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   Table of Contents - Current issue
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April-June 2022
Volume 11 | Issue 2
Page Nos. 103-160

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REVIEW ARTICLE  

Ensuring systematic introduction and implementation of the pandemic module in the medical undergraduate training in India p. 103
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jdrntruhs.jdrntruhs_77_21  
The coronavirus disease-2019 (COVID-19) pandemic has created a sense of emergency among the public health authorities and the general population across the world. The present review has been carried out to explore the introduction of pandemic module in the undergraduate medical training period in India. An extensive search of all materials related to the topic was carried out in the PubMed search engine, the Medical Council of India website, and the World Health Organization website. Keywords used in the search include pandemic module, medical education, COVID-19, and awareness in the title alone. Initially, a total of 15 studies were identified, of which five were excluded as they were not matching with the current review objectives. Finally, a total of 10 research articles and one document were selected based upon the suitability with the current review objectives and analyzed. In order to be better prepared for the upcoming public health emergencies, including pandemics in the future, it has emerged as one of the necessities that the medical undergraduate students are exposed to the pandemics during the period of their training. Acknowledging the presence of these pressing needs, the Medical Council of India has introduced a Pandemic Module, which will be run on a longitudinal basis, starting right from the time of entry, across all the professional phases, and also in the form of an elective course. To conclude, the introduction of pandemic module in the undergraduate medical education training period is a welcome step to empower the students to discharge their roles effectively in their career. It is now the responsibility of individual medical colleges to properly plan and implement the designated number of sessions and benefit the students.
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ORIGINAL ARTICLES Top

Use of saliva aspartate aminotransferase in diagnosing periodontal disease: A clinical and biochemical study p. 107
Harshada Shinde, Reetika Gaddale, Karthikeyan Ilangovan
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_90_20  
Background and Aims: Periodontal disease is one of the common inflammatory diseases. Several enzymes in saliva and gingival crevicular fluid are evaluated for early diagnosis of periodontal disease. The objective of our study was to evaluate the relationship between aspartate aminotransferase (AST) levels in saliva and periodontal status indicated by the Community Periodontal Index of Treatment Needs (CPITN). Methods: Thirty patients were assigned to each one of four groups C0, C1, C3, and C4, based on their largest CPITN code among the examined sites, totaling 120 participants. Un-stimulated saliva was collected from the individuals. Biochemical analysis of saliva samples was carried out with an RA-XT auto analyzer by using the International Federation of Clinical Chemistry method in order to quantify their AST concentration. Results: There were statistically significant differences between levels of AST (IU/L) from groups C0 (24.07 ± 15.16 IU/L), C1 (39.73 ± 21.46 IU/L), C3 (68.27 ± 44.41 IU/L), and C4 (175.93 ± 137.39 IU/L). There was a significant positive correlation between clinical parameters and AST concentration in saliva in each group. Conclusion: AST levels in saliva increased with an increase in the CPITN score, Group C0 had the least and Group C4 had the highest AST levels. Periodontal destruction such as periodontal pockets, gingival bleeding seems to be related to AST levels in saliva. Salivary AST levels represent useful adjuncts to the diagnostic of screening periodontal diseases.
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A cross-sectional anti-SARS coV-2 seroprevalence study among healthcare workers in a tertiary care hospital of eastern India p. 113
Samatirtha Chandra, Roumi Ghosh, Md Khalid Rashid
DOI:10.4103/jdrntruhs.jdrntruhs_90_21  
Purpose: Seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a cohort of health care workers (HCWs) in our tertiary health care set-up and determine the association of seroconversion with demographic characteristics, level of exposure, job responsibilities, and clinical symptoms of HCWs exposed to COVID-19 patients. Method: An observational cross-sectional epidemiological study was conducted in the Department of Microbiology, ESI-Postgraduate Institute of Medical Science and Research (PGIMSR), Kolkata. The study population was hospital staff who deliver care and services to patients Result: A total of 242 HCWs participated in this cross-sectional study. Among the study population, 161 (66.5%) were male, and 81 (33.5%) were females, and the median age was 43 years. Of all, 22.7% were physicians, 22.3% nurses, 15.7% lab technician. A total of 16 HCWs had reported having diabetes mellitus, 7 chronic lung diseases, and 4 cardiac diseases. Out of 242 participants, 30 (12.4%) HCWs were found to be anti-SARS-CoV-2 IgG antibody positive after 4 months of duty in COVID hospital. Seropositivity rate was more among the age group 18–44 years (76.7%) and doctors (33.3%) than other disciplines. Around 31.4% (76/242) of them had high-risk exposure with either COVID patients or samples, and 18.4% became seropositive. A total of 59.1% HCWs gave the history of known or suspected contact with COVID patients in the household, and 14.7% turned seropositive. A total of 84.8% of those participants, who attended in-house training on infection control practices, remained seronegative. Conclusion: In conclusion, the cross-sectional serology study in a tertiary care hospital in Kolkata revealed 30 (12.4%) HCWs had positive serology responses to SARS-CoV-2 out of 242 participants. Though there was an infection control policy and practice in the hospital to prevent the disease transmission, high-risk exposure and presence of comorbidities were definite risk factors for acquiring disease in our study.
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Unique tumors come in small packages: A single centre experience of histopathological spectrum of solid pediatric tumors in North West India p. 118
Shikha Narang, Pavneet Selhi, Ruchita Tyagi, Harshi Dhingra, Neena Sood, Sumit Dhuria
DOI:10.4103/jdrntruhs.jdrntruhs_5_22  
Introduction: Nonhematologic tumors in children differ biologically and histologically from adults in terms of incidence, type of tumor, and tendency to regress spontaneously. The study was aimed to evaluate the pattern, frequency, and histopathological spectrum of solid tumors and to correlate histopathological findings with immunohistochemistry (IHC) wherever feasible. Materials and Methods: This observational study was a retrospective analysis of all solid tumors of children less than 18 years, conducted over a period of 5 years. The specimens were analyzed grossly and microscopically with IHC wherever feasible. All leukemias and myeloproliferative neoplasms/myeloproliferative disorders were excluded from the study. Results: A total of 261 solid tumors were seen in the age of 2 days to 17 years with the median age being 10.41 years. The M: F ratio was 1.6:1. Benign tumors were more common (59.39%), with soft tissue tumors being more frequent. Lymphomas and reticuloendothelial cell tumors constituted the majority (27%) of malignant tumors. Conclusion: This institution-based study depicted the pattern of childhood tumors. As most of the studies have focused on malignant tumors, data on the prevalence of benign pediatric tumors is scarce. Pediatric tumors need to have a dedicated pediatric cancer registry for assessing the magnitude of the problem. This study provides useful insight into the pattern of benign and malignant pediatric tumors in the northwest region of India, which can be utilized in planning health policies. The present study also proves the importance of IHC in making the final diagnosis.
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A comparative study to evaluate the efficacy of intraperitoneal instillation of 0.25% levobupivacaine with or without clonidine (0.75 μg/kg) for postoperative analgesia in patients undergoing laparoscopic cholecystectomy p. 126
Neena Jain, Surendra K Sethi, Bhupendra Soni, Veena Patodi, Kavita Jain, Deepak Kumar Garg
DOI:10.4103/jdrntruhs.jdrntruhs_119_21  
Background: In recent years, the use of intraperitoneal instillation of local anesthetics with adjuvants has become popular for postoperative analgesia in laparoscopic cholecystectomy. This study aimed to compare the analgesic efficacy and safety of levobupivacaine alone or with clonidine as an adjuvant given through intraperitoneal instillation in laparoscopic cholecystectomy under general anesthesia. Material and Methods: In this prospective randomized double-blind study, 100 patients, aged 18–60 years belonging to ASA physical status I or II, were randomly allocated into two groups. Group L (n = 50) received 0.25% levobupivacaine 28 ml + 2 ml normal saline, whereas Group LC (n = 50) received 0.25% levobupivacaine 28 ml + clonidine 0.75 μg/kg (diluted in 2 ml normal saline) as intraperitoneal instillation before removing trocar. The duration of analgesia, pain scores, total number of doses, and amount of rescue analgesic consumed in 24 h, sedation score, hemodynamics, and adverse effects was noted. Results: Duration of analgesia was significantly prolonged in Group LC (744.10 ± 96.72 min) compared to Group L (525.20 ± 67.91 min) (P < 0.05). Pain scores (VAS) were significantly lower in Group LC (P < 0.05). The total number of doses and amount of rescue analgesic consumption in 24 hours were less in Group LC as compared to Group L (P < 0.05). Sedation, hemodynamics, and side effect profile were comparable in two groups (P > 0.05). Conclusion: Clonidine (0.75 μg/kg) was found to be a safe and effective adjuvant to 0.25% levobupivacaine for intraperitoneal instillation in laparoscopic cholecystectomy in terms of prolonged postoperative analgesia, lower pain scores, reduced rescue analgesic consumption along with no significant sedation, hemodynamic changes, and adverse effects.
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Prevalence of genetic pattern in isoniazid-resistant PTB cases and its association with other TB-resistance drugs p. 134
S Lakshmi Kumari, Srikanti Raghu, Karri Maruthi Devi, Aswina Tripura Sundari, D Sudheer, P Hima Sanjana
DOI:10.4103/jdrntruhs.jdrntruhs_200_20  
Introduction: Isoniazid (H) is one of the most important first-line antituberculosis drugs used for the treatment of active tuberculosis (TB) and latent TB infection (LTBI) with high bactericidal activity and a good safety profile. The emergence of TB strains resistant to isoniazid threatens to reduce the effectiveness of TB treatment. Specific INH resistance allele is more frequently associated with resistance to other drugs. Aim and Objectives: To analyze the prevalence of mutations in genes associated with isoniazid resistance and to explore the association of specific mutations conferring other drugs resistance. Material and Methods: This is a prospective study done from October 2018 to July 2020 in the Department of Pulmonary Medicine, Guntur Medical College, Govt. Fever Hospital, Guntur. A total of 369 sputum-positive isoniazid-resistant pulmonary TB cases were included in the study and subjected to line probe assay (LPA). Results: The prevalence of InhA and KatG gene mutation is 63.14% and 36.85%, respectively. InhA gene is associated with fifampicin mutation in 7.72%, fluoroquinolone (FQ) in 6%, and second-line injectables (SLI) in 1.71% cases. KatG gene is associated with rifampicin mutation in 13.23%, FQ in 7.35%, and SLI in 1.47% cases. Conclusion: InhA gene is the most common gene pattern observed in isoniazid-resistant cases and associated equivalently with other drug resistance patterns such as KatG indicating the recent change in the level of resistance of InhA-resistant strains.
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An alternative method of teaching for the medical students- the need of the hour p. 138
Arijit Majumdar, Soumali Biswas, Angshuman Jana
DOI:10.4103/jdrntruhs.jdrntruhs_64_21  
Aim and Objective: The coronavirus disease 2019 (COVID-19) pandemic has caused an unprecedented disruption in the medical education and health care systems worldwide. In India, responses to the COVID19 pandemic in medical education resulted in the closure of medical colleges and the adoption of online teachinglearning methods, which is challenging for both the faculty and students. Rising concerns among the students urged to evaluate the strengths and weaknesses of the ongoing online teaching and learning methods. The objective of the study was to find out the perceptions of the students and faculties regarding E-learning during the lockdown period of the COVID-19 pandemic. Methods: A descriptive cross-sectional study was conducted at the BS Medical College Bankura. A sample size of 500 was calculated. MBBS students of all semesters participated in this study. The responses were collected from 50 teachers. Two separate Google questionnaires for the students and teachers were developed and were validated by the Medical Education Unit of the college. The respective Google questionnaires were mailed to the students and faculty. The data were transferred to the Excel sheet and analysis was done on various parameters to derive descriptive statistics between classroom teaching and online teaching. Results: A total of 500 responses from the students and 50 responses from the faculties were received; 300 (60%) males and 200 (40%) females participated in the study. About 45% of the students and 40% of the teachers used mobile phones as their gadgets for E-learning and most of the teachers used laptops as their devices and preferred Google Meet as their platform of online teaching. Overall, only 10% of the teachers and 15% of the students preferred to use only E-learning. About 30% of the students preferred classical didactic learning; 50% of the teachers and 55% of the students preferred a combination of classical offline and E-learning as useful methods of learning. Conclusions: Students did not prefer E-learning over classroom learning. The teachers admit the usefulness of E-learning but classroom learning with rational use of E-learning is preferred by both.
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CASE REPORTS Top

Vasoplegic syndrome in urology: Report of an unusual case p. 143
Anil K Nallabothula, Manoj Bojja, Vaibhao M Nasare, Ashish K Singh
DOI:10.4103/jdrntruhs.jdrntruhs_166_21  
Vasoplegic syndrome is often characterized by low systemic vascular resistance with clinical features of reduced blood pressure and normal or high cardiac output. Causes of vasoplegia are diverse and mostly include sepsis, cardiac surgery, non-cardiac surgery, burns, trauma, and pancreatitis. We report a case of Vasoplegic syndrome that encountered during left adrenalectomy operated for left pheochromocytoma. Postoperative hypotension is common and well documented in pheochromocytoma and it responds well to regular inotropes and volume replacement. The purpose of presenting this article is to highlight the possibility of rare resistant hypotension in this case and the invaluable role of drugs like vasopressin and methylene blue in such scenario. Hence, vasoplegia may be encountered even in urology case and we should keep high level of suspicion.
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Unusual and rare complication during submental intubation – Pilot cuff fracture, localization by CT and retrieval- A case report p. 146
Venkata Ramana Murthy Vasupilli, Ramakrishna Suvvari, Sudha Madhuri Sampatirao, Swathi Tummalapalli
DOI:10.4103/jdrntruhs.jdrntruhs_63_21  
A secure airway is always a challenging task in the management of facial trauma. Open reduction and Internal fixation in Lefort II and III warrants airway patency during general anesthesia. Unobstructed surgical field provided by submental intubation helps in open reduction internal fixation (ORIF) and achieving intermaxillary fixation (IMF) during the procedure. However, submental intubation poses few complications such as bleeding, flexometallic tube damage, and obstruction of the tube. We report an unusual complication of pilot cuff fracture and retrieval during submental intubation with exact localization by computed tomography. Even though the technique is safer, it carries a number of rare risks depending on the exact techniques used and act as a reminder of unusual complications that might occur and be aware of the unusual risks of this surgery.
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Epithelioid sarcoma: A rare neoplasm of the soft tissues found in a pelvic swelling p. 149
Niharika Bisht, Sankalp Singh, Arti Sarin, Richa Joshi, Nishant Lohia, Manoj M Gopal
DOI:10.4103/jdrntruhs.jdrntruhs_10_22  
Epithelioid sarcoma (ES) is a rare, clinically polymorphic tumor that afflicts the dermal and subcutaneous region of distal extremity of young adults. In the distal extremity, the involvement of pubic and inguinal region is very rare. We present a case of an epithelioid sarcoma of the pubic region, which was managed, with a combination of upfront surgery and adjuvant therapy, and is presently disease free 5 years after completion of treatment.
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A rare case of primary renal leiomyosarcoma with peritoneal sarcomatosis – A case report p. 152
Maruthi D Karri, Kaumudi Konkay, Vijaya S Mandava, Geetha V Panchakarla, Padmavathi D Chaganti
DOI:10.4103/jdrntruhs.jdrntruhs_152_21  
Primary renal leiomyosarcoma is an extremely rare renal malignancy. This case report presents clinicopathological and immunophenotypic features of a case of primary renal leiomyosarcoma with peritoneal sarcomatosis.
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LETTERS TO THE EDITOR Top

Improving treatment adherence and outcome among TB patients under daily regimen - The way forward p. 155
Anugraha John, Sinthu Sarathamani Swaminathan, Hari Teja Avirneni
DOI:10.4103/jdrntruhs.jdrntruhs_78_21  
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Preventing COVID-19 breakthrough infection in the healthcare workforce in institutions p. 157
Abhijit V Boratne, Amrit Mishra
DOI:10.4103/jdrntruhs.jdrntruhs_62_21  
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Neuropsychiatric manifestations associated with neurocysticercosis p. 159
Jamir P Rissardo, Ana L Fornari Caprara
DOI:10.4103/jdrntruhs.jdrntruhs_27_22  
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