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   Table of Contents - Current issue
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July-September 2018
Volume 7 | Issue 3
Page Nos. 157-239

Online since Monday, September 17, 2018

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ORIGINAL ARTICLES  

Evaluation of narrowband ultraviolet B phototherapy in patients with generalized lichen planus Highly accessed article p. 157
Krishna P. P Arumilli, Raghurama Rao Gandikota, Prasad C Arumilli
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_21_18  
Background: Lichen planus (LP) is a chronic inflammatory pruritic dermatosis affecting people of all ages and both sexes. Various therapeutic modalities have been tried in acute generalized LP with limited success. Currently, narrowband ultraviolet B (NB-UVB) therapy is being used to treat various inflammatory diseases. There are limited published studies in the literature to evaluate the efficacy of NB-UVB therapy in LP. Aim: To evaluate the efficacy, tolerability, and safety of NB-UVB therapy in acute generalized LP in both children and adults clinically and to observe relapse on follow-up. Materials and Methods: This was a prospective, open, and nonrandomized study. The study group included 70 patients of both sexes with a mean age group of 5–65 years. For the purpose of the study, a template of 5 × 5 cm with a high density of lesions was taken in addition to general response and photographic evaluation before and after treatment. A starting dose of 150 mJ/cm2 was started given twice weekly on nonconsecutive days with a 20% increment on every third exposure. The clinical response was graded on a four-point scale (excellent to poor). All cases who responded were observed for a period of 6 months for relapse. Appropriate statistical methods were employed. Results: In this study, excellent response was seen in 35 patients (mean: 25.7 exposures), good response in 11 patients (25.3 exposures), fair response in 9 patients (50 exposures), and poor response in 5 patients (50 exposures) (P-value = 0.000). A relapse rate of 9% after 6 months of follow-up and 36% after 1-year follow-up was observed (P-value = –0.002). Limitations: As the sample size of this study is small, large studies are needed to establish the efficacy of NB-UVB therapy in acute generalized LP. Conclusion: NB-UVB therapy is an effective and safe modality of treatment for acute generalized LP in both children and adults. Approximately, 20–25 exposures are needed to get good response. Prolonged remission is obtained with NB-UVB therapy.
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HIV knowledge, attitude, and practices among nursing students in Guntur city Highly accessed article p. 162
Ambica Reddy, Vikram S Bommireddy, Srinivas Pachava, Viswa C Chandu, Suresh C Yaddanapalli, Asha Lodagala
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_11_18  
Introduction: Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) has become one of the dreadful health problems in the world. An integrated approach is strongly suggested for creating knowledge, attitude, and awareness to control the spread of HIV/AIDS among healthcare workers. Aim: The aim of this study was to assess the knowledge, attitude, and practices of nursing students toward provision of care for HIV/AIDS-affected people. Materials and Methods: This cross-sectional study was conducted among students attending four nursing colleges in Guntur city, Andhra Pradesh. A self-administered semi-structured questionnaire was used to collect data regarding knowledge, attitude, and practices in provision of care for HIV patients. Of 1012 students, a total of 839 students agreed to participate in the study, of which 800 completely filled questionnaires were returned and subjected to statistical analysis. Data analysis was done using SPSS version 20 software and Chi-square tests were used to analyze the data. Results: Approximately 96.37% of students were aware that sexual intercourse can spread HIV/AIDS, whereas only 47.75% had knowledge on spread of HIV through tattooing. In total, 37.25% erroneously believe that salivary contact can spread HIV/AIDS. Around 20.37% of the study participants reported that they would not prefer to care for HIV patients. Approximately 50.75% of females and 54.17% of males expressed their apprehension of being exposed to HIV/AIDS at work. Conclusion: A majority of nursing students had adequate knowledge, and few students held discriminatory attitudes toward people with HIV/AIDS.
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Tobacco-induced alterations in exfoliated oral epithelial cells: A comparative image analysis study p. 168
Divyasri Godavarthy, Rashmi Naik, B R. Ahmed Mujib, Praveen K Gali, V Smitha, Mukund Nair
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_10_18  
Background: Squamous cell carcinoma is the most prevalent neoplasm of the oral cavity. A strong relationship exists between tobacco smoking and development of oral squamous cell carcinoma. The mortality rate associated with head and neck cancers remains high, and thus detection techniques are important. Oral exfoliative cytology is a simple, noninvasive method that involves microscopic analysis of cells collected from the surface of oral mucosa which can reveal various cellular and nuclear alterations in squamous cell carcinoma. Aims: This study aims to analyze the cytomorphometric changes in smokers and nonsmokers and to compare and evaluate the efficacy of different stains, that is, Papanicolaou, Methyl green-pyronin, and Feulgen stains in assessing the oral smears. Patients and Methods: Study sample consists of 72 healthy individuals of 30–40 years including two groups (36 smokers and 36 nonsmokers) who had no clinically apparent oral mucosal lesions. Three smears were obtained from each subject with oral cytobrush and were then stained separately with Papanicolaou, Methyl green-pyronin, and Feulgen stains. Smears were observed and assessed for cytoplasmic diameter, nuclear diameter, and nuclear color intensity. Results: All three stains in our study showed significant variations in all three parameters between smokers and nonsmokers (P < 0.05). Out of all the three stains, Methyl green-pyronin Y stain proved to give better results. Conclusion: This study contributed to the fact that exfoliative cytology is a simple, noninvasive diagnostic technique for identifying cancerous changes in oral mucosa at an early stage for early intervention.
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Evaluation of acellular dermal matrix allograft [Alloderm®] with coronally positioned flap in the treatment of Miller's Class I or Class II gingival recession p. 174
K Lakshmi Kanth, S Chakrapani, D Narasimha Swamy, Santosh B. B Kumar
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_74_17  
Aim: The aim of the study was to clinically evaluate the efficacy of acellular dermal matrix allograft [Alloderm®] in combination with coronally positioned flap in treatment of Miller's Class I or Class II isolated gingival recessions. Materials and Methods: Fifteen systemically healthy patients with Miller's Class I or Class II isolated gingival recessions participated in the study. Coronally positioned flap was performed and acellular dermal matrix allograft [Alloderm®] was placed over the defect. Clinical parameters such as recession height, recession width, keratinized tissue height, clinical attachment level, probing depth, plaque index, and gingival index were evaluated at baseline, 3 months, and 6 months post surgery. The percentage of root coverage was calculated. Descriptive statistical analysis has been carried out using Student's t-test (two-tailed, dependent) to determine the significance of study parameters on continuous scale within each group. The Statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0, and R environment ver. 2.11.1 were used for data analysis. Results: In the study, the recession height decreased from the baseline of 2.50 ± 0.53 mm to 0.3 ± 0.48 mm at 3 months and remained unchanged after 6 months with percentage of reduction being 89%; recession width decreased from the baseline of 4.10 ± 0.74 mm to 0.7 ± 0.95 mm after 3 months and to 0.4 ± 0.52 mm after 6 months (91%), increase in the keratinized tissue height (KTH) from the baseline of 3.6 ± 0.70 mm to 4.7 ± 0.67 mm after 3 months and further increased to 6.4 ± 0.52 mm after 6 months (64%) and gain in CAL from baseline of 4 ± 0.82 mm to 1.9 ± 1.2 mm after 3 months and further reduced to 1.4 ± 0.52 mm after 6 months (74%). There was statistical difference in all the parameters indicating good percentage of root coverage. Conclusion: The use of Alloderm® along with coronally positioned flap provided significant improvement in all measured clinical parameters, indicating that graft gives favorable results in treating Miller's Class I or Class II isolated gingival recessions.
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Oral submucous fibrosis: Clinical and histopathological correlation of collagen fibers using Masson's trichrome and Van Gieson stains p. 181
Swetha Kanneganti, Kiran K Kattappagari, K Tanuja, K Lalith Prakash Chandra, Chandrasekhar Poosarla, Venkata R. R. Baddam
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_78_17  
Background: Oral sub mucous fibrosis (OSMF) is chronic insidious diseases of the oral cavity, pharynx and larynx with unknown etiology. It is characterized by mucosal rigidity. The proposed etiological factor for causing OSMF areca nut. Areca nut and arecoline cause fibroblast proliferation and collagen production. Aim and Objectives: Correlate the clinical and histopathological grading using Masson's trichrome and Van Gieson's stain in OSMF. Materials and Methods: Thirty patients with clinically proven cases of OSMF and grouped according to their mouth opening. Incisional biopsy was done. The sections were stained with hematoxylin and eosin for histopathological conformation. Selected cases were sectioned and stained with Masson's trichrome and Van Gieson special stain and graded histopathologically. Data was analyzed using SPSS 20.0 version. Pearson's correlation coefficient and Chi-square test were done to find out the association between variables. Student's t-test was used to find clinical and histopathological correlation. Results: The mean age of OSMF patients was 20–40 years and when compared with gender males were affected more than females. The stains between Masson's trichrome with Van Gieson's stain showed significant correlation, but when compared between clinical and histopathological grading there was no statistically significant. Conclusion: Clinical staging and histopathological grading in OSMF there is no correlation when using special stains such as Masson's trichrome and Van Gieson's stain.
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A quantitative expression of Ki-67 to evaluate malignant transformation rate in potentially malignant disorders p. 185
Mani D Chitipothu, Kiran K Kattappagari, Divyasri Godavarthy, Chandrashekar Poosarla, Sridhar R Gountu, Venkata R. R. Baddam
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_40_18  
Objective: To evaluate the quantitative expression of Ki-67 in oral leukoplakia, oral submucous fibrosis (OSF) and to compare their expression with normal oral epithelium. Materials and Methods: Thirty archival paraffin-embedded blocks were retrieved from the Department of Oral and Maxillofacial Pathology. It includes three groups with 10 specimens each of histopathologically confirmed oral leukoplakia, OSF, and controls, which were taken as standard for comparison. Ki-67 immunostaining was detected and numbers of positive cells out of 1000 were counted in 10 random high-power fields in each case. Statistical analysis was done using one-way analysis of variance test. Results: Mean and standard deviation of oral leukoplakia was found to be higher (398 ± 82) followed by OSF (343 ± 83) and controls (290 ± 72). Pairwise comparison of three groups with respect to expression of total number and percentage of cells was statistically significant between oral leukoplakia and controls (P < 0.05). Conclusion: The results of the present study emphasize that malignant transformation rate was higher for oral leukoplakia compared with OSF and controls. Hence, it serves as a prognostic tool for early detection of malignancy.
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Perceptions on epilepsy stigma among attendants of patients other than epilepsy p. 190
M Nagarathnam, S A. A. Latheef
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_104_17  
Background: Stigma is an important contributor for epilepsy. In India, most studies on epilepsy stigma were carried out using knowledge, attitude, and practice questionnaires. Of the four studies which used stigma scale, only three studies investigated up to 50 healthy subjects and were of eastern and western-central India; however, representation is lacking from south India. Perceptions on stigma vary by region and cultural group. Aim: To study the perceptions among attendants of patients other epilepsy. Materials and Methods: In a prospective observational study, 170 healthy attendants of patients other than epilepsy belonging to south India were recruited and their perceptions on epilepsy stigma were documented. Results: Mean age of the subjects was 34.39 ± 11.49 years. The mean score of epilepsy stigma was 20.06 ± 13.66. Majority of the subjects had mild epilepsy stigma perception (83.6%). No significant difference in epilepsy stigma score was observed with respect to gender, age groups, religion, and marital status. Higher epilepsy stigma score was observed in rural, less educated, and low income groups. In regression analysis, family income (standardized beta = −0.201, P < 0.01) and occupation (standardized beta = −0.174, P < 0.05) were found to be the significant predictors of epilepsy stigma. Conclusions: The results suggest that, to reduce the stigma of epilepsy among the public, socioeconomic and educationally disadvantaged groups should be given priority for destigmatization campaigns.
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CASE REPORTS Top

Tuberculosis: Cause or association in a young female with Takayasu arteritis with dilated cardiomyopathy p. 196
Kekathi Vidyasagar, Boya Chinna Maddiletigari Pullaiah, Penumadu Sudhakar, Sravan Kumar Korrapati
DOI:10.4103/2277-8632.241287  
Takayasu arteritis (TA) is a rare, systemic, and inflammatory large-vessel vasculitis of unknown etiology. A possible relationship between TA and tuberculosis (TB) has been suggested. Both diseases have similar chronic inflammatory lesions and occasionally granulomas on the arterial walls. Although TA may present in many ways, its presentation as dilated cardiomyopathy (DCM) is rare. We hereby report a case of TA with DCM, associated with TB.
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Nevoid basal cell carcinoma syndrome: A case report p. 200
Venkatesh K Dodda, Sravya Taneeru, Venkateshwara R Guttikonda, Rajsekhar Gaddipati
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_3_18  
Nevoid basal cell carcinoma syndrome (NBCCS) is an autosomal dominant inherited condition that exhibits high penetrance and variable expressivity. The syndrome is caused by mutations in patch (PTCH), a tumor suppressor gene that has been mapped to chromosome 9q22.3-q31. NBCCS is characterized by basal cell carcinomas (BCCs), odontogenic keratocysts of the jaws, pits of the palms and soles, ectopic calcification particularly of the falx cerebri, and skeletal anomalies. Other features, including ovarian fibromas, medulloblastoma, ocular anomalies, and neurological defects, are also associated with this syndrome. It arises in all races with equal sexual predilection. It is a rare syndrome and incidence rate is 5%. In this report, we present a case of NBCCS in a 30-year-old male patient.
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Unusual presentation of a recurrent hydatid of the liver p. 204
Tripuraneni Venkata Aditya Chowdary, Sivanpillay Mahadevan Sivaraj, Bathalapalli Jagan Mohan Reddy, Sampath Thirunavukkarasu
DOI:10.4103/2277-8632.241283  
Hydatid disease of the liver is still a common disease in our country with the involvement of the liver being the most common. Recurrence after surgery is, usually, confined to the liver, or generalized dissemination occurs throughout the peritoneal cavity. A female patient presented with a glistening swelling in the right upper quadrant of 6 month's duration. She was previously operated for a hepatic hydatid. She was investigated and found to have a hepatic recurrence infiltrating into the subcutaneous tissue. She underwent excision of the same. This case is being reported as for it is uncommon for a hepatic hydatid to present as a subcutaneous cyst.
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Mucinous adenocarcinoma of stomach with multiple foci of calcification: Addition of a case and a review of literature p. 207
Rashmi Patnayak, Bodagala Vijaylaxmi, H Narendra, Amitabh Jena, Gajjala Venkata Sivanath Reddy
DOI:10.4103/2277-8632.241285  
In gastric carcinoma, tissue calcification is rarely noted. Most of the adenocarcinoma cases with calcification described in literature are gastric mucinous adenocarcinoma. We present one such case of a 33-year-old female with a brief review of literature. The multiple foci of punctate calcification were visible in images, gross specimen, and also on histopathological examination. This is an addition of a case to the existing literature.
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Watery diarrhea: An unusual presentation of adrenal ganglioneuroma in a child p. 210
Pramila Sharma, Rahul Gupta, Arvind K Shukla, Ranjana Solanki, Aarti Mittal
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_59_18  
A 2-year-old male child presented with upper respiratory tract infection along with history of recurrent watery diarrhea for the last 9 months, which was being treated as lactose intolerance. Computed tomography revealed a 5 cm right adrenal mass; complete excision was performed. Histopathology revealed a mature adrenal ganglioneuroma. The patient is no longer suffering from frequent diarrhea and is doing fine on 1-year follow-up. In any pediatric patient with adrenal tumor presenting with watery diarrhea, vasoactive intestinal polypeptide-producing ganglioneuroma must be kept as differential diagnosis.
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Elizabethkingia meningoseptica: An emerging pathogen causing neonatal meningitis p. 213
Siva Kalyani Chamalla, Satya Sri Karri, Sesagiri Koripadu, Nitin Mohan
DOI:10.4103/2277-8632.241278  
Cerebrospinal fluid from a near-term second twin female baby with a history of seizures and respiratory distress requiring ventilator support was sent to our laboratory for culture. Light yellow colored colonies of 1-2 mm diameter of Gram-negative bacilli on chocolate and blood agar with no growth on MacConkey agar seen. The bacterium was multidrug resistant. Based upon the growth characteristics, bio-chemical reactions, drug susceptibility pattern and identification by Vitek 2 system (BioMerieux, France) the isolate was identified as Elizabethkingia meningoseptica. Treatment was started with cefoperazone-sulbactam. Baby subsequently developed hydrocephalus and required the insertion of a ventriculo-peritoneal shunt. Baby slowly improved and was discharged. The presence in the hospital environment along with multidrug resistance makes E. meningoseptica a successful emerging nosocomial pathogen.
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Diffuse multiple giant adenomyomatous endometrial polyps: A rare case report p. 216
Atla Bhagyalakshmi, T Nagamani, B V. S. Kartheek, Chowdari Balaji
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_23_18  
Endometrial polyps represent a limited focal, circumscribed overgrowth of the endometrium. They are often found in perimenopausal women. Here we present a case of a 25-year-old infertile lady admitted with chief complaint of frequent heavy prolonged menstrual bleeding. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. On gross examination of the uterus, there were multiple endometrial polyps filling the entire endometrial cavity. Histopathology revealed adenomyomatous endometrial polyps.
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Follicular dendritic cell sarcoma of axillary lymph node: A rare entity presenting with diagnostic challenge p. 219
Sandip Kumar Mohanty, Debahuti Mohapatra, Shirin Dasgupta, Pranita Mohanty, Kaushambi Chakraborty
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_53_18  
Follicular dendritic cell sarcoma (FDCS) originating from follicular dendritic cells is an uncommon proliferation of spindle to ovoid cells with morphological and immunophenotypic diversity. While most of the FDCSs are primary tumors of lymph nodes, at least one-third of them occur in extranodal sites. A 60-year-old male presented with right-side axillary swelling without systemic features; clinically and radiologically suspected as inflammatory lesion, but cytologically diagnosed as pleomorphic sarcoma. Microscopy revealed diagnostic challenge because of complex histomorphology and architecture which was pinpointed only after a battery of immunohistochemical (IHC) studies. Broad differential diagnosis both clinically and histomorphologically ranging from undifferentiated carcinoma, melanoma, to pleomorphic sarcoma creates diagnostic pitfall. Thus, IHC plays a major role in establishing this rare entity.
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Seckel syndrome: A case report of the rare syndrome p. 223
N Mahesh, Sivan Sathish, Lakshmayya Naidu, Sanjay Reddy, J Rajesh K. Reddy, Pavan Kancherla
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_100_14  
Seckel syndrome is a rare genetic disorder characterized by marked intra-uterine growth retardation (primordial dwarfism) and post natal dwarfism, microcephaly, mental retardation and typical facial features with a 'bird-headed' appearance. The syndrome has autosomal recessive inheritance with equal male and female sex occurrence. Here is an interesting case of a nineteen years old male patient, presented with various clinical manifestations, typical radiographic features and characteristic dental manifestations correlated with the literature. A thorough knowledge aids in better diagnosis, proper management and prevention of disastrous complications arising from this extremely rare inherited disorder, the Seckel syndrome.
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An insight of intramural plexiform hemangiomatous proliferation in unicystic ameloblastoma: A rare case report p. 228
Kailash Chandra Dash, Sujatha Ramachandra, Lipsa Bhuyan, Harish Kumar
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_58_17  
Ameloblastoma is one of the most common benign odontogenic tumors of the jaw. It is generally categorized into: solid (multicystic), unicystic, and peripheral. Unicystic ameloblastoma is a single cystic cavity presenting ameloblastomatous differentiation in the lining. The clinical, radiographic, and histopathological features of unicystic ameloblastoma are usually confusing and misdiagnosed as odontogenic cysts of jaws. Increased vascularity in a tumor can not only affect its prognosis but can also increase the risk of tumor seeding and secondary tumor. Here, we present a case of intramural plexiform hemangiomatous proliferation in unicystic ameloblastoma in a 25-year-old male that is a rare entity and needs to be explored.
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A case report of Weil's disease p. 233
Venkata Krishna Pothukuchi, Shaik Ahmed, Katreddy Venkata Narasimha Reddy
DOI:10.4103/2277-8632.241282  
We are reporting a case of Weil's disease which is a severe form of leptospirosis manifesting with fever, jaundice, renal failure and hemorrhagic manifestations as it is a very important public health problem and to focus that it is also occurring in our area. The treating physicians may be alerted to consider the leptospirosis in the differential diagnosis of fevers so that early empirical treatment can be given to avoid the multi-organ dysfunction and mortality.
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Maxillary osteomyelitis in Albers-Schönberg disease: A rare presentation p. 236
Borra Venkata Naga Koti Jyothi Pavan, Gouri Shankar Kejriwal, Bagadi Lava Kumar
DOI:10.4103/2277-8632.241279  
Osteopetrosis (Albers-Schönberg disease) is a rare congenital disorder in which the bones become overly dense. This results from an imbalance between the formation of bone and the breakdown of bone. Osteomyelitis is well-documented as a complication of osteopetrosis. Decreased vascularity of the involved bones predisposes the patient to the development of osteomyelitis. Several case reports have been published of infectious complications affecting the mandible but maxillary infection is quite rare. This discusses a case of osteopetrosis with maxillary osteomyelitis as a complication in a 13-year-old boy.
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