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   Table of Contents - Current issue
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July-September 2022
Volume 17 | Issue 3
Page Nos. 527-813

Online since Wednesday, November 2, 2022

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EDITORIAL  

A study of patterns of substance used in final year MBBS students part 1 and part 2 Highly accessed article p. 527
Nainika Shah, Shruti Bajaj, Ankit Yadav, Mayuri Jain
DOI:10.4103/jdmimsu.jdmimsu_23_19  
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ORIGINAL ARTICLES Top

Knowledge, attitude, and practices among front-line health-care workers in a COVID hospital: An online questionnaire-based cross-sectional study Highly accessed article p. 530
Priya Tomar, Naveen Chauhan
DOI:10.4103/jdmimsu.jdmimsu_284_20  
Background and Objectives: COVID-19 pandemic has currently attacked the health-care system of the whole world. Prevention and collaboration are the key to its management. Our study aims to assess the knowledge, attitude, and practices (KAP) among front-line health-care workers (HCWs) of a COVID dedicated hospital regarding the infection. Materials and Methods: An online questionnaire based study was conducted. Participants were doctors and nursing staff working in a medical college. KAPs were assessed using a 26-item questionnaire with questions pertaining to knowledge (n = 13), attitude (n = 6), and practice (n = 7). Individual scores were generated and stratified as good (>10)/moderate (7–10)/poor knowledge (<7), positive (≥4)/negative (<4), attitude and good (≥4)/poor (<4) practice scores. Percentages of correct and incorrect responses were calculated for each question. Predictors of good overall scores were identified. Results: Response rate was 75%. Participants were interns (n = 45, 28.7%), junior residents (n = 7, 4.5%), postgraduate students (n = 58, 36.9%), clinicians (n = 9, 5.7%), and nursing staff (n = 38, 24%). Mean age was 26.13 ± 3.27 years. 8 (5%), 98 (62%), and 51 (32.5%) participants acquired good, moderate, and poor scores, respectively. Seventy-seven (49%) participants had positive attitude scores. Majority (n = 149, 94.9%) participants had good practice scores. Older age of HCWs was found significantly associated with better knowledge (adjusted odds ratio [aOR] = 3.81, 95% confidence interval [CI] = 1.29–11.22, P = 0.015). Similarly, HCWs who had personal experience of work in COVID area had more positive attitude than those who did not (aOR = 2.58, 95% CI = 1.23–5.42, P = 0.013). Good practices were evenly distributed among all subgroups. Interpretation and Conclusions: Repeated training sessions for correct dissemination of knowledge are essential in the fight against this novel pandemic. Collective efforts should be made regarding management.
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Comparative evaluation of transverse dental arch width changes with conventional and self-ligating brackets Highly accessed article p. 536
Nivethigaa Balakrishnan, Aravind Kumar Subramanian
DOI:10.4103/jdmimsu.jdmimsu_105_20  
Aim: This study aims at comparing the transverse width changes during leveling and aligning phase with conventional and self-ligating brackets. Materials and Methods: The study consisted of twenty samples. The sample was split into two groups. Group 1 consisted of ten samples treated with conventional brackets and ten samples treated with self-ligating brackets. Pretreatment and leveling aligning cast were used for the study. Measurement of transverse dimension was taken at two different regions, premolar and molar. Reference points were chosen according to the Pont's model analysis. In the premolar region, measurements were made from the distal pit of the first premolar on either side, and in the molar region, measurements were made from the mesial pit on either side. The overall values are compiled and compared among both the bracket groups. Results: The results of the study showed that there were changes in the interpremolar and intermolar arch width during leveling and aligning phase in both the bracket types. Conclusion: Since the arch width changes can affect the stability in the posttreatment phase, an orderly use of custom-made archwires from the very beginning is advised. The amount of arch width changes that occur with the treatment is irrespective of the bracket type, provided that other factors are maintained to be constant. Both conventional metal-ligated brackets and dual-activation self-ligating brackets provide an equal amount of changes in the dental arch transverse dimensions.
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Approaching medical humanities with an interactive tool: Theater of the oppressed Highly accessed article p. 540
Monika Bansal, Manoj Goyal, Anurag Bajpai
DOI:10.4103/jdmimsu.jdmimsu_306_20  
Introduction and Background: The focus of medical education should not only be the cognitive aspects but also be the qualities and values that make us human. Researchers suggest that the required attitudes and values can be inculcated by exposing the students to medical humanities, which will be helpful in making them not only competent but also ethical and humane doctors. “Theatre of the Oppressed (TO),” which was devised by Augusto Boal, has been used as a tool in medical humanities with positive outcomes. Aim: A study was conceptualized with the aim of sensitizing the students with medical humanities with “Theatre of the Oppressed” and to evaluate the workshop by students' perceptions and reflections. Materials and Methods: A workshop of 7 days, 5 days online and 2 days physical, was conducted for 30 students, in which they participated in TO games and activities, which are based on theoretical framework of Paulo Freire's “Pedagogy of the Oppressed” TO. Results: Students participated very enthusiastically in the workshop. The feedback and reflections of students reveal that they felt more empathetic toward patients and underprivileged, developed mutual trust between their class mates, listened more during the workshop, and developed better understanding on their bodies and emotions. Conclusion: The study documents the experience of exposing the students to TO as an interactive tool to address medical humanities. The feedback of students reflects that TO workshop was successful in bringing deep insights on the role of human values in medicine and they want to participate in more of TO workshops in future.
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An observational study about incidence of upper gastrointestinal bleeding, endoscopic profile of patients in tertiary care hospital Highly accessed article p. 548
Sanujit A Pawde, Abhay D Chougale
DOI:10.4103/jdmimsu.jdmimsu_188_20  
Background: Despite treatment advancement of upper gastrointestinal bleeding (UGIB), overall mortality has still remained constant and the reasons behind it are still unclear. Aim: The aim is to study the endoscopic profile of patients suffering from UGIB in a tertiary care hospital. Materials and Methods: Observational study conducted among consenting patients, undergoing Esophago gastro duodenoscopy in the department of general surgery at a tertiary care hospital, between November 2018 and April 2019. Cases included were (n = 86). Standard case history pro forma was used for data collection. Interventions were given in the form of pharmacotherapy, endoscopic band ligation, and sclerotherapy. Follow-up was done after 2 months. Data were analyzed using R software version 3.6.0. Chi-square test used to find the association between variables (P < 0.05). Results: Most patients were male (n = 78) with a mean age of 48.05 ± 14.96 years. Common complaints were of melena (n = 71). History of cases included in this study; history of alcoholic liver disease (n = 35), long-term use of nonsteroidal anti-inflammatory drugs (NSAIDS) (n = 26). The common causes for GI bleeding were esophageal varices (n = 52). Significant association was observed between diagnosis and alcoholic liver disease (P = 0.004), history of long-term NSAIDS (P = 0.002), respectively. All cases were given pharmacological intervention. Higher statistically significant association found between follow-up and sclerotherapy(P = 0.0004). Association was seen between the number of interventions and follow-up (P = 0.016). Adverse event in form of bleeding was seen in 1.2% of cases. Conclusion: The most common cause of UGIB was esophageal varices. Combination of interventions could provide solution to reduce mortality in cases of UGIB.
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The efficacy of music therapy in lowering intraoperative sedative requirement and recall of intraoperative processes by patients under spinal anesthesia p. 552
Aruna Chandak, Monika Sharma, VC Chandak, S Ninave
DOI:10.4103/jdmimsu.jdmimsu_180_22  
Background: This music therapy was found to be a potent and efficient means of strategy for the treatment of illness in all the health aspects. It modifies the normal body's flight and fight response to stress during surgeries. It is a unique approach for relieving patients, making them stress-free without any means of side effects. Methods: This prospective comparative observational study includes a total of 50 cases, randomly assigned in 2 sets of 25 each in age (20–60 years), lower abdomen, urinary complaints related to surgeries, etc. under spinal blockade. These patients were assigned randomly to Group M (music group) and Group C (nonmusic group). Midazolam was given for sedation in both the groups with the aim to achieve Observer's Assessment Sedation/Alertness Score (OAS)-3 or less and to calculate and compare midazolam (total dose) requirement. After giving spinal to the patient and achieving desired levels, the patients were given headphones and the music was set up n music group patients. Basic vitals and requirements (total sedative) during surgery were recorded and then compared between the two groups. The ability of the patient to recall intraoperative events after surgery was also calculated by 6-point questionnaire, and for assessing pain severity, the visual analog scale score method was used. Results: We have found that intraoperatively, midazolam requirement (total) was found to be very low in the patients who listened music (P < 0.01), the OAS score was better in the music group, and the systolic and diastolic blood pressure and pulse rate may be comparable in both the groups. Conversations between doctors/nurses, OT staff during surgery, and monitors sound, instruments, etc., were more significantly recalled by a group of people who do not listen to music intraoperatively. Conclusion: Our study concluded that the use of intraoperative music in patients under spinal anesthesia can be demanding therapy by reducing patient's requirement of medication, needed for sedating them and relieving pain. This helps in creating an effective, safe method for patient's overall satisfaction.
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Cartridge-based nucleic acid amplification test: An early tool for the diagnosis of sputum smear-negative pulmonary tuberculosis p. 557
Pankaj Wagh, Rakesh Rajpurohit, Saood Ali, Sameer Adwani, Juhi Kadukar, Gaurang Aurangabadkar
DOI:10.4103/jdmimsu.jdmimsu_62_22  
Introduction: Tuberculosis (TB) of the lung is an infectious disease caused by Mycobacterium tuberculosis, which is an aerobic, acid-fast, Gram-positive bacillus. India has the world's highest number of TB cases, accounting for one-fourth of all TB cases. For efficient treatment of pulmonary TB, microbiological diagnosis is the mainstay. Acid-fast bacillus (AFB) smear-negative patients could account for 31% of new cases. After multiple negative induced-sputum smear tests, we conducted this study to observe whether cartridge-based nucleic acid amplification test (CBNAAT) provides an additional and early diagnostic yield for undiagnosed cases of pulmonary TB. Objectives and Goals: The purpose of this study was to observe if CBNAAT could be used to diagnose pulmonary TB early in patients who had TB clinically and radiologically but negative for sputum direct smear. Materials and Methods: At our institute, 82 patients were involved in an observational study for assessing the utility of CBNAAT in the early confirmation of TB in individuals who had an X-ray chest that is indicative of PTB, but a negative sputum smear for AFB. Our hospital's department of respiratory medicine was the site of the current clinical study. Results: The patients were mostly between the ages of 31 and 40 years, with a male majority. Cough was the most common symptom in 72 (88%) patients. In 30 patients, the sputum CBNAAT test was positive (36.5%). All 82 instances were given a bronchoalveolar lavage (BAL). In 46 (56%) patients, BAL CBNAAT was positive. In 12 (15%) cases, bronchial brushings tested positive for AFB on smear examination. Caseating epithelioid granuloma was seen in 4 (14%) patients after a transbronchial lung biopsy. Conclusion: In individuals with strong indication of pulmonary TB, sputum CBNAAT and BAL CBNAAT provide a higher bacteriological confirmation of diagnosis.
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Comparison of efficacy of local anesthetic drugs lignocaine, ropivacaine, and bupivacaine in pain control during extraction of mandibular posterior teeth p. 563
Preeti Gupta
DOI:10.4103/jdmimsu.jdmimsu_78_20  
Background: Posterior tooth extractions provide a challenge due to variations in anesthetic capacity and effects, especially postoperatively. The aim of the study was to compare the efficacy of three anesthetic agents – lignocaine, bupivacaine, and ropivacaine – during extraction procedure of mandibular posterior teeth. Materials and Methods: Two hundred and fifty study participants were randomly divided into three groups: Group I – individuals under 2% lignocaine (n = 84), Group 2 – individuals under bupivacaine (n = 86), and Group 3 – individuals under ropivacaine (n = 80). Hemodynamic and anesthetic and analgesic parameters were recorded and statistically analyzed using analysis of variance. Results: Significant differences were observed between three anesthetic agents used pertaining to anesthetic and analgesic changes, whereas no significant effects were observed when comparing the hemodynamic parameters. Conclusion: Ropivacaine provided the best clinical outcome in terms of both anesthetic efficacy and postoperative analgesia following the extraction of mandibular posterior teeth.
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Effectiveness of three different types of oral health promotion programs among schoolchildren in Sakaka, Saudi Arabia: A cluster randomized controlled trial p. 568
Sakaka Vundavalli, Muhammad Nadeem Baig
DOI:10.4103/jdmimsu.jdmimsu_247_20  
Background: Untreated component of dental caries in Saudi Arabia is alarming even though the accessibility of dental services is at free of cost to all Saudi nationals. Aim/Objective: The aim of the present study is to assess the efficiency among three different types of school-based oral health promotion programs in Sakaka children. Materials and Methods: A cluster randomized controlled trail included 765 schoolchildren. Three different models of school-based oral health promotion programs were tested in this study. Outcome measures were evaluated after 12-month follow-up, which include difference in prevalence and mean number of untreated dental caries, annual dental service utilization rates, and difference in mean oral health-promoting behavior between baseline and at the end of the program. Results: Seven hundred and two children were available for outcome measurement. There is reduction in both prevalence and mean number of untreated dental caries in all the three groups but significant reduction observed in Model-3 group of children. Similarly, improvement in dental visit patterns was also observed more in Model-3 group compared with other two groups. Conclusion: Health education including teachers with 6-monthly reinforcement, screening, and referral to specific treatment facility with follow-up reminders was found to be an effective model.
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Determination of serum procalcitonin and total antioxidant capacity in patients of sepsis before and after treatment, in a tertiary care hospital p. 575
Divya Anand Jain, Ajit V Sontakke, Vaishali S Pawar, Ashutosh Jain
DOI:10.4103/jdmimsu.jdmimsu_151_22  
Introduction: Sepsis is a medical emergency, occurring due to the body's systemic immunological response to an infection. It is among the most common reasons for intensive care unit admissions worldwide and is one of the top 10 leading causes of death worldwide. Procalcitonin (PCT) is the marker of sepsis, and total antioxidant capacity (TAC) is a marker of oxidative stress and gives a mirror image about patient's antioxidant status. The purpose of the study was to estimate serum PCT and TAC levels in sepsis patients, before and after treatment, and to find the correlation between them. Materials and Methods: In this observational follow-up study, 60 sepsis patients were recruited using purposive sampling method, and samples were taken before and after treatment. Separated serum was used to measure PCT and TAC. PCT was measured by a rapid quantitative test using a sandwich immunodetection method based on fluorescence immunoassay technology, on a Finecare FIA system. Values over 0.5 ng/ml were considered significant. TAC was measured using the ferric-reducing antioxidant power method based on reduction of a colorless Fe3+-TPTZ on interaction with a potential antioxidant, into an intense blue Fe2+-TPTZ complex. Results: The mean PCT in subjects before treatment was as high as 40.62 ± 12.02 ng/ml, and the difference between before and after treatment values was highly significant (P = 0.000). For TAC also, before treatment value was higher (485.64 ± 106.53 μm/l) than the after treatment (277.79 ± 74.17 μm/l) value with a significantly high difference (P = 0.000). Furthermore, a strong positive correlation between PCT and TAC (r = 0.754, P = 0.000) was observed. Conclusion: It was concluded that in sepsis, there is a concomitant existence of inflammation and oxidative stress. Since TAC values correlate with values of PCT, TAC could be a reliable prognostic marker and may be helpful in evaluating interventions on follow-up of patients.
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Evaluation of efficacy of hi-ora mouthrinse as against 0.12% chlorhexidine in treatment of patients with chronic gingivitis: A randomized-controlled trial p. 579
Anitha Akkaloori, Maher Al Shayeb, Praveena Raman, Kurian Punnoose, Prajna Pattanaik, Reghunathan S Preethanath, J Suresh Babu, C Swarnalatha, Abhishek Singh Nayyar
DOI:10.4103/jdmimsu.jdmimsu_364_22  
Background: The present study was planned to compare the efficacy of Hi-Ora mouthrinse as against 0.12% chlorhexidine (CHX) in treatment of patients with chronic gingivitis. Materials and Methods: The present study was designed as a randomized controlled trial including 90 patients with chronic gingivitis who were divided into three groups including Group A in which 0.12% CHX was prescribed, Group B in which patients were prescribed Hi-Ora, and Group C in which normal saline was prescribed after oral prophylaxis while the mean gingival index (GI) and plaque index (PI) scores were recorded after 1 week. Inter-group comparisons between different groups were done with the help of Independent t-test and Tukey's post hoc test while P < 0.05 was considered statistically significant. Results: In the present study, the mean GI score (postintervention) was found to be 0.71 ± 0.27 in CHX, 0.68 ± 0.17 in Hi-Ora, and 1.59 ± 0.55 in the normal saline group with the results being statistically significant (P < 0.0001). Similarly, the mean PI score in the present study was found to be 0.81 ± 0.34 in the CHX group with the corresponding values being 0.79 ± 0.28 in Hi-Ora and 1.86 ± 0.61 in the normal saline group with statistically significant results (P < 0.0001). Conclusions: The results of the present study suggested Hi-Ora to be equally efficacious as 0.12% CHX in reducing the mean GI and PI scores in patients with chronic gingivitis.
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Prevalence of Carbapenem-Resistant Escherichia coli and Klebsiella pneumoniae in Rural Uttar Pradesh p. 584
Pratiksha Srivastava, Dakshina Bisht, Ajay Kumar, Atosh Tripathi
DOI:10.4103/jdmimsu.jdmimsu_76_22  
Introduction: In recent years, increased incidences of carbapenem resistance among Escherichia coli and Klebsiella pneumoniae have been reported worldwide. Due to the higher prevalence and wide range of clinical infections, E. coli and K. pneumoniae are considered great risks for public health. Furthermore, carbapenem resistance limits the treatment options in individuals infected with E. coli and K. pneumoniae. Thus, rapid detection of carbapenem resistance is essential to initiate appropriate treatment and effective management and prevent further dissemination. In the present study, we aimed to explore the prevalence of carbapenem-resistant E. coli and K. pneumoniae at a tertiary care hospital in rural Uttar Pradesh. Materials and Methods: A cross-sectional study was performed at Government Medical College, Azamgarh, in collaboration with Santosh Medical College, Ghaziabad. A total of 2736 clinical specimens comprising urine (1939), pus and wound swabs (486), sputum and throat swabs (257), and other samples (54) were collected following the standard guidelines and were processed for culture by standard bacteriological methods. After obtaining the growth, Gram staining and standard biochemical reactions were performed for the identification of E. coli and K. pneumoniae. All these isolates were subjected to antibiotic sensitivity testing for carbapenem by Kirby–Bauer disc diffusion method. Results: Of the 2736 specimens, 48.57% showed the growth of various organisms. Of these, 59.51% of isolates showed the growth of Enterobacteriaceae, of which 60.93% among them were E. coli whereas 26.92% were K. pneumoniae. The overall prevalence of carbapenem resistance in the present study was found to be 29.35%. Among the carbapenem-resistant isolates, 68.13% were E. coli whereas 31.86% were identified as K. pneumoniae. Conclusion: Carbapenem resistance in E. coli and K. pneumoniae isolates in the present study was found to be higher compared to previous studies from India. Our study highlights the urgent need of proper monitoring, judicious use of antibiotics, and implementation of strict infection control practices in this region.
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A study to assess the reliability of structured viva examination over traditional viva examination among 2nd-year pharmacology students p. 589
Marya Ahsan, Ayaz Khurram Mallick
DOI:10.4103/jdmimsu.jdmimsu_449_21  
Introduction: Although viva voce provides the examiner an opportunity to probe and assess the reasoning and higher-order thinking abilities of the student, it is marred by inconsistency, subjectivity, and biases. These issues can be addressed by increasing the objectivity and standardization of the viva examination. Hence, this study was done to explore the perception and opinion regarding structured viva examination and to compare and correlate the marks of structured viva with theory examinations among 2nd-year medical students. Materials and Methods: An educational study was carried out on 150 students after obtaining institutional ethical committee and informed consent, out of which 42 students had dropped. The students were subjected to a theory examination of 30 marks following which they were divided into two groups. One group was assessed by traditional viva examination, whereas the other group was assessed by structured viva. The perception of the students and faculty was recorded using a five-point Likert scale. The marks obtained in the viva examination were correlated with the theory examination using Pearson coefficient. The significance of the mean was compared using Student's t-test. P < 0.05 was considered statistically significant. Results: A moderate positive correlation (r = 0.442; P = 0.001) was seen between marks scored in structured viva and theory examination. The overall response of the students and examiners was favorable toward a structured examination. Conclusion: Structured viva examination may be considered more reliable and fairer in comparison to a traditional viva examination. Hence, it may be preferred over the traditional viva examination.
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Evaluation of the consequences of menopause on women with respect to salivary flow rate, gustatory function, and pH p. 595
Anshu Agrawal, Minal S Chaudhary, Alka Harish Hande
DOI:10.4103/jdmimsu.jdmimsu_13_22  
Context: Saliva is considered a predictive gateway to the body. Alterations in salivary secretion can be assessed quantitatively and/or qualitatively. Thus, estimation of salivary components may give insight to the general health of an individual and be considered the mirror of the body's health. The health needs of women vary mainly due to hormonal fluctuations occurring throughout the woman's life. Hence, the “menstruation cycle and menopause” may affect the metabolism of periodontal tissue including swollen salivary glands, bright red swollen gums, or bleeding gums or might cause alterations in the flow rate of saliva, its pH, as well as taste function. Due to menopause, there are unique hormonal changes in women and they are more receptive to salivary alterations, such as sensitivity to hot and cold food, altered taste, burning sensation, and reduced flow rate of saliva that lead to xerostomia and atrophic gingivitis also. Aim: This research project is designed for the evaluation of “salivary flow rate,” gustatory perception, and “pH” of resting saliva in premenopausal, menopausal, and postmenopausal women. Subjects and Methods: The evaluation of salivary flow rate, gustatory perception, and salivary pH was carried out in a total of 105 women, each 35 from, the premenopausal, menopausal, and postmenopausal categories. Results: The present study observed significant alterations of reduced salivary flow rate, reduced sweet intensity, and pH in postmenopausal women than the menstruating women. Conclusion: Menopause is followed by a variety of alterations, few of which occur in the mouth. The use of salivary flow rate, gustatory perception, and pH is helpful to identify the risks linked with menopause.
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Critical appraisal of curriculum content for undergraduate academic curricula under Faculty of Allied Health Sciences, Datta Meghe Institute of Medical Sciences (Deemed to be University) as against principles of curriculum design p. 600
Gaurav Vedprakash Mishra, Archana Dhok, Tripti Srivastava, Rohan Kumar Singh, Prerna Anup Patwa
DOI:10.4103/jdmimsu.jdmimsu_297_21  
Background: A judicious mix of all three domains makes the curriculum better suited to the needs of the learner. At the same time, the curricula can be considered for their compliance with certain qualities such as the degree at which the curriculum addresses the cognitive domain, psychomotor domain as well as affective domains. Moreover, the design of the curricula should be such that they should be standardized for all interested learners taking into mind their different mental and psychological makeup. On this front, principles of curriculum design were given by The Curriculum Centre and are considered as standard of reference for this present study. Materials and Methods: Rapid review of literature with reference to curriculum of Intensive Care Technology, Biomedical Sciences, Clinical psychology, and Physician Assistant under faculty of Allied Health Sciences, Datta Meghe Institute of Medical Sciences (Deemed to be University) in the academic year 2020–2021 for purpose of their “Typing” with principles of curriculum design was done. Results: The academic curricula included in the present study were found to adhere to the principles of richness of knowledge, curriculum designed with memory of the learner in mind, curriculum designed for novices and not experts. However, they were found to be not in consonance with the principles of domain specificity, coherence, cumulation, and academic challenge. Conclusion: The undergraduate course curricula of academic course curricula launched under the Faculty of Allied Health Sciences included in the present study have been critically appraised on the basis of their adherence with the principles of curriculum design as proposed by The Curriculum Centre.
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Dental anomalies prevalence in cleft lip and palate patients: An observational study p. 603
SR Ashwinirani, Girish Suragimath, Pratap Mane
DOI:10.4103/jdmimsu.jdmimsu_317_21  
Background: Dental anomalies are a common finding in patients with cleft lip (CL) and cleft lip with palate (CLP). CL and CLP are congenital disorder that occurs in newborns and will have a physical defect throughout life if not treated. The variety of dental anomalies reported are peg laterals, tooth agenesis, taurodontism, hypoplasia, and ectopic eruptions. The purpose of this study was to analyze the prevalence of various dental anomalies in CL and CLP patients. Methodology: A descriptive cross-sectional study was conducted among 80 patients of CL and CLP. Patients were selected by convenience sampling technique, from the department of oral medicine and radiology. Oral examination and dental panoramic radiographs were assessed. The diagnosis was arrived as per the findings of the clinical and radiographic evaluation. The findings of the study were reported as frequency and percentage. Results: Out of the 80 patients, the majority were males accounting for 55% and 45% were females. All the patients were diagnosed with one or the other dental anomaly. Tooth agenesis was the most commonly observed anomaly accounting for 70%. Patients with bilateral CL with palate (BCLP) had a higher percentage of tooth agenesis (96.5%) compared to patients with unilateral CL with palate (72.9%) (UCLP). Conclusion: One or more dental anomalies were observed in CL and CLP patients. Tooth agenesis, taurodontism, hypoplasia, and ectopic eruptions were the most prevalent anomalies. BCLP patients had more dental anomalies than UCLP patients.
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Design and evaluate psychometric properties of scale to assess students' perception toward online teaching in nursing education: Sequential exploratory study p. 608
Suresh K Sharma, Shiv K Mudgal, Rakhi Gaur
DOI:10.4103/jdmimsu.jdmimsu_268_21  
Background and Aims: Given the scarcity of a valid and reliable tool specially designed to measure perception to online teaching in nursing science students. This study was done with an aim to design and evaluate the psychometric properties of perception to online teaching questionnaire. Methods: The present study was conducted using mixed-method approach in two phases at the Eternal University, in 2020. In first phase, qualitative study was done to explore the students' perception on online teaching. Then, the theme and subtheme were extracted, and initial items were developed through reviewing the literature. In the second phase, total of 384 nursing students who were recruited conveniently participated in the study. Furthermore, the psychometric properties including face, content, and construct validities, test–retest reliability and internal consistency (Cronbach's alpha), were measured in the second phase. Statistical analysis was done using SPSS Analysis of Moment Structure version 23 (SPSS Inc., Chicago, IL, USA) for quantitative data. Results: Four factors were extracted through exploratory factor analysis. The confirmatory factor analysis confirmed 28 items in four factors: Ascendancy, snag, technophilia and prerequisites, and these factors explained 61.67% of variances. The Cronbach's alpha and stability of the questionnaire were 0.906 and 0.91, respectively. The discriminant validity and composite reliability of this final model were confirmed. Conclusion: This proposed questionnaire had met at desired standard of reliability and validity making it a useful measurement tool for measuring the perception to online teaching in nursing science students. It could be used for teaching–learning method improvement.
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Health problems and challenges for optimal health-care delivery in Humla District, Nepal p. 616
Dinesh Rokaya, Nabin Rokaya, Jot Narayan Patel, Alok Sah, Ranjit Kumar Yadav, Kanokwan Suttagul
DOI:10.4103/jdmimsu.jdmimsu_85_18  
Background: Humla is one of the remote districts located in the north-west of Nepal and located at an altitude between 1500 and 7300 meters. Poor health-care services, less health-care professional, seasonal outbreak of diseases, food deficit in winter, and traditional beliefs in the curative service have caused health-care problems, hindrance, and challenges in the proper health-care delivery in Humla. Objectives: This study aims to provide information on the health problems and describes the difficulties and challenges to the health-care system in Humla district. Materials and Methods: A retrospective cross-sectional survey was conducted at the District Hospital Humla regarding medical treatment and disease prevalent from June 2017 to April 2018. Microsoft and SPSS version 18 were used to analyze the data. Results: It showed that the majority of the patients visiting at hospital show gastritis (30%), followed by pelvic inflammatory disease (20%), chronic obstructive pulmonary disease (12%), trauma (from landslide injury and fall injury) (8%), and alcoholic liver disease (10%). In addition, 35% of Humli people follow the traditional belief of witch doctor, 15% do home remedy, and 50% of people go to see a medical doctor and do modern treatment. Conclusions: Humli people face several difficulties in the health care, such as less number of hospitals, less number of doctors and health-care personals, few specialists, and less medical equipment. Among medical problems, gastritis and pelvic inflammatory disease were the most common medical problems in Humla.
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Open defecation practice in twenty remote villages located in South India: A population-based cross-sectional study p. 620
Mohandas Roselin, Ariarathinam Newtonraj, Ganesan Girija, Mani Manikandan, Antony Vincent
DOI:10.4103/jdmimsu.jdmimsu_217_20  
Introduction: Open defecation practice is a major public health problem in India. We intended to study the practice of open defecation and its related risk factors in a rural area of South India. Methodology: This study was conducted in twenty villages surrounding a rural health training center, located in Tamil Nadu. Data collection was done by medical interns and medical social workers using a structured questionnaire. Results: The total population surveyed was 14,925, of which 14,061 individuals were in the age group of 5 years and above. Among them, 9069 (64% [63–65]) individuals were practicing open defecation. When compared to backward caste, individuals belonging to the most backward caste were 10% more likely (adjusted prevalence ratio [aPR]: 1.1 [1.0–1.2]) and individuals belonging to scheduled caste were 40% more likely (aPR: 1.4 [1.3–1.5]) to be practicing open defecation. With increase in age, there was a decrease in the prevalence of open defecation practice by 1% (aPR: 0.99 [0.99–0.99]) and with increase in family members, there was a decrease in the prevalence of open defecation practice by 2% (aPR: 0.98 [0.96–0.99]). Illiterate people had 14% higher chance of preferring open defecation (aPR: 1.14 [1.07–1.2]). Tobacco users were 10% more likely (aPR: 1.1 [1.0–1.3]) to be associated with the open defecation practice and nonvegetarians were 20% more likely to be associated with the open defecation practice (aPR: 1.2 [1.1–1.3]). When compared to kutcha house individuals, pucca house individuals were 10% less likely (aPR: 0.9 [0.8–1.0]) and semi-puccca house individuals were 10% more likely (aPR: 1.1 [1.0–1.2]) to adopt open defecation method. Gender, marital status, and hypertension were not associated with the open defecation practice. Conclusion: Open defecation practice is still continuing as an important public health problem in remote rural areas of South India.
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Self-care behaviors and safety concerns toward self-medication among the general public in Ajman, United Arab Emirates: An exploratory survey p. 624
Manal Buabeid, Subish Palaian, Akram Ashames, Nageeb Hassan
DOI:10.4103/jdmimsu.jdmimsu_404_21  
Background: Self-medication offers advantages but raises multiple safety-related questions. There are different factors that influence the self-medication patterns among different population, such as age, income, gender, self-care-orientation, educational level, expenditure, satisfaction, and known seriousness of the illness. Data on self-care behavior and safety concerns among the general public are lacking in the United Arab Emirates (UAE). This study assessed the general public's self-care behaviors and medication safety concerns among the general public. Materials and Methods: A cross-sectional, questionnaire-based survey was conducted among the 210 general public in Ajman, UAE, from December 2019 to February 2020. The filled surveys, entered in SPSS 26, were analyzed applying Chi-square tests and Fisher's exact tests with an alpha value = 0.05. Results: Of the respondents, 152 (72.3%) have participated in self-medication with no association seen between education (P = 0.107), gender (P = 0.185), age (P = 0.122). The commonly self-medicated ones were over-the-counter medications (n = 103; 41.37%) and antibiotics (n = 66; 26.51%). Seventy-two percentage (n = 151) stopped the self-medicated drugs if the underlying conditions improved which was not influenced by age (P = 0.327), gender (P = 1.00), or educational qualifications (P = 0.338). Sixty percentage (n = 126) checked the side effects of the self-medicated drugs before taking them, a habit influenced by education (P = 0.015), gender (0.002), and age group (P = 0.014). Half of the respondents (n = 105; 50%) stopped medications if they experience side effects a practice largely influenced by age (P = 0.0.30). Of the respondents 77.6% (n = 163) checked the medicine leaflets for drug information and the ease of obtaining an antibiotic was easy among 19.62% (n = 20) respondents; P = 000 (education), 0.006 (age); 65.7% (n = 138) of respondents check for allergy before self-medicating (P = 0.014, education), 13.3% (n = 28) felt the drugs that do not require a prescription is safe for everyone (P = 0.012, education). Conclusion: Self-medication is rampant and often used for symptomatic management. Antibiotics were also self-medicated by nearly one-fourth of respondents. Education had a significant influence on self-medication practices and safety concerns. Innovative strategies may be needed to contain irresponsible self-medication practices among the general public.
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Sonoelastographic characterization of parotid and submandibular lesions our initial experience: A prospective observational study p. 632
Megha Manoj, Suresh V Phatak, KB Harshith Gowda, Prashanthi Ghanta, Soumya Jain, Rishabh Gupta
DOI:10.4103/jdmimsu.jdmimsu_419_20  
Context: Sonoelastography is an emerging noninvasive imaging modality used for the assessment of soft tissue lesions. Parotid and submandibular glands are relatively superficial structures which can be easily assessed and examined to characterize the lesions. Aim: The aim of the present study is to evaluate the sonoelastographic features of various benign and malignant parotid and submandibular gland lesions, and correlate their findings with pathology. Materials and Methods: In a prospective observational study conducted in Acharya Vinoba Bhave Rural Hospital of JNMC College, Sawangi, Wardha, 24 patients who presented with salivary gland lesions were evaluated with sonoelastography during 2 years. Results: The most common age group in this study was 51–60 years, followed by 31–40 years. Benign lesions were more common than malignant ones. Higher values of strain ratio were seen in cases of malignant tumours correlating well with score of 3 and 4 on elastography. Conclusions: Sonoelastography is a recent advance in ultrasound for the evaluation of salivary gland lesions showing good correlation with pathology so it can be employed routinely in presurgical evaluation.
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To assess the knowledge and skill regarding oral rehydration solution preparation among the mother having under five children p. 637
Mayuri Deshmukh, Shivali Kalode, Anushka Jaiswal, Vaishnavee Chiddarwar, R Nidhishree
DOI:10.4103/jdmimsu.jdmimsu_48_20  
Background: Oral rehydration solution (ORS) is the most significant development in the management of acute diarrheal disease in children. Aims and Objectives: The aim of the study was to assess the knowledge and skill regarding ORS preparation among the mothers having under five children. Methodology: The cross-sectional study was done among 100 mothers of under five children from rural areas of Selsura, Wardha district. Results: The results showed that 15% of the mothers had the knowledge of taking a clean glass of water, 76% of the mothers knew to add a spoonful of sugar and to add a pinch of salt, 21% knew to stir it till all dissolves, 18% mothers tasted the solution, and 2% replaced the caps of salt and sugar bottle.
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Lesions in the parotidomasseteric domain: A plethora of diversity p. 641
Srivalli Natarajan, Yash Oswal, Adil Gandevivala, Padmakar Sudhakar Baviskar, Sagar Vaishampayan, Sushrut Vaidya, Gaurav Deshpande, Sunil Sidana
DOI:10.4103/jdmimsu.jdmimsu_59_20  
Context: Swellings in parotidomasseteric region are one of the most intriguing and challenging lesions in the head and neck. Diverse array of diagnosis, striking clinical similarities between different pathologies and anatomical complexity of this region make parotidomasseteric lesions unique. Aims: This article aims to provide a detailed description of various pathologies associated, the diagnostic challenges posed, and the respective management strategies. Settings and Design: The study design involves retrospective observational. Subjects and Methods: Sixteen rare cases of various parotidomasseteric pathologies were reviewed to delineate clinical presentation and characteristic features in diagnostic investigations and subsequent treatment strategies. Statistical Analysis Used: Not applicable. Results: The analysis showed that lesions in the parotidomasseteric region can be categorized into specific entities with distinct but often overlapping clinical features. Given the location and anatomy of the parotidomasseteric region, these lesions can often remain indolent Investigations are fruitful to some extent in determining the expanse of these lesions, however, remain inconclusive in diagnosing the origin and their true nature. Conclusions: The authors conclude that a systematic approach to the diagnosis of a parotidomasseteric lesion is of utmost importance because the differential diagnosis is prodigious. These lesions can be considered very deceptive, demanding surgical intervention and their excision. With the exception of surgical exploration, physical examination remains the most indispensable tool. Hence, a better classification system which determines the treatment required for a particular parotidomasseteric lesion and which correlates the clinical findings with the preoperative investigations will be more beneficial for the operating surgeon.
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Association of wash practices with diarrheal diseases among residential and nonresidential school children at Wardha District: A comparative study p. 650
Rutuj N Waghmare, Sarika Dakhode, Sonali Choudhari, Shobha K Joshi, Abhay Gaidhane, Vijay Waghmare
DOI:10.4103/jdmimsu.jdmimsu_10_21  
Introduction: Sustainable development goals, adopted at the 2015 UN general assembly, aim to significantly boost water and sanitation globally and include two concrete targets for drinking water, sanitation, and hygiene (WASH) as set out in objective 6. Improved water supply and sanitation results in a reduction of 23% and 36% respectively in morbidity due to diarrhea and an increase of around 2 billion school days. The present study was conducted to assess and to compare the WASH practices and its association with diarrheal diseases in residential and nonresidential schools at Wardha district. Methodology: A cross-sectional school-based study conducted using a prestructured and predesigned questionnaire carried out among residential and nonresidential schools in Wardha district. The study participants were the students of 8–13 years of age group or 3rd–7th standard. Data collection tools were prepared using the World Health Organization standards for WASH in Schools in Low-cost Settings and Monitoring Package developed by UNICEF for WASH in Schools which is adaptable in developing countries. Results: In residential school, out of 240 boys 96 (40%) and out of 231 girl students 30 (12.98%) were suffered from diarrheal disease in the past 3 months of interview. While in nonresidential school out of 178 male students 10 and 12 female students gives a history of diarrheal disease in the past 3 months; this association was statistically nonsignificant. When compared by Binomial Logistic Regression found that in residential school variables like Gender, Not Using “Urinals” provided in the school, Not using soap for washing hands found to be statistically significant, with an odds ratio of 0.433, 1.65, and 4.43, respectively. Conclusion: This study shows that male participants from residential schools have a high incidence of diarrheal disease compared with females from the schools, whereas in nonresidential schools females suffered from diarrheal comparatively more than males; improper water handling practices seem to be more in residential schools than that of nonresidential schools this may be the main reason of getting more incidence of diarrheal diseases in residential school.
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Age assessment by dental and skeletal maturity pattern: A cross-sectional study p. 657
Mohd Malik Afroz, Avinash Tejasvi, Prashanth Shenai, Laxmikanth Chatra, C K Anulekha Avinash
DOI:10.4103/jdmimsu.jdmimsu_229_19  
Aim: An attempt was made to estimate the chronologic age of an individual using the dental and skeletal maturity in the Mangalore population. Sample: This study sample comprised 150 individuals (75 males and 75 females) ranging from 10 to 20 years of age. We have divided our sample as ≤16 years and individuals >16 years from 1 month to 20 years for better accuracy. Methodology: Dental age was assessed using the Demirjian method based on seven mandibular teeth. The skeletal age was assessed using a hand-wrist radiograph by applying the method of Bjork, Grave, and Brown. Results: We have found a positive correlation between the chronologic age, estimated dental and skeletal age in individuals ≤16 years. There was a negative correlation seen in the individuals who are >16 years. We propose a linear regression equation obtained using the dental and skeletal method separately for males and females; this can be used to decrease the difference between the estimated age and chronologic age. Conclusion: Both the dental and skeletal methods can be used for age estimation, with the dental method being more accurate than the skeletal method in our population.
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Study of expression of epithelial cadherin in benign and malignant epithelial lesions of uterine cervix p. 662
Pooja Gupta, Pooja Agarwal, Lalit Kumar, Shikha Prakash, Poonam Yadav
DOI:10.4103/jdmimsu.jdmimsu_215_20  
Context: Epithelial cadherin (E-cadherin) is inversely proportional to the histologic grade of squamous cell carcinoma (SCC) of the cervix and is reduced with the increasing grade of cervical intraepithelial neoplasia, with downregulation upon transition to cervical intraepithelial neoplasia and further to invasive cancer. Aims: The aim of the study was to study the expression of E-cadherin in benign and malignant epithelial cervical lesions and to compare the results statistically. Settings and Design: The cross-sectional study was hospital based conducted in the department of pathology from January 2018 to March 2019. Methods: The study was carried out on sixty biopsy specimen of cervix (33 malignant, 4 premalignant, and 23 benign lesions). Two sections were taken; one for hematoxylin and eosin and other for E-cadherin immunohistochemical staining. Statistical Analysis Used: Statistical analysis was done using Chi-square test and Fisher's exact test. Results: In well-differentiated SCC, the majority cases (40%) revealed membranous staining while in moderately differentiated SCC and poorly differentiated SCC, the most common staining pattern was membranous and cytoplasmic (70% and 45.4%, respectively). In adenocarcinoma, 66.6% of cases had membranous pattern of staining, whereas two cases (33.3%) were negative. In High-grade Squamous Intraepithelial Lesion (HSIL), 75% of cases had membranous staining. Pure membranous pattern of staining of E-cadherin showed a progressive decline with a loss of differentiation while pure cytoplasmic revealed a reverse pattern. Conclusions: We concluded that, in malignant lesions, there is a loss of membranous E-cadherin pattern as compared to benign lesions. Furthermore, there is a progressive decline in pure membranous staining of E-cadherin with increase in shift to cytoplasmic staining as differentiation decreases.
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Adverse event following immunization surveillance and management: A case of two Districts in Madhya Pradesh p. 666
Snehal Parmar, Tapasvi Puwar, Deepak Saxena, Santosh Shukla, Apurvakumar Pandya
DOI:10.4103/jdmimsu.jdmimsu_74_20  
Background: Adverse event following immunization (AEFI) is defined as a medical incident that takes place after immunization, which is believed to be caused by the immunization. Health-care staff should be able to identify and report all serious and nonserious AEFI. Objective: The objective of this study is to analyze the reporting pattern of AEFI by grass-root health-care workers in Madhya Pradesh. Methods: Data related to AEFI were retrieved from three different reporting forms in Vidisha and Bhopal districts of Madhya Pradesh. Results: The results revealed gaps in the reporting patterns of health-care workers and limited understanding of reporting guidelines. AEFI surveillance and management are suboptimal, which can be strengthened with strategic actions. Conclusion: Robust AEFI surveillance and management are warranted. AEFI surveillance can potentially minimize the risk of serious adverse reactions, improve reporting and treatment, prevent any further complications which can overall reduce the negative impact on the immunization programme.
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Role of open laparostomy in severe abdominal sepsis and other acute abdominal conditions p. 670
Kishan Danvath, Praveen Kumar Pokala
DOI:10.4103/jdmimsu.jdmimsu_106_20  
Introduction: Laparostomy or open abdomen is defined as intentionally leaving the abdomen open following laparotomy and closed once condition of the patient becomes stable. The exposed abdominal contents are protected with a temporary cover. This is performed in severely where repeat access to the peritoneal cavity is needed in the postoperative period. This allows free drainage from the peritoneal cavity and prevents the development of complications due to immediate closure of abdomen, such as abdominal compartment syndrome. However, this is a morbid procedure and is associated with many complications. Materials and Methods: In this retrospective study, a total of 25 patients were included. Data were obtained from case records from the emergency and elective surgical departments of patients who had laparostomy in the last 3 years. Analysis of data was done with regard to indications, surgical procedure, timing of return to theatre, fascial closure, and complications including death. Results: In all cases, temporary abdominal closure (TAC) done using a plastic cover or silo bag. Out of 25 patients, 10 patients had gross peritoneal contamination due to gastrointestinal perforation, pancreatic necrosis in 2 cases, bowel gangrene in 2 cases, and abdominal trauma with intraperitoneal bleeding in 3 cases. Two patients died within 48 h of initial surgery. Fascial closure was achieved between 3 and 7 days, with an average of 3.8 days. Only skin closure without fascial closure was performed in 3 cases. Conclusions: Laparostomy is a very useful procedure in severely ill and unstable patients with multiple intra-abdominal injuries, gross peritoneal contamination, and severe bowel edema, where repeat access to the peritoneal cavity is required in the postoperative period. Fascial closure rates are similar to other TAC closure techniques. Wound infections and inability to close fascia are important complications.
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Evaluation of completeness of hematology requisition forms leading preanalytical errors in laboratory of a tertiary care teaching hospital p. 676
Ramanan Duraiswami, Varun Vijay Gaiki
DOI:10.4103/jdmimsu.jdmimsu_304_20  
Background: Laboratory services provide crucial information for the optimal management of patients in a hospital setting. A crucial step in the preanalytical phase of sample testing is the correct filling up of the laboratory requisition form (LRF). Objectives: this study as planned to identify the possible parameters for pre analytical errors. Methodology: We analyzed the LRF submitted to the Hematology Section of Central Laboratory of a tertiary care teaching hospital from Hyderabad to assess the degree of completeness of the submitted LRF as a cause of preanalytical error in the laboratory workflow. Randomly selected laboratory forms submitted along with specimens to the Central Hematology Laboratory of a tertiary hospital over a period of 1 month for their completeness, as laid down in standard operating procedures. Collected data were entered in an Microsoft Excel Worksheet and analyzed by SPSS version 23. Only the patient's name, identification number, gender, type of sample, and examination requested were correctly filled. Results: Patient contact details were available only in 0.82% of LRFs. The diagnosis and clinical history were correctly filled in only 39.62% and 0.27% LRFs, respectively. There was a significant lack of information regarding the doctor requesting the investigation (doctor's name written in 8.47% of forms and doctor's contact telephone number written in 0.27% of forms evaluated). It was also found that the present format of the LRF was inadequate for providing the necessary details of the samples received. Conclusion: The existing LRF needs to be re-designed to enable the clinicians to provide more clinical details and patient-related details. Clinicians need to be sensitized regarding the necessity of submitting correctly filled LRFs. The use of system generated online requisition forms can also be done, where forms cannot be submitted unless complete.
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Impact of internet on rural lifestyle in Bihar, India p. 680
Neha Raj, Ravi Shekhar
DOI:10.4103/jdmimsu.jdmimsu_334_20  
Background: The lifestyle is a way of living by a person, group or society. The practice and transmitting the lifestyle occur across generation. The urbanization in rural areas has led to this change. The factors governing the lifestyle are diet, physical activity, use of tobacco and alcohol, and stress. Aims and Objective: This study was aimed to evaluate the lifestyle of rural adults using simple lifestyle indicator questionnaire (SLIQ) and internet use. Materials and Methods: A questionnaire-based study was conducted among the rural adult residents of Patna Dist. The lifestyle questionnaire was used with permission of Godwin et al. Results: A total of 296 participants aged 18–65 years were included in the study. SLIQ score confirmed 36% of rural participants were having healthy lifestyle. Conclusion: People are dependent on internet of things which has affected the lifestyle.
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Association of genetic polymorphism in Vitamin D receptor and Paraoxonase I genes with type II diabetes mellitus patients in rural South Western Maharashtra p. 684
Pratik P Durgawale, Kailas D Datkhile, Virendra C Patil, Vasant V Devkar, Satish V Kakade, Sarjerao A Dabane, Vijaykumar S Wader
DOI:10.4103/jdmimsu.jdmimsu_362_20  
Background: Type II diabetes mellitus (T2DM) is increasing at an alarming rate in urban as well as rural parts of India. Change in life-style, dietary habits, aging, environmental factors contribute to developing this disorder, T2DM is a polygenic disorder which involves large number of genes interacting with each other and the environment to manifest itself phenotypically. Aims and Objectives: In the present study, we investigated the association of Vitamin D receptor (VDR) and Paraoxonase I (PON I) gene polymorphisms with T2DM patients among rural population in South western Maharashtra. Materials and Methods: The study groups included healthy non-diabetic control group (n = 120), non-obese diabetic group (n = 120), obese diabetic group (n = 120) from the same geographical region. The single nucleotide polymorphisms (SNPs) amongst these groups were studied using Polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP) for VDR and PON I genes. Results and Conclusion: Amongst the studied genes VDR SNP rs1544410 [OR 0.24 (0.1-0.63); P 0.005] and Paraoxonase I SNP rs854560 (OR 0.47 (0.26-0.84); P 0.015) had a protective effect against T2DM for non-obese individuals. Whereas only VDR SNP rs1544410 [OR 0.025 (0.003-0.91); P 0.001] had a protective effect in case of obese individuals. The findings suggest greater gene-gene interaction and gene-environment interactions influence the phenotypic outcomes of genetic polymorphisms.
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Features of anxiety and arterial pressure level in children with chronic gastroduodenal pathology p. 690
Yu N Nechytailo, Dmytro Yu Nechytailo, Tetiana A Nechytailo, Natalia I Kovtyuk, Tetiana N Mikhieieva, Valentyna V Poniuk
DOI:10.4103/jdmimsu.jdmimsu_142_19  
Context: The children of the school-age are most prone to the development of hypertension, which is determined by the characteristic disorders of the autonomic function for this period of childhood, which is accompanied by an increased level of anxiety. Aims: The aim of this study was to assess the level of anxiety in the background of fluctuations of blood pressure (BP) in schoolchildren with chronic gastroduodenal pathology. Settings and Design: This was a cross-sectional study done in city children's clinical hospital conducted for 8 months. Subjects and Methods: One hundred and twenty children with chronic gastroduodenal pathology were examined. To assess the level of arterial hypertension by tonometry. Spielberger-Hanin scale was used to assess the level of personal and situational anxiety. Statistical Analysis Used: Statistical analysis was performed using descriptive and inferential statistics and software used in the analysis was Statistica 12 (Statsoft, USA) and P < 0.05 was considered as the level of statistical significance. Results: In assessing the level of BP in children by percentile tables, it was found that in the second group there is a greater tendency to hypertension than in the first group, and in the children of second group, there were higher rates of both systolic and diastolic BP. In addition, children of the second group experienced an increase in both the personal and situational levels of anxiety. Conclusions: Children with chronic hyperplastic and erosive gastroduodenitis more often observed an increase in BP, also they experience significantly higher levels of both personal and situational anxiety.
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Pulse of Gujarat during lockdown p. 693
Somen Saha, Tapasvi Puwar, Deepak Saxena, Priya Kotwani, Devang Raval, Yogini Kandre, Abid Qureshi
DOI:10.4103/jdmimsu.jdmimsu_318_20  
Background: Coronavirus pandemic has dealt a severe blow to India's poor and socioeconomically disadvantaged group. Among a nationwide lockdown to contain the spread of the infection. This study assessed the availability of food and access to healthcare among the vulnerable population of Gujarat– pregnant women and severe acute malnourished children. Specifically, we assessed events of starvation or skipped meal, availability of healthcare services, and self-reported psychological distress during the lock down. Materials and Methods: A cross-sectional study across 252 talukas and 33 districts of Gujarat was undertaken using a structured questionnaire. A telephonic survey was carried out and positive responses were received from 161 households (HHs) with severe acute malnourished children, 328 pregnant women with severe maternal anemia, and 402 lactating women. Results: We found 79.7% of surveyed HHs received ration where major reliance was on public distribution system (51.7%). Less than half of the beneficiaries (48.6%) received take-home ration under the ICDS program. Despite efforts of the State as well as voluntary agencies, 7.3% of HHs experienced episode of hunger, mostly from Devbhumi Dwarka, and Navsari district. A third of the respondents showed signs of psychological distress associated with lockdown. Conclusion: Food insecurity may lead to malnutrition impairing the immunity of the individuals to cope with the disease. Thus, given the uncertainty around the emergency situation, preparedness measures should not only focus on the availability of healthcare commodities but also to ensure the availability of other essentials, especially to the socioeconomic disadvantaged group.
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An in vitro digital comparative evaluation of the accuracy and dimensional stability of vinyl polyether silicone impression material with the conventionally used elastomeric materials scanned using a blue light scanner p. 699
Bhavna Mahesh Ahuja, Pronob Kumar Sanyal, Rakshith Guru, Abhijeet Kore
DOI:10.4103/jdmimsu.jdmimsu_291_20  
Background: The development of material science has allowed integrating qualities of polyether (PE) and Vinyl Polysiloxane (VPS) into a newer material Vinyl polyether silicone (VPES). There is limited literature available on this combination material. The aim was to evaluate and compare the accuracy and dimensional change of elastomeric impression materials with a three-dimensional (3D) approach. Materials and Methodology: Impressions were made of standard tooth model and custom trays using the three monophase impression materials, i.e., Group A–Vinyl polysiloxane (VPS), Group B-Polyether (PE), and Group C-Vinyl Polyether silicone (VPES). All the impressions were digitized and compared on eight predetermined points using a 3D compare software by the superimposition of computer-aided design files of impressions onto that of Standard tooth model. Three-dimensional comparison is repeated after storage of impressions for 1 week to re-evaluate the dimensional stability of the impression materials. Results: The average measurement of mean discrepancies of all the 8 points obtained on day 1 for VPS, PE, and VPES were 75.758 μm, 139.52 μm, and 49.24 μm, respectively, which helps in the determination of accuracy and after interval of 1 week 91.27 μm, 157.25 μm, and 89.76 μm, respectively, which helps to deduce that the linear dimensional change values for Group A, Group B, and Group C were 15.52 μm, 17.73 μm, and 40.52 μm, respectively. Conclusions: Average dimensional accuracy was highest of VPES followed by VPS and PE. Whereas VPS impression material shows the highest dimensional stability after prolonged storage of 1 week, followed by PE and then VPES impression material.
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Comparative evaluation of bacterial growth following removal of peripheral intravenous cannula inserted in an emergency room and in aseptic condition: A prospective randomized double-blind study p. 705
Srivalli Natarajan, Pradeep Vathare, Usha Asnani, Sushrut Vaidya, Padmakar Baviskar, Ruchita Balkawade
DOI:10.4103/jdmimsu.jdmimsu_238_20  
Context: Approximately 60% of hospital inpatients annually undergo peripheral intravenous cannulation to receive therapeutic intravenous (IV) medication. About 6.2% of hospital-acquired bacteremia may be directly attributable to peripheral IV cannulation. The setting in which the PICs are inserted may influence the microbial flora around the site of insertion. Aims: The study aims to evaluate and compare the incidence of bacterial growth and assess the local complications like cellulitis and phlebitis following removal of PIC inserted in an emergency room and in aseptic condition. Settings and Design: This was a prospective randomized double-blind Study. Materials and Methods: A total of 50 subjects (Group A n = 25 and Group B n = 25) were randomly divided and evaluated for the incidence of bacterial growth and assessing the cellulitis and phlebitis. Group A underwent removal of PIC inserted in aseptic condition after 72–96 h and Group B underwent removal of PIC inserted in the emergency room after 72–96 h. Statistical Analysis Used: Unpaired t-test and Chi-square test were used for statistical analysis. Results: No (0%) subjects had bacterial growth in Group A and 2 (8%) subjects in Group B had bacterial growth, but the difference was not found to be statistically significant (P = 0.149). On comparison, cellulitis and phlebitis were absent in both the groups. Conclusions: The incidence of bacterial growth and the local complications like cellulitis and phlebitis following removal of PIC inserted in the emergency room and in aseptic condition was nominal. However, strict aseptic precautions should always be followed while inserting a foreign object into the circulatory system.
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Diagnostic utility of imprint cytology for assessment of breast lumps p. 709
K Vinod, Tirou Aroul, K Anand Raj Vaithi
DOI:10.4103/jdmimsu.jdmimsu_189_20  
Background: Breast lesions are a commonly encountered complaint in the surgical outpatient department. Although majority of these lesions are benign, breast carcinoma is the second most common malignancy in women. Fine-needle aspiration cytology (FNAC) is a well-established preoperative diagnostic measure, whereas histopathological examination (HPE) forms the gold standard for the postoperative diagnosis. Imprint cytology (IC) is a rapid, inexpensive intraoperative diagnostic method under investigation. This study attempted to compare IC with FNAC and HPE for the diagnosis of breast lesions. Materials and Methods: This study included 65 patients with breast lesions. In each case, a diagnosis was established by preoperative FNAC, an intraoperative IC, and their sensitivity and specificity were compared to the diagnosis by HPE which was considered the gold standard for the diagnosis. Results: Sensitivity of IC for diagnosing malignant lesions was 91.6% and specificity was 100%. Similarly, for FNAC, the sensitivity for diagnosing malignant lesions was 91.6% and specificity was 100%. Conclusion: Intraoperative IC is a good diagnostic modality comparable to FNAC in the diagnosis of breast lesions and a reliable adjunct to HPE.
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Human papillomavirus immunohistochemistry in high grade squamous cell lesions of esophagus p. 713
Purvee Agrawal, Arvind Bhake
DOI:10.4103/jdmimsu.jdmimsu_158_19  
Background: Over the past decade, the cause–effect relationship between human papillomavirus (HPV) and squamous cell carcinoma (SCC) of the esophagus has been worked over. A few reports in the literature have demonstrated HPV protein within premalignant and malignant cells of SCC of the esophagus. Aims and Objectives: The aim was to study the high-grade squamous cell lesions and its relation with high-risk HPV infection to be evident on immunohistochemistry for high-risk HPV on biopsies of esophageal lesions. Materials and Methods: Biopsy from 20 esophageal growth processed conventionally, and histological section is stained by hematoxylin and eosin stains; paraffin-embedded tissue of esophageal lesions is processed and stained for immunohistochemistry in the detection of HPV by cocktail HPV16 and HPV18 antibodies by the standard procedure. Results: The present poster describes the results of immunohistochemistry for high-risk HPV on 20 cases of esophagus premalignant squamous cell lesions along with the SCC types and its grade. It has been observed that five cases have been demonstrated for positive results of immunohistochemistry for high-risk HPV. Conclusions: It may be postulated that HPV plays an important role in the pathogenesis of SCC esophagus.
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CASE REPORTS Top

Delayed diagnosis of ankylosing spondylitis p. 715
Nareshkumar Satyanarayan Dhaniwala, Shivangee Prasad, Mukund Naresh Dhaniwala, Ankur Salwan
DOI:10.4103/jdmimsu.jdmimsu_303_22  
Ankylosing spondylitis (AS) is a chronic inflammatory condition affecting the axial skeleton, enthesis, and peripheral joints and is included in a group of disorders termed spondyloarthropathy. Its diagnosis is based on clinical and radiological features. This article reports an atypical case of AS in a 24-year-old female presenting with bilateral hip arthritis without any back symptoms. The report discusses the causes of delayed diagnosis and the relevance of thorough clinical examination.
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Transforming the face of life with a customized ocular prosthesis made using digital photographic sheet p. 718
Maithilee Vikram Hoskalle, Abhilasha Sunny Bhasin, Gaurang S Mistry, Ashwini Y Kini
DOI:10.4103/jdmimsu.jdmimsu_2_22  
Anophthalmic eye has a physical, social, and psychological influence on the affected person. It is quite challenging to restore the normal look of the patient for bringing him to normality in society. An Indian female presented with the chief complaint of an ocular defect due to enucleation for choroidal melanoma, leading to an unpleasant facial appearance. Bearing in mind her psychological and economical status, a customized ocular prosthesis using a digital photographic film for the iris was planned, fabricated, inserted into the ocular defect, and was followed to assess improvement in quality of life. This case report describes the fabrication of an ocular prosthesis using a digital photographic sheet having multiple images of the iris of the patient's normal eye with slight variation in shade and size. Artistic skills, extra time needed in painting the iris, and errors happening due to incorrect sizing of the iris are avoided. The technique is advantageous for a setup where modern equipment is unavailable and a patient's economical status restricts the use of an expensive approach.
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Adenomatoid odontogenic tumor: “Quiet but not Quiet” – A rare case report p. 723
Soumi Samuel, Biju Thomas, Saurabh Pillai, Harish Kumar, Abel Abraham, Deeyah Miriam Deepak
DOI:10.4103/jdmimsu.jdmimsu_40_21  
The adenomatoid odontogenic tumor (AOT) is a hamartomatous benign neoplasia of odontogenic origin. It appears to be, mostly prevalent in young female patients, mostly during the second decade of life. The maxillary region is most affected when compared to the mandible. Its presentation is slow-growing, asymptomatic, and quiet but not quite a lesion. It is related to canines which are unerupted. Here, we report a case of the AOT in the left maxillary region of a female patient aged 13 years. We approached with a surgical enucleation resulting in an excellent outcome.
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Idiopathic necrotizing fasciitis of the breast p. 729
Siddharth Pramod Dubhashi
DOI:10.4103/jdmimsu.jdmimsu_130_20  
Necrotizing fasciitis of the breast is extremely rare. This is a report of a 41-year-old woman with idiopathic necrotizing fasciitis of the breast, who was managed successfully with a good index of clinical suspicion, early surgical intervention, parenteral antibiotics, and nutritional support. This helped in further spread of local infection, minimizing the damage to the breast parenchyma.
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Granulomatosis with polyangiitis affecting nervous system p. 731
Vivek Ramanandi, Kakkad Ashish, Anjan Desai
DOI:10.4103/jdmimsu.jdmimsu_30_20  
Central nervous system involvement in granulomatosis with polyangiitis is quite rare condition. Involvement of multiple systems makes the management of condition difficult. Role of physiotherapy for such a rare condition is unexplored. In this case report, the disease and its medical and physiotherapy management are discussed in brief.
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Steroids in the management of superior orbital fissure syndrome p. 734
Padmakar Sudhakar Baviskar, Srivalli Natarajan, Pradeep Pandurang Vathare, Chinmay Vasant Rao, Ruchita Arun Balkawade, Saloni Bharat Shah, Prachi Manoj Goyal
DOI:10.4103/jdmimsu.jdmimsu_65_20  
Superior orbital fissure syndrome (SOFS) presents as complex impaired function of multiple cranial nerves with unique signs and symptoms. Traumatic etiology is seen in cases of trauma to the deep orbit with associated craniofacial fractures. Being a rare presentation to the oral and maxillofacial surgeon, a sound knowledge of this condition renders an effective diagnosis and prompt initiation of treatment necessary. Current literature evidence on management of this entity is low but highly debated. The authors present a case report of traumatic SOFS of an otherwise systemically healthy patient with detailed diagnostic evaluation and a close follow-up. A combination therapy of high then low-dose corticosteroids was initiated for the patient who demonstrated a rapid as well as complete recovery in 12 weeks. The authors conclude that steroid therapy for management has significantly reduced recovery time and should be considered over observational line of management.
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Extraorally proliferating verrucous carcinoma of buccal mucosa mimicking squamous cell carcinoma: A rare case presentation p. 737
S Akhil, RS Krishna Prasad, KL Girish, T Harinee, RG Mridula
DOI:10.4103/jdmimsu.jdmimsu_97_19  
Verrucous carcinoma (VC) (Ackerman's tumor/Snuff dipper's cancer) is a variant of oral squamous cell carcinoma (SCC) with minimum aggressive potential. The most common sites of involvement in the head-and-neck regions are oral cavity and larynx. VC of the oral cavity is a different clinicopathologic tumor distinguished from the usual SCC because of its local invasiveness, nonmetastasizing behavior, and special clinical appearance, but long-standing cases have shown transformation into SCC. An accurate pathological diagnosis is difficult because of an inadequate tumor sample for the study, and more importantly, a close collaboration is needed between a clinician and a pathologist to achieve the correct diagnosis. In this article, we discuss a case of 42-year-old male with VC of the left buccal mucosa which was proliferating extraorally.
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Immune thrombocytopenic purpura in an elderly male p. 741
Mahesh Mahadeviah, Nikhil Ramdas Shinde, Mamatha Shivanagappa, Madhumitha Mahesh
DOI:10.4103/jdmimsu.jdmimsu_187_20  
Idiopathic Thrombocytopenic Purpura (ITP) is an acquired disorder in which there is immune mediated destruction of platelets and also inhibition of platelet release from the megakaryocytes.[1] The features are by mucocutaneous bleeding and a low platelet count with an otherwise normal peripheral blood cells and smear. ITP is a heterogeneous disease with varying severity and clinical course. It is mainly a disorder of children. In adults the peak prevalence is between 20-50 years.[2] The clinical features in adults are different from those seen in children. ITP in persons above 60 years is being increasingly recognized in literature. ITP in elderly differs in its presentation, course and severity compared to its manifestations in younger adults. The response to treatment is different and the presence of co-morbid conditions such as diabetes, hypertension and ischemic heart disease needs to be kept in mind in the management algorithm.[3] A case of ITP in elderly is presented herewith with a brief review of literature.
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Management of gummy smile with an interdisciplinary approach p. 744
Pooja R Disale, Sameer A Zope, Girish Suragimath, Siddhartha Varma
DOI:10.4103/jdmimsu.jdmimsu_3_20  
In this extremely competitive society, esthetic appearance plays an important role in the acceptance and self-esteem of individuals. Facial expressions and smile are the primary constituents of fast and effective nonverbal communication. Gummy smile is a frequent finding that can occur because of various intraoral or extraoral etiologies. Gummy smile is considered unattractive and a major cause of embarrassment. Lip repositioning was first described in 1973 by Rubinstein and Kostianovsky as a conservative surgical method for correcting a gummy smile. This procedure minimizes the gingival display by limiting the retraction of the elevator smile muscles. This case report describes the management of gummy smile using an interdisciplinary approach. Despite other possible alternatives, the present case was treated with minimally invasive perioplastic surgery (crown lengthening and lip repositioning) and cosmetic restorations of maxillary anterior teeth. Surgical lip repositioning is a safe, predictable procedure with minimal risks or side effects.
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IMAGES Top

Orientation of the iris in ocular prosthesis use of a light source p. 747
Dinesh Rokaya, Pawarit Wanichsetakul, Suppapong Tirakunwichcha, Preamjit Saonanon
DOI:10.4103/jdmimsu.jdmimsu_220_19  
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REVIEW ARTICLES Top

An innovative device for finding submerged cover screws of dental implants: “An implant cover screw detector!” p. 749
Jasmeet Chandhok, Deepika Chandhok, Grishmi Niswade
DOI:10.4103/jdmimsu.jdmimsu_231_20  
This article describes the use of an electronic instrument to detect the presence of cover screws of dental implants submerged inside the mucous membrane during the second-stage surgical procedure for placement of gingival former. The instrument detects the presence of a metallic object at a certain distance from it and makes the clinical procedure of giving a precise incision without unnecessary trauma to the periodontal tissues. Clinical Implication: This device is of use when detecting the exact position of implant cover screw during the second-stage implant surgery. This makes the clinical procedure easy and saves the tissues from unnecessary trauma.
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Doppler profiles of renal and hepatic hemodynamics in patients with cirrhosis of the liver p. 751
Shivesh Pandey, Rajasbala Pradeep Dhande, Gaurav Vedprakash Mishra
DOI:10.4103/jdmimsu.jdmimsu_411_22  
One in five individuals with cirrhosis of the liver may experience renal impairment, a frequent consequence that is linked to increased mortality and morbidity. Even before changes in serum creatinine concentration can be detected, renal hemodynamic alterations start to occur early in the course of functional kidney failure caused by liver disease. Studying the Doppler profiles of renal and hepatic hemodynamics in people with liver cirrhosis is the goal of this review article. People with liver cirrhosis, even before clinical signs of renal impairment appear. Doppler is a quick, reliable, and noninvasive technique that makes it possible to identify renal hemodynamic changes in individuals with liver cirrhosis even before they become clinically obvious.
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Utility of uterine artery doppler indices for prediction of preeclampsia: A narrative review with systematic analysis p. 757
Prerna Anup Patwa, Gaurav Vedprakash Mishra, Rajasbala Pradeep Dhande, Rohan Kumar Singh, Sonal Singh
DOI:10.4103/jdmimsu.jdmimsu_413_21  
Background: Hypertensive disorders complicating pregnancy are common. Preeclampsia and eclampsia are major causes of maternal morbidity and mortality, particularly in developing countries. With prompt recognition of symptoms and early diagnosis of preeclampsia can lead to improved maternal and neonatal outcomes. Although, numerous tests have been proposed for the prediction of preeclampsia, their results have been inconsistent. So, we focused our research to study the uterine artery doppler for predicting preeclampsia in high-risk women. Methodology: We conducted a search on Google Scholar and PubMed based on Medical Subject Heading terms preeclampsia and uterine artery Doppler ultrasound. The articles between 2016 and 2020 which were in English were taken into consideration. We performed a qualitative interpretation as an approach for extracting the data. Results: Majority of the studies showed raised pulsatility index as a good predictor of preeclampsia, although it was closely followed by uterine artery notching which is in the early diastolic period. Conclusion: The findings of our research suggest that uterine artery Doppler indices and early diastolic notch can be used as a tool for the prediction of preeclampsia with high confidence.
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Computed tomography evaluation of temporal bone fracture and hearing loss: A narrative review with systematic analysis p. 762
Rohan Kumar Singh, Gaurav Vedprakash Mishra, Rajasbala Pradeep Dhande, Prerna Anup Patwa, Sonal Singh
DOI:10.4103/jdmimsu.jdmimsu_415_21  
In the modern world, the most common cause of head trauma causing temporal bone fracture in adults is road traffic accidents with high impact force. Hearing loss is one of the most common complaints after head trauma involving temporal bone fracture. Because of other life-threatening conditions associated with road traffic accidents, fractures of temporal bone is often overlooked. If these fractures are detected early, there complications can be avoided with conservative or surgical intervention. In this research following databases were used to search for published as well as unpublished studies over the period 2000–2021 in the English language: PubMed, EMBASE, and Web of Science. The terms used to generate a search were as follows: Temporal bone fracture and hearing loss. Those studies which did not fulfil the inclusion criteria were removed. Case reports, documentaries, and duplicate data were excluded. Most common cause of injury leading to temporal bone fracture was road traffic accident. Majority of cases were males belonging to the age group of 31–40 years and average age was 36 years. According to traditional classification, majority had longitudinal fracture followed by transverse fracture. According to newer classification, otic capsule sparing was more common in comparison to otic capsule involvement. The conductive type of hearing loss was more common and it was found associated with longitudinal fracture while sensorineural type of hearing loss was associated with transverse type of fracture. The conductive type of hearing loss was usually common in otic capsule sparing while sensorineural type of hearing loss is associated with otic capsule involvement. Otic capsule sparing is mostly seen in longitudinal fracture and transverse fracture involves otic capsule involvement. Head trauma due to fast moving vehicles is the most common cause of injury leading to temporal bone fracture. Because of complex structure of temporal bone identification of line of fracture is necessary which requires high-resolution computed tomography (CT) of the head. High-resolution CT not only helps in knowing anatomy and types of fracture but also it helps in knowing sequelae of various types of fractures which helps in treating physician weather to go for conservative or surgical intervention.
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The spectrum of the atomic energy regulatory board under the department of atomic energy with respect to a medical radiation facility p. 766
Luharia Anurag, Mishra Gaurav, Dhoble Sanjay, Mahakalkar Chandrashekar
DOI:10.4103/jdmimsu.jdmimsu_254_22  
Increasing medical radiation facility strongly demands to have a dedicated, competent regulatory body for guiding and managing radiation safety, quality, and standardization of rules and regulations to safeguard the human population nature from adverse effects of radiation. In India, we have the Atomic Energy Regulatory Board for managing the medical radiation facility for diagnosis and treatment of medical conditions and also to save them from radiation hazards under the Department of Atomic Energy (DAE), India. The Atomic Energy Regulatory Board (AERB) has launched the e-Licensing of Radiation Application (eLORA), which is an application built on the web-based that establishes a channel of direct communication between the AERB and its stakeholders for information and communication exchanges in terms of providing regulatory services with higher levels of effectiveness, reliability, and transparency. They also provide various radiation awareness programs, advertisements, and radiation safety guidelines for diagnostic and therapeutic procedures. DAE has a very wide spectrum in which the AERB plays a vital role in establishing regulatory processes, activities of radiation facilities such as radiodiagnosis, radiotherapy, and nuclear medicine in medical also create and publish regulatory safety documentation for utilities and consumers along with acts and regulation. Basically, AERB provides the common platform for all the radiation practicing medical institutions through eLORA, which help to streamline the radiation practice toward the betterment of humankind.
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Modern diagnostics processes among new strains of Coronaviruses: A review Highly accessed article p. 772
Afzal Husain Khan, Mohammad Hadi Dehghani, Nadeem A Khan, Syed Sadat Ali, Muhammad Akram, Sharmili Roy, Shah Saud Alam
DOI:10.4103/jdmimsu.jdmimsu_375_22  
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes the COVID-19 disease, which is a considerable outbreak that appeared in late 2019, and within a short period, this disease rapidly extended globally. Its prompt airborne transmission and highly infectious pneumonia-like symptoms in patients caused turmoil worldwide. This virus has a relatively high mortality rate compared to previous outbreaks such as Middle East respiratory syndrome coronavirus and SARS-CoV. Therefore, the World Health Organization declared COVID-19 a global health pandemic on January 30, 2020. However, the recent COVID-19 outbreak and newly emerged variants such as Delta and Omicron are having a huge spike in the human population. This rise has been a kind of challenging situation worldwide as perception is still limited in terms of modes of transmission, severity, diagnostics clinical oversight. Therefore, this review highlights the importance of these issues via a Medline search using the terms novel, coronavirus, sources, genetic nature, contagious routes, clinical characteristics, and diagnostic procedures for COVID-19. The authors extensively reviewed the analysis of behavior and impacts of this virus's activities worldwide. The study reveals that patients' epidemiology and clinical characteristics in different frames are sensitive toward commanding this virus and its associated diseases. Finally, the parametric data gathered for this study are also presented for use in forecasting models. Along with these searches, the authors have comprehensively discussed the current modern diagnostic processes.
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Dysphagia in the elderly: A multidisciplinary approach p. 779
Manish Gupta, Monica Gupta, Akanksha Gupta
DOI:10.4103/jdmimsu.jdmimsu_194_22  
The process of eating and swallowing is a complex physiologic process requiring volitional as well as reflexive activities and involving multiple structural and functional elements. Dysphagia is a geriatric syndrome resulting in multiple negative health consequences. Dysphagia can have profound adverse influences, including malnutrition, dehydration, aspiration pneumonia, and depression poor quality of life in the elderly. With the aging of the population across the globe, health-care providers are encountering older patients with dysphagia either due to oropharyngeal or esophageal disease. Barium swallow remains a low-cost initial alternative for luminal and esophageal motility assessment. A variety of emerging modalities can help detect anatomical and functional deficits. These include fiberoptic endoscopic evaluation of swallowing, videofluoroscopic swallow study, high-resolution pharyngeal manometry, and esophagogastroduodenoscopy. This review provides a comprehensive review of diagnostic modalities and addresses several issues regarding the collaborative management of elderly persons with dysphagia, including a brief discussion on how swallowing mechanisms are affected by the aging process.
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Dentinal hypersensitivity: A clinical dilemma p. 786
Deepa Sara John, Nina Shenoy, Rahul Bhandary
DOI:10.4103/jdmimsu.jdmimsu_339_21  
The increase in lifespan and decrease in the prevalence of edentulism have increased the overall risk of tooth wear. This in turn has caused dentinal hypersensitivity (DHS) to be one of the most frequently encountered oral health problems. DHS, commonly referred to as the “common cold” of dentistry, is associated with pain due to exposure of dentine following loss of the enamel. The discomfort caused due to DHS is highly subjective and can lead to deterioration of their quality of life. The most crucial but often neglected phase of the management of DHS is the elimination of its etiology. Identifying the etiology enables the clinician to include prevention in the treatment plan. There is a wide range of treatment modalities ranging from those that can be self-administered by the patient at home or those that can be applied by clinicians in a dental clinic. However, one of the main limitations is that there is no universally accepted, gold-standard treatment for DHS, which gives a long-term pain relief. Different agents have been suggested with varying degrees of efficacy when studied scientifically. An electronic literature search was conducted through PubMed, and dental associations of different countries' website and full-text articles in the English language were selected. This article concisely reviews the prevalence and distribution, etiological factors, and the management of DHS.
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Autoimmune disorders with special reference to Coronavirus Disease-2019 p. 792
Swathi Gurajala
DOI:10.4103/jdmimsu.jdmimsu_475_20  
The COVID-19 outbreak by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, was reported in late December 2019 in Wuhan, China, and has gradually evolved into a pandemic. The number of cases is increasing enormously, so is our knowledge of possible signs and symptoms, clinical manifestations, diagnosis, and management. Few cases develop complications due to excessive cytokine release and uncontrolled immune activation. Several researchers believe that the extensive organ, tissue, and cellular damage done by the virus can be due to antigenic mimicry with the human tissues and the production of autoantibodies. Recent reports of SARS-CoV-2 preceding antiphospholipid antibody syndrome, Miller Fisher syndrome, Guillain–Barré syndrome, Kawasaki syndrome, etc., provide definite examples of this virus's capability to cause the immune system dysregulation. With the rush to mass immunization against the disease, several types of vaccine candidates are in clinical trials, and the risk of developing autoimmune reactions should be considered due to host and pathogen interactions. Hence, in this review, we aim to summarize the various immune dysregulation autoimmune syndromes concerning the SARS-CoV-2 infection published to date.
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LETTERS TO EDITOR Top

Is surgery necessary in benign thyroid lesions? p. 799
Pushkar Chaudhary, Naseem Noorunnisa
DOI:10.4103/jdmimsu.jdmimsu_58_19  
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Foreign-body type of giant cell reaction in a case of spinal epidural abscess p. 800
Vissa Santhi, Bhimasen Soren, Amit Agrawal, V Umamaheswara Reddy, Yashwanth Sandeep
DOI:10.4103/jdmimsu.jdmimsu_7_16  
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N95: Hurdles ahead! p. 802
Poonam Chauhan, Parakriti Gupta, Kapil Goyal, K Sangeetha, Mini P Singh
DOI:10.4103/jdmimsu.jdmimsu_236_20  
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Left congenital seminal vesicle cyst associated with ipsilateral renal agenesis and testicular atrophy: An important association p. 804
Megha Manoj, Suresh V Phatak, KB Harshith Gowda, Soumya Jain
DOI:10.4103/jdmimsu.jdmimsu_431_20  
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Summarization on 57 pregnant women with COVID-19 with special reference to vertical transmission feasibility p. 806
Pathum Sookaromdee, Viroj Wiwanitkit
DOI:10.4103/jdmimsu.jdmimsu_167_20  
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Mental health nurse and COVID-19: View from Southeast Asia p. 807
Viroj Wiwanitkit
DOI:10.4103/jdmimsu.jdmimsu_197_20  
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Expected incidence of thrombocytopenia in influenza patient after ruling out for dengue concurrence p. 808
Beuy Joob, Viroj Wiwanitkit
DOI:10.4103/jdmimsu.jdmimsu_92_19  
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COVID and the loss of smell p. 809
Rujittika Mungmungpuntipantip, Viroj Wiwanitkit
DOI:10.4103/jdmimsu.jdmimsu_153_20  
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Obesity among COVID-19 death cases: Observation from Thailand p. 810
Sora Yasri, Viroj Wiwanitkit
DOI:10.4103/jdmimsu.jdmimsu_79_20  
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Multifocal transitional carcinoma of urinary bladder: Ultrasonography and doppler imaging p. 811
Shivesh Pandey, Suresh V Phatak, Gopidi Sai Nidhi Reddy, Amruta Dinesh Varma
DOI:10.4103/jdmimsu.jdmimsu_459_20  
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ERRATUM Top

Erratum: Predictive accuracy of neutrophil-to-lymphocyte ratio on severity and outcomes in COVID-19 patients: A retrospective study p. 813

DOI:10.4103/0974-3901.339468  
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