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   Table of Contents - Current issue
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January-March 2021
Volume 10 | Issue 1
Page Nos. 1-68

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ORIGINAL ARTICLES  

Road traffic accidents at Government General Hospital, Kakinada, in 2018-19 versus 2019.20: Case series p. 1
Korukonda Babji, Manukonda Raghavendra Rao, Goru Krishna Babu, J S. Surya Prabha Kona, Vandana Valluri
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_103_20  
Background: Alcohol-related road traffic accidents (RTAs) are the foremost threat to the civilization due to premature loss of life. Policy-making is one such tool for reduction of alcohol-related RTAs. Andhra Pradesh state government implemented the Prohibition and Excise Policy for 2019-20 with respect to liquor sales from October 1, 2019 to September 30, 2020. Aim: This study aims at documenting the reduction of alcohol-related RTAs (head injuries and others) after the introduction of the new policy. Methodology: Case series involving all the RTAs reported to the Government General Hospital, Kakinada, during September 2018–February 2019 and September 2019–February 2020. Secondary data was collected using a semi-structured questionnaire, from the hospital accident registers, in the medical records department. Data was analyzed using Microsoft Excel 2010. Results and Discussion: There is a significant decrease in number of fractures sustained in RTAs from 12.5% in 2018–19 to 9.5% in 2019–20 (P = 0.018, 95% CL). The proportion of RTAs occurring under the influence of alcohol reduced from 9.4% in 2018–19 to 8.4% in 2019–20. There is a marked reduction in deaths of RTA cases, and grievous injuries and head injuries have also reduced during September 19–February 2020 as compared to September 18– February 2019. Conclusions: The fatal injuries sustained in RTAs under the influence of alcohol dramatically reduced to zero from November 2019 to February 2020, suggesting a protective effect of the new prohibition of liquor sales policy.
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Dexmedetomidine with 0.5% lignocaine enhances postoperative analgesia in patients undergoing upper limb orthopedic surgeries under intravenous regional anesthesia p. 8
Neena Jain, Shilpi Tada, Surendra Kumar Sethi, Veena Patodi, Kavita Jain, Deepak Kumar Garg
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_105_20  
Background: Intravenous regional anesthesia (IVRA) is an effective technique to provide analgesia for upper limb surgeries of shorter duration. Various adjuvants are used with local anesthetics to prolong the duration of analgesia. This study was undertaken to establish the effect of dexmedetomidine with lignocaine for IVRA in upper limb orthopedic surgeries. Materials and Methods: Sixty patients aged 15 to 65 years of either sex belonging to the American Society of Anesthesiologists (ASA) physical status I and II undergoing upper limb orthopedic surgeries were enrolled. Group L (n = 30) received lignocaine 2%, 7.5 mL diluted to total volume of 30 mL using normal saline while Group LD (n = 30) received lignocaine 2%, 7.5 ml with dexmedetomidine 1 μg/kg dilu ted to total volume of 30 mL using normal saline in IVRA. The onset of sensory and motor block, recovery of sensory and motor block, duration of analgesia, hemodynamics, and adverse effects were noted. Results: The mean onset time of sensory block was significantly faster in Group LD (3.50 ± 0.41 min) than Group L (6.67 ± 0.65 min); P < 0.05. Group LD had significantly earlier motor blockade (8.83 ± 0.96 min vs 11.9 ± 0.75 min); P < 0.05. The recovery of sensory block was also significantly prolonged in Group LD (61.64 ± 5.18 min) when compared to Group L (12.76 ± 4.41 min); P < 0.05. The recovery of motor block was significantly prolonged in Group LD (67.40 ± 4.92 min vs 15.25 ± 4.44 min); P < 0.05. The duration of analgesia was significantly prolonged in Group LD (79.22 ± 4.84 min) as compared to Group L (22.07 ± 4.16 min); P < 0.05. No significant hemodynamic changes and side effects were noted; P > 0.05. Conclusion: Dexmedetomidine (1 μg/kg) in IVRA leads to faster onset of sensory and motor block, prolonged duration of analgesia with better hemodynamic stability and minimal side effects.
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Prevalence of organ-specific autoantibodies in children with type 1 DM in south central region of India p. 15
Chaitanya Konda, Vijay Sheker Reddy Danda, Srinivas Rao Paidipally, Krishna Reddy Thaduri
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_116_20  
Introduction: Type 1 diabetes mellitus (T1DM) is a long-standing metabolic disease caused by autoimmune beta cell destruction leading to absence or lowered insulin production. T1DM is associated with various other autoimmune disorders, including autoimmune thyroid disease, Celiac disease, and Addison disease. Detection of these antibodies is crucial to prevent morbidity related to unrecognized disease. Indian data regarding prevalence of these antibodies in T1DM is lacking, particularly antibodies against 21 hydroxylase. Patients and Methods: Total 100 patients with T1DM were taken into the study, in all patients anti-transglutaminase (anti-tTG) IgA, anti-thyroid peroxidase (anti-TPO) were done, and 21 hydroxylase anti bodies were done in 86 cases. Descriptive statistics were reported using mean, SD, numbers, and percentages. Student's t-test was used to assess the differences between the groups. Results: Fifteen cases were found to be TPOAb positive (eight had hypothyroidism, two had sub-clinical hypothyroidism, and five cases had normal thyroid function). tTGAb were positive in four cases, three were positive for 21-Hyroxylase antibody, and all had normal cortisol levels. Conclusion: Organ-specific autoimmune antibodies were elevated in T1DM when compared to general population. Screening of all these antibodies in T1DM patient should become standard of care.
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Infant mortality in Empowered Action Group states in India: An analysis of sociodemographic factors Highly accessed article p. 21
Manas Pratim Roy
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_8_20  
Introduction: Infant mortality rate (IMR) is considered one of the key indicators of the social and economical development of a country. Therefore, some sociodemographic indicators were evaluated from eight poorly performing states of India. Materials and Methods: Data from National Family Health Survey 4 (2015-16) were analyzed, using Pearson Correlation Coefficient. Female literacy, provision for improved drinking water and sanitation, use of clean fuel for cooking, measles vaccination, the occurrence of diarrhea, and exclusive breastfeeding were taken into account. Rural and urban parts were considered separately. Results: Lower IMR was noted in urban areas in Empowered Action Group (EAG) states. Urban Odisha recorded better IMR than other units (21/1000 live births). Female literacy (r = −0.558) and improved sanitation (r = −0.555) were significantly related to IMR. In comparison to National Family Health Survey 3 (2005-06), appreciable reduction was noted in IMR in urban Rajasthan (53%) and urban Odisha (48%). Conclusion: Literacy and improved sanitation are important factors associated with infant mortality in EAG states. Strategies targeting social development could spell wonder in the future, in terms of reducing IMR in these states.
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Estimation of salivary superoxide dismutase, glutathione peroxidase, catalase individuals with and without tobacco habits p. 27
Afroz K Syed, Divya Sri Godavarthy, Kattappagari K Kumar, Chandra Sekhar Poosarla, Gontu S Reddy, Baddam V R. Reddy
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_101_20  
Context: Tobacco usage is associated with the derailment of antioxidant status. Salivary studies for diagnostic potential as a biofluid. Saliva may provide acumen into disease pathogenesis. Aims: To determine the influence of tobacco on salivary superoxide dismutase (SOD), glutathione peroxidase (GPX), and catalase (CAT) enzyme levels in individuals with and without tobacco habits. Settings and Design: One mL of unstimulated whole saliva was collected, centrifuged immediately at 2000 RPM, and stored at 4°C for analysis. The supernatant was aspirated and assayed. Methods and Material: Eighty males subjects aged 25–40 years were selected and included 20 controls, 20 smokers, 20 chewers, and 20 with both habits. The saliva samples were collected and SOD, GPX, CAT levels were analyzed using UV spectrophotometric assay. Statistical Analysis Used: Mann-Whitney U test was used for comparison taking the probability value of P ≤ 0.05 as statistically significant using SPSS 20.0 version. Results: SOD, CAT, GPX enzyme levels in the saliva were significantly lower in those with tobacco habit than in the controls (P < 0.05). A significant correlation existed between SOD, CAT, GPX levels, and the type of the habit. The antioxidant status is affected by the impact of tobacco. Conclusions: This study emphasizes the importance of saliva as an easy noninvasive tool in diagnosing patients who are more prone to precancerous lesions and conditions, and its importance in patient education and motivation programs for tobacco habit cessation.
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Knowledge, attitude, and practices of cervical cancer screening in health care providers in a teaching hospital p. 33
Anvitha Desaraju, Prabha Devi Kodey
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_126_20  
Introduction: Cervical cancer is the most common cause of mortality and morbidity among women of reproductive age group in the world and is one of the few cancers amenable for prevention. Healthcare providers in hospitals (medical and nursing staff) constitute the most visible, front-line personnel play an integral role in educating women in the prevention of diseases, they can influence regarding cervical cancer screening adherence and health promotion among women. Aim and Objectives: The purpose of this study is to assess knowledge, attitude, and level of awareness regarding cervical cancer among female health care providers with respect to risk factors, screening methods, vaccination, and the barriers in the acceptance of cervical cancer vaccine. Materials and Methods: A descriptive cross-sectional study with self-administered, predesigned, questionnaire for knowledge of symptoms, screening, risk factors for cervical cancer and HPV vaccine in health care providers (n = 100) comprising doctors, nurses over duration of 2 months from May to June 2018 in teaching hospital setting on women aged between 21 and 65 years. Data was analyzed with SPSS17. Chi-square test used for statistical significance. Results: Mean age of respondents was 32.9 years (range 21–54 years). Most participants were aware that cervical cancer is the most common female genital cancer (94%), majority were able to identify the HPV as most important etiological factor (88%) and believed that screening may prevent cervical cancer (92%), awareness about HPV vaccine and screening was known fully in doctors but only 72% of nurses. Knowledge about cancer etiology and screening was low among nurses than doctors. Self-practice and vaccination was low in total study population. Conclusions: Knowledge and awareness on risk factors, cervical cancer screening, and HPV vaccination is more among doctors than on nursing staff, but self-practice and vaccination was low in total study subjects. Knowledge and awareness of cervical cancer among health care providers can help in promoting screening and early diagnosis, reducing cervical cancer morbidity and mortality.
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Non-invasive estimation of sialic acid in saliva among patients with oral potentially malignant disorders and oral cancer p. 39
Krithigaa Sivaraman, C Sreeja, K Murugavel, Serena Florence Francis, R Sathish Muthukumar, Merlin Jayaraj
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_129_20  
Background: Oral potentially malignant disorders (OPMDs) account for about 2.5% of all the oral lesions, among which 37.5% show malignant transformation. Clinical appearances of any lesion which are deceived are finally confirmed and diagnosed using routine gold standard histological H and E stains. However, with newer technologies, cancer biomarkers in saliva are found to be highly sensitive. So, the early detection of cellular alterations at a non-lesional stage is of utmost importance to prevent its progression. Aim: To analyze the salivary sialic acid levels in the spectrum of patients having habits with no clinically visible lesion, leukoplakia, oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC) along with the healthy groups and compare the levels with clinical and histological parameters. Materials and Methods: A total of 60 subjects were enrolled in this study. Sialic acid levels, total protein (TP) and total carbohydrate (TC) levels were estimated in saliva using appropriate biochemical analysis. Results: Results were analyzed using mean, standard deviation and Student's t test. Salivary sialic acid levels were significantly increased in leukoplakia, OSMF and OSCC. There is a significant difference in sialic acid levels in smokers and chewers yielding a mean value of 18.97 mg/dL and 23.4 mg/dL, respectively, against the mean value of 15.29 mg/dL of healthy controls. The sialic acid levels showed a statistical difference between clinical staging and histological grading of leukoplakia, OSMF and OSCC. Salivary sialic acid, protein and carbohydrate levels also showed significance. Conclusion: The present study highlights the altered expression of sialic acid among various groups suggesting that aberrant glycosylation in cell surface molecules during malignant transformation can give a clue on the tumor burden.
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A comparative study on effect of 4% gelatin and dextran-40 on blood glucose levels during surgery under subarachnoid block - A randomized, prospective study p. 47
KG Sreehari, V Satyanarayana, M Madhusudan, K Vijay, GS Ravi Raj
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_122_19  
Background: Stress response to surgery induces hyperglycemia to a limited extent. An additive hyperglycemic response, secondary to the metabolism of intravenous fluids, can thus prove detrimental to the well-being of the patient, if ignored. Aim and Objectives: Our study aimed to examine and compare the effects of 4% gelatin and dextran-40 on blood glucose levels during surgery under subarachnoid block and their potential to induce hyperglycemia. Materials and Methods: Sixty ASA grade I and II patients were randomized into two groups, 30 patients in each. Group 1 patients were preloaded with 4% gelatin (10 mL/kg) and Group 2 patients were preloaded with Dextran-40 in normal saline (10 mL/kg), over a period of 30 min. Just prior to preloading, baseline capillary blood glucose (CBG) level was noted this is followed by subsequent readings at 20 min interval until 100 min from baseline reading. All patients received normal saline (0.9%) as a maintenance fluid. Under strict aseptic precautions, subarachnoid block using 15 mg of hyperbaric bupivacaine at L3–L4 or L4–L5 level was given after preloading. Results: Both groups are comparable in age, weight, sex, age-wise distribution, type and duration of surgery. The CBG levels in both the groups at 20, 40, 60, 80, and 100 min from the baseline were within physiological limits. In group 2, the maximum mean blood glucose level of 98.53 ± 14.57 mg/dL was found at 60 min from onset of preloading, which was found to be statistically significant (P = 0.017) when compared with corresponding blood glucose level (86.50 ± 10.44 mg/dL) in group 1. Conclusion: Preloading the patients prior to subarachnoid block with 4% gelatin or dextran 40 does not raise CBG levels significantly above the physiological limits.
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Shear bond strength of orthodontic brackets using orthodontic and restorative self-etching primer. An in vitro study p. 52
Vasumurthy Sesham, BR Anoob, Praveen Kumar Neela, Pavan Kumar Mamillapalli, Lalitha Chiguripati
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_7_20  
Background and Aim: Self-etching primers (SEPs) are used to reduce the chair side time. However, there are different SEPs that are used in orthodontics. This study is aimed to test the shear bond strength of brackets bonded using SEPs used in restorative dentistry in comparison to orthodontic SEPs. Settings and Design: Department of Orthodontics, Post-graduate dental college, Council of Scientific and Industrial Research (CSIR) laboratory, in vitro study. Methods and Material: Seventy-five freshly extracted human maxillary first premolar teeth were used in this study. Orthodontic maxillary first premolar McLaughlin Bennett Trevisi (MBT) metal brackets (3M Unitek) were used to bond the teeth. The study consisted of two groups. Group A: 25 teeth were etched with Orthodontic SEP Transbond Plus (3M Unitek). Group B: Experimental group which is divided into two subgroups, Experimental subgroup a and Experimental subgroup b. Subgroup a: 25 teeth were etched with Restorative purpose SEP Adper SE Plus (3M ESPE). Sub group-b: 25 teeth were etched with Restorative purpose SEP Adper Easy One (3M ESPE). In all the groups, the same adhesive material, Transbond XT (3M Unitek) was used for fixing the brackets. All the 75 teeth were subjected to shear force to test shear bond strength by using Instron machine. Statistical Analysis: ANOVA & Scheffe multiple comparison test were used. Results and Conclusion: Shear bond strength of brackets using orthodontic purpose SEP, Transbond Plus, is more than the SEPs used for restorative purpose, i.e., Adper SE Plus and Adper Easy One. Restorative purpose SEPs are not suitable for orthodontic bonding of brackets. Orthodontic bonding, self-etching primer (SEP), shear bond strength (SBS)
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CASE REPORTS Top

Hemisection with socket preservation using Platelet Rich Fibrin [PRF] - A case report with one year follow up p. 59
Tammineedi Sravanthi, Ram Chowdary Basam, Lakshman Chowdary Basam, Supraja Govula
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_115_20  
With advances in dentistry as well as the increased patients' desire to retain their natural teeth, there is a paradigm shift from extraction to the preservation of teeth. Mandibular first molars are the primary occlusal load-bearing teeth, commonly extracted teeth due to dental caries and periodontal disease. Hemisection is a conservative alternative to retain a hopeless tooth. Following endodontic treatment and selective root removal, the remaining portion of the tooth is splinted to the adjacent teeth with a fixed partial denture prosthesis. The resorption of the alveolar ridge surrounding the extraction socket may complicate the subsequent prosthetic procedure. Hence, socket preservation technique evolved, which prevents such untoward changes in the extraction socket. This case report shows hemisection procedure in a grossly carious first mandibular right molar with furcation involvement of a healthy 40-year-old female patient followed by autologous platelet-rich fibrin placement in the extraction socket. One year follow-up showed little alveolar resorptive changes with better healing and function clinically.
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Intra-articular osteoid osteoma of tempromandibular joint: A rare entity p. 63
Uday Kiran Uppada, Ramen Sinha, BS Ravi Kiran, M Susmitha, Syeda Afroz Ahmed
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_39_20  
Osteoid osteomas are benign neoplasms of bone that generally manifests in the long bones. Intra-articular osteoid stoma of tempromandibular joint is a rare manifestation. We report a rare case of osteoid osteoma of the mandibular condyle encompassing the intra-articular space with emphasis on how to differentiate it from other benign neoplasms of the bone that affects the jaws.
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SHORT COMMUNICATION Top

Strategies to protect camp residents from coronavirus disease-2019 p. 67
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_41_20  
The coronavirus disease-2019 (COVID-19) pandemic and the subsequent emergence of variants of the causative virus has compromised the public health system and even highlighted our shortcomings in preparedness and response plan. Considering the fact that we have fallen short in our efforts to contain the disease among normal populations, it becomes a really big challenge for the authorities to prevent the occurrence of similar incidents (outbreaks) in vulnerable settings like camps. As most of the inmates will have not much awareness about the infection or will have misconceptions about the disease, the first and foremost strategy is to create awareness about the disease and explain them about the way disease can be prevented or manifests. The need of the hour is to ensure that provisions are strengthened for early identification & initiation of prompt treatment to the infected people. To conclude, the outbreak of COVID-19 in camp settings can prove to be quite severe considering the fact that their environment is quite compromised and they are highly vulnerable to acquire the infection. It is essential that specific targeted interventions are planned and implemented to ensure their safety and wellbeing.
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