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   Table of Contents - Current issue
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July-September 2020
Volume 15 | Issue 3
Page Nos. 337-519

Online since Monday, February 1, 2021

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ORIGINAL ARTICLES  

Minimal optimum uterine filling pressure for diagnostic hysteroscopy: A randomized study Highly accessed article p. 337
Deepika K C. Dewani, Neema Acharya, Anup Patil, Kalyani Mahajan
DOI:10.4103/jdmimsu.jdmimsu_122_19  
Background: Hysteroscopy involves uterine cavity distension to allow adequate visualization. Higher uterine filling pressures ensure adequate visualization but might cause intravasation of the distension media into the vasculature and its various adverse effects. Aim: The aim of the study was to ascertain the minimum adequate filling pressure required for the optimal visualization of the uterine cavity during diagnostic hysteroscopy while minimizing the total fluid usage, thereby reducing the associated complications. Study Design: Randomized study. Materials and Methods: This was a study designed to assess whether optimal visibility can be achieved with lower uterine filling pressures for diagnostic hysteroscopy and whether patient discomfort can be reduced. A total of sixty patients were randomized and subjected to uterine distension pressure of 70 mmHg (thirty patients) or 100 mmHg (thirty patients). The primary outcome measure was the proportion of procedures where adequate visibility was achieved during diagnostic hysteroscopy. The secondary outcome was the level of pain experienced by the patient, duration of the procedure, and fluid deficit during the procedure. Results: Optimal visualization was achieved in 93.33% and 96.66% with a uterine filling pressure of 70 mm hg and 100 mm hg, respectively, and is comparable. Conclusion: The uterine filling pressure of 70 mm Hg was associated with optimum visualization as obtained that in 100 mmHg lower pain scores than 100 mmHg with no difference in the proportion of completed procedures.
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A study of clinical, radiological, and spirometric profile of COPD Highly accessed article p. 341
Sameer Adwani, Babaji Ghewade, Mohit Gupte, Ulhas Jadhav
DOI:10.4103/jdmimsu.jdmimsu_47_20  
Background: Chronic obstructive lung disease (COPD) is a high prevalence chronic disease and disease that leads to substantial health costs. The diagnosis of COPD is based on respiratory symptoms, persistent airflow obstruction and presence of causative agent such as the inhalation of multiple pollutants, primarily tobacco. Although the COPD is usually underdiagnosed, inaccurate diagnosis is also not uncommon. Material and Methods: A thorough knowledge of clinical, radiological and spirometric data is important for the proper diagnosis and management of COPD. The ususal symptoms of cough, breathlessness and chest tightness may be present in many other diseases. Results: A correlation of symptoms, spirometry and radiology is more likely to give us a more accurate diagnosis and help in management of patients. The usual symptoms of COPD with radiological findings suggestive of COPD and a spirometry showing obstructive abnormality make the diagnosis more accurate. Conclusion: In addition this may also help to diagnose any complications and comorbidities of COPD which can be missed if suspicion is low and patient is not evaluated.
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Evaluation of the awareness of different orthodontic treatment appliances in patients undergoing orthodontic treatment of Maharashtra – A survey Highly accessed article p. 347
Amol Verulkar, Ranjit Kamble, Sunita Srivastav, Twinkle Bajaj, Niyati Potode
DOI:10.4103/jdmimsu.jdmimsu_67_20  
Aim: The aim of the study was to evaluate and compare the awareness of different orthodontic treatment appliances in patients undergoing orthodontic treatment, in Maharashtra, India. Materials and Methods: A cross-sectional questionnaire-based study was conducted among patients undergoing orthodontic treatment in different teaching institutes of Maharashtra through an e-survey using Google Forms. A total of 360 patients undergoing orthodontic treatment in different teaching institutes of Maharashtra were randomly selected. The 10-item closed questionnaire in structured format was framed for the patients undergoing orthodontic treatment in Maharashtra. Ten orthodontic treatment appliances' options representing the major therapeutic modalities of choice used in daily practices were listed, namely, space maintainers, arch expanders, external growth modification devices, internal growth modification devices, stainless steel (SS)/ceramic/lingual braces, clear aligners, and combined orthodontic-surgical cases. Details regarding the E-mail were collected, which was followed by questions on awareness and knowledge. Participants were asked to rate their awareness level using a Likert-type scale. Conclusion: (1) The study group showed very low awareness of growth modification devices and moderate-to-high awareness of SS brackets and ceramic brackets. (2) Educational community programs should focus on improving the general knowledge of orthodontic appliances, especially the ones concerning early functional jaw orthopedic treatments.
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Evaluation of the bond strength of reattached incisal fragments using different techniques: An In vitro study Highly accessed article p. 353
Ankita Rajurkar, Manoj Chandak, Pradnya Nikhade, Aditya Patel, Aun Taheri, Shruti Bhongade
DOI:10.4103/jdmimsu.jdmimsu_71_19  
Aim: The aim of this study is to compare the bond strength of fractured teeth reattached using four different techniques, i.e., simple reattachment, overcontour, internal dentinal groove, and enamel bevelling using nanohybrid resin composite. Materials and Methods: A total of eighty extracted permanent maxillary central incisor teeth was used in this study. Sample was uniformly divided into four groups, i.e., (n = 20). Group I: Fracture teeth reattached with a simple technique. Group II: Fracture teeth reattached with overcontouring technique. Group III: Fracture teeth reattached with the internal dentinal groove technique. Group IV: Fracture teeth reattached with enamel bevelling technique. After the fracture teeth reattachment, the specimens were mounted on a custom-made fixture and were kept in saline till the specimens were subjected to the bond strength testing. The universal testing machine was used for the determination of bond strength. One-way ANOVA test was used to analyze the data and post hoc test was used for comparing (testing) three or more means (groups or variables) for statistical significance. SPSS 17.0 version was the software used in this analysis, and the level of significance was set at P = 0.002. Results: Highest bond strength was seen with Group II (reattached with overcontour technique) (9.04 ± 4.94) followed by Group III (inter-dentinal groove technique) group (8.04 ± 2.48), then Group IV (enamel bevelling technique) (5.87 ± 3.77), and least bond strength was with Group I (simple reattachment) (5.17 ± 1.59). Conclusion: Overcontour fracture reattachment technique displayed significantly higher bond strength as compared to simple reattachment, internal dentinal groove, and enamel bevelling techniques.
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Comparison of the chemical composition and the structural characteristics of normal enamel from the teeth affected with early childhood caries in pre-term and full-term born children: An In vitro study Highly accessed article p. 358
Pooja Bhansali, Sudhindra Baliga, Nilima Thosar, Suruchi Gupta
DOI:10.4103/jdmimsu.jdmimsu_116_20  
Background: Early childhood caries (ECC) is considered as one of the most concerned topics of investigation in order to prevent its occurrence by targeting multiple causative factors. Time of birth of a child has an effect on the development of tooth and might show differences in the structure and composition of enamel. Aim: To evaluate the chemical composition and structural characteristics of enamel in primary teeth of pre-and full-term born children affected with ECC. Material and Methods: Twenty extracted primary teeth from pre-term (n = 10) and full-term (n = 10) born children affected with ECC were selected. Unaffected portions of enamel were subjected to polarized light microscope (POLMI), scanning electron microscope (SEM) and energy dispersive X-ray spectroscopy (EDS). Results: The thickness of prenatally formed enamel was less in pre-term born children under POLMI. The concentrations of calcium and phosphorus were higher in full-term born children on EDS analysis. The surfaces of enamel in primary teeth from full-term group were smooth whereas pitted and eroded along with a larger distribution of hypoplasia in pre-term group when observed under SEM. Conclusion: Primary teeth enamel of pre-term born children was found to be defective in both qualitative and quantitative aspects and could be a possible risk factor in the causation of ECC.
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Knowledge and awareness regarding giving do-not-resuscitate orders among resident doctors in various intensive care units of a rural tertiary care center p. 364
Aditya Khandekar, Sourya Acharya, Samarth Shukla, Neema Acharya
DOI:10.4103/jdmimsu.jdmimsu_118_19  
Background: Bioethics is a subject rarely taught, or discussed in residency. This can often result in a lack of awareness regarding patient rights and decision-making policies, especially amongst residents working in such high dependency units. To improve awareness regarding patient ethics, a study was thus conducted in AVBRH under the Dept. of Internal Medicine, to assess knowledge, aptitude and awareness of Residents working in Critical Care Units across the tertiary care centre. Aim and Objectives: To assess knowledge, aptitude and awareness of Residents working in Critical Care Units across the tertiary care centre. Methodology: The study was a cross-sectional study conducted across a period of two months, from 1st April 2019 to 1st June 2019. Study participants included 50 residents working in critical care units across multiple Departments of the Tertiary Care centre, with inclusion criteria being 1st, 2nd and 3rd Year Junior residents who consented to participate in the study. Questionnaires were distributed to residents containing 10 multiple choice questions based on often-used terms with reagards to ethics, including DNR (Do Not resuscitate), 'respect of autonomy', and 'best interest standards' of a patient, and included clinical case scenarios on decision-making in emergency and ICU settings. On completion of filling of the questionnaire by all residents, data was entered into Microsoft Excel v. 2010, and responses were assessed based on percentages of residents that got each question right. Results: Results showed that while >50% residents scored correct answers on the clinical-based scenarios of critical care, aptitude regarding terminologies and decision-making ethics, including patient rights in such scenarios, needed considerable improvement, as no more than 30%. Conclusion: Thus, there is a need to inculcate bioethics-based learning into residency in today's times, which will directly result in better decision-making practices.
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Evaluation of anatomical variants in paranasal sinuses with computed tomography in central India region p. 368
Pratapsingh Parihar, Shraddha Patel, Money Banssal, Aditya Patel, Akhilesh Parihar, Swapnil Mohod
DOI:10.4103/jdmimsu.jdmimsu_124_19  
Aim: This study aimed to assess the congenital anatomical variations in paranasal sinuses (PNS) and determine the incidence of these variants using helical computed tomography (CT) scan. Materials and Methods: The study included 477 cases in whom unenhanced CT of the brain and PNS was performed in the axial plane, complemented by reconstructed coronal and sagittal sections. These patients were then reviewed for anatomical variants of the PNS and their relation to sinusitis. The results were statistically analyzed by using descriptive and inferential statistics with Chi-square test and predictive values. Statistical Package for Social Sciences version 17.0 and GraphPad Prism 5.0 were used for analysis. Results: Among all the patients studied, deviated nasal septum was noted as the most common anatomical variant in 178 (37.3%) patients followed by concha bullosa in 124 (26%) patients. Other variations found were agger nasi cells in 109 (22.9%), paradoxical middle turbinate in 45 (9.5%), Haller's cells in 47 (9.8%), and Onodi cells in 34 (7.1%) patients. Other uncommon anatomical variants such as hypoplastic frontal sinus and hyperpneumatization of PNS were noted in eight (1.68%) and two (0.42%) patients, respectively. Conclusion: The presence of anatomical variants may predispose to sinus pathology. Radiologists must pay close attention to anatomical variants in the preoperative evaluation, which helps avoid possible complications and improves the success of management strategies.
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Evaluation of role of sonoelastography in solitary thyroid nodule with pathological correlation p. 372
Suresh Phatak, Shraddha Jain, Kaustubh Madurwar, Sakshi Daga, Soumya Jain, Rishab Gupta
DOI:10.4103/jdmimsu.jdmimsu_131_19  
Aims: To evaluate the role of sonoelastography in solitary thyroid nodule with a pathological correlation. Subjects and Methods: This was a prospective observational study conducted in patients presenting with solitary thyroid nodule. It was carried out in AVBRH Hospital, Sawangi, Wardha, during July 2016–June 2019. One hundred and two patients were included in the study. Most of them were female patients. Most of the patients were in the age group of 41–50 years followed by 31–40 years. Results: Sonoelastography shows good sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in identifying thyroid pathology. Conclusions: Sonoelastography is a new imaging modality which is helpful in characterization of thyroid nodule and shows significant accuracy in differentiating benign from malignant lesion.
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Role of sialic acid as biochemical marker in oral leukoplakia and oral squamous cell carcinoma p. 376
Archana Sonone, Alka Hande, Madhuri Gawande, Swati Patil, Preeti Sharma
DOI:10.4103/jdmimsu.jdmimsu_162_20  
Introduction: Tumor markers are biochemical substances released by tumor cells either due to the reason or consequence of carcinogenesis process. Neoplasms often have an increased concentration of sialic acid on the tumor cell surface and are shed or secreted by some of these cells which increase the concentration in blood. Aim and Objectives: We aimed to determine the serum levels of total sialic acid (TSA), lipid-bound sialic acid (LBSA), and ratio of TSA to total protein (TP) in patients with oral leukoplakia (LP) and oral squamous cell carcinoma (OSCC) patients. Materials and Methods: The study comprises 75 participants which include 25 cases of LP, 25 cases of OSCC, and 25 cases of healthy cases as control. Ten-milliliter intravenous blood was collected under aseptic condition, and biochemical analysis of TSA, LBSA, and TP was done by spectrophotometer. Results: We observed that the levels of TSA, LBSA, and TSA/TP were significantly increased in Oral Leukoplakia (OLP) and OSCC as compared to the healthy control group. Conclusion: The increased level of TSA, LBSA, and TSA/TP in LP helps to determine the early stage of the disease. Further differentiation in grades of OSCC is also possible by these biochemical markers. Thus, serum levels of total antioxidant status, LBSA, and TSA/TP can be used as diagnostic and prognostic markers.
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Effect of epidural labor analgesia on fetal heart rate and neonatal outcome p. 382
Harsha Shekhawat, Deepti Shrivastava, Kiran Dhurve, Uttara Shelke, Asawari Deo
DOI:10.4103/jdmimsu.jdmimsu_194_20  
Introduction: Epidural analgesia does not affect the neonatal outcome as shown in this study by the similar APGAR scores and neonatal intensive care unit (NICU) admissions when compared with normal delivery without epidural analgesia. Aims: This study aims to find the fetal heart rate variability and neonatal outcome in women, who are opting for epidural anesthesia in comparison to women without any pain reliving modality. Subjects and Methods: The present study was conducted in the Department of Obstetrics and Gynaecology at Datta Meghe Institute of Medical Sciences, Wardha, over period of 2 years from September 2017 to August 2019 after taking approval from Institutional Ethical Committee. One hundred women who fulfilled the inclusion criteria were included in the study, 50 women received epidural analgesia for relief of labor pain at =4 cm and 50 women were left for spontaneous delivery. The factors studied were fetal heart rate (FHR) variability and NICU admissions in both the groups. Statistical Analysis Used: SPSS version 19; Chi-square test and Student's t-test. Results: Epidural analgesia was associated with transient fetal heart variability which however was not statistically significant and was comparable with nonepidural group. Conclusions: Epidural analgesia is an effective method of pain relief and it must be an option available to all laboring women. There are no significant effects on FHR variability and does not affect neonatal outcome.
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Effectiveness of blend-in syndicate group method in practical classes among medical students in the subject of microbiology p. 387
Smita Damke, Archana Dhok, Sachin Damke
DOI:10.4103/jdmimsu.jdmimsu_209_20  
Introduction: The core discussion skills of small group learning are questioning, listening, responding, and explaining. These skills provide the basis for the development of teamwork and collaborative learning. In the longer term, they can aid the development of communication competency with patients and colleagues. These benefits include the development of discussion skills and thinking, exploration of attitudes, and sharing and reflecting on experiences. With this view, this present study was carried out to enhance the importance of small group learning in the form of syndicate groups in practical classes. Materials and Methods: The study was prospective interventional study carried out in the department of microbiology. The study population included of 2nd year MBBS students attending microbiology practical class. A total of 54 students were included in the study. These students were divided into two groups, a study group and a control group by random sampling method. Pretest was given to all the students before the start of practical class. The control group was taught with the traditional method by one facilitator. The study group was engaged by other facilitator in syndicate small groups. Results: The posttest scores showed significant increase over the pretest in both exercises for both the groups. Posttest scores were compared using Student's t-test, between the study group and control group for both exercises, it showed significant difference implying syndicate group was effective for learning. The feedback from the students was also encouraging for the blend in syndicate group method. Conclusion: The primary purpose of the small group method is to develop discussion skills and thinking. Both tutors and students have roles and responsibilities in small group learning sessions. Blend-in syndicate group serves this purpose.
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Study of stress, anxiety, depression, coping, and associated factors among medical students from central India p. 391
Vijay Babar, Sachin Ratan Gedam, Sharad Manore, Kedarnath Dewangan, Prafulla Gaikwad, Swapnil Patond
DOI:10.4103/jdmimsu.jdmimsu_226_20  
Objectives: Previous studies worldwide have reported that medical students are subjected to stress and related psychological morbidities. Stress could lead to psychological problems such as depression and anxiety. The objectives were to estimate the prevalence of depression, anxiety, and stress; to identify sources of stress and coping strategies; and their association with depression, anxiety, and stress scores (Depression, Anxiety and Stress scale (DASSs)). Materials and Methods: this cross-sectional survey was conducted among 2nd-year MBBS students during June–July 2017 from Jawaharlal Nehru Medical College, Sawangi (Meghe) Wardha, Maharashtra. A total of 169 students were assessed through semi-structured pro forma, Depression, Anxiety and Stress scale (DASS), coping inventory for the stressful situation, and sources of academic stress among students for data collection. Results: The overall prevalences of depression, anxiety, and stress among the students were found to be 60.94%, 73.37%, and 37.27%, respectively. The most common source of stress was found to be academic factors, with coping strategy being task-oriented. A significant association of student's satisfaction with depression and stress; gender with stress; depression with emotion and task-oriented coping strategies; emotion oriented with stress and anxiety; and all stress sources with DASS had been found. Conclusion: The students were subjected to depression, stress, and anxiety. Academic factors were found to be the important stressor. Hence, appropriate strategies need to be conducted to decrease the burden of students.
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Crossword puzzle: An effective self-learning modality for dental undergraduates p. 397
Rizwan Gilani, Priyanka Niranjane, Pallavi Daigavane, Pavan Bajaj, Nikhil Mankar, Rozina Vishnani
DOI:10.4103/jdmimsu.jdmimsu_233_20  
Purpose of the Study: Teaching/learning modalities modified with certain interactive and innovative learning modalities can make dental education interesting and fun-loving. Dental graduates are taught too many concepts/subjects in a very limited time period. This makes remembering and recollecting things difficult by the conventional monotonous methods of teaching. The purpose of conducting the study was to see the practicality and efficiency of using crossword puzzle as an alternative learning methodology for undergraduates and to assess the practicality and use of crossword puzzle solving as an alternative way to remember essential concepts and promote self-learning among dental undergraduates. Materials and Methods: Crossword puzzles were created online and content was validated by subject experts by compiling the clues and answers to essential objectives of the topic and the students were instructed to complete the puzzle solving in a specified time period. The students completed it in collaborative groups of 3–4. The first group who successfully complete the puzzle was reward. 30 min was allotted for 25–30 clues of crossword puzzle. Student perceptions toward crosswords for their learning were assessed with a survey questionnaire using 10 questions on a 5-point Likert scale and informal feedback. Results: Most students agreed that crossword puzzle solving was very effective and useful teaching/learning modality and it immensely contributed to active learning and improved remembering the topics and concepts better than the conventional teaching modalities. Conclusions: Exceptionally good response was obtained from undergraduates students to crossword puzzle technique as an effective teaching–learning modality in dental curriculum.
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Comparison of effectiveness of hold-relax technique and maitlandfs mobilization in improving range of motion in posttraumatic stiffness of knee joint p. 402
Swapna Jawade, GG Vardharajulu, Namrata Naidu
DOI:10.4103/jdmimsu.jdmimsu_243_20  
Aims: This study aims to compare the effectiveness of Hold-Relax technique and Maitland's Mobilization in improving range of motion (ROM) in posttraumatic stiffness of knee joint. Materials and Methods: This was a randomized interventional comparative study with 30 subjects with posttraumatic stiffness of knee joint with restricted range of knee flexion were randomly allotted into two groups: Group A was given Hold-Relax technique and Group B was given Maitland's Mobilization consisted of Grade 3 posterior glide along with paraffin wax bath and isometric exercises of quadriceps and hamstring as a common baseline treatment for 5 days per week for 4 weeks. The baseline outcome measure was active knee flexion ROM measured by universal Goniometer before and after 4 weeks interventions. Results: Statistical analysis of data was done using paired t-test and unpaired t-test. Paired t-test showed that statistically significant increase in active knee flexion ROM in both the groups. On comparing by unpaired t-test it was found that both the techniques are equally effective in improving ROM. Conclusion: Both the Hold-Relax technique and Maitland's Mobilization are equally effective, in improving the knee flexion ROM.
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Clinical and functional outcome analysis of posterior decompression and spinal fusion surgery in the management of lumbar and sacral listhesis: A prospective cohort study p. 407
Dhruva Angachekar, Sanjay Deshpande, Mahendra Gudhe, Nitin Samal, Sohael Khan, Suvarn Gupta
DOI:10.4103/jdmimsu.jdmimsu_245_20  
Introduction: Spondylolisthesis resulting in low backache, radiculopathy, and neurological involvement is a very common clinical entity. Conservative and surgical managements are available for the treatment of spondylolisthesis. Cases with severe instability and neurological deficits that cannot be managed conservatively may require surgical intervention. According to the SPORT trial, posterior decompression and spinal fusion was found to be an effective treatment modality. The present study was undertaken with an aim to understand the functional and clinical effects of posterior decompression and spinal fusion at lumbosacral region in patients with listhesis. Purpose: The purpose of this study is to evaluate the clinical and functional outcomes of listhesis at lumbar and sacral region managed by posterior decompression and spinal fusion. Methods: This was a prospective randomized study involving patients above 18 years, having low backache with or without sciatica, and having neurological deficits. Listhesis was diagnosed clinically and on stress radiograms and magnetic resonance imaging. All patients who fit the inclusion criteria underwent posterior decompression and if needed spinal fusion for symptomatic management. Results: A total of 30 patients participated in this study, with 73.33% women and the rest 26.67% men (mean age 51.37 ± 12.70 years). The most commonly affected level was L4–L5 along with L5–S1 right below it. Out of 30 patients, three underwent posterior decompression and fixation without fusion while one was managed with laminotomy and discectomy. The remaining patients were managed with posterior decompression and intervertebral fusion which was mainly at the L4–L5 level. At 6 months of follow-up, the mean preoperative visual analog scale score which was 8.70 ± 0.83 was reduced to 1.53 ± 1.38 along with appreciable reduction in Japan Orthopedic Association and Oswestry index scores. Three patients had surgical site infections while one patient had no pain relief. Conclusion: Posterior decompression and spinal fusion is an effective way in the management of lumbosacral listhesis.
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Ergonomic awareness and musculoskeletal pain suffered by dental professionals of Western Maharashtra p. 414
Renuka Pawar, Chanamallappa Ganiger, Sandesh Phaphe, Yusuf Ronad, Pratap Mane, Monica Satpute, Karan Gaikwad
DOI:10.4103/jdmimsu.jdmimsu_57_20  
Context: Musculoskeletal pain, in particular back pain, has been found to be a major health problem for most dental practitioners. Thus, it was necessary to investigate the ergonomic awareness and musculoskeletal pain among dental health professionals. Aims: The aim of this study was to investigate and bring awareness among dental practitioners regarding ergonomics and determine the proportion of dentists suffering from musculoskeletal pain. Materials and Methods: A cross-sectional survey was conducted for a period of 2 months on 500 dental professionals practicing in the region of Western Maharashtra. A set of closed-ended questions along with the informed consent form were tabulated on the basis of type of pain, onset, working position, operating hand, duration of work hours, type of practice, use of proper measures while working, and time since practice started. Practicing dental professionals were included, whereas those having musculoskeletal problems before joining dentistry or who had suffered any physical injury previously were excluded. Statistical Analysis: Data were analyzed using the Statistical Package for the Social Sciences, version 16, Illinois, Chicago, USA. The Chi-square test was used for assessing categorical data, and an independent t-test was used for comparing means. Results: General practitioners and specialists reported a prevalence of pain on different anatomical locations depending on their specialty. Conclusions: Musculoskeletal disorder (MSD) remains a major occupational problem. The awareness of MSD among the dentists practicing in Western Maharashtra was low. Majority of the dentists reported more neck pain and lower back pain. Hence, maintaining proper posture will ensure a significant decrease in MSDs, thus improving their work efficiency and preventing burnout.
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Vancomycin-resistant enterococci causing bacteriuria in hospitalized patients from Northwest India p. 421
Sakshee Gupta, Preeti Srivastava, Sonam Yadav, SN Tayade
DOI:10.4103/jdmimsu.jdmimsu_69_20  
Background: Vancomycin-resistant enterococci (VRE) are an important opportunistic pathogen in hospitalized patients due to their resistance to commonly administered antimicrobial agents. Material and Methods: A pilot study consisting of 100 urinary enterococcal isolates with significant bacteriuria (>105 CFU/ml) was conducted to assess the resistance pattern in our hospital. Culture, identification, and antibiotic sensitivity testing were performed as per standard protocols. Resistance to vancomycin was confirmed by minimum inhibitory concentration method using commercially available E strips (Hi Media). Results: Fifty-four percent (54/100) of isolates were Enterococcus faecalis, 33% (33/100) Enterococcus faecium followed by 13% (13/100) nonfaecalis nonfaecium species. 4% (4/100) of enterococci were vancomycin resistant out of which 1 (25%) was resistant to linezolid. All VRE were sensitive to nitrofurantoin. Conclusion: Emerging resistance to vancomycin in cases of significant bacteriuria found in our study raises a concern for reserving higher antibiotics such as linezolid, daptomycin, and quinupristin-dalfopristin. Efforts are required to assess the clinical significance of VRE in terms of colonization and infection and switch to evidence-based treatment plan.
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Comparative evaluation of masticatory efficiency between conventional complete dentures and implant retained over dentures using color-changing chewing gum p. 426
Mohammed Abid Zahir Hussain, Nagesh Bhat, Seema Abdul Gani, Ramesh Nagarajappa
DOI:10.4103/jdmimsu.jdmimsu_109_19  
Background: The prosthodontic treatment for the edentulous patient is always a major challenge among prosthodontists. Conventional complete denture wearers often complain about dissatisfactory performance of their lower dentures, this could be due to the instability and loss of retention owing to the poor alveolar ridge. Implant-retained overdentures help to solve this instability problem. Masticatory efficiency is considered a major indicator for determining the functional state of the masticatory system. Masticatory efficiency measurement may be an important parameter when planning dental implant treatment. Materials and Methods: This study involves the use of color-changing chewing gum and manual visualization with a color scale provided by the manufacturer to evaluate the masticatory efficiency in 20 edentulous patients wearing conventional complete dentures and compared with ball-retained implant overdentures and also bar-retained overdentures. Statistics: The paired t-test and ANOVA test were applied to statistically evaluate the data. Results: The results indicated that patients with bar-retained implant overdentures demonstrated significantly the higher levels of masticatory efficiency in implant-retained overdentures compared with conventional complete dentures and significant levels in overdentures retained with bar and clip as compared with ball-retained over dentures and conventional complete dentures. Conclusion: Masticatory efficiency levels were increased in bar IOD when compared with conventional complete dentures and ball IOD.
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Conventional and molecular diagnosis of clostridium difficile infections in a tertiary care hospital p. 432
Priyanka M Mane, Satish R Patil, Kailash D Datkhile, Makarand B Mane, Geeta S Karande
DOI:10.4103/jdmimsu.jdmimsu_163_19  
Introduction: Indiscriminate use of broad-spectrum antibiotics has dramatically increased the incidence of Clostridium difficile-associated diarrhea (CDAD) in recent years. It is the most common cause of antibiotic-associated diarrhea (AAD) responsible for one-third of AAD cases. Aim: The aim was to study C. difficile in AAD. Objectives: The objectives were to study the prevalence of CDAD, to isolate C. difficile from AAD, and to study the molecular detection of toxin-producing strains of C. difficile. Materials and Methods: A total of 222 patients of AAD were assessed for C. difficile over a period of 2 years. Anaerobic culture for C. difficile was done on cycloserine-cefoxitin-fructose agar and brain–heart infusion agar. Enzyme-linked immunosorbent assay (ELISA) for toxin A and toxin B was used for detecting toxigenic strains of C. difficile. Identification of C. difficile and toxin-producing strains was done with the help of polymerase chain reaction (PCR). Observation and Results: Out of the total 222 cases of AAD, 20 (9%) were positive by culture and 70 (31.53%) were found to be toxin-producing C. difficile by ELISA. C. difficile was positive by PCR in 32 (14.41%); of these, 18 (56.25%) isolates were toxigenic, i.e., they possessed either the tcdA or the tcdB gene or both. Among the toxigenic isolates, 10 (31.25%) possessed both of the toxigenic genes (tcdA and tcdB) and the remaining 8 (25%) had one of the toxin genes. Only the toxin A (tcdA+ tcdB-) gene was found in 4 (12.5%) and only the toxin B (tcdA- tcdB+) gene in 4 (12.5%) of the toxigenic isolates. Conclusion: CDAD is an emerging nosocomial infection. Frequent and indiscriminate use of antibiotics has increased the prevalence of C. difficile infection. Conventional and molecular diagnosis can help to accurate diagnosis of these infections.
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Verbal, written, and video-based health education on prevention and early detection of cervical cancer p. 438
Seeta Devi, Prabha K Dasila
DOI:10.4103/jdmimsu.jdmimsu_200_19  
Background: In India, the incidence of cervical cancer significantly rises among the age of 45 years and peaks at 55 years of age. The proportion of the range is raised up from 15% to 55% female cancers from diverse parts of India. Nearly 80% of the women with cervical cancers reported in the clinics in advanced stage of cancer. Objectives: The objective of this study was to assess the participation of women for cervical screening before and after verbal, written, and video-based health education. Methodology: The research design was a one-group pretest–posttest quasi-experimental design. Samples were the women in the age group between 30 and 60 years attending gynecology OPDs. The total sample size was 501, and samples are selected using a multistage sampling technique. A structured questionnaire was used to collect the data using interview techniques. Results: Across all three study groups, majority of the participants were observed in the age group between 30 and 45 years. Most of the participants did never have the information regarding cervical cancer and screening procedures before the interventions. Majority of the participants (97%) had never screened for cervical cancer. In all three study groups, there is a significant association between participation of women in screening before and after intervention as P < 0.0001. Conclusion: A key strategy to reduce the prevalence of cervical cancer is to educate the women regarding prevention of cervical cancer by using various kinds of educational instructional methods.
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Estimation of biochemical markers in differential diagnosis of meningitis in a tertiary care hospital p. 444
Prashant Vaishya, Madhusmita Acharya, Manoj Kumar Yadav, Prafulla Kumar Mishra
DOI:10.4103/jdmimsu.jdmimsu_347_20  
Background: The clinical syndrome of meningitis is caused by inflammation of the meninges. Infections due to viruses, bacteria, mycobacterium, fungi, and other organisms are the most frequent causes of meningitis. It may contribute to extreme long-term neurological sequelae such as deafness, epilepsy, hydrocephalus, and cognitive deficits, if not recognized earlier. Our aim was to evaluate the cerebrospinal fluid (CSF)-adenosine deaminase (ADA), lactate dehydrogenase (LDH), glucose, and protein in differential diagnosis of meningitis. Materials and Methods: A total of 60 meningitis patients, of which 26 tubercular, 18 bacterial, and 16 viral meningitis, were analyzed based on the data from the initial clinical examinations. Results: Increased level CSF-ADA was found in tubercular meningitis as compared to bacterial and viral meningitis. Increased levels of CSF-LDH and protein were found in bacterial meningitis as compared to tubercular and viral meningitis, whereas the decreased level of CSF-glucose in bacterial meningitis as compared to tubercular meningitis, while normal level in viral meningitis. Conclusion: CSF-ADA, LDH, glucose, and protein may be sensitive biochemical markers for diagnosing and differentiating meningitis. CSF-ADA was higher in patients with tubercular meningitis as compared to bacterial and viral meningitis, and LDH activity was higher in patients with bacterial meningitis as compared to tubercular and viral meningitis. CSF-glucose was very low and CSF-Protein was very high in both bacterial and tubercular meningitis as compared to viral meningitis.
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Evaluation of dyslipidemia and oxidative stress in type II diabetes patients p. 448
Manoj Kumar Yadav, Pradeep Kumar, Preeti Sharma, Tapan Kumar Mohapatra
DOI:10.4103/jdmimsu.jdmimsu_366_20  
Background: Diabetes mellitus (DM) is a metabolic disorder characterized by the presence of chronic hyperglycemia associated with impairment in the metabolism of carbohydrate, lipids, and proteins. The most common endocrine and metabolic disease in the world is Type II DM. Elevated glucose levels characterize a complicated combination of genes and environmental influences, contributing to decreased insulin secretions or resistance. Materials and Methods: This observational, case-control study was conducted in the Department of Biochemistry, Santosh Medical College and Hospital, Ghaziabad in collaboration with the Department of Medicine during the period from November 2016 to July 2018. A total of 316 subjects between the age of 30 and 60 years were enrolled in the study and they were divided into two groups-Cases: One hundred and fifty eighty Type-II diabetic patients and Controls: One hundred and fifty eighty healthy adults volunteers. Results: The mean age of Type 2 diabetic subjects had higher 44.52 ± 8.17 years and in 40.20 ± 7.42 years for healthy controls. Similarly, the mean body mass index of the Type II Diabetes subjects was higher 25.28 ± 2.55 as compared to 23.07 ± 1.49 healthy controls. Large changes have been observed in fasting blood sugar, Glycated Haemoglobin (HbA1c), and total cholesterol (TC), along with triglycerides. Low-density lipoprotein cholesterol (LDL-C) was also elevated, along with very low-density lipoprotein cholesterol (VLDL-C) and Malondialdehyde (MDA). With TG, LDL-C, and VLDL-C, fasting blood glucose with TC shows a favorable correlation between MDA and negative interaction with high-density lipoprotein cholesterol. Good interaction of MDA with HbA1c. Conclusion: Increased blood glucose levels lead to the generation of oxygen free radicals and decreased levels of antioxidants, which causes erythrocyte fragility in type 2 diabetes. As a step for the prevention of vascular complications along with macrovascular problems in Type II Diabetes subjects, early detection of dyslipidemia and oxidative stress may be used.
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Early complications in patients undergoing mitral valve replacement surgery: An observational study p. 454
Imran Ali M. Khan, Anil Patwardhan
DOI:10.4103/jdmimsu.jdmimsu_7_17  
Background: Rheumatic fever(RF) & Rheumatic Heart disease(RHD) present a problem in all parts of the world especially in developing countries. In India RHD accounts for 12%-65% hospital admissions related to cardiovascular disease. It is the most common cause of Mitral valve disease with associated morbidity and mortality. Mitral valve replacement (MVR) is the surgical treatment when conservative approach fails.Mitral stenosis(MS), Mitral regurgitation (MR) or both MS+MR are main indications for MVR. Material and Method: Despite a rise in the rate of success of total valve replacement, the procedure has been associated with complications inherent to prosthesis as well as to any intra cardiac procedure. Majority of authors have defined complications occuring within thirty days in post operative period as early complications. Observations and Results: In this observational study of 85 patients at a rural cardiac surgery center, who underwent MVR for Mitral valve disease with concomittant Maze-III procedure(modified) for the surgical ablation of Atrialfibrillation (AF) if present, the early complications observed were General complications( AF, Post operative excessive bleeding, haemolysis,Neurological-psychiatric-Thromboembolic complications, wound infection,respiratory complications, Renal complications,prolonged inotropic support& Mechanical ventillation, Prolonged hospital stay & early mortality and Prosthesis specific complications of Paravulvular regugitation( PVR), Obstruction to valve by thrombus,valve endocarditis. Conclusion: AF was the most common post operative complication observed in 24.7% patients,Acute delirium(psychosis) was seen in 21.17% patients,prolonged hospital stay(more than 10 days) was observed in 17.7% of patients, prolonged inotropic support was needed in 12.9% patients, pulmonary complications were observed in 10.5% patients. The rate for other isolated complications was less than 10% each. Overall mortality rate was 1.17%. Prosthetic Valve related complicaio.
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CASE REPORTS Top

A rare case of an azygos lobe in the right lung of a 45-year-old female p. 462
Sameer Ashok Arbat, Ashok Pandurang Arbat, Tejveer Singh, Parimal Shriniwas Deshpande
DOI:10.4103/jdmimsu.jdmimsu_4_20  
A 45-year-old female, who was a known case of bronchial asthma with a past history of pulmonary tuberculosis (TB) came to us with chief complaints of cough with expectoration and multiple episodes of blood in sputum. The patient was diagnosed with pulmonary TB and had received empirical AKT without microbiological evidence at other health-care centers. At our hospital, she was found to have right paratracheal opacity on chest X-ray. A computed tomography scan of the chest showed an azygos lobe in the right lung. There was consolidation in the azygos lobe that lead to the symptoms of cough and hemoptysis.
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Ovarian torsion: Ultrasonography and color doppler imaging p. 465
Shreya Tapadia, Suresh Phatak, Varun Singh
DOI:10.4103/jdmimsu.jdmimsu_100_20  
Young women with abdominal pain usually localized to a lower quadrant. We must first consider ovarian torsion as the cause and should be able to differentiate it from other conditions, such as appendicitis, cholecystitis, pelvic inflammatory disease, urinary collecting system calculi, and ruptured benign adnexal cysts. The ovarian torsion if identified in early-stage ovary can be saved.
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Sphingomonas paucimobilis - A Rare Cause of Community-Acquired Pneumonia p. 468
Pankaj Wagh, Babaji Ghewade
DOI:10.4103/jdmimsu.jdmimsu_111_20  
Nonresolving pneumonia (NRP) is a common diagnostic challenge encountered in daily practice. Sphingomonas paucimobilis grows easily in hospital equipment. However, it is also an emerging pathogen and not just a contaminant of hospital setup. Most of the S. paucimobilis infections reported in the literature have been health care associated, but contrary to the recent publications, we revealed a community-acquired infection. Due to its low virulent features of bacteria, it is not associated with serious life-threatening infections, but with increasing number of case reports, it should be considered as an important pathogen in NRP. We report a case of a 35-year-old female presenting with? Nonresolving pneumonia c/o cough with expectoration for 10 months and low-grade fever for 2 months. She had received multiple courses of antibiotics including intravenous beta-lactams and macrolide. Her blood investigations were normal. Her sputum? dsAFB was negative. Her initial chest X-ray (CXR) was suggestive of bilateral lower zone consolidation. Computed tomography thorax was suggestive of right middle lobe and left lingular lobe consolidation. Bronchoscopy was normal except for pus flakes seen in the left lingular lobe. Reports of BAL were negative for dsAFB, AFB?CBNAAT, and malignant cells. Culture and sensitivity report was suggestive of growth of S. paucimobilis sensitive to meropenem, third-generation cephalosporins, fluoroquinolones, and aminoglycosides. The patient was started on meropenem and amikacin for 10 days, and the patient's repeat CXR showing a significant resolution was hence discharged on levofloxacin for 7 days.
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Infantile hypertrophic pyloric stenosis: Transabdominal ultrasonography diagnosis p. 471
Soumya Jain, Suresh Phatak, Apoorvi Shah, Ayush Gupta
DOI:10.4103/jdmimsu.jdmimsu_132_19  
Infantile hypertrophic pyloric stenosis is an important cause of vomiting in the first 6 weeks of life in a neonate. The condition is life-threatening if left untreated because vomiting can lead to dehydration and electrolyte imbalance. Transabdominal sonography is highly accurate in its diagnosis. We present the case of a 2-month-old male infant presented with a complaint of vomiting for 1 month which was milky (nonbilious) and used to occur after feeding. Classical sonographic findings are discussed.
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Ultrasonography, doppler, and elastograhic imaging of sebaceous cyst of breast p. 474
Prerna Patwa, Suresh Phatak, Bharat Lohchab, Sharvari Gulve
DOI:10.4103/jdmimsu.jdmimsu_136_19  
Sebaceous cysts are very common, but their location in breast is unusual. The most common site of occurrence is the face, trunk, and neck. Breast ultrasound and elastography provides readily available, noninvasive, and cost-effective modality for evaluating various breast masses and discriminating between benign and malignant pathologies. We present an interesting case of a 66-year-old woman who presented with a history of a nontender lump in the left breast with the presence of a punctum. Gray-scale ultrasound, color Doppler, and sono-elastography findings are discussed.
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Postcesarean section keloid: Ultrasonography, color doppler, and elastography evaluation p. 477
Sharvari Gulve, Suresh Phatak, Bharat Lohchab, Prerna Patwa, Shreya Tapadia
DOI:10.4103/jdmimsu.jdmimsu_141_19  
Keloid is the overgrowth of scar tissue at the site of wound. We report a case of young female who presented with minimal discharge from previous cesarean section site. On ultrasonography, Doppler, and elastography are discussed.
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Sagittal venous thrombosis in disseminated tuberculosis: A rare presentation p. 480
Saood Ali, Mona Vohra, Ulhas Jadhav, Babaji Ghewade
DOI:10.4103/jdmimsu.jdmimsu_148_20  
Sagittal venous thrombosis (SVT) is most commonly seen in hypercoagulable conditions, whereas infection-related thrombosis is very rare. Infections due to viruses, fungi, and bacteria can cause SVT. Disseminated tuberculosis (TB) causing SVT is rarely reported. Here, we report the case of a 38-year-old male who presented with the complaints of numbness and weakness to the right side of the body, cough with mucopurulent expectoration, and breathlessness. The patient was examined, which showed signs of cerebral inflammation and right-sided hemiparesis. Respiratory examination was suggestive of pulmonary TB. Chest X-ray was done which was suggestive of bilateral nodular opacities, and sputum Cartridge based nucleic acid amplification test (CBNAAT) was positive for Mycobacterium TB. Cerebrospinal fluid analysis was suggestive of tubercular meningitis. Magnetic resonance imaging brain was also done which revealed sagittal sinus thrombosis and bilateral frontoparietal cortical vein thrombosis and associated hemorrhagic infarct in the left parietal lobe. The patient was treated with antitubercular drugs along with anticoagulants.
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Rehabilitation of completely edentulous patient using implant supported overdenture p. 484
Ruchika Mandhane, Mithilesh Dhamnade, Rohit Mistry, Chinmay Ghavat
DOI:10.4103/jdmimsu.jdmimsu_159_20  
The prosthetic rehabilitation of the completely edentulous patient with resorbed mandibular ridge has always been a major challenge. Conventional maxillary and mandibular dentures have been the traditional standard of care. In the situation of resorbed mandibular ridge patient with conventional mandibular denture report difficulties such as lack of retention, stability, support, and inability to masticate. Implant-supported overdenture has become a boon in such condition. The number of implants to be placed depends on the amount of bone available. Various attachment systems are available for implant-retained overdenture, i.e., bar attachment, stud abutment, magnetic attachment, locator attachment, and many more. This case report describes a design and fabrication technique of the implant-retained overdenture using three freestanding mandibular implants with stud abutment and O-ring attachment.
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A rare case of kikuchi-fujimoto disease presenting as a mediastinal tumor with bilateral chylothorax p. 488
Aishwarya Dubey, Rashmi Wankhade, Babaji Ghewade, Arvind Bhake
DOI:10.4103/jdmimsu.jdmimsu_161_20  
Kikuchi-Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a rare, benign, and self-limiting condition with unknown etiology primarily affecting young women of Asian descent and is characterized by cervical lymphadenopathy. Diagnosis requires histopathologic examination and exclusion of other factors by ancillary studies. Non-Hodgkin lymphoma and systemic lupus erythematosus should be ruled out before a diagnosis of KFD, given the overlapped clinical and histologic features as well as the different therapeutic approaches. However, pleural effusion has rarely been reported in KFD patients. Here, we report an interesting case of an 18-year-old male who presented to us with features of cervical lymphadenopathy and fever who was later diagnosed as a case of Kikuchi-Fujimoto disease with bilateral chylothorax.
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Acute chest syndrome, a distinctive manifestation in sickle cell disease – A case study p. 492
Ulhas Jadhav, Reshma Babu, Babaji Ghewade, Ajay Lanjewar, Diti Gandhasiri
DOI:10.4103/jdmimsu.jdmimsu_166_20  
Acute chest syndrome is the most common cause of death and second most common cause for hospitalization of the adult population suffering from sickle cell disease. Therefore, it is important to make the diagnosis and begin treatment quickly and for this clinician must have a high degree of suspicion. Here, we report the case of a 27-year-old male with homozygous sickle cell disease (SS pattern) since childhood who presented with complaints of high-grade fever with chills, dry cough, chest pain, joint pain, and breathlessness? MMRC Grade I. The patient was stable on admission, but he had recurrent fever spikes. Chest X-ray posteroanterior view was suggestive of right lower lobe consolidation. Contrast-enhanced computed tomography of the thorax revealed consolidation in the superior and posterior basal segments of the right lower lobe. He developed sudden onset of breathlessness and severe chest pain and abdominal pain and saturation drop on the 4th day of admission, and he was put on oxygen support. There was a fall in his hemoglobin. After appropriate management with intravenous (IV) antibiotics, IV analgesics, hydroxyurea, IV fluids resuscitation and blood transfusion, the patient was clinically better and was discharged home safely. Significant improvement was noted on subsequent follow-up.
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Safeguarding the pier abutment p. 495
Rupali Patel, Trupti Dahane, Priyanka Khungar, Surekha Godbole, Seema Sathe Kambala
DOI:10.4103/jdmimsu.jdmimsu_168_20  
In certain partially edentulous cases, the pattern of missing teeth may lead to use of fixed partial denture on pier abutment. However, it has been reported that restoration of two missing teeth and an intermediate pier abutment with a rigid FPD is not an ideal treatment option. Using rigid connector in such situation leads to concentration of stresses on pier abutment. Pier abutment in such case acts as fulcrum leading to more debonding of fixed dental prosthesis which ultimately affects the success of fixed partial denture. Non rigid connector can overcome these problems. Non rigid connector transfers shear stresses to supporting bone & permits abutments to move independently. The non-rigid connector acts as stress breaker between retainer and pontic instead of usual rigid connector. This case report presents a simple method to rehabilitate pier abutment cases.
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A rare case report of wilson's disease affecting a 23-year-old girl p. 500
Ravindra Kadu, Vidya K Lohe
DOI:10.4103/jdmimsu.jdmimsu_196_20  
The present article describes a case of Wilson's disease in a 23-year-old girl. In Wilson's disease, there is an excessive absorption of copper from the small intestine and decreased excretion of copper by the liver, resulting in increased tissue deposition, especially in the liver, brain, cornea, and kidney. The patient in our case presented with poor esthetics due to proclinated upper anterior teeth. Careful history and clinical examination led to the appropriate phase of the disease. The acquaintance of the clinical presentations and management of Wilson's disease led to the safe delivery of medical and dental care.
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Open-lip schizencephaly with neuroregression p. 503
Sarika Gaikwad, Punam Uke, Divya Pujari, Keerti Swarnkar
DOI:10.4103/jdmimsu.jdmimsu_223_20  
Schizencephaly is a very rare congenital brain anomaly, and it is a part of disorder of neuronal migration. It has a wide spectrum of clinical presentations depending upon the size and location of the lesion, which include global developmental delay, spastic quadriparesis, and refractory seizures. Here, we report a 15-year-old adolescent female with complaints of multiple episodes of convulsions for the past 11 years (from the age of 4 years) followed by neuroregression but diagnosed late with neuroimaging.
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A rare presentation of a subungual melanoma with distant metastasis p. 506
Anurag Bhattacharjee, Bhavaniprasad Kalagani, Ravi Ponnugoti, Harshal Ramteke, Samarth Shukla, Niveditha Suresh
DOI:10.4103/jdmimsu.jdmimsu_360_20  
Subungual melanoma is a rare melanoma globally and melanoma by itself is reported rarely from the Indian population. This case is being reported for the rare occurrence of subungual melanoma in the Indian population and also for presentation with a long history of the lesion with no evidence of metastasis. Hereby presenting a rare case of a 40-year-old male who presented with blackish discoloration and ulcer of the left index fingernail of 5 months' duration post history of trauma to the index finger. Examination revealed black dystrophic left index fingernail. A detailed examination showed a mass under the dystrophic nail. Histopathology revealed characteristic features of melanoma. A detailed evaluation revealed features of regional metastasis. The entire finger was then amputated surgically by disarticulation at the metacarpophalangeal joint and regional nodes removed by ipsilateral axillary dissection.
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Multiple carcinoid tumor of the ileum presented as intestinal obstruction Highly accessed article p. 510
Sunil Jagtap, Abhijit Phalke, RG Naniadekar, SS Jagtap, Amol Bhoite
DOI:10.4103/jdmimsu.jdmimsu_195_19  
Gastrointestinal carcinoid arises from enterochromaffin cells. These are relatively slow-growing tumors with an indolent course. We present the case of a 70-year-old male patient complaining of abdominal pain and vomiting with palpable abdominal mass clinically suspected as an intestinal obstruction. On radioimaging, computed tomography abdomen and pelvis revealed malignant stricture small bowel likely carcinoid causing mechanical small bowel obstruction. Histopathology reported multiple carcinoid tumor of the ileum with stricture and extensive spread in multiple nodules at mesentery. We present this case for its clinical, radiological, and histopathological findings.
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LETTERS TO EDITOR Top

Creatine kinase-MB level more than total creatine kinase level: A macro creatine kinase type 2 phenomenon p. 513
Won Sriwijitalai, Viroj Wiwanitkit
DOI:10.4103/jdmimsu.jdmimsu_147_19  
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Comet tail artifact in thyroid nodule on ultrasonography: A marker of benignity p. 515
Varun Singh, Suresh Phatak, Konika Chaudary, Pererna Patwa
DOI:10.4103/jdmimsu.jdmimsu_182_20  
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Human immunodeficiency virus-associated neuroinflammation and CD16+ pathobiological process in concurrent human immunodeficiency virus infection and parkinson disease p. 517
Beuy Joob, Viroj Wiwantikit
DOI:10.4103/jdmimsu.jdmimsu_183_19  
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Bilateral krukenberg tumor in a case of carcinoma stomach: Ultrasonography and doppler findings p. 518
Shreya Tapadia, Suresh Phatak
DOI:10.4103/jdmimsu.jdmimsu_222_20  
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