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   Table of Contents - Current issue
Coverpage
January-March 2019
Volume 8 | Issue 1
Page Nos. 1-81

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ORIGINAL ARTICLES  

Study of outcome of management of MDR-TB cases under programmatic condition in India Highly accessed article p. 1
Ajay Agarwalla, Somnath Bhattacharya, Atin Dey, Saurav Kar, Arunabha Datta Chaudhuri
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_31_19  
Background: Multi-drug resistant tuberculosis is a grave challenge for tuberculosis control program in India. These patients are treated with standardized 2nd line antitubercular drugs for a period of at least 24 months and are followed up by serial sputum cultures under RNTCP. Aims: This study aims to analyze various outcomes of treatment of MDR-TB patients under DOTS-Plus program and impact of different parameters over the outcome. Materials and Methods: In this retrospective study treatment outcome all the MDR-TB patients who have initiated treatment from concerned DRTB centre over a period of six months, have been taken for analysis, after 30–36 months of starting the therapy. Outcomes are categorized as cured, treatment completed, treatment default, treatment failure, and death as per program guideline. Outcome of different group of patients are compared also. Results: Out of total 71 patients 54 resides in rural area and 52 have low BMI (<18.5). Total 27 (38%) patients are successfully treated. Treatment failure observed in 11 (16%). 20 (28%) patients defaulted. Rural patients have lower success rate (33%) and high default rate (30%). Low BMI patients have poor success (29%). Conclusion: The present study finds a low success rate in comparison to WHO reports from India. Default rate is also found to be high. Majority of patients are from rural area and they have higher default rate compared to urban patients. Patients with low BMI have lower success rate and these patients constitutes about three-fourth of total patients. But as the total number of patients is very small, the significance of this observation cannot be ascertained.
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Fetal transcerebellar diameter to abdominal circumference ratio (TCD/AC) and to femur length ratio (TCD/FL) in the assessment of normal fetal growth p. 5
Karumanchi Ashok Hussain, Silpa Kadiyala, Amancharla Yadagiri Lakshmi, Manchala Hindumathi
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_2_19  
Context: Intrauterine growth retardation (IUGR) is a major risk factor for perinatal mortality and morbidity, and its early detection is useful in deciding frequency of antenatal surveillance, optimal delivery timing, and early neonatal management to avoid perinatal mortality and morbidity. Most of the parameters for detection of IUGR are gestational age dependent. Transcerebellar diameter to abdominal circumference ratio (TCD/AC) is a gestational age independent parameter. IUGR due to uteroplacental insufficiency can present as isolated femur length reduction. So, transcerebellar diameter to femur length ratio (TCD/FL) can be useful in early detection of IUGR. Aims: To evaluate the accuracy of TCD/AC and utility of TCD/FL in normal pregnancy at varying periods of gestation and to derive a cut-off value for assessment of fetal growth. Materials and Methods: In this prospective study, 200 patients with cumulative ultrasound age (CUA) between 14-40 weeks. Routine ultrasound parameters and transcerebellar diameter were measured. TCD/AC and TCD/FL was calculated in all patients and for individual subgroups formed according to CUA. Statistical Analysis: Mean and standard deviation, 3rd, 50th and 97th percentile for TCD/AC and TCD/FL was determined for all patients to determine age specific cut off values. Relationship between continuous variables is studied using correlation and simple regression. Results: In our study, TCD with AC and FL show strong correlation throughout pregnancy. TCD/AC dispersed normally with mean value of 14.013 and SD of 0.738 and cut off value is 15.49. TCD/FL is dispersed normally throughout pregnancy with mean value 64.592 and SD of 3.998. TCD/AC, TCD/FL in subgroups also shows similar mean and SD as compared to entire study population. Conclusion: A cut off value of mean +/- SD (15.49), (72.588) for TCD/AC and TCD/FL could be used as a growth parameter for detection and determine the severity of IUGR.
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Application of the Milan system of reporting salivary cytopathology – A retrospective cytohistological correlation study p. 11
Ramya Katta, Devi Padmavathi Chaganti
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_52_19  
Context: Fine needle aspiration cytology for salivary gland lesions has shown to be adequately sensitive and specific for diagnosing and treating salivary gland pathologies. The Milan System for Reporting Salivary Gland Cytopathology was developed and introduced to provide enhanced communication and improved overall care. Aims: The present study was taken up to assess the accuracy (sensitivity, specificity, positive and negative predictive values) and risk of malignancy of various diagnostic categories when the Milan system is applied and particular emphasis has been laid on cases that showed varied cytohistopathological correlation to highlight the analytical intricacies. Settings and Design: The present study is a two-year retrospective descriptive study conducted in a tertiary care hospital, Vijayawada. Methods and Material: Fine needle aspiration smears, relevant clinical details, histopathological slides and final reports were retrieved from the Departmental archives. The FNA results of the present study were re-categorized according to the Milan system and number of false positives, false negatives, true positives and true negatives were assessed in comparison with the final histopathological diagnosis and thus the accuracy and risk of malignancy of each diagnostic category were calculated. Results: The overall cytological diagnostic accuracy for differentiating malignant from benign tumors in the present study is 90%, with a sensitivity of 73.34%, specificity of 95.56%, positive and negative predictive values of 84.62% and 91.49% respectively.In the present study the highest risk of malignancy was seen in Atypia of undetermined significance (category III-100%) according to the Milan system. Conclusions: Use of The Milan System of Reporting salivary gland Cytopathology can increase the overall effectiveness and communication with clinicians and between institutions thus improving the overall patient care.
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Serum and gingival crevicular fluid macrophage inflammatory protein-1β (MIP-1β): Their relationship in periodontal health, disease, and after treatment with nonsurgical therapy p. 18
Ravindra R Nagireddy, Bindu Sighinam, Deepa Anumla, Sravani R Cheppali, Lakshmi S Shellysistla, Madhu B Dandu Subramanyam
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_95_18Original  
Objectives: Earlier studies have revealed high macrophage inflammatory protein-1β (MIP-1β) levels in the gingival crevicular fluid (GCF) and the serum of patients with chronic periodontitis. However, reports correlating effect of non surgical theraphy on levels of GCF and serum MIP-1βlevels are inadequate. Therefore, the present study estimates the GCF and serum MIP-1β levels in periodontal health, disease and after periodontal treatment with non surgical theraphy. Materials and Methods: Periodontal examination and collection of GCF and serum was performed for 60 subjects categorized into four groups with 20 subjects in each group: Group I (healthy); group II (gingivitis), group III (chronic periodontitis). Twelve weeks after scaling and root planing, the GCF and serum were collected from 20 patients of group III, who were considered as group IV. MIP-1β levels were estimated using the enzyme-linked immunosorbent assay. Results: MIP-1β was detected in all samples. However, the levels reduced significantly in group IV (P < 0.05). Mean MIP-1β levels in GCF and serum were the highest in group III (1.404 ng/μL,1.712 ng/μl) and the lowest in group I (0.342 ng/μl,0.465 ng/μl), and those in groups II and IV appeared between those of groups I and III. Conclusions: The GCF and serum MIP-1β levelsincreased proportionally with the progression of periodontal disease (PD) and decreased after treatment. Because MIP-1β levels in the GCF and serum correlated positively with clinical parameters, MIP-1βmay be considered a “novel biomarker” in PD progression. However, controlled longitudinal studies are required to confirm this possibility.
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Comparative assessment of effectiveness of Biomin, NovaMin, herbal, and potassium nitrate desensitizing agents in the treatment of hypersensitive teeth: A clinical study Highly accessed article p. 24
Guntakala Vikram Reddy, Jayaprada Reddy Surakanti, Harikumar Vemisetty, Suryasowjanya Doranala, Jayasree Reddy Hanumanpally, Suryakanth Malgikar
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_110_18  
Aim and Objectives: To compare the efficacy of four commercially available toothpastes in the treatment of dentinal hypersensitivity (DH). Materials and Methods: In a single-centered clinical trial, a total of 160 subjects were divided equally into four groups: group 1 – a toothpaste containing 5% fluoro calcium sodium phosphosilicate with fused silica (Biomin); group 2 – a toothpaste containing 5% CSPS (NovaMin); group 3 – herbal formulation; and group 4 – a toothpaste containing 5% potassium nitrate. The patient's DH scores for tactile, evaporative stimuli were recorded on a visual analog scale at baseline, 2 weeks, and at the end of 4 weeks. Results: All the four desensitizing toothpastes containing different active agents were effective in relieving DH. However, the Biomin group showed a better clinical response at the end of 4 weeks when compared with others. Conclusion: The Biomin group showed significantly better results compared with either NovaMin, herbal, and potassium nitrate toothpastes in the treatment of dental hypersensitivity symptoms.
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Prevalence of dental caries and dental fluorosis among 6-12 years old school children in relation to fluoride concentration in an endemic fluoride belt of Mahabubnagar district, Telangana state, India p. 29
Srikanth Reddy Kola, Manoj Kumar Mallela, Ravindar Puppala, Balaji Kethenaeni, P Tharasingh, Venumbaka Sivakalyan Reddy
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_54_17  
Aim: The aim of the study is to evaluate the prevalence of dental caries and dental fluorosis among the school going children in Mahabubnagar district, and also to assess F- levels in drinking water from different areas of Mahabubnagar district. Materials and Methods: The study was carried out in 2,000 children of age group 6–12 years. The dental caries status was assessed by Decayed/missed filled tooth (DMFT)/deft index using WHO criteria 1997 and dental fluorosis status using Modified Dean's fluorosis index. Alizarin visual method was used to estimate F levels in water. Statistical Analysis: All data entered to an SPSS (18) program (IBM Corporation, Chicago, USA); both descriptive and analytic approaches were used in the data analysis. The correlation of deft with different F- levels using ANOVA test. The P < 0.005 was considered statistically significant. Results: The prevalence of dental caries in primary teeth and permanent dentition was 64.2% and 26.6%, respectively. Indicating that dental caries was more among 7–8 years old children and less in 11–12 years old children (P > 0.005). Dental fluorosis in primary dentition was 15% and 70.3% in the permanent dentition; it was more in 9–10-year-old children and less in 6-year-old children. Conclusion: The dental caries and dental fluorosis were more in Northern, Eastern region of Mahabubnagar district, whereas dental caries and dental fluorosis were less in local villages of Mahabubnagar district. The F- content in Northern, Eastern zone of Mahabubnagar district was about 2 mg/l, whereas in local villages of Mahabubnagar is 1.2 mg/l.
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Efficacy of autologous platelet-rich fibrin in osseous regeneration after mandibular third molar surgery: A comparative study p. 37
K Surekha, Sudhakar Gudipalli, Praveen Peramulla, T Prathima, Y Narendra Kumar, Anil Budumuru
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_25_18  
Aims and Objectives: To evaluate the efficacy of soft tissue healing and bone regeneration in mandibular third molar extraction sockets after placement of platelet-rich fibrin (PRF). Patients and Methods: A split-mouth study was carried out in 15 patients requiring extraction of bilateral impacted mandibular third molars. Patients were divided into group I (test group) and II (control group) of 15 sites in each. Results were compared within the parameters of postoperative pain, facial swelling, soft tissue healing and bone density. Radiological assessment of the extraction site was done. Results: This study clearly indicates a definite improvement in the wound healing, decrease in postoperative edema, wound dehiscence, and increase in the bone density, which signifies and highlights the use of PRF certainly as a valid method inducing hard tissue regeneration. Conclusion: The procedure of PRF preparation is simple, cost-effective, and has demonstrated good results.
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Dental students persepctive towards a learning environment and in determining the learning barriers p. 42
P Gayathri, L Gayathri, D Sravya Sai, Vikram Simha Bommireddy, Y Suresh Chand
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_97_18  
Background: Dental education is relatively complex, demanding and a unique pedagogical procedure. The purpose of this study was to determine dental student's perception of the learning environment and to determine the learning barriers among dental students in a private college located in Guntur district, Andhra Pradesh. Materials and Methods: The source of the data includes 306 dental under-graduate students, from academic years 1-4. There are divided into two groups i.e. 159 pre-clinical students and 147 clinical students. They were posed with a validated structured questionnaire, which includes 28 closed ended questions along with questions on 3 different domains i.e. administrative, academic and environmental learning barriers. Results: The overall response rate is 100%. At the administrative level, maximum number of students identified that there was poor academic guidance for the students during courses registration given and there are inadequate extra-curricular activities for the students such as conferences, workshops and seminars. At academic level, 20.6% dental students proposed that questions in the exam are depending on memorising rather than understanding and analysing. 12.2% of the clinical students stated that there was lack of appropriate teaching strategies of the lecturers which are acting as learning barriers. As environmental factors, most of the students agree that inadequate number of computers and the unavailability of internet connection, unavailability of entertainment facilities that motivate the learning process and that the laboratories aren't equipped in terms of space and equipment's for training which would affect the learning process. Conclusion: This study has emphasized on the factors which requires improvement with respect to student's perspective. These learning barriers are to be noted by the educational institutions and the required modifications are done in the infrastructure as well as in the curriculum proposed to the students. Better dental education will instill positive reinforcement, social well-being and a better professional and personality development in the dental students which would guide them into their future.
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Reconstruction of lost ear lobule p. 48
Subodh Kumar Arige, Ramesh Pokkula, Avula Krishnaveni
DOI:10.4103/2277-8632.257163  
Introduction: An absent ear lobule may be congenital or the result of trauma, infection, etc. Many procedures have been described for reconstruction. Aim: To present our experience with the Zenteno Alanis and the Gavello techniques. Materials and Methods: The lobule was reconstructed in four patients. Reconstruction of the lobule in the first patient was done by Zenteno Alanis technique and in the next three patients, it was done by Gavello's technique. Results: Results were satisfactory with both techniques. Division and inset were needed in Zenteno Alanis technique to correct the bunched skin behind the lobule at the base of the flap. The scar was inferior and visible. In Gavello's technique, the surgery was single-staged and the scar was retroauricular. Conclusions: Zenteno Alanis technique needed “division and inset” and the scar was visible. Gavello's single-staged reconstruction resulted in a scar, which could be concealed.
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CASE REPORTS Top

Prenatal diagnosis of intrauterine fetal goiter a rare case report p. 52
Joji Reddy Onteddoo, J Abdul Gafoor, I Pratyusha, N Bhavana
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_3_19  
The incidence of fetal goiters is rare and can have poor neonatal outcomes due to tracheal and esophageal obstruction. This makes prenatal diagnosis and treatment pertinent. We report a case of a 25-year-old fifth gravida diagnosed with a large solid homogenous bilobed hypervascular mass noted on the anterior of the fetal neck, causing hyperextension of the cervical spine. A Fetal MRI was performed which revealed intermediate to hyper intensity on T2 weighted image, which were consistent with fetal goiter. The fetus was delivered at 38 weeks of gestation, and the intrapartum and postpartum period was uneventful. Postnatal TSH FT3 and FT4 were done which were consistent with hypothyroidism. With appropriate treatment, the size of the thyroid gland was observed to decrease. The neonate was found to be doing well postnatally.
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Coexistence of lepromatous leprosy, cutaneous tuberculosis and pulmonary tuberculosis: A rare occurrence p. 55
Sandeep Kodali, Mythri Priyadarshini Kodali
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_58_18Case  
Leprosy and Tuberculosis, the two oldest diseases known to mankind, are chronic, granulomatous infections caused by intracellular, gram–positive, aerobic, acid fast bacilli of the genus Mycobacterium. Their coexistence in the same patient has been uncommonly reported in the literature. We report a concomitant infection of cutaneous tuberculosis in the form of lupus vulgaris and scrofuloderma, leprosy and sputum positive pulmonary tuberculosis in the same patient, which is the first to be reported, to the best of our knowledge. There is a need for screening of patients for TB in patients diagnosed with leprosy to prevent the possibility of rifampicin related drug-resistant TB.
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Schamberg's disease; a forgotten dermatoses: A case report with review p. 59
Pranita Mohanty, Anima Hota, Kaushambi Chakraborty, Debahuti Mohapatra
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_47_18  
Schamberg's Disease (SD) also known as progressive pigmented purpuric dermatitis is the most common PPD (Pigmented Purpuric Dermatitis). PPD includes a spectrum of vascular diseases with an incidence of 0.18% of all skin and VD lesions. SD has Idiopathic aetiology, affects all races and ages (with mean age of 34 years). Males are affected more, especially the legs showing reddish brown purpuric patch/macules which has a chronic slow progression to other body parts. Long standing medications are thought to be one of the precipitating factor. Extravasation of RBCs from the superficial venous plexus of skin is thought to be the cause of skin discoloration. Histopapathology (HP) of the skin lesion show mild epithelial hyperplasia, occasional foci of spongiosis and lymphohistiocytic infiltrate with extravasation of RBCs. The disease has a cosmetic problem. No malignant transformation has been documented yet and to date there is no effective treatment. It is usually diagnosed by Clinical suspicion followed by HP confirmation.
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Cystic echinococcus of head and neck: Anaphylactic dilemma and surgical considerations p. 62
Phani Kumar Kuchimanchi, P Chandrasekhar, P Lakshmi Manasa, Ganesh Koneru
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_61_18  
Hydatid cyst or echinococcosis is a zoonotic parasitic disease caused by dog tapeworm and occurs in humans only when they are accidental intermediate hosts for dog tapeworms. The liver is the most common organ affected (60%), followed by the lung (20%), kidneys (3%), brain (1%) and bone (1%). Previous literature recorded its occurrence in a very few cases involving head and neck region with only three cases involving cheek so far. The present case report demonstrates extreme rare occurrence of hydatid cyst in orofacial region. It is a rarity and potential risk of anaphylactic shock in susceptible individuals poses diagnostic and surgical challenge. Surgical management demands to be prepared with appropriate precautions to be taken perioperatively. Rationale for perioperative management of anaphylactic shock from cystic echinococcus is emphasized.
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The purple urinary bag syndrome – Be alerted, not alarmed! p. 67
Mahesh Mahadevaiah, Mamatha Shivanagappa, Siddharth Jain
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_84_18  
Purple-appearing urinary catheter and urosac can be alarming to the patient's attenders and doctors. It may be misinterpreted and overinvestigated if the underlying causes and mechanisms of this phenomenon are not understood. Urinary tract infection with sulfatase- and phosphatase-producing bacteria is implicated in the pathogenesis. We hereby report the appearance of purple color of urinary bag and catheter in an elderly female patient with dementia and chronic paraplegia on long-term Foley's catheterization.
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Rare presentation of hyperthyroidism as thyrotoxic crisis p. 69
Varun Karri
DOI:10.4103/2277-8632.257161  
Thyrotoxic crisis is a rare manifestation of thyroid disease. It is an end manifestation of hyperthyroidism. Their life-threatening manifestations and functional reversible features on treatment make every clinician to think about diagnosis of thyrotoxic crisis. Here, we present a rare case of thyrotoxic crisis with neurological and cardiovascular manifestations. His illness was well-controlled with antithyroid drugs. It is thus concluded that thyroid function should be evaluated in otherwise unexplained altered sensorium and tachycardia as a response to treatment is dramatic and most rewarding.
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Verrucous lymphangioma circumscriptum in a child p. 72
Pragya A Nair, Rahul Krishna S. Kota, Rochit R Singhal, Shailee S Gandhi
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_113_16  
Lymphangioma circumscriptum (LC) is characterized by dilation of lymphatic vessels in the skin and subcutaneous tissue. It presents as asymptomatic vesicles filled with lymphatic fluid giving characteristic frog spawn appearance, but does not progress into warty plaque. LC can also be divided into congenital and acquired form. The common sites are axillary folds, shoulder, upper arm, scrotum, penis, rectum, and vulva. It needs to be differentiated from certain common conditions such as herpes zoster, molluscum contagiosum, hemangioma, verruca vulgaris, and angiokeratoma. Surgical modality is the first choice of treatment. A case of a 5-year-old girl having verrucous plaque on the right knee joint diagnosed as LC is presented here.
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LETTERS TO THE EDITOR Top

Bilirubin crystals in thyroid p. 75
Rashmi Patnayak, Kaushambi Chakraborty, Rajesh Bhola, Amitabh Jena
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_37_18  
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An Unusual location of porokeratosis of Mibelli p. 77
Yugandar Inakanti, Srilakshmi Peddireddy, Akshaya Nagaraja, Sujalalitha Kotla
DOI:10.4103/2277-8632.257158  
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An unusual case of colonic perforation p. 80
Rashmi Patnayak, Sivakumar Vuvula, Venkat Rami Reddy, Amitabh Jena
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_12_18  
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