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   Table of Contents - Current issue
Coverpage
July-September 2019
Volume 8 | Issue 3
Page Nos. 153-231

Online since Thursday, October 17, 2019

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REVIEW ARTICLE  

Cathepsins in oral diseases Highly accessed article p. 153
K Ajay Benarji, K Roja Lakshmi, Hasini Nelakurthi, Pothuraju Haritha, Rudraraju Amrutha
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_54_19  
Cathepsins are a class of globular lysosomal proteases known to be responsible for protein degradation. In addition to proteolysis they have many biological roles such as apoptosis wound healing angiogenesis, proenzymatic activation, bone remodelling and resorption. Cathepsins role has been implicated in the pathogenesis of systemic diseases such as cancer, bronchial asthma, atherosclerosis, neurological disorders, rheumatoid arthritis and osteoarthritis. This review highlights the role of cathepsins in various oral diseases like periodontitis, odontogenic cysts, ameloblastomas, salivary gland tumours and oral malignant melanoma.
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RESEARCH ARTICLE Top

A study of effect of end-stage renal disease on fingerprints p. 159
J Indirakshi, Hari Krishna Reddy Mogili, R Ram, V Siva Kumar, Abhilash Koratala
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_38_18  
Background: Epidermal ridge patterns on fingers, commonly known as fingerprints are one of the oldest and reliable means for human identification. Their reliability is based on the fundamental premise that these patterns are unique to individuals and persistent, i.e., do not change with time. In our maintenance hemodialysis program, we have observed that some of the patients were experiencing problems due to alteration in the pattern while using fingerprints as a biometric for identification. Therefore, we conducted an observational study to understand the magnitude and changes in patterns of the fingerprint impression in patients with end-stage renal disease (ESRD) on hemodialysis. Objectives: To compare and record loss of fingerprint pattern in patients of Chronic Kidney Disease on maintenance hemodialysis and in controls. Methods: A case control study was conducted over six months period on 150 patients with Chronic Kidney Disease on dialysis and 150 patients of healthy controls in Sri Venkateshwara Institute of Medical Sciences,Tirupati. The fingerprints were obtained from all the ten fingers and were analyzed using a magnifying lens under good day light for finger print clarity and pattern . Statistical analysis was performed using SPSS 17.0 software (SPSS, Chicago, 2, USA), unpaired student T test. Results: Fingerprints were partially lost in 13.3% and completely lost in 10% of patients with ESRD while it was only 1.3% in control group.
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ORIGINAL ARTICLES Top

Perfusion-weighted imaging in differentiating ring-enhancing lesions in brain p. 162
G P Venkat Choudary, Amancharla Yadagiri Lakshmi, Vijaya Lakshmi Devi Bodagala, V V Ramesh Chandra, Naveen Thota, Amit Kumar Chowhan
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_63_19  
Context: Ring-enhancing lesions in the brain always raise questions among radiologists and given the many possible differential diagnosis, it may sometimes be difficult to reach a diagnosis with conventional magnetic resonance imaging (MRI). The introduction of advanced imaging techniques, such as perfusion- and diffusion-weighted imaging, has contributed to the differentiation. Aim: The aim of the study was to differentiate various ring-enhancing lesions in the brain using perfusion-weighted imaging (PWI) on the basis of relative cerebral blood volume (rCBV). Materials and Methods: This prospective study was conducted on 39 consecutive patients, from rural and suburban areas of Tirupati, in the time frame of 14 months and included neoplastic (24 cases) and infectious (15 cases) lesions showing ring-shaped contrast enhancement on conventional MRI. PWI was performed and the rCBV values were obtained. The final diagnosis was made by histopathology of surgical specimen (in operated cases) and on response to treatment in the form of symptom improvement and lesion clearance on follow-up imaging (computed tomography or MRI) done at 1–6 months after appropriate therapy in unoperated cases. Results: Neoplastic lesions had higher rCBV values (5.04 ± 1.86) than infectious lesions (0.90 ± 0.43) (P < 0.001). When using an rCBV value, 1.95 as the parameter to define neoplastic lesions, the sensitivity of the method was 95.8% and the specificity was 93.3%, with a positive predictive value of 96%, a negative predictive value of 94%, and an accuracy of 97.4%. Statistical Analysis: We compared the rCBV values between the two groups using Student's t-test. We used receiver operating characteristic curve analysis to assess the performance of the diagnostic test. Conclusion: PWI is an efficient advanced imaging technique in ring-enhancing brain lesions and is a useful complementary tool to routine structural MRI in distinguishing between infectious and neoplastic brain lesions.
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Diffusion weighted MR imaging in the diagnosis of acute pyelonephritis and its complications: A prospective observational study p. 170
Bhaskara Rao Sanga Reddi, Vijayalakshmi Devi Bodagala, AY Lakshmi, N Anil Kumar, V Siva Kumar
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_116_18  
Introduction: In diagnosing complicated pyelonephritis, imaging is essential for which traditionally computed tomography (CT) has been in use but in renal failure patients contrast enhanced CT can't be performed due to elevated serum creatine levels. This can be overcome with the help of Diffusion weighted (DW) magnetic resonance imaging (MRI). Purpose: To assess the morphological changes and signal abnormalities, in kidneys in patients with acute pyelonephritis (APN) on conventional MRI and DWI and to measure the ADC values in areas of abnormal signal intensity in DWI so as to differentiate between abscess and nephritis. Materials and Methods: In our study, 32 patients with clinical and laboratory diagnosis of pyelonephritis underwent conventional and Diffusion weighted MRI. Diffusion images were obtained by using a non-breath-hold, single-shot echo-planar sequence with b values of 50/400/800 s/mm2. Circular regions of interest were drawn in the areas of normal renal parenchyma, nephritis and abscesses. The ADC values of three tissue types were compared by using the paired t-test and ANOVA.P value < 0.001 was considered to be statistically significant. Results: In our study, areas of normal renal parenchyma showed ADC values of (1.83 ± 0.06) × 10-3 mm2/s while areas of nephritis had ADC values of (1.20 ± 0.08) × 10-3 mm2/s which was significantly lower (P < 0.001). Also, significantly lower ADC values of (0.77 ± 0.05) × 10-3 mm2/s were found in abscesses, when compared to nephritis and normal renal parenchyma. Conclusion: Diffusion weighted MR imaging is useful to diagnose abscess formation in patients with pyelonephritis without using IV contrast medium.
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Thiamine deficiency in alcoholics with normal body mass index Highly accessed article p. 175
Shanmugiah Arumugam
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_65_19  
Background: Ethanol consumption leads to nutritional deficiency due to various causes. Well known theoretical as well as literature supports the hypothesis on dietary factors, metabolic derangement and alcohol per se produces empty calories. In this study completed in 2000 go hand in hand with the earlier observations and the available literature after 2000. Nutritional deficiency in turn leads to Alcoholic brain damage which is reversible if identified early. Among the nutritional deficiency Thiamine deficiency (Vitamin B6) appears as the most common findings across the studies. Aim: To find out the nutritional deficiency in otherwise normal healthy males who consume alcohol amounting to dependence. Materials and Methods: In this study, 40 males who were moderate drinkers, diagnosed as Alcohol dependence syndrome according to ICD-10 DCR-criteria with no indicators of overt nutritional deficiency on clinical assessment by ICMR Scale, Biochemical assessment and anthropometric assessment were included for the study. All the study subjects were subjected to detailed diet history by 24 hours recall, clinical assessment, biochemical investigations, anthropometric assessment along with demographic data and drinking history. Results: All the samples were clinically healthy and the BMI was 19.4 which fall under normal BMI. Anorexia was the predominant clinical symptom (45 percent). Biochemical and anthropometric assessment were within normal limits for an average Indian Males. But, serum Pyrophosphate was 318.47 mmol per litre (Normal value is 0.08 to 0.16 mmol per litre), which is an indirect indicator of thiamine deficiency. Conclusion: Though very preliminary and cross sectional analysis, sub-clinical thiamine deficiency was found in this study and corroborate with the previous observations. Hence, thiamine supplementation of all the drinkers irrespective of the clinical and biochemical nutritional deficiency will prevent at large both acute and chronic alcoholic brain damage.
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Perceptions of facial proportions and lip competency on facial attractiveness among people of Telangana origin p. 183
Shubhnita Verma, Prasad Chitra
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_9_19  
Context: Modern orthodontics focuses on soft tissue paradigms. Successful treatment outcomes are dependent on the patient's self-impression. Understanding individual differences in perception of facial attractiveness across orthodontics, their patients and other dental specialists would help obtain optimal and satisfactory results. Aim: To determine facial frontal proportions and lip position preferences among lay people, general dentists, specialists, and orthodontists to estimate differences in perceptions. Materials and Methods: 200 raters divided into Group 1 [50 each of orthodontists, general dentists, specialist dentists (oral surgeons, endodontists, periodontists, prosthodontists, and pedodontists)] and Group 2 (50 lay individuals of Telangana origin) participated in a questionnaire-based survey comprising photographs of one male and one female of Telangana origin with mesoprosopic faces and competent lips morphed as leptoprosopic and euryprosopic with lip positions morphed as potentially incompetent and incompetent. Raters evaluated and ranked each set of three altered frontal images on a 3-point Likert scale and lips on a 6-point Likert scale. Statistical Analysis Used: Means and standard deviation for the entire sample population and independently for gender and professional groups were obtained. Mann–Whitney test to compare rankings of each male and female image according to gender and Kruskal–Wallis test to compare rankings of male and female images between the four groups were done. Results: Mesoprosopic faces were most attractive in males and females followed by leptoprosopic and euryprosopic patterns. Male and female subject values did not differ significantly when analyzed. Orthodontists and specialist dentists found mesoprosopic male and female faces to be most attractive. Euryprosopic female faces were deemed more acceptable by lay public. Competent lip images were found to be most attractive. Potentially incompetent lips in males and incompetent lips in females were least attractive. Conclusion: These findings can assist orthodontists in treatment planning. Lower facial height changes can be assessed, and effects on overall patient esthetics can be determined for treatment results to closely mimic patient expectations.
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Age estimation using pulp/tooth area ratio of permanent mandibular first premolar p. 192
Shravya Ravipati, Venkateswar Rao Guttikonda
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_51_19  
Background and Objectives: This study was done to estimate age using pulp/tooth area ratio (PTR) of permanent left mandibular first premolar on digital orthopantamograph (OPG) with a commercially available software. The estimated age was compared with chronological age of all subjects in different age groups and also in male and female subjects. Materials and Methods: 200 patients of differing ages visiting the outpatient department of our dental hospital were included as study subjects. The digital OPGs were imported to AutoCAD, commercial (Computer Aided Design) software program developed by Autodesk and then the PTR was derived. The estimated age was calculated using linear regression equation and then compared statistically. Results: Age was calculated using linear regression analysis. The results revealed decreased PTR with an increase in age. Application of this formula gave a standard error of 8.586 years. The effect of gender showed low correlation between PTR and age. Analysis of variance test was used to compare chronological and estimated ages in all three age groups and it was found to be closely related to each other. Interpretation and Conclusion: This study confirms a superior age estimation ability of the formula developed, inferring that customized formulas developed for the local population are better suited for age estimation.
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Bacteriology of orofacial space infections-A retrospective study p. 198
Uppaluru Vijaya Lakshmi, Kotha Padma Rayalu, Kishore Moturi, Ramakrishna Yelamolu, Chanderraju Sai Prakash
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_9_18  
Aim: The purpose of this study was to assess causative micro-organisms responsible for Orofacial space infections of odontogenic origin, and to evaluate their sensitivity to various antibiotics used in the treatment of these infections. Methods: The bacteriology and antimicrobial susceptibility of major pathogens in 30 patients with orofacial odontogenic infections were examined excluding the patients who were on prior antibiotic therapy, who were diagnosed to be immunocompromised and the patients were on immunosuppressants and the following patients underwent incision and drainage and received IV antibiotics. Results: A total of 46 bacterial strains were isolated from 30 patients out of which five patients' culture results were sterile. The most common aerobic bacteria isolated were Viridans Streptococci, Klebsiella Pneumonia and Streptococcus Pyogens, and anaerobic bacteria were Porphyromonas Gingivalis, Streptococci, Fusobacterium and Prevotella Melanogenicus. As per our study, Gentamycin (84%) and Cefotaxime (80%) were the most effective antibiotics. Conclusion: In conclusion, the surgical treatment incision and drainage must always be in the foreground for the therapy of orofacial space infections of odontogenic origin. Cultures and sensitivities commonly showed greater growth in aerobes (76%) than in anaerobes (23.9%).
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Evaluation of biological behavior of odontogenic keratocyst and orthokeratinized odontogenic cyst using picrosirius red stain: A clinicopathological retrospective study p. 206
Suvarna Manthapuri, Shylaja Sanjeevareddygari, Harshini Mantha, Ramanand V Oruganti, Sharath Reddy, V Raghu Vamshi
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_69_19  
Background: Odontogenic keratocyst (OKC) and orthokeratinized odontogenic cyst (OOC) show considerable difference in biological behavior, and the study of the organization of collagen fibers may be helpful in understanding the nature of these variants. Aims: The purpose of this study is to determine the clinicopathological features and to analyze the birefringence of collagen fibers in OKC and OOC using picrosirius red stain to delineate its exact role in biological behavior. Materials and Methods: Clinical data were obtained from the case records of 71 patients, and for the analysis of birefringence, paraffin-embedded blocks of 10 cases each of OKC and OOC were retrieved from the archives of our department during the period of 2010–2018. Tissue sections were obtained and stained with picrosirius red stain to determine the birefringence of collagen fibers in both the variants. Statistical analysis was done by unpaired t-test. Results: Out of 71 cases, 61 were OKC and 10 were OOC. The clinicopathological data revealed that the most common affected age group was third decade with male predilection and the most common site noted was posterior mandible, and considerable difference in birefringence was noted in the collagen fibers of OKC and OOC. Conclusion: The study results analyzing the clinicopathological parameters of OKC and OOC could act as a viable record for the distribution of odontogenic lesions in the sample population. Significant differences in birefringence were demonstrated in OKC and OOC, suggesting that different collagen fibers may exist in the two lesions.
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Vascular access related aneurysms in patients on maintenance hemodialysis p. 211
P Lokesh, Siva Parvathi Karanam, RD Nagaraj, N Praveen, A Sunnesh, N Sai Sameera, K Naveen, Teja , AY Lakshmi, Rukmangada , V Sivakumar
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_84_19  
Background and Aims: Arterio-venous (AV) access has been considered as an Achilles heel in the management and outcomes of End Stage Renal Disease (ESRD) patients on Maintenance Hemodialysis (MHD). Vascular Access Related Aneurysms (VARA) significantly impact the functional status of the AV access and thus affects the patients' outcomes. Our study was taken up in this context. This study was conducted to decipher the anatomical, functional, imaging, complications and management aspects of VARA. Methods: A cross-sectional, observational study was done on 429 patients of ESRD on MHD in our institute. The clinical aspects, demographics, imaging aspects were stressed followed by management. Both descriptive and inferential statistics were used and aP value <0.05 was considered as significant. Results: Total number of study participants were 429. Of them, 48 patients developed AVF aneurysms (11.1%). The mean age of the patients was 52.9 years with a male: female ratio of 34: 14. Majority of them were ESRD due to diabetic nephroathy (62.5%). Morphologically majority of them were saccular (69%) while rest of them were fusiform (31%) None of our patients had downstream stenosis, and thrombus was seen in 5 patients (10.4%), complications secondary to rupture of AVF with hemorrhage, was seen in 6.25% (n = 3). Conclusions: We found VARA in 11.6% of our MHD population predominantly in men, in their middle age. They were more common in diabetic ESRDS. Aneurysmal rupture was seen in 6.25%. Our study highlights the importance of periodic evaluation for aneurysms and necessary management.
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CASE REPORTS Top

Unusual cause of intestinal perforation during induction chemotherapy in acute myeloid leukemia p. 215
Rajani Priya Yedla, Stalin Bala, Megha S Uppin, Sadashivudu Gundeti
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_82_19  
Primary intestinal aspergillosis is a rare but serious infectious complication with a high morbidity and mortality in immunocompromised patients. We report a case of 47-year old male diagnosed with acute myeloid leukaemia and started on induction chemotherapy. On day 18 of chemotherapy, he presented with an acute abdomen and underwent emergency exploratory laparotomy. Histopathological specimen revealed transmural necrosis with fungal hyphae due to aspergillosis and voriconazole was started. Serum galactomannan test done was negative. In the post-induction chemotherapy, he attained complete remission and received three cycles of consolidation with high-dose cytarabine. With this case, we would like to emphasize that early recognition of primary intestinal aspergillosis is of the utmost importance because of its fulminant clinical course. It should be included in the differential diagnosis of neutropenic patients with sudden onset abdominal pain and ongoing fever, even in the absence of a positive serum galactomannan.
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Recurrent giant intermuscular lipoma of thigh p. 219
Rajababu Pakanati, Raghuveer Chakravarthy Gogineni, Naresh Babu Ede
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_4_19  
Lipomas are ubiquitous tumors which can occur anywhere in the body. They are usually small-sized, but giant lipomas are rare. This report presents a female with a recurrent large swelling over the posteromedial aspect of the right thigh. Investigations revealed a giant intermuscular lipoma for which excision was done in toto safeguarding vital structures.
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Left-sided mesocolic hernia presenting as internal Maydl's hernia, complicated by jejunal volvulus p. 222
Rajababu Pakanati, G V.S.N. Prasad, B Ratta Reddy, Bheemaneni Swathi
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_5_19  
Left mesocolic hernia (syn – left paraduodenal hernia/hernia of Landzert) is a type of internal hernia which occurs due to malrotation of the midgut and forms a potential space near the ligament of trietz. Prompt diagnosis is crucial to prevent strangulation. We report a rare case of left mesocolic hernia presenting as internal Maydl's hernia complicated by jejunal volulus, presenting as acute abdomen. An emergency derotation and reduction of small bowel was done with repair of the defect.
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Incidentally discovered adrenal mass: A study of two cases and review of literature p. 225
Ruchi Nagpal, Purnima Malhotra
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_106_18  
Adrenal myelolipoma is a rare tumor that is benign in nature, usually asymptomatic, unilateral, and nonsecreting. It is composed of variable mixture of mature adipose tissue and hematopoietic elements and develops within the adrenal gland. With the widespread use of cross-sectional imaging modalities such as ultrasonography (USG) and computed tomography (CT), the incidental detection of these tumors is increasing in frequency. We report two cases of adrenal myelolipoma in a 48-year-old female and a 47-year old male who presented with pain in the abdomen. Contrast-enhanced computed tomography scan of the abdomen revealed the possibility of myelolipoma. The patients were subjected to adrenalectomy and their postoperative course was uneventful. The histopathological evaluation of the mass confirmed the initial diagnosis of adrenal myelolipoma. Although mostly discovered as an “incidentaloma,” the diagnosis of adrenal myelolipoma requires thorough diagnostic study. Imaging techniques such as USG and CT scans as well as biochemical studies are useful for indicating the best treatment taking into account the size of the mass and possible hormone production. Surgical resection is advocated through extraperitoneal approach as it minimizes postoperative complications and leads to quicker recovery.
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A rare case report of familial koilonychia with azoospermia p. 229
Prabhat Agarwal, Nikhil Pursnani, Boentika Singh, Awantika Parihar
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_92_19  
We report a case of a middle-aged male patient presenting with complaints of infertility. On examination and history-taking, familial koilonychia was reported without any association with ectodermal, systemic, or orthopedic defects. His iron profile was within normal limits. Hemoglobin was in normal limit. KOH smear taken from the nail showed no fungal growth. Family history of three generations revealed males suffering with familial koilonychias with infertility. Patients admitted with azoospermia should be asked about family history of koilonychia and pedigree analysis should be done.
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