. Participants in the intervention group will undergo both VR training using oculus and conventional therapy for 6 weeks, and the participants in the conventional group will undergo only conventional therapy. Functional independence and HWQoL will be assessed using (patient-rated wrist evaluation) scale, Michigan hand outcomes questionnaire and disabilities of the arm, shoulder, and hand (DASH) Outcome Questionnaire throughout the treatment duration and after 6 weeks of rehabilitation. Result: There is significant impact of gamification on functional independence and health-related quality of life post distal radius fracture. Conclusion: This research seeks to examine the rapid and long-term results of VR-based rehabilitation in post DRF patients. The findings of this study will help prospective patients with DRF, which may include a newly designed method of rehabilitation.
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