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   Table of Contents - Current issue
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July-September 2022
Volume 11 | Issue 3
Page Nos. 161-258

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REVIEW ARTICLE  

The necessity, barriers and strategies to overcome the barriers in evaluation in medical education p. 161
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jdrntruhs.jdrntruhs_112_21  
The curriculum delivered to medical students as a part of their training program has to be multi-faceted, dynamic and should have the component of quality assurance and continuous quality improvement to ensure that competent medical graduates are produced. This review has been carried out to understand the necessity, acknowledge the presence of barriers, and identify the strategies that can be planned to ensure systematic evaluation in medical education. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of 15 research articles were included in the review. Keywords used in the search include evaluation and medical education in the title alone only. There are no doubts that evaluation of medical education is an indispensable component of the learning cycle. Nevertheless, we cannot ignore the fact that the overall process of evaluation is complex, predominantly because of the long time interval between the introduction of the educational intervention and the learning outcome. We realize that there can be multiple barriers in the evaluation process in the field of medical education, but we have to overcome these challenges to ensure that the process of evaluation eventually benefits the administrators, teachers and the students. In conclusion, evaluation in medical education is an indispensable component of the training process. However, considering that multiple factors can determine the quality of evaluation, it is essential that specific steps are taken to eliminate these factors and ensure that the findings are valid and that they can be used for remedial actions.
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ORIGINAL ARTICLES Top

Changes in renal function following per cutaneous nephro lithotomy in chronic kidney disease patients with symptomatic renal calculus disease p. 165
Anil N Kumar, AY Tyagi, Tushar Sharma, MM Suchitra, Sivaparvathi Karanam, KV Siva
DOI:10.4103/jdrntruhs.jdrntruhs_150_20  
Introduction: Preserving renal function is the Achilles heel in the management of chronic kidney disease (CKD) patient due to the influence of multiple factors in its progression both reversible and irreversible. Renal calcular disease has both cause-and-effect relationship with CKD. Symptomatic renal calcular disease in a CKD patient gives an opportunity to preserve renal function to a variable extent depending on the stage of CKD as well as other comorbities of the patient. Percutaneous nephro lithotripsy is one of the best modalities to relieve obstructed renal tracts and its beneficial effects are established in patients with normal renal function however its efficacy in preserving renal function in CKD patients is less well studied, hence we have undertaken this study. Materials and Methods: A prospective observational study was done to study the changes in renal function as assessed by eGFR and Sr creatinine following Per Cutaneous Nephro Lithotripsy at 0-, 1-, and 3-months interval in CKD patients with symptomatic renal calculus disease. Repeated measure ANNOVA test followed by multiple comparison test was applied to study the outcome. P < 0.05 was considered statistically significant. Results: A total of 60 patients were studied, 80% were male and 20% female. Mean age of the patients in our study was 50.66 ± 13.82 years. out of 60 patients, 36.7% patients had diabetes mellitus, 55% patients had hypertension, and 11.6% had coronary heart disease. The most common presenting symptom was pain 70%, followed by recurrent fever. Most of the patients belong to CKD stage IV (30%). 65% showed improvement in renal function, 25% has stabilization in renal function, and only 10% showed deterioration of renal function. The complication rate was 23%. Discussion and Conclusion: In our study male to female patients' ratio was 4:1 and the most common presenting symptom is flank pain (70%). The renal function improved or stabilized in 90% of patients which was high compared to other studies and deteriorated in 10% patients. PCNL has favourable outcomes in CKD patients with improvement in eGFR, good clearance rate, and low secondary procedure rates. CKD Patients with age above 60 years and having both Diabetes Mellitus and Hypertension may not show significant improvement in Serum creatinine and eGFR. In conclusion, CKD patients can be benefitted by PCNL with good improvement of eGFR and acceptable morbidity when aggressive preoperative stabilization is being done.
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Head and neck cancers – Prevalence and risk factors in Andhra Pradesh state, India: A preliminary analysis p. 171
A Vangara, V S N Rao, KP Ranganath, J Kumar Reddy, D Vinod
DOI:10.4103/jdrntruhs.jdrntruhs_178_21  
Aim: The aim of this article is to study the prevalence of Head and Neck Cancers (HNC), risk factors, stage at diagnosis, site, and histopathology status in Andhra Pradesh from a hospital-based data and compared with the data available in other areas in the state. Materials and Methods: A retrospective analysis is carried out from the hospital data collected from the records and clinical files from the years 2010 to 2018. Patient's geographical area, risk factors, staging, etc., are analysed. Staging is done based on T- tumour size, N – Lymph nodal status, M – metastases status (TNM) classification and group stage. The cancer site is classified based on International Classification of Disease (ICD) for oncology (ICD-02). Results: 2544 patients of HNC are found in this study. A significant male predominance is noticed. Majority of the patients belong to the 40–60 age group (P < 0.001). The risk factors or habits are smoking, alcohol, chewing or combination of these in both males and females (P < 0.001). In both the sexes all the risk factors are seen mainly in tongue, hypo pharynx, and buccal mucosa. And, buccal mucosa patients are associated mainly with chewing tobacco habit, with male predominance. Most of the early stage disease (Stages 1 and 2) are noticed in females, whereas late stages (Stages 3 and 4) are noticed in males. (p-value < 0.001). Conclusion: Smoking, alcohol, and chewing are the common risk factors found among the patients. There is male predominance in the present study. Tongue and hypo pharynx cancers are associated with smoking and alcohol whereas chewing is found in buccal mucosa cancers.
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Evaluation of fracture resistance of maxillary premolars with class II mod cavities restored with fiber-reinforced composite and Cention N — An in vitro study p. 176
Leela Naga T. Pavani, Krishnaveni M Marella, Srividya Putta, MK Ramya
DOI:10.4103/jdrntruhs.jdrntruhs_50_21  
Aim: The purpose of this in vitro study is to assess the influence of fiber-reinforced composite (FRC) and Cention N on the fracture resistance of maxillary premolars with class II mesio-occluso-distal (MOD) cavities. Materials and Methods: Forty-five freshly extracted human maxillary premolar teeth were collected and embedded in an acrylic cylinder up to 2.0 mm below the cementoenamel junction (CEJ) using self-cure acrylic resin. MOD cavities were prepared with continuous water cooling using a high-speed handpiece and a diamond bur. Samples were then divided randomly into three experimental groups with 15 teeth each according to the respective composite: Group A: teeth were left intact; Group B: fiber-reinforced composite (FRC); and Group C: Cention N. All groups were stored in water at 37°C for 24 hours and thermocycled 500 times between 5°C and 55°C. All specimens were subjected to compressive axial loading in a universal testing machine using a steel bar which was placed centrally to the occlusal surface and applied in parallel to the long axis of the tooth until fracture occurred. Statistical Analysis: One-way analysis of variance (ANOVA) and Tukey's post hoc test were used to analyze the results. Results: In the present study, Cention N showed significantly high fracture resistance compared to fiber-reinforced composite. Conclusion: Among the test specimens, Cention N showed significantly high fracture resistance.
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Study of intraoperative squash cytology and frozen section diagnosis of central nervous system lesions with histopathological correlation p. 181
Praneeth Kadiyala, Sruthi Nannapaneni, Apuroopa Murari, Kalyan Chakravarthy Vallabhaneni, Naveen Chandra Rao Damera, Ranga Rao Diddi
DOI:10.4103/jdrntruhs.jdrntruhs_51_21  
Context: Intraoperative evaluation of central nervous system (CNS) lesions helps to guide the management by providing preliminary diagnosis, confirming the presence or absence of a neoplasm. Squash cytology and frozen section are reliable and sensitive techniques for rapid intraoperative diagnosis. However, both have respective limitations and the choice of the technique depends on individual preference and tissue availability. Aims: This study aims to determine the diagnostic accuracy of intraoperative squash cytology and frozen section diagnosis by correlating with the final histopathological diagnosis. Settings and Design: Prospective study over a span of 2 years in a tertiary care center. Materials and Methods: A total of 64 cases were subjected to intraoperative squash cytology and frozen section study and the intraoperative diagnosis was compared with final histopathological diagnosis. Statistical Analysis Used: Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. Results: Out of the 64 cases, 86% cases were neoplastic and 14% cases were non-neoplastic. The overall diagnostic accuracy of squash cytology was 90.6% and frozen section was 93.7%. Conclusion: Squash cytology and frozen section are highly accurate and reliable techniques for intraoperative frozen section evaluation of CNS lesions. However, both the techniques have respective limitations. When combined together they help improve the overall diagnostic accuracy.
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Knowledge, Attitude, Practice (KAP) study regarding antimicrobial use guidelines of ICMR among doctors working in primary, secondary, tertiary healthcare facilities in a tribal area of North Odisha p. 186
Kumar Haraprasad Misra, Kali Prasad Pattanaik, Anjali Tarai, Bhakti Sagar Pradhan
DOI:10.4103/jdrntruhs.jdrntruhs_153_21  
Background: Antimicrobial resistance occurs with irrational use of antimicrobials, self-medication, and misuse of drug. Using data from ICMR's AMR surveillance, ICMR has developed evidence-based treatment guidelines for the treatment of 10 syndrome and infection. Aims and Objective:
  • To assess the knowledge, attitude, and practice regarding the use of antimicrobials according to ICMR guidelines among doctors working in a tribal area of North Odisha.
Methods: A self-administered 18-question KAP survey tool was provided to total 53 doctors working in primary, secondary, tertiary healthcare facilities. The study systematically was done at the primary health center (in Rangamatia) and then upgraded primary health center (in Kisantandi), then community health center (in Bangiriposi) and finally medical college (PRM Medical College, Baripada) from June to August. Data were collected regarding how they are practicing use of antimicrobials in
  • Prophylaxis and treatment of surgical site infections.
  • Use of antimicrobials for upper respiratory tract infection
  • For management of antibiotic-associated diarrhea.
Results: We discovered that most of the doctor's, i.e., 77% are unaware about the ICMR guideline while 13% know very well. In case of attitude of doctors toward ICMR guideline of antimicrobial use, it is found that majority of them, i.e., 90%, have very good attitude. So while 5% of doctors have no attitude toward the guideline. But when it comes to practice according to ICMR guidelines, a majority of doctors i.e., 58% fared well. Conclusions: Our findings indicate dissonance between knowledge and practices among doctors. So there needs to be much more widened awareness program so that the treatment guideline can be reached near the doctors working in tribal areas.
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The perception of attractiveness of the facial profile among people of Telangana ethnicity p. 193
Agrima Thakur, Prasad Chitra
DOI:10.4103/jdrntruhs.jdrntruhs_19_21  
Background: The success of orthodontic treatment to a significant extent is largely dependent on the patient's and lay peoples' perception. Treatment can influence the soft tissue profile of the face, which is why, it is important for orthodontists to perceive what is considered attractive and unattractive amongst locals, and further, incorporate this knowledge in their diagnosis and treatment planning for population-specific groups. Aim: To evaluate differences in perception of attractiveness of the human face (in profile view) among ethnic Telangana subjects when compared to ideal Caucasian facial profile attractiveness standards. Methods: Profile silhouettes of ethnic Telangana subjects with straight, convex and concave facial profiles were rated by 10 adult laypersons (ethnic Telangana origin) and scored from least to most attractive. Fifteen relevant soft-tissue parameters from the Ricketts, Legan-Burstone, Steiner's and Z-Merrifield analysis were then evaluated on lateral cephalometric radiographs of the highest scoring subjects (considered most attractive) and sample t test statistical analysis was done in order to investigate differences between obtained values of the 'attractive' group as compared to standard values given in these analyses. Results: Of 15 parameters compared, significant differences from standard cephalometric values were evident for- vertical lip-chin ratio, lower lip protrusion, mento-labial sulcus and Z- angle. These measurements were smaller in the evaluated population group as compared to orthodontic norms. Conclusion: People of ethnic Telangana origin considered a shorter and less prominent lower lip and chin and a shallower mento-labial sulcus to be more attractive, as compared to standard orthodontic cephalometric norms of Caucasian populations.
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Phenotypic detection of ESBL-producing Enterobacteriaceae using combined disk diffusion, ESBL HiCrome agar, and E-test: A comparative study p. 200
Swetalina Dash, Susmita Kumari Sahu, Bimoch Projna Paty
DOI:10.4103/jdrntruhs.jdrntruhs_105_21  
Background: Extended-spectrum beta-lactamases (ESBLs) are in a rising trend in recent years, creating confusion for physicians to choose appropriate antimicrobials for treatment. Aim: The aim of the study is to detect ESBL-producing Enterobacteriaceae by using rapid detection tests such as combined disk diffusion, ESBL E-test strips (based on cefotaxime and cefotaxime+clavulanate), and ESBL HiCrome agar and compare the efficacy of these tests. Materials and Methods: Samples were processed using conventional methods. Bacterial antibiotic susceptibility testing was done on Mueller-Hinton agar according to the Clinical and Laboratory Standards Institute guidelines. All Enterobacteriaceae isolates were subjected to ESBL HiCrome agar, combined disk diffusion, and E-test. Results: Out of 5299 samples, 2097 (39.57%) were culture-positive, and 200 (9.5%) Enterobacteriaceae isolates were obtained. The majority of the isolates were Escherichia coli (67.5%), followed by Klebsiella pneumoniae (25%), Proteus mirabilis (3.5%), Proteus vulgaris (2%), and Citrobacter freundii (2%). 29.5% of all Enterobacteriaceae isolates were found to be ESBL producers by combined disk diffusion, ESBL HiCrome agar, and E-test methods, which showed 100% concordance. Conclusion: It is important to identify ESBL-producing Enterobacteriaceae from clinical samples for the judicious use of antibiotics. For early detection of ESBL-producing Enterobacteriaceae isolates, combined disk diffusion, ESBL HiCrome agar, and E tests were found to be equally effective in detecting ESBL production.
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The effect of age on COVID-19 patient's outcome p. 208
Venkata Suresh Babu Adapa, Smitha Sree Adapa, Hanumanth Narni
DOI:10.4103/jdrntruhs.jdrntruhs_156_21  
Background: The first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in Wuhan, China, in late 2019. In India, the first case was reported on 30.01.2020, and first COVID-19 death occurred on 10.03.2020. The case fatality rate (CFR) was 3.4% estimate by the World Health Organization (WHO) as of 03.03.2020. All age groups had significantly higher mortality compared with the immediately younger age group. The largest increase in mortality risk was observed in patients aged 60 to 69 years compared with those aged 50 to 59 years. Objective: The aim of this study is to determine the effect of age on COVID-19 patient's outcome. Methods: All the secondary data were collected either from the Indian institute statistics, Bangalore website, or COVID-19 india website, or GitHub website, or Indian government websites. The effect of age on COVID-19 patient's outcome was determined. Results: Age at first quartile was 50 years in the deceased group, whereas in recovered, it was 25 years. The median age in the deceased group and recovered group were 59 and 34 years, respectively. Significant difference was observed in age between the deceased and recovered group. Age was showing a medium effect size (0.574) in the outcome of the COVID-19. The cut-off value of age for estimating risk of death was established by using Receiver Operating Characteristic (ROC) analysis. The cut-off value was 48 years. The sensitivity was 77.5% and the specificity was 78.8%. More than 48 years age group had a 13 times higher risk than the less than 48 years age group. Area under the curve was 0.855 (95% CI: 0.846–0.864). Conclusions: This study suggests that the strong association between the age and outcome of COVID-19 patients. We can predict the outcome of COVID-19 patient based on their age. The outcome of COVID-19 patient prediction may give better results with associated comorbid conditions. The cut-off value of age for outcome was 48 years.
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Students attitude towards newer methods of medical education teaching in CBME phase-1 (Anatomy) in a Government Medical College, Andhra Pradesh p. 215
Adabala N.V V. Veerraju, J S. Surya Prabha Kona, Goru Krishna Babu, Devarakonda A.V S. Sesi, Korukonda Babji
DOI:10.4103/jdrntruhs.jdrntruhs_163_21  
Background: In the era of new competency based medical education (CBME) curriculum, teaching and learning anatomy is considered as most challenging part both for students and teachers. Objectives: The aim of this study was (1) to assess the attitude of students towards newer methods introduced in competency-based medical education curriculum and (2) to know the opinion of students regarding knowledge gained & skill acquired in anatomy through CBME. Materials and Methods: A descriptive cross-sectional study was conducted among second-year MBBS students who had just passed their first year in the month of August 2021 by using a pre-designed and pretested questionnaire sent through google forms to their mails. The inclusion criteria of the study were students who are willing to participate and gave consent were included. The exclusion criteria of the study were students who were absent and refused to give consent were excluded. Data were entered and analyzed in MS-Excel and descriptive statistics like simple frequencies and percentages were used. Results: Approximately 76% of the students were below 20 years of age. Female students (63%) were more when compared to male students (37%). Regarding newer methods, 83% of students agreed with introduction of AETCOM (Attitude, Ethics & Communication skills) whereas only 58% agreed with Vertical integration. Mean score was highest for introduction of Ethics & Communication skills (2.8). Majority (88%) of students marked good for opinion regarding knowledge in gross structure of anatomy and 82% for skill in identifying and locating gross anatomical structure. Conclusion: Importance of newer methods in medical education curriculum has to be addressed to students to make learning active. Evaluation of students attitude regarding effectiveness of newer teaching methods will improve quality of the teaching–learning process.
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Awareness and knowledge regarding human papilloma virus vaccine among medical students p. 220
Mannava Sai Priya, Atchyuta Mathi, Renuka Inuganti
DOI:10.4103/jdrntruhs.jdrntruhs_135_22  
Context: Cervical cancer is the commonest type of cancer in females worldwide and can lead to mortality in some of the cases. Most cases of cervical carcinomas are due to infection by Human Papilloma Virus types 16 and 18. Cervical carcinomas can be prevented by vaccination against HPV as HPV is the commonest risk factor that can be prevented. Despite the availability of vaccine, its existence is hardly known and is seldom used due to lack of awareness. Hence this study is being undertaken to assess the awareness amongst medical students. Aim: To analyze the knowledge of medical students about the availability and acceptance of HPV vaccination against cervical cancer Settings and Design: It is an observational descriptive study done after taking the informed consent from all the undergraduate medical students in our institute. Methods and Material: The study was done on all the undergraduate medical students by providing a preformed questionnaire, regarding HPV vaccination. Statistical Analysis: The results were entered into a Microsoft excel sheet. Standard error of difference between proportions is applied to know the significance of difference in results between the variables. Results: The results will help in assessing the need for awareness programs among the medical students Conclusions: As prevention is better can cure, awareness about the HPV vaccine among the medical students, will definitively help to prevent cervical cancer.
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Screening and assessment of mental health issues in patients with COVID-19 p. 227
Sarath Bodepudi, Srikanth Lella, Therissa Benerji, Roshan Miyan, Himaja Palagulla, Madhavi Kodali
DOI:10.4103/jdrntruhs.jdrntruhs_19_22  
Context: COVID-19 pandemic has an impact on the mental health of the most vulnerable populations, especially those afflicted with the disease. Psychological consequences can be due to disease progression, perceived danger, fear of virus transmission to others, uncertainty, and physical discomfort among others. Aim: To screen for mental health issues and to assess the levels of anxiety and depression in patients with COVID-19. Setting and Design: Designed as a cross-sectional study conducted in district COVID-19 hospital. Methods and Material: A cross-sectional study was conducted involving 510 hospitalized patients with COVID-19 between 18 and 60 years of age. Screening instrument of clinical schedule for clinical psychiatry version 2.3 was applied to screen for common psychiatric disorders and Hospital Anxiety and Depression Scale was applied to assess the levels of anxiety and depression in these patients. Statistical Analysis Used: Data were analysed using SPSS version 25. Results: The mean age of our sample was 38.7 years. Panic disorder followed by generalized anxiety disorder, depressive disorder, and alcohol use disorder was the most frequent psychiatric disorder in our sample of participants. Fear of infection with Corona virus was observed to be greater among the patients with COVID-19 screened for mental illnesses, and they were at an increased risk of developing symptoms of anxiety and depression. Conclusion: COVID-19 has a significant psychological impact on the mental health of those afflicted with the disease.
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Role of platelet count and indices in the diagnosis of neonatal sepsis p. 233
Banothu Sudhakar, Sravan Kumar Kusuma, Gare Karunakar, Vura U. V Naga Jyothi, V Krishna Kanth, M Shyam Prasad, T Jaya Chandra
DOI:10.4103/jdrntruhs.jdrntruhs_112_22  
Introduction: Neonatal sepsis (NS) is the leading cause of morbidity and mortality. Studies on the role of platelet indices (PIs) are limited. With this, a study was undertaken to evaluate thrombocytopenia and variations in PI in the diagnosis of NS. Methods: This was a prospective study, conducted in the Department of Pediatrics, Kakatiya Medical College, Warangal. Neonates aged <28 days with signs and symptoms of sepsis were included. Those without clinical or laboratory suspicion were excluded. The detailed history was collected and recorded. Physical examination was also recorded; 3 ml blood was collected for blood culture, C-reactive protein (CRP), and PI. Based on the clinical and laboratory findings, neonates were divided into sepsis proven (SP), probable infection, and non-infected categories. Results: A total of 110 were included; 41.8% were SP. The male–female ratio was 1.3. In the <3 CRP category, 32.3% (11) were SP. The majority (32; 36.36%) were 2–7 days aged; Klebsiella pneumoniae (14; 12.73%) was the leading causative agent. Severe thrombocytopenia was diagnosed in 18.2%, and 65% (13) were blood culture-positive. Increased PIs were observed. Conclusion: There was a rise in PI as well as CRP in NS. Hence, this combination can be used in the early diagnosis of NS.
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Styrene gas poisoning: A histopathological study of autopsy cases in a tertiary care center p. 237
Venkata Sudhakar Peddireddi, Bhagyalakshmi Atla, Chandra Sekhar Vadde, Satyasri Karri, Venkata Satya Kartheek Botta
DOI:10.4103/jdrntruhs.jdrntruhs_164_21  
Background: Styrene is an organic compound used to make plastics and rubber. Exposure to toxic levels of styrene is a rare phenomenon. Hence, there is a paucity of knowledge of its effect on various organs. The objective of the present study is to study the histopathological features of the organs affected in the deceased persons in a population who have been accidentally exposed to high concentrations of styrene. Methods: The present study is an observational study conducted in the Department of Pathology, Andhra Medical College, Visakhapatnam. Organs from 11 deceased cases were received following autopsy. All the organs were grossly examined and microscopically studied, following staining by Hematoxylin and Eosin stains. Results: In the present study, the lung is the most common organ affected (100%) characterized by acute lung injury. Other organs showing significant histopathological findings were the brain, liver, kidney, and spleen. Brain showing edema and congestion in 90% cases, liver revealed cholestasis, hydropic change, and congestion. In the kidney, cloudy swelling was the most common histopathological finding (70%), and in the spleen, congested sinusoids were seen in 100% of cases. Conclusion: Lungs, brain, liver, kidneys, and spleen showed histopathological changes in the deceased cases following styrene exposure. The lung is the most commonly affected organ leading to acute lung injury.
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SHORT COMMUNICATION Top

Role of omega 3 fatty acids in the management of various diseases---A special emphasis on COVID-19 p. 243
S S Kowshik Chandramahanti, Sahithi K Budharaju
DOI:10.4103/jdrntruhs.jdrntruhs_135_21  
Omega fatty acids (FA) have been found to have significant anti-inflammatory actions in several inflammatory diseases like inflammatory bowel disease, rheumatoid arthritis psoriasis and asthma. The metabolites of these omega FA are found to have strong anti-inflammatory effects against several allergic and inflammatory diseases. A significant reduction of almost 25% of adverse cardiovascular events has been observed with supplementation of omega FA in many of the studies conducted globally. Neurological function of human brain is invariably dependent on the adequate intake of omega FA's, as the omega-6 and omega-3 FA's promote systemic anti-inflammatory and proinflammatory states. Supplementation of Omega 3 FA can be a promising option as an adjuvant therapy in eczema and psoriasis, retinoid-induced cutaneous side effects, chemotherapy and systemic photoprotection. Omega-3 FA-rich diet or dietary supplementation of omega fatty acids can be considered as one of the therapeutic supplementing options among the home treated and hospitalized patients of COVID-19, because of their immunomodulatory and anti-inflammatory properties.
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CASE REPORTS Top

Angiolymphoid hyperplasia with eosinophilia of the palate: A case report with literature review p. 246
Pooja Medikonda, Satya Tejaswi Akula, Ravikanth Manyam, P Swetha, Kishore Moturi, Ramesh Tatapudi
DOI:10.4103/jdrntruhs.jdrntruhs_48_21  
Angiolymphoid hyperplasia with tissue eosinophilia (ALHE) is a rarely occurring benign vascular tumor of unknown etiology and most commonly affecting the head and neck region. It usually presents clinically as brownish or purplish papules or nodules with major prevalence in females. As the name defines, histologically it shows proliferating endothelial cells and lymphoid aggregates with stromal eosinophilia. It is very rarely identified clinically and the diagnosis is purely based on histopathology. This is a unique case report of intraoral ALHE with an unusual clinical appearance as ulceroproliferative lesion that showed quick remission after incisional biopsy.
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VISTA technique combined with collagen membrane for treatment of multiple gingival recession: A case report p. 251
Deepti Mittal, Meenakshi Panda, Gautam Khatak
DOI:10.4103/jdrntruhs.jdrntruhs_162_20  
Gingival recession is an exposure of root surface due to the apical migration of the marginal periodontal tissues apical to cementoenamel junction. Many therapeutic options are available for the treatment of gingival recession, among these techniques, Vestibular Incision Subperiosteal Tunnel Access (VISTA) technique in combination with collagen membrane (BIO-GIDE) was used in the present study for the treatment of multiple gingival recession defects in the maxillary anterior region. In the VISTA technique, a single vestibular incision provides broader access to the entire surgical area which reduces the possibility of traumatizing the gingiva, with little or no scar formation. And the use of collagen membrane offers several advantages over other techniques as it is biocompatible, there is no need for donor site or secondary surgical procedure there by reducing post-harvesting morbidity and patient discomfort. In this case report VISTA technique in combination with collagen membrane was found to be a reliable treatment method for multiple gingival recession defects.
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An incidental papillary renal cell carcinoma in a unilocular renal cyst: A case report p. 255
Neha Aggarwal, Sunayana Misra, Arvind Ahuja
DOI:10.4103/jdrntruhs.jdrntruhs_139_21  
Cystic renal cell carcinoma (RCC) is a malignant epithelial tumor arising in a pre-existing renal cyst. The renal cyst maybe multilocular or unilocular with the latter being an even rarer occurrence. Cystic renal malignancy arising in a unilocular cyst is quite rare with only a few cases reported till date, most of which are clear cell RCCs. Literature available with regard to staging tumor nodule in a benign unilocular cyst is limited. We report a case of a 52-year-old male presenting with a single large unilocular cyst which had a small solid nodule of papillary RCC in its posterior wall which was detected on microsopy. On pathologic examination, all cases of clinically/ radiologically benign renal cysts should be examined with a high index of suspicion as a small tumor focus may be present in the form of a nodule or in the free wall of the cyst which was initially missed.
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