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   2021| October-December  | Volume 10 | Issue 4  
    Online since March 22, 2022

 
 
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REVIEW ARTICLES
Oral microflora: Varied habitats, niche and their disparity in systemic health
Shilpy Jain, Ashalata Gannepalli, Pacha V Baghirath, B Hari Vinay, A Bhargavi Krishna
October-December 2021, 10(4):209-218
DOI:10.4103/jdrntruhs.jdrntruhs_188_20  
The discovery of microbes dates back to the 1700s when Dutchman Antony Van Leeuwenhoek observed his own dental plaque and reported 'little living animalcules prettily moving' further named them as microbes “Dierken”, meaning small lively objects. Since then, the understanding of oral microflora has become profound. Oral microflora is the aggregation of microorganism inhabiting the oral cavity which include bacteria, fungi, viruses and protozoa. The term “microbiome” is defined as the collective genome of microorganisms that reside in the oral cavity. The mouth is an exceedingly complex habitat with its variable niches where microbes settle down and colonize. At present, the connection that has taken a limelight is the link between the oral microbial community and their interactions with the host in the maintenance of homeostasis and in the pathogenesis of many diseases. In today's urbanized society, change in lifestyle, diet along with other environmental factors and distinct health habits, there is precise switching in the composition of the oral microbiota with a remarkable increase in the frequency of systemic diseases. Recently there are few advancements made in the field of 16S RNA sequencing and other technologies. Here in this review, we emphasize on the varied habitats and niches that microorganisms colonize along with their disparity in systemic health and the use of currently available methods to determine the oral microflora.
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ORIGINAL ARTICLES
Oral hygiene practices and awareness among first-year students of UG professional courses in Rajahmundry: A comparative cross-sectional study
Anupama Masapu, KP Ashok, S S Manikanta Kumar Thirumalasetty, Ganni Lakshmi Sri Divya, Abdul Riyaz Shaik, Banala Aishwarya
October-December 2021, 10(4):229-232
DOI:10.4103/jdrntruhs.jdrntruhs_199_20  
Introduction: Young individuals like Engineering students, Dentists and Medical practitioners play a pivotal role in raising awareness of oral health. These professionals should be equipped with a basic knowledge of oral hygiene regimen at an early age for the prevention of oral diseases. Aim: Our study aimed to compare oral hygiene awareness and practices by evaluating the Questionnaire filled by students of first-year dental, first-year engineering, and first-year medical students in Rajahmundry. Subjects and Methods: This prospective cross-sectional study included 50 Students each from dental, medical, and an engineering college in Rajahmundry, Andhra Pradesh. Students were asked to fill a questionnaire pertaining to oral hygiene practice, awareness of oral health. Data was collected, tabulated and subjected to statistical analysis, and results were expressed as numbers and percentages from each group. Results: All the data collected from the participants were analyzed using SPSS software. Inter-group comparison was made for each question using the Chi-square test. Results of this study show statistically significant outcomes in Q2, Q4, Q6, Q7, Q9, Q12, Q13 which are pertaining to frequency of dental check-ups, mechanical plaque control aids and practices. Conclusions: Our study found that oral health awareness of dental students was marginally better than their counterparts during initial phase of graduation regarding oral hygiene knowledge and awareness. Further emphasis should be done on the health education regarding improvement in their knowledge of oral hygiene to every individual irrespective of their field on regular basis by workshops which demonstrates oral hygiene practices.
  1,048 132 -
A study on anxiety, obsession, and reassurance-seeking behavior due to COVID-19 pandemic
Sai SreeValli Sreepada, Phanindra Dulipala, Jagannath Rao Dara
October-December 2021, 10(4):233-237
DOI:10.4103/jdrntruhs.jdrntruhs_38_21  
Background: Coronavirus disease-2019 (COVID-19) has a devastating impact on public health and requires extensive preventive and precautionary measures to contain its spread. These measures result in dramatic lifestyle changes which might lead to disturbed mental health outcomes among individuals. Aims and Objective: The aims of this study were to (1) assess anxiety, obsession, and reassurance-seeking behavior due to COVID-19 pandemic, and (2) to compare these outcomes among health-care professionals and the general population. Settings and Design: This was an online community based cross sectional study done in the month of November, 2020. Subjects and Methods: The study was conducted in November 2020 among 527 individuals selected randomly. A self-designed, semi-structured questionnaire consisting of 25 questions about demographic details, anxiety, obsession, and reassurance-seeking behavior was applied using Google forms. Statistical Analysis Used: SPSS version 25.0 (IBM). Results: Of 527 individuals, 246 (46.7%) were men and 281 (53.3%) were women. Health-care professionals and general population comprised 255 (48.4%) and 272 (51.6%) individuals respectively. Anxiety was found among 14 (2.65%) individuals, obsession in 97 (18%) and reassurance-seeking behavior in 51 (9.67%) individuals. Obsession and reassurance-seeking behavior was found to be significantly higher (p < 0.05) among general population than in health-care professionals. Reassurance-seeking behavior was found to be significantly higher in COVID-19 positive patients. (p < 0.05). Conclusions: Anxious and obsessive thinking about health during the COVID-19 pandemic stimulating reassurance-seeking behavior was more among the general population in comparison to health-care professionals. This indicates the need for proper health education, guidance, and training regarding the preventive measures and precautions to be taken in order to avoid adverse mental health outcomes.
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REVIEW ARTICLES
Training undergraduate medical students in trauma management skills
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
October-December 2021, 10(4):219-221
DOI:10.4103/jdrntruhs.jdrntruhs_57_21  
Trauma has been ranked as one of the commonest cause accounting for untimely deaths, disabilities, sufferings and impairment in the quality of life. The aim of the review was to explore the status and the ways in which trauma management skills can be taught to undergraduate medical students. An extensive search of all materials related to the topic was carried out in the PubMed search engine and World Health Organization website using the keywords trauma, undergraduate, and medical education. A total of four articles were selected based upon the suitability with the current review objectives. The teaching of trauma evaluation and management has to be regarded as one of the most essential, yet undermined field in the medical institutions. From the medical college perspective, the task of training undergraduate medical students in trauma management is definitely a challenging one. However, considering that the initial time after a trauma is the golden period for saving the life of a person, which is actually being managed by a junior doctor, we have to find out a way for bridging the existing lacuna in the curriculum. In conclusion, trauma management is an essential and integral aspect of undergraduate medical training. However, in the present scenario, it has been neglected in most of the medical institutions due to various reasons. The need of the hour is to formulate specific competencies, go ahead with curriculum mapping and ensure that students are trained and competent before they land into clinical practice.
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CASE REPORTS
Acrania-exencephaly-anencephaly sequence
Sunil Vitthalrao Jagtap, Swati S Jagtap, Kaushiki Varshney, Parneet Kaur, Ramnik Singh
October-December 2021, 10(4):282-285
DOI:10.4103/jdrntruhs.jdrntruhs_89_21  
Acrania–exencephaly–anencephaly sequence is rare forms of neural tube defects. The progression is from a relatively normal-appearing exposed brain due to an absent cranium called as acrania, to an amorphous brain mass term as exencephaly. We present a case of 20 years female, nonconsaguinous marriage, G1P0A0 having amenorrhea since 3 months. On ultrasonography, a single fetus of gestational age of about 15 weeks gestation showed congenital malformation- acrania with exencephaly. Final impression on fetal autopsy given was acrania–exencephaly with deformed brain, ill-formed cervical C1, 2 spine, bilateral pulmonary immaturity- Grade II with pulmonary congestion and hemorrhage. We are presenting this rare fetal anomaly of acrania–exencephaly–anenecephaly sequence for its clinical, radio imaging, and fetal autopsy findings.
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Why ceramic? When you can use composite. Indirect restoration of tooth in a more biomimetic way using heat treated direct resin composite
Bhavika Bhavsar, Kamei Neilalung, Michelle Vaz
October-December 2021, 10(4):277-281
DOI:10.4103/jdrntruhs.jdrntruhs_35_21  
Direct resin composites have a greater degree of conversion, physical properties, color, and resistance to abrasion when heat treated. So, it is best suited for indirect use as heat-treated direct resin using oven, autoclave or porcelain furnace, or microwave. We have chosen direct resin composite as a suitable material and heat-treated it for endo crown fabrication or aesthetic indirect restoration. The reason for such technique is supported by various research studies, and case reports available have shown positive results, and it is also considered as a biomimetic method.
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REVIEW ARTICLES
Cancer-related fibrosis: Prevention or treatment? – A descriptive review
Renu Pattanshetty, Mounica Srinivas Rao
October-December 2021, 10(4):222-228
DOI:10.4103/jdrntruhs.jdrntruhs_104_21  
Cancer and its therapies, including surgeries, radiation therapy, and chemotherapy, have a significant influence on the body of the patient. Tissue fibrosis is one of the most significant adverse effects noticed in cancer patients. Fibrosis caused by any tissue damage or various intracellular mechanisms can result in physical and functional impairments such as trismus, neuro-musculoskeletal dysfunction syndromes, fibrosis, speech and swallowing dysfunctions, upper limb and lower limb impairments, and sexual dysfunctions, all of which have a negative impact on patients' quality of life. Using manual therapy and therapeutic modalities, speech and swallowing therapy, and vocational rehabilitation are some of the important approaches to treating postcancer treatment problems. As a result, when to begin rehabilitation to enhance and maintain functional and physical performance becomes critical.
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ORIGINAL ARTICLES
Clinical and mycological features of recurrent dermatophytosis: A hospital-based observational cross-sectional study
Seva Praveen, Satya Saka, Konala Subhashini, Godha Venkataramana, Gogineni Sathvika, P Ramanamurty, Seetharam Anjaneyulu
October-December 2021, 10(4):243-248
DOI:10.4103/jdrntruhs.jdrntruhs_70_21  
Background: Dermatophytosis has changed its facets. The prevalence, clinical features, and causative organisms are changing leading to recurrent, recalcitrant, and chronic dermatophytosis. The misuse of potent topical steroids is further aggravating the problem. The risk factors, clinical features, and mycological nature of recurrent dermatophytosis are sparsely documented. Objectives: To know the epidemiological and clinical features, and to identify the organisms causing recurrent dermatophytosis. Materials and Methods: Patients attending to our OPD with dermatophytic infections from December 2017 to June 2019 were scrutinized and those, who had recurrence within 6 weeks after treating with 4 weeks of systemic antifungal treatment were recruited into our study. Demographic data and clinical patterns were documented after informed consent. KOH smears were taken, and the scrapings were cultured in Sabouraud's dextrose agar with 0.05% chloramphenicol and 0.5% cycloheximide. Results: Ninety-six patients were recruited to the study after following the inclusion and exclusion criteria. The most common age group was 21–30 years, and males were slightly more. A total of 66.7% (64/96) had used topical corticosteroids or steroid combinations. KOH positivity was seen in 67.7%, and the culture was positive in 58.3% of cases. The most common organism isolated in culture was the Trichophyton rubrum (27.1%), followed by Trichophyton mentagrophytes (22.9%). Recurrences were early in those who used topical potent corticosteroids like clobetasol. Limitation: Minimum inhibitory concentrations (MIC) levels of the antifungal drugs were not done to know the relation between MIC levels and recurrence. Conclusion: Recurrent dermatophytosis is increasing and presenting with modified clinical patterns. Topical steroid use, mainly with potent clobetasol or its combinations, seems to be the main culprit for recurrences.
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Association of computed tomography pulmonary angiography findings with clinical outcome in patients with acute pulmonary embolism
Chandana Bimineni, Pavan Kumar G. Kale, AY Lakshmi, D Rajasekhar, M Madhusudan
October-December 2021, 10(4):238-242
DOI:10.4103/jdrntruhs.jdrntruhs_197_20  
Context: Acute pulmonary embolism (PE) is one of the common and potentially fatal medical emergencies. The short-term mortality of PE ranges from less than 1% in hemodynamically stable patients to over 90% in patients presenting with cardiopulmonary arrest.[1] Patients presenting with PE have a high risk of mortality in the first 30 days.[2],[3],[4],[5] Echocardiography is routinely done in cases of PE for knowing cardiac status but echo being highly operator dependent, Computed Tomography (CT) pulmonary angiography (CTPA) can provide an alternative with lesser operator dependence. The main purpose of this study is to assess the prognostic value of different parameters measured by multi-detector CT pulmonary angiography (CTPA) in evaluating the clinical outcome of acute PE patients. Aim and Objectives: To study association of left atrium (LA) volume, LA volume index, RVV/LVV ratio, IVC reflux, interventricular septal bowing with clinical outcome. Methods and Materials: The prospective study was conducted in the Department of Radio-Diagnosis, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati in the time frame of March 2018 to June 2019. A total of 46 cases that were confirmed to have acute pulmonary thromboembolism on CTPA meeting the study criteria were studied for location of emboli, LA volume, LA volume index, RVV/LVV ratio, IVC reflux, interventricular septal bowing. The parameters were compared with adverse clinical outcomes which were defined as death within 30 days or escalation of therapy, according to the MAPPET-3 ( Management Strategies and Prognosis in Pulmonary Embolism Trial-3) study criteria.[7] Statistical Analysis Used: Chi-square test was used for comparisons of categorical variables, and Student t-test was used for comparisons in the distributions of continuous variables by using IBM SPSS statistics 20. A P value <0.05 was considered significant. Results: Our study included 46 patients belonging to age range of 18 to 83 years with evidence of pulmonary thromboembolism on CTPA study. Out of these, 18 (39%) patients had adverse events, where 17 (37%) patients died within 30 days, and 1 (2%) had a cardiac arrest where he was revived after cardiopulmonary resuscitation within 30 days from diagnosis of acute PE. There was no difference in the distribution of age, sex or other comorbidities between the patients who had adverse events and those who did not. In our study, patients with centrally lodged thrombi showed higher mortality and other adverse events than patients with more peripherally lodged PE (p value = 0.022). There was no evidence of any statistically significant association between the IVC reflux, septal bowing, cardiac volume parameters with adverse events within 30 days of diagnosis of acute PE. Conclusion: In our study, we found the location of thrombus on CTPA to be a significant factor in predicting the adverse outcome. Other parameters like LA volume, LA volume index, RVV/LVV ratio, IVC reflux interventricular septal bowing did not demonstrate a significant relationship with 30-day adverse outcomes. The use of cardiac volumes in predicting the clinical outcome did not show any significant relationship, and this could be due to underlying conditions like hypertension, smoking, systemic diseases. The use of cardiac chamber volumes in predicting clinical outcome needs to be studied on a larger sample size to look for the role of other systemic factors affecting its volume.
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Knowledge, attitude, and practice of Indian Endodontic postgraduate students regarding the COVID – 19 pandemic and its consequences: A cross-sectional study
Sravanthi Tammineedi, Nagesh Bolla, Ram Chowdary Basam, Sayesh Vemuri, Ramsunil Chukka, Lakshman Chowdary Basam
October-December 2021, 10(4):252-260
DOI:10.4103/jdrntruhs.jdrntruhs_159_20  
Aim: To assess the knowledge, attitude, and practice of Indian endodontic postgraduate students regarding the COVID-19 pandemic. Methods: A questionnaire-based survey was designed and circulated amongst the endodontic postgraduate students at various colleges in India by convenience sampling and snowball sampling. A total of 540 voluntary responses were recorded. The survey consisted of 15 questions about their knowledge, attitude, and practice regarding the COVID-19 pandemic. Descriptive statistics were performed to analyze the demographic details, mean scores of knowledge, attitude, and practice among the participants. Chi-square tests were performed to assess the association between the demographic variables and the questions. Pearson's correlation test was performed to study the association. Results: Indian endodontic postgraduate students have adequate knowledge (64.7%), attitude (80%), and practice scores (85%). Good knowledge and attitude scores were associated with the place (P = 0.0004) and year of studying (P < 0.0001). Good practice was associated with gender (P < 0.0001) and year of study (P < 0.0001). Positive correlation was observed between knowledge and attitude (r = 0.92, P < 0.0001), knowledge and practice (r = 0.76, < 0.0001), and attitude and practice (r = 0.70, < 0.0001). Conclusion: The Indian endodontic postgraduate students who participated in the study showed adequate knowledge, attitude, and practice with few lacunae. Decision-making regarding the treatments to be performed and fear of hindered academic and clinical skills need to be addressed.
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Bacteriological profile of postoperative wound infection in LSCS patients in MKCG Medical College, Berhampur
Swetalina Dash, Bimoch Projna Paty, Susmita Kumari Sahu
October-December 2021, 10(4):261-268
DOI:10.4103/jdrntruhs.jdrntruhs_202_20  
Background: Post-lower segment cesarean section (LSCS) infection is a common complication and is mainly responsible for a longer hospital stay, higher treatment cost, and maternal mortality. Aim: To isolate and identify the different bacterial spp. in patients with postoperative LSCS wound infection and to determine their antimicrobial susceptibility. Material and Methods: Pus samples were collected from 30 patients with infected LSCS wounds using two sterile swabs from each patient from May 2019 to July 2019. One was used for Gram stain and the other inoculated into blood agar and MacConkey agar. The bacterial isolates were identified using a standard protocol. An antimicrobial susceptibility test was carried out using the Kirby Bauer disk diffusion method. Double-disk diffusion and E-test using Cefotaxime (CTX)/CTX+and Ceftazidime (CAZ)/CAZ+ were done for Extended Spectrum beta lactamases (ESBL) producer. All isolates were put in Congo red agar to see the biofilm production. Results: Out of 30 samples, 76% (22) were culture positive. The predominant age group was 20–30 years. Gestational diabetes and hypertension were the common risk factors. Pond bathing was a major predisposing factor. Of the 23 isolates, 65.2% (15) were gram-positive and 34.8% (8) were gram-negative bacteria. Among the gram-positive isolates, Staphylococcus aureus was the predominant isolate (80%) and the other being Enterococcus and M. tuberculosis. Among the gram-negative isolates, Acinetobacter was predominant (50%) followed by Pseudomonas, Escherichia coli, and Klebsiella. All the gram-positive isolates were sensitive to linezolid and vancomycin while among the gram-negative isolates, Escherichia coli, Pseudomonas spp., and Klebsiella spp. were 100% sensitive to piperacillin-tazobactam. A case of multidrug resistance Acinetobacter was found. Of all the isolates, two were ESBL producers, and five were biofilm producers. Those were also methicillin-resistant Staphylococcus aureus (MRSA). Conclusions: A majority of the LSCS wound infection was due to gram-positive bacteria. Educating the patients about personal hygiene and antimicrobial prophylaxis is thought to decrease the incidence of LSCS wound infection.
  668 65 -
CASE REPORTS
Juvenile onset pleomorphic adenoma presenting as giant tumor of parotid gland in a young female
Surender Verma, Shivika Aggarwal, Pradeep Garg, Anjali Verma, Mridul Gera, Swaran S Yadav
October-December 2021, 10(4):286-288
DOI:10.4103/jdrntruhs.jdrntruhs_91_21  
Salivary gland tumors are rare and carry diverse histologies. There is a paucity of clinical and biological details about pediatric salivary gland tumors and their clinical behavior in the literature. We present a case of 25-year-old female with giant pleomorphic adenoma of the parotid which started in her childhood at the age of 13 years. Presentation at such an early age is a rare entity. The patient underwent a superficial parotidectomy. Periodic follow-up was done for 1 year and there was no recurrence. For benign salivary gland tumor, surgical excision with preservation of neurovascular structure is the main treatment option.
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SHORT COMMUNICATION
Envisaging adoption of a systematic assessment framework for students during their medical training
Saurabh RamBihariLa Shrivastava, Prateek Saurabh Shrivastava
October-December 2021, 10(4):275-276
DOI:10.4103/jdrntruhs.jdrntruhs_69_21  
During the period of medical training, undergraduate students and postgraduate residents are posted in rotation for their clinical training to different departments or unit. It is the responsibility of the departmental head or the faculty members to not only be a source of information provider, but also to assess them once their posting is over to measure the learning progression and acquisition of skills. This calls for the need to have and to adopt a specific framework for assessment of medical students, which can enable the assessment of all types of skills of the medical student. In conclusion, there is an indispensable need to adopt assessment frameworks for ensuring systematic and objective assessments of the medical students during their clinical training. The adoption of such frameworks makes the process of assessment transparent and consistent and thus all the medical colleges should work in the direction of their implementation in their own settings.
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ORIGINAL ARTICLES
Relapsing neuromyelitis optica spectrum disorder
M Lakshmi Lavanya, G Butchi Raju, S Gopi, T Sateesh Kumar, U Aruna Kumari
October-December 2021, 10(4):269-274
DOI:10.4103/JDRNTRUHS.JDRNTRUHS_65_20  
Background: Neuromyelitis optica spectrum disorder (NMOSD) is a devastating inflammatory disorder of the central nervous system. Relapsing NMOSD (RNMOSD) is being reported frequently, leading to severe and permanent relapse related disability. Aims and Objectives: To study the clinical profile and imaging features of the NMOSD cases at the index time and addressing the long-term clinical spectrum of relapsing type of NMOSD who presented to the tertiary care hospital. Materials and Methods: All patients who attended the King George Hospital, Visakhapatnam and fulfilled the diagnostic criteria of NMOSD were studied for the epidemiological details, type of clinical spectrum on relapses, imaging features and treatment prescribed, and were studied between April, 2011 and March, 2018. Results: Total diagnosed cases were 28, out of which relapsing type were seen in 11 patients and all tested positive for antibodies. Female to male ratio is 3:1, and in RNMOSD group all were females. Most common clinical presentation was myelitis followed by optic neuritis. Noted clinical spectrum in the RNMOSD was unusual presentations like one each patient of Area-Postrema syndrome, diencephalic syndrome, cerebral syndrome, acute brainstem syndrome, and frequent relapses within a month in two. Five cases had also associated systemic autoimmune disorders. Conclusion: RNMOSD is very rapidly evolving disease, affecting primarily young women with wide spectrum of neurological presentations and also other non-neurological systemic features. Early diagnosis and aggressive immune therapy in the early phase might be warranted in NMOSD for relapse prevention and improving the quality of life.
  596 60 -
A retrospective study of histopathological features of appendectomy specimens at Amreli district-Gujarat
Pooja D Kagathara, Abhishek R Godhani
October-December 2021, 10(4):249-251
DOI:10.4103/jdrntruhs.jdrntruhs_15_21  
Background and Objective: Acute appendicitis is the most common general surgical emergency. Appendicectomy for acute appendicitis is one of the most commonly performed surgical procedures. A retrospective study was performed to evaluate histological diagnosis, geographical data, and the rate of different appendicitis. Methods: This study was retrospective, conducted at Shantabaa Medical College & General Hospital, Amreli during the period of 7 months from July 2020 to January 2021. All emergency appendectomies and planned appendectomies performed on clinically suspected appendicitis were included. Total 101 cases were included. Patients' age, gender, sign and symptoms, and operative findings were noted. Results: Out of these 101 specimens, 100 (99.0%) cases were appendicitis histologically, and 1 (0.99%) case was normal appendix. There were 44 (43.56%) male and 57 (56.43%) female, with the male:female ratio of 0.77:1. Maximum numbers of female and male both were from 21 to 30 age. Conclusion: The present study showed maximum cases in the second and third decades. The study suggests routine histological examination of all the appendicectomy specimens to avoid missing any clinically important and treatable condition.
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LETTER TO THE EDITOR
Mortality of families rage with COVID, The MENTAL health of children pushed to the edge
Jemima Wilson, Pallerla Srikanth
October-December 2021, 10(4):289-290
DOI:10.4103/jdrntruhs.jdrntruhs_61_21  
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