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   Table of Contents - Current issue
Coverpage
January-March 2022
Volume 11 | Issue 1
Page Nos. 1-102

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ORIGINAL ARTICLES  

Pattern of poly pharmacy among geriatric patients in a tertiary care teaching hospital: A cross-sectional study p. 1
K J. S Surya Prabha, K Vijaya, P Sai Shri, E Ravi Kiran
DOI:10.4103/jdrntruhs.jdrntruhs_133_20  
Background: In older adults multimorbidity increases with age and this increases the consumption of medications and the risk of Polypharmacy (PP). Along with this, the use of Potentially Inappropriate Medications (PIMs) among the elderly patients is a very common public concern. Objectives: The primary objective is to assess the pattern of PP and estimate the proportion of PP and PIMs among the geriatric in-patients. The secondary objective is to find out the association between serum creatinine and PP. Methods: A cross-sectional observational study was conducted among the geriatric in-patients aged ≥65 years admitted in medical wards by reviewing the case sheets. PIMs use was identified using Beer's criteria. Descriptive statistics like mean, range, standard deviation and proportions were used for Polypharmacy and PIMS. Inferential statistics like Pearson's Chi-squared test was used to find out association between serum creatinine and PP. Results: A total of 84 geriatric in-patients were enrolled as study subjects. Mean number of drugs prescribed was 6.9 (±3.2) and range 2-18. Proportion of PP was 73.8% and that of PIMs was found in 33.3% in the patients. There was significant association between an increase in serum creatinine levels with an increase in consumption of drugs. (p = 0.009) Conclusion: The proportion of PP and PIM and was found to be high among the geriatric patients. There was an increase in serum creatinine levels with increased consumption of drugs.
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Appraisal of root-crown ratio of maxillary incisors in various skeletal and dental malocclusions p. 6
G V D Harsha, CV Padma Priya, Siva Kumar Arunachalam, D P K Varma, V Goutham Chakravarthy, Anoosha Manda
DOI:10.4103/jdrntruhs.jdrntruhs_205_20  
Background: Shortening of the dental roots denoted by a decrease in root-crown ratio is a common manifestation of root resorption. Several natural conditions place roots at risk of resorption without any pathology. To date, information regarding root resorption in sagittal malocclusions is deplete in the literature. Aims: To measure and associate the root-crown ratio of maxillary incisors in different malocclusions. Methods: About 85 patients were allocated to three groups, Skeletal and Angle's Class I, Class II and Class III. Panoramic radiographs and periapical radiographs for maxillary incisors (340 teeth) using paralleling technique were taken and traced. Length of the root and crown were assessed and root-crown ratios were calculated. Results: The root-crown ratio was significantly lower in Skeletal and Angle's Class III group (P < 0.05) compared to Classes I and II groups. Gender predilection was found to be absent. Conclusion: Root resorption of maxillary incisors was observed in Skeletal and Angle's Class III patients. Maxillary central incisors were observed to have decreased root-crown ratios compared to maxillary lateral incisors irrespective of malocclusion.
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Clinical outcomes after modified radical mastectomy in a tertiary care hospital: An observational study p. 11
Akshita Bhandari, Pankaj P Rao, Arvind Tyagi, Dronacharya Routh, Simarjit S Rehsi
DOI:10.4103/jdrntruhs.jdrntruhs_46_21  
Background: Despite advances in medical sciences, modified radical mastectomy (MRM) remains the mainstay of treatment in breast cancer management in India. However, a wide range (0.8%–26%) of postoperative complications occur following MRM. Lacunae exist in the existing extensive medical literature regarding any correlation between preoperative staging and demographic profile of such patients with the incidence of these complications, which might aid in adapting a preventive approach accordingly. Aim: The aim of this work was to study the association of preoperative tumor size, nodal status, and clinical profile (age, diabetes mellitus, hypertension) of breast cancer patients with the postoperative complications (seroma formation, surgical site infection, wound dehiscence, flap necrosis, paresthesia, and lymphedema). Methods: All patients diagnosed with carcinoma breast and undergoing MRM. a. Settings and Design: This was a prospective observational study at a tertiary care hospital. b. Duration: Two years. c. Statistical Analysis Used: Data were recorded in an Excel datasheet and statistically analyzed by using the SPSS version 22.0. Results: A significant positive association was established between seroma formation, wound dehiscence with increasing age (P = 0.006), tumor staging (P = 0.003), and nodal staging (P = 0.022). However, no significant correlation could be established between the other parameters that were studied. Conclusion: Meticulous surgical techniques and postoperative care should be used to reduce Seroma formation and wound dehiscence in patients with advanced age, higher tumor, and nodal staging.
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An in vitro evaluation of smear layer removal with non-activated self adjusting file, xp-endo finisher and rotary canal brush: A scanning electron microscopic study p. 17
Krishnaveni M Marella, Nagalakshmi R Sampathi, Leela N T. Pavani, Chandra S Manduru, Gopi K Moosani
DOI:10.4103/jdrntruhs.jdrntruhs_86_21  
Background: Endodontic success involves removal of necrotic vital tissue and microorganisms from the root canal. Irrigation is an essential part of canal debridement, because it allows cleaning beyond what might be achieved by instrumentation alone. Aim: The aim of this in vitro study is to compare the smear layer removal efficacy of different final irrigation agitation devices. Materials and Methods: A total of 60 extracted single-rooted human premolar tooth were taken and decoronated. All the specimens were cleaned and shaped using ProTaper universal rotary files system and intermittent irrigation was done using 2 ml of 3% NaOCl and randomly divided into four groups, based on irrigant agitation device. Group 1 = conventional needle, Group 2 = Rotary canal brush, Group 3 = Non-activated Self adjusting file, and Group 4 = Xp-endo finisher. Final irrigant used is 17% Ethylene Diamine Tetra Acetic acid (EDTA) smear clear. All the specimens were finally flushed with distilled water and dried with paper points, then they were split longitudinally into halves and examined under scanning electron microscope. Data were analyzed using SPSS version 23, P value of <0.05 was considered statistically significant. Results: Non-activated self adjusting file (SAF) and Xp-endo finisher showed significantly cleaner walls with removal of smear layer followed by canal brush. There was no significant statistical difference (P < 0.05) between non-activated SAF and Xp-endo finisher. Conclusion: Xp-endo finisher shows superior results compared with other agitation methods.
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Impact of COVID-19 pandemic on the academics of medical students p. 23
Dedeepya Kobaku, Phanindra Dulipala
DOI:10.4103/jdrntruhs.jdrntruhs_114_21  
Context: Almost every sector in the world is affected due to COVID-19 pandemic. Among them educational sector is the one which is also badly affected. Due to this pandemic, all the students across the world were forced to an online mode of teaching. Aims: The aim of this study is to assess the impact of COVID-19 pandemic among the medical students on their academics. Settings and Design: This is a descriptive, cross-sectional study conducted in a teaching hospital, Guntur, in the month of October 2020. Methods and Material: A self-designed, semistructured questionnaire was circulated to all 600 students of the college through online social media groups. Statistical Analysis Used: The data were entered in to MS Excel and were analyzed statistically using SPSS 25 software. Results: Five-hundred and thirty-seven (89.5%) students responded from 600. Out of 537, females were 362 (67.4%) and 175 (32.6%) were males. Among them, 424 (79%) were using smartphones to attend online classes. Network issues were the main reason of disinterest; 439 (81.8%) of the students followed by lack of interaction during classes for 319 (59.4%). The problems raised were visual fatigue by 374 (69.6%) and auditory fatigue by 299 (55.7%). Two-hundred and eighty-six (53.3%) of them were not comfortable with online exams. Conclusions: As social distancing is one of the major barriers against COVID-19 pandemic, online classes were acceptable but the network issues being faced by many students must be addressed. Teachers must take an initiative to make the sessions more interactive and interesting.
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Study of clinical profile, laboratory parameters and outcomes of COVID-19 Patients in a Tertiary Care Centre in North India p. 29
Seema Rahar, Sunayana Misra, Anukrishnaa Kannappan, Vijay Kumar, Desh Deepak, Sanjeet Panesar
DOI:10.4103/jdrntruhs.jdrntruhs_116_21  
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has rapidly spread to many countries around the world and is still spreading due to newer variants. The clinico-hematological characteristics of COVID-19 have been reported from different countries but only a few large-scale studies have been conducted in India. This study aims to describe the clinical-laboratory data and outcome of COVID-19 patients admitted to tertiary care COVID center in North India. Method: This is a cross-sectional observational study. Data were collected from the medical records department regarding the epidemiological parameters, comorbidities, symptoms, laboratory parameters, and outcomes of patients with the COVID-19 disease admitted to our hospital over 4 months. The follow-up of the laboratory parameters (in a subset of patients) was also evaluated. Result: The mean age of the patients was 46.5 years with a male preponderance (male: female ratio: 2:1). The comorbidities were present in 103 (60.6%) patients, of which diabetes mellitus (n = 65; 38.2%) was the most common. A significant proportion of the patients were symptomatic (n = 148; 87.1%); the most common symptom being fever followed by dyspnea in 65 and 60% of the patients. Anemia was present in 36.5% of the patients, leukocytosis in 15.3% of the patients while lymphopenia was noted in 41.2% of the patients; 12.9% of the patients had thrombocytopenia. A majority of the patients were managed with supportive treatment. Seventy-five (46.5%) patients required oxygen supplementation and 29 (17%) patients had severe disease. Mortality occurred in 20 (11.8%) patients. Conclusion: In this single-center study of hospitalized COVID-19 patients, most of the patients were symptomatic having comorbidities. The most common symptoms were fever and shortness of breath. Many patients had lymphopenia and neutrophilia.
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A study on acceptance of COVID-19 vaccination among health-care workers in a tertiary care hospital in Eastern India p. 37
Mausumi Basu, Vineeta Shukla, Vanlaldiki Chhakchhuak, Prince Kerketta, Ratul Kumar Bysack, Anamitra Chakraborty
DOI:10.4103/jdrntruhs.jdrntruhs_98_21  
Background and Objectives: Vaccination is perhaps the only modality for providing specific protection to the general population against the ongoing coronavirus disease-19 (COVID-19) pandemic. This study was conducted among the health-care workers of a tertiary care hospital in Kolkata with objectives to estimate the proportion of the acceptance of vaccination against COVID-19 as well as to find the factors associated with vaccine acceptance. Methodology: A cross-sectional observational study was conducted among 350 health-care workers of a tertiary care hospital in Kolkata using a predesigned, pretested, structured schedule by face-to-face interview method. Data were analyzed using SPSS 25.0. Pearson's Chi-square test and multivariable binary logistic regression were performed to find the factors associated with vaccine acceptance. Results: The proportion of vaccine acceptance was 88.7%. Education above secondary level, occupation—doctor, and living with family and friends had higher odds of vaccine acceptance. Age above 55 years and residing in rented house/flat were significantly associated with vaccine denial. Conclusion: There was a high proportion of vaccine acceptance in our study. However, concerns about vaccine safety are prevalent and this may affect vaccine uptake in the future.
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Assessment of knowledge and awareness of general public on COVID-19 in Hyderabad city: A cross-sectional study p. 46
V Krishna Priya, V V V. R Krishna Murthy, M Divya Banu, Milan S Mali
DOI:10.4103/jdrntruhs.jdrntruhs_75_21  
Background: Coronavirus disease, also called COVID-19, is caused by the SARS-CoV-2 virus. Since it has turned to be a pandemic, the main management aims at prevention protocols. It is important to understand the knowledge and awareness levels of the general public regarding this infection to form guidelines and implement them. Objectives: The study is focused on the evaluation of knowledge and awareness levels, their attitude, and the practices being followed by both adults and children in Hyderabad about the COVID-19 pandemic and thus, helping in eliminating possible barriers related to implementation and practicing of guidelines by the public and formation of customized guidelines for the population under study. Methodology: A cross-sectional online questionnaire study was conducted among the general population of Hyderabad during the peak incidence of COVID-19 cases in the city. The questionnaire consisted of 22 questions which were divided into two parts: Sociodemographic details and the COVID-19 questionnaire. Results: A total of 682 responses were obtained from all age groups (20 years and above) with varied frequency. Nearly 98% population was aware of the ongoing pandemic and the majority knew the important details about the virus. 93% public followed a combination of preventive measures. The majority of children were staying at home. Only 18% were aware of the helpline numbers. Conclusion: The main strategy to prevent or limit COVID-19 is campaigns and events to enhance health education and awareness. Also, changing the attitude of the public and forming strict guidelines will help in the long run.
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Knowledge and awareness of breast cancer in Muslim population of Belagavi city: A population survey p. 52
Renu Pattanshetty, Varsha S Huddar, Saira Khan
DOI:10.4103/jdrntruhs.jdrntruhs_60_21  
Introduction: Breast cancer is a common cancer seen in women. The awareness of breast cancer plays an important role in the early detection and prevention of the disease, but due to lack of awareness regarding breast cancer screening, most of the cases are detected at later stages, which leads to lower rates of recovery. The presently aimed to evaluate the knowledge and awareness of breast cancer among the Muslim female population in Belagavi city, Karnataka. Materials and Methods: A cross-sectional survey was conducted on 97 Muslim Women, and a direct semi-structured questionnaire was administered to collect data. Results: Our results indicated a low knowledge about breast cancer, breast self-examination, mammogram, and clinical breast examination. In total, 29% of women had knowledge regarding breast self-examination, but due to lack of practice, they never performed self-examination. The most common barrier for screening methods of breast cancer was that women were unaware of half of the screening methods and other barriers were related to their religious beliefs. Social media was found to be the main source of information among the female. Conclusions: In conclusion, the majority of women showed poor knowledge about breast cancer and screening methods. Additional effort should be put forth through women to increase the awareness of breast cancer screening, indicating the need to continue emphasizing the importance of early detection of breast cancer in the early stages.
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Effect of surface treatments on the tensile bond strength of heat cure silicone soft liner to an acrylic resin denture base in a simulated oral environment - A comparative SEM study p. 57
Nithisha Brahmandabheri, Chalapathi Rao Duggineni, Ravi Kumar Chitturi, Harilal Guguloth, Mahinder Dubasi
DOI:10.4103/jdrntruhs.jdrntruhs_8_21  
Aim: To assess and compare the effect of surface treatments in a simulated oral environment through thermocycling on tensile bond strength of silicone soft liner with acrylic resin base. Settings and Design: In Vitro Comparative and SEM analytical study. Materials and Methodology: 120 samples of heat cured acrylic resin (DPI) and silicone soft liner (Molloplast B) with desired dimensions were fabricated using customized brass flask. 120 samples were divided into 1 control group (untreated) and 3 test groups (treated) consisting of 30 samples each. 3 test groups were divided based on surface treatments of resin samples to adhere to silicone soft liner to them via acid etching (36% phosphoric acid), air abrasion (50 μm Al2O3) and laser treatment (Er-YAG). All the 4 groups (1 control and 3 test groups) were subdivided into two subgroups based on their subjection to thermocycling i.e., 15 samples of each group were not subjected to thermocycling (before) and remaining 15 samples of each group were subjected to thermocycling (after). Statistical Analysis Used: All the samples were evaluated for tensile bond strength using universal testing machine. Obtained values were statistically analyzed with student paired T test, one way ANOVA and post HOC Tukey B test to compare, identify significant differences and also to arrive at order of groups. The effects of surface treatments and silicone liner on the surface of denture base resin were examined with scanning electron microscopy. Results: The tensile bond strength was significantly different between control and test groups and also among test groups before and after thermocycling (P < 0.05). The specimens of acid group had higher bond strength values followed by laser treated and abraded groups. Thermocycling had decreased bond strength values. SEM observations also revealed that, surface treatments modified the surface of the denture base resin with variability. Conclusions: Surface treatments increased the bond strength values while thermocycling had decreased them. Among all the groups tested, acid etching group of samples exhibited higher bond strength values of all test groups before and after thermocycling followed by laser, abrasion and control groups. Bond strength values of all test groups before and after thermocycling were still higher than 0.45 MPa, which is clinically acceptable bond strength level.
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Initial oxygen saturation at presentation as a predictor of mortality in COVID-19-positive cases in a tertiary care center in South India p. 64
Praveen V Janipalli
DOI:10.4103/jdrntruhs.jdrntruhs_101_21  
Background: The rapid emergence of novel coronavirus 2019 (COVID-19) infections has resulted in infection to millions of people and hundreds of deaths around the world. India is ranking second in terms of the number of COVID-19 cases. Although there is no specific treatment for COVID, early recognition and supportive treatment can help in reducing mortality. Aims: The aim of this study is to describe the association between the initial oxygen saturation when the patient presented to the hospital and the risk of mortality. Methods: This is a retrospective study of all laboratory-confirmed cases of COVID-19 patients admitted in Government Hospital for Chest and Communicable Diseases (GHCCD), tertiary hospital in Visakhapatnam from April to June month of 2021. Demographic, clinical history, initial oxygen saturation, comorbidities, and outcome data were collected from GHCCD and were entered in MS Excel. The data were analyzed using univariate binomial logistic regression and generalized linear model with Poisson distribution. Results: By using multiple Cox regression, oxygen saturation values of less than 90% on admission correlated with mortality, presenting 1.67 (95% confidence interval [CI] 1.02–3.36), 2.23 (95% CI 1.89–5.63), 4.89 (95% CI 3.02–8.09), 6.97 (95% CI 4.63–11.07), and 9.87 (95% CI 5.23–13.53) times greater risk of death for SPO2 of 89–80, 79–70, 69–60, 59–50, and 49–40, respectively, when compared to patients with SPO2 >90%. We included 306 COVID-19-positive patients with a median age of 46 years. Of these, 64.05% were males and 36.94% were females. Risk associated with worse outcome included males, old age, comorbidities like hypertension (47.38%), diabetes (37.58%), cardiac disease (4.9%), hypothyroidism (3.26%), Chronic kidney disease (CKD) (3.26%), and malignancies (1.63%). Conclusions: SPO2 below 90% on admission is a strong predictor of mortality in patients with COVID-19. Risk factors for poor outcomes among COVID-19 cases include old age, males, diabetic patients, hypertensive patients, cardiac patients, and chronic kidney disease patients.
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Evaluation of the efficacy of collagen membrane for mucousal defect in oral sub mucous fibrosis p. 69
Manas Dutt, Sourav Kumar, Dipti Nayak, Musaab Khan, Shashank Kumar, Neha Nayak
DOI:10.4103/jdrntruhs.jdrntruhs_49_21  
Background: Oral submucous fibrosis is well diagnosed as a premalignant condition. Through this article, an attempt was tried to improve the knowledge regarding surgical management which improves the existence expectancy of patients suffering from OSMF. Materials and Methods: The study included 15 patients in the age group of 15 to 60 years with stage II, III and IVa of oral submucous fibrosis all of which underwent operation under general anesthesia to facilitate an increase in their mouth opening by excision of fibrous bands and placement of collagen membrane by the same operator. After surgery, all were given similar prescriptions for analgesics, antibiotics, and postoperative instructions. All patients were reviewed at 1st week, 2nd week, 3rd week till 6th months postoperatively. Results: In this study, the mean age of occurrence of OSMF was 2nd to 3rd decade of life with males (86.6%) more commonly affected. The preoperative mouth opening was a mean value of 16.4 mm in all patients. At the first week postoperatively, a mean mouth opening of 24.96 mm was achieved which gradually increased to a mean mouth opening of 28.16 mm at the 2nd month with the help of rigorous physiotherapy. There was a slight gradual increase of mean mouth opening at consecutive months at 29.1 mm at the follow-up period of 6th months. Conclusion: In our study, we noticed that surgical excision of fibrous bands and placement of collagen membrane provided us with satisfactory results, there was a significant increase in the mouth opening of the patients till the last follow-up month as compared to the preoperative mouth opening. However, to prove a more significant result, we need a larger sample size, as well as a longer follow-up for the establishment of the same.
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Designing and implementing e-anubandh: A mentorship program during the COVID pandemic for medical undergraduate students p. 74
Madhur Gupta, Suresh Chari, Arti A Kasulkar
DOI:10.4103/jdrntruhs.jdrntruhs_113_21  
Background: There is a feeling of uncertainty in the COVID era and the graduate students are facing the challenge of being disconnected from the college. Mentorship has been shown to be essential for the attainment of skills as well as psychological development. The mentor-mentee relationship is a continuous process to dissolve the boundaries, and hence, e-mentoring could be one of the ways in which both the students and teachers connect. Material and Methods: A mentorship program called e-anubandh was designed and implemented. Six hundred medical undergraduate students were grouped with 47 faculty and 94 senior students. An online session was conducted in groups. At the end of the mentorship program, the feedback and perception of the mentors and mentees were taken using both open-ended as well as closed-ended validated questionnaires. Results: A total of 308 (out of 438 who participated) students, 94 senior mentors and 47 faculty mentors, completed the feedback questionnaire. The majority considered the initiative taken by the institute worth appreciating. The mentees and mentors found the program useful in building student–teacher relationships. They opined that such programs should be undertaken more frequently and for longer durations. Conclusion: The e-anubandh mentorship program helped in bridging the gap between the students and teachers created in the COVID era. Both the mentors and mentees were extremely satisfied with this program and such intervention appears to be a promising strategy in the COVID period.
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CASE REPORTS Top

Rarest of the rare-male triple negative breast cancer p. 81
Haneesha Polavarapu, Ravi C Ambalathandi, R Ramesh Reddy, Archana Balasubramanian, Manickavasagam Meenakshisundaram
DOI:10.4103/jdrntruhs.jdrntruhs_17_21  
Breast cancer in males is rare. Luminal A is the predominant subtype in male breast cancer. Clinical data on triple negative breast cancer in male patients is sparse. This case report will add to the literature on male breast cancers. This is a rare case of a 60-year-old male patient who was diagnosed to have locally advanced breast cancer of triple negative (basal-like) subtype. He received eight cycles of neoadjuvant chemotherapy. He later underwent modified radical mastectomy followed by adjuvant radiotherapy and 6 months of adjuvant capecitabine. He is on regular follow-up for the past 3 years.
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Mandibular permanent first molar with six conduits – A case report p. 85
V V. R Krishna Murthy, Soumya Pusuluri, Krishna Priya Vellore, M Divya Banu
DOI:10.4103/jdrntruhs.jdrntruhs_74_21  
Success in the non-vital pulpal therapy in permanent teeth can be achieved after a complete and thorough cleaning and shaping of all the canals and achieving hermetic seal through restoration of those prepared canals. This clinical case describes the unusual morphological configuration of the root canals in the mandibular permanent first molar. This case report adds to the available literature on various anatomical variations in the root canal system of mandibular first molars and emphasizes the importance of dealing with rare morphological variations while performing pulpal therapies to have a successful outcome in them.
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Systemic lupus erythematosus presenting as unprovoked brachio-cephalic vein thrombosis: A case report p. 89
Gautam Jesrani, Samiksha Gupta, Shivani Gupta, Tagru Raju, Monica Gupta
DOI:10.4103/jdrntruhs.jdrntruhs_129_21  
Systemic lupus erythematosus (SLE) is an autoimmune disease with multisystem involvement, and majorly affects the female population of the childbearing age. Vascular thrombosis is a known complication in the natural disease course, but the thrombotic event as the initial presentation of SLE is rarely depicted, especially for the thoracic vasculature. Herein, we are narrating a case of a 38-year-old gentleman, who previously suffered from myocardial infarction, due to left coronary artery occlusion and this time presented with left brachiocephalic vein thrombosis. On evaluation, SLE was diagnosed, without antiphospholipid syndrome, and a standard treatment of anticoagulant with hydroxychloroquine was prescribed for this. This report illustrates that an unusual vascular location can be involved in SLE and reemphasizes that a thorough immunological work-up should be performed promptly in the absence of any identified etiology.
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Blurry vision unraveling underlying aplastic anemia p. 94
Jasmita Satapathy, Pradeep K Panigrahi, Japesh Thareja
DOI:10.4103/jdrntruhs.jdrntruhs_85_21  
A 23-year-old male presented with sudden diminution of vision in both eyes due to massive retinal hemorrhages involving the macula. Hematological workup revealed severe anemia with thrombocytopenia and leukopenia. A bone marrow biopsy was advised, and the diagnosis of Aplastic anemia was confirmed. Replacement therapy resulted in dramatic resolution of the fundus picture with improvement in visual acuity to near normal on follow-up visit after three months. A careful examination including dilated fundoscopy, a high index of suspicion, and prompt management can save vision as well as life in such cases.
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BRIEF COMMUNICATION Top

Actinomyces in vault smear p. 97
Rashmi Patnayak, Sujata Naik, Divya Bulusu, Prabhudatta Dash
DOI:10.4103/jdrntruhs.jdrntruhs_9_21  
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LETTERS TO THE EDITOR Top

Are medical residents research work being at stake? p. 99
Sinthu Sarathamani, Lalithambigai Chellamuthu, Abhijit V Boratne
DOI:10.4103/jdrntruhs.jdrntruhs_58_21  
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COVID-19 pandemic: A three-step protocol for ED triage p. 101
Suhrith Bhattaram, Varsha S Shinde
DOI:10.4103/jdrntruhs.jdrntruhs_125_21  
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