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   Table of Contents - Current issue
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July-September 2021
Volume 8 | Issue 3
Page Nos. 139-221

Online since Friday, March 4, 2022

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REVIEW ARTICLES  

Teledentistry: Role, scope, and future ahead p. 139
Malvika Singh, Manju Jamwal
DOI:10.4103/cjhr.cjhr_88_21  
Teledentistry is the use of information technology and telecommunications for dental care, consultation, education, and public awareness and has been ray of hope for patients who need treatment but that have been confined to home due to COVID-19 restrictions. The objective behind writing this article was to assess the relevance of teledentistry during and after COVID-19 pandemic. Internet database Medline/PubMed search for word “teledentistry” resulted in 758 articles. Articles with Medline/PubMed were only considered in writing this review. The result showed that teledentistry became a popular and successful means of tele-treatment during the COVID-19 pandemic. Although not much used earlier, teledentistry is here to stay, it has presented itself as a boon not only during COVID-19 period but holds a strong promise to treat patients in rural inaccessible areas, old age patients, and patients with special needs among others.
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“First responder” bike ambulance service in India: An innovative concept by the provider end Highly accessed article p. 143
Mahendra M Reddy, Bijaya Nanda Naik, Kalaiselvi Selvaraj, Srikanta Kanungo, Manisha Verma, Anuvarshini Ramalingam
DOI:10.4103/cjhr.cjhr_28_21  
Most of the deaths due to road traffic injuries occur outside the hospital. However, the trauma care system in India is still in the nascent stage to provide emergency prehospital health-care services. The emergency prehospital trauma health-care services are mostly limited to the urban areas in India. The heavy traffic in urban areas, adverse topography, poor health infrastructure, and unavailability of skilled human resources in the rural areas limit the provision of prehospital trauma care services in India by using traditional car ambulance. The bike ambulance service and the first responder seems to complement each other to provide prehospital emergency trauma care services in the every corner of India negotiating the constraints faced by car ambulance services. The bike ambulance service has been started in few cities across few states/union territories in India, but it has a long way to go. Inadequate public funding, lack of guidelines, and skilled workforce form the bottle neck in rolling out of bike ambulance services across India. The government can take the opportunity of the services of vast network of nongovernmental organizations (NGO), self-help groups, youth clubs, and other social organizations to make this initiative an exemplary solution for providing optimum prehospital emergency trauma care services.
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ORIGINAL ARTICLES Top

What went wrong with Rashtriya Swasthya Bima Yojana: An evaluation of the scheme in rural areas of a District in West Bengal, India p. 149
Suman Das, Somnath Naskar, Dilip Kumar Das
DOI:10.4103/cjhr.cjhr_133_20  
Context: Rashtriya Swasthya Bima Yojana (RSBY) had been implemented in India to improve access to quality health care, reducing out-of-pocket (OOP) and catastrophic health expenditure. Aims: We aimed to evaluate the current status of RSBY in rural areas of a district in West Bengal. Settings and Design: A cross-sectional study was done in erstwhile “Burdwan Health District,” West Bengal. Subjects and Methods: This study was conducted from September 2016 to August 2018. Primary study units were below poverty line (BPL) families; members of selected families comprised the study subjects. The calculated sample size was 350 families, out of which 324 could be studied covering 22 blocks following multistage sampling technique. Data were collected by interviewing head of the family (HOF). Statistical Analysis Used: Descriptive statistics and logistic regression were used for statistical analysis. Results: Awareness on different benefits and features of RSBY varied widely from 6.8% to 97.2%. Overall current enrollment rate was 79.6%, while 20.4% of families remained nonenrolled. On the multivariable logistic regression, type of family, socioeconomic status of the family, and education of HOF were significant variables predicting nonenrollment. Among enrolled BPL families, 24.0% and 8.1% utilized services under RSBY since their enrollment and in the last 1 year, respectively. OOP expenditure, nonprovision of free food, inadequate posthospital treatment, inattentiveness of doctor and hospital staff, etc., were major difficulties faced in utilization of services. Conclusions: Nonenrollment in RSBY was quite high in the area with few predicting variables. Low level of utilization of services was also noted with some obstacles.
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Material needs insecurity and dietary salt – Role in uncontrolled hypertension: A case–Control study p. 155
Alfia Rachel Kaki, Jayaprakash Muliyil, Arun Jose Nellickal, Visakakshi Jeyaseelan, Vijay Prakash Turaka, Anand Zachariah, Samuel George Hansdak, Manjeera Jagannati, Thambu David Sudarsanam
DOI:10.4103/cjhr.cjhr_124_19  
We performed a case control study of 108 patients for the risk of uncontrolled hypertension Housing insecurity, a part of material needs insecurity is an independent predictor of uncontrolled hypertension (adjusted odds ratio 29.9, 1.2-734). Food insecurity, cost related medication underuse and housing instability were seen in 32.4%, 33.3%.and 39.8% of our study subjects respectively. On average patients had 6 stressful life events, which was not different among those with different levels of blood pressure control. We did not find correlation with 24-urine sodium excretion, a reflection of salt intake and hypertension control. The average hypertensive subject was taking more than 10 grams of sodium per day, far higher than recommended.
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Microbiological profile of bloodstream infections in cancer patients p. 159
Sunita Kabi, Bichitrananda Swain, Swati Jain
DOI:10.4103/cjhr.cjhr_11_20  
Background: Bloodstream infections (BSIs) remain a major cause of mortality in patients with malignancies. Up to 17% of patients who develop a nosocomial BSI in the hospital have an underlying malignancy. Gram-negative bacilli are the predominant etiologic agents of BSI, and their multidrug resistance rate is increasingly being recognized. This study attempts to identify the likely causative agents and their antibiotic susceptibility profile of BSI in cancer patients. Methodology: We conducted a prospective study for a period of 1 year and analyzed the spectrum of BSI and their antimicrobial susceptibility profile in cancer patients. Blood samples were collected aseptically and inoculated in BacT/ALERT (BioMerieux) blood culture bottles. Identification and antimicrobial susceptibility testing of the isolates including their methicillin resistance and β-lactamase and carbapenemase production were done by Vitek-2 (BioMerieux) method. Results: Of a total of 250 cancer patients, 60 (24%) were found to have BSI. The most common underlying malignancy associated with BSI was of gastrointestinal system (45%) followed by acute myeloid leukemia (21.7%). Most of the isolates belonged to Gram-negative bacteria (53.3%). Coagulase-negative Staphylococcus was the most common organism isolated followed by Escherichia coli. Conclusion: The treatment of infections in patients with malignancy relies on the use of established guidelines along with the consideration of local epidemiological data. The poor activity of primary empirical agents and the emergence of multidrug-resistance is alarming.
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Correlates of COVID-19 incidence: A descriptive study p. 163
Dibakar Haldar, Baisakhi Maji, Samir Kumar Ray, Tanushree Mondal, Anjan Adhikary, Parthapratim Pradhan, Debasish Roy Burman
DOI:10.4103/cjhr.cjhr_72_20  
Background and Objectives: The enigma COVID-19 pandemic already involved major parts of globe with toll of 2,074,529 victims and 139,378 deaths from 213 countries/territories as on April 14, 2020. It cripples nations by the loss of human resources, economic decline, hunger, unemployment insecurities giving way to mental morbidities, and still many others to be discovered. Till it completes its trajectory, a systematic investigation, a prerequisite of any epidemic control, is warranted. Materials and Methods: A cross-sectional survey over 2 weeks (April 15, 2020–April 28, 2020) has been conducted at a teaching institution at Kolkata aiming to describe the magnitude, pattern, severity, and correlates of coronavirus pandemic 2020. Data pertaining to COVID-19 cases, deaths of affected countries, and their reported and or potential correlates were retrieved from various public domains, for example, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports, worldpopulationreview.com, data.worldbank.org. Results: Multiple linear regression analysis revealed a maximum R2 of 32.3% (P = 0.013) with a significant model fit (P = 0.000) for COVID-19 incidence rate per million which is associated positively with the proportion of the urban population (b = 0.024) and the percentage of the population aged 65 years or higher (b = 0.112) and negatively with current universal Bacille Calmette-Guérin vaccination (b = −1.021) policy of countries. Conclusion: Against this viral catastrophe evidence-based classical public health measures are underway. Notwithstanding variations in testing and reporting policy, the findings of this research ignite further study.
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Impact evaluation and cost–Benefit analysis of remote orthopedic consultation methods in a low-resource health-care setting p. 169
Deeptiman James, Nirmal Kurian, Arun John, Viju Daniel Verghese, Vinoo Mathew Cherian
DOI:10.4103/cjhr.cjhr_93_20  
Background: Geographic barriers, inadequate infrastructure, and large-scale logistics severely limit telemedicine and e-health systems' ability to make orthopedic care accessible to masses in rural centers. With <1% of the registered hospitals in our country connected through telemedicine, novel alternatives are necessary for effective remote consultation in low-resource health-care settings. Materials and Methods: A retrospective cohort analysis to compare the impact of “e-mail and telephone-” and “WhatsApp-” assisted remote orthopedic consultations (ROCs) on surgical decision-making and outcome of complex orthopedic conditions treated at a remote location hospital in Central India was conducted by assessing the response time, clarity, peer review accessibility, cost-effectiveness and functional outcome parameters (Visual Analog Score [VAS] and Single Assessment Numerical Evaluation [SANE]), complication rates, and duration of hospital stay. Unpaired t-test was used for statistical analysis. Results: Forty-eight patients were included in the study. Remote consultation was carried out through “e-mail and telephone” for 17 patients and through “WhatsApp” for 31 patients. “WhatsApp-” assisted remote consultation enabled quicker response (P < 0.0001), ensured nonambiguity (P < 0.0001), was cost-effective, and facilitated more peer review (P < 0.0001). Mean VAS and SANE scores reflected better outcome in the “WhatsApp-” assisted remote consultation (P < 0.0001), but hospital stay and complication rates were higher in this group. Conclusions: “WhatsApp-” assisted ROC had a higher impact and was cost-effective in management of complex orthopedic conditions in the low-resource setting.
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Serum creatine kinase and other profile of duchenne muscular dystrophy and becker muscular dystrophy: A cross-sectional survey in a tertiary care institution at Kolkata p. 175
Santa Saha, Anindita Joardar, Sarnava Roy, Tanushree Mondal, Gautam Gangopadhyay, Dibakar Haldar, Harendra Nath Das
DOI:10.4103/cjhr.cjhr_15_20  
Background: Serum creatine kinase (CK) level is increased muscular dystrophy (MD) and may be used as a clue to identify MDs. Objective: The objective is to compare CK levels between Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD), to correlate value of serum CK with number of deletions, duration of illness and to establish a cut off value of CK for screening. Materials and Methods: A cross-sectional survey was carried out in a tertiary care institute of Kolkata. Clinically diagnosed patients of 139 DMDs and 50 BMDs along with 69 age-matched individuals suffering from diseases other than MDs was included. Estimation of serum CK levels and gene analysis were done for all. Results: DMD victims were found to be younger with low age of onset and lesser disease duration but higher serum CK level compared to those having BMD. Most of the genetic deletions were happened in distal region of dystrophin gene and a significant difference was revealed to exist between DMD and BMD neither in regard to proportion of overall deletion nor deletions in proximal and distal region. However, gene deletion was found absent in 31% and 42% of DMD and BMD cases. Serum CK level of 511.5 unit/L was seemed to be a reliable cut-off for detection of DMD and BMD with 97.3% sensitivity, 100% specificity, and area under the curve 0.989 with a P = 0.000. Conclusion: In case of nonavailability of genetic test facility as well as negative genetic test serum CK may be tried for identifying MD.
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A cross-sectional study of anxiety, depression, and stress among health-care workers managing COVID-19 patients in a tertiary care hospital in North India p. 182
Aneesha Haryal, Aradhana Singh, Pallavi Abhilasha, Mamta Singla, Divya Salwan, Nidhi Agrawal
DOI:10.4103/cjhr.cjhr_26_21  
Objective: The objective of the study was to identify the incidence of anxiety, depression, and stress in health-care workers managing COVID-19 patients in a tertiary care hospital in North India. Methodology: A cross-sectional online survey was conducted using Depression, Anxiety, and Stress Scale-21 Questionnaire (Google Form). All health-care workers (HCWs) of the hospital were included in the study. HCWs with a past or current history of psychiatric illness and on psychotropic medication were excluded from the study. Results: Two hundred and twenty HCWs answered the questionnaire, of whom 114 (51.8%) were female. Of the 220, 128 (58.2%) were single, 97 (44.1%) were physicians. Level one exposure (direct interaction with COVID-19 patients) was seen in 111 (55.5%). One hundred and thirty-three (60.5%) HCWs worked for 8–12 h/day. Conclusions: Our findings highlight the factors which need to be taken into consideration to protect the mental well-being of doctors while fighting with a disaster that has major impacts on society worldwide.
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Responsiveness to hemophilia joint health score and functional independence score in patients with hemophilia with intermittent factor support and physiotherapy p. 187
Ripudaman Singh, Mullai Dinakaran, GD Vandhiyadevan, Santhosh Mathangi, Ritesh Arvind Pandey, M Joseph John
DOI:10.4103/cjhr.cjhr_138_20  
Introduction: Hemophilia is a hereditary bleeding disorder with significant consequences involving the joints, leading to debilitating functions. Prophylactic replacement therapy is limited in lower-middle-income countries, and often it is the episodic or intermittent factor replacement which is feasible. Although many tools are available to evaluate the assessment of joints at the time of initial contact, its utility in response evaluation to intervention is limited. Materials and Methods: In this quasi-experimental study, we compared the Hemophilia Joint Health Score (HJHS) and Functional Independence Score in Hemophilia (FISH) scores pre and postphysiotherapy with intermittent factor support. Results: Forty-eight patients with hemophilia (PwH) were screened, and 18 PwH consented and completed the treatment protocol. The mean duration of physiotherapy was 11 days, with an average total factor consumption of 120 U/Kg. The pre and postphysiotherapy HJHS was 40 ± 18.8 and 19.5 ± 11.9 with a standardized response mean (SRM) of −2.41 (95% confidence interval [CI] −3.25–−1.53) and FISH, 16.89 ± 3.44 and 22.33 ± 3.36 with SRM of 1.78 (195% CI.29–2.23). Both the SRMs were statistically significant (both the P values were 0.000). Conclusion: This study highlights the utility of HJHS and FISH in assessing responsiveness to intermittent prophylaxis and physiotherapy.
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Assessment of Quality of Life in Childhood Asthma: A Prospective Comparative Study p. 192
Divyesh Savdahiya, Jagdish Singh, Neha Agarwal, Vivek Athwani, Sunil Gothwal
DOI:10.4103/cjhr.cjhr_1_21  
Context: Childhood asthma is common and affects quality of life (QOL). Aim: The aim is to compare the QOL using pediatric asthma QOL questionnaire with standardized activities (PAQLQ [S]) before and after 4 weeks of standard asthma treatment in children with asthma. Settings and Design: This prospective observational study was conducted in the department of pediatrics at a tertiary care center in North India from January 2019 to December 2019. Subjects and Methods: Children aged 7–17 years with asthma were subjected to PAQLQ (S) before and after 4 weeks of standard asthma treatment. Subgroup analysis was done as per severity of asthma at presentation and control of asthma after 4 weeks' treatment. Statistical Analysis Used: The results were analyzed using Wilcoxon signed-rank test. Results: One hundred asthmatic children (mean age10.94 ± 1.9, M:F = 64:36) were evaluated. All 3 domains (activity limitation, symptoms, and emotion) of QOL affected equally and all domains had shown significant improvement after 4 weeks of standard asthma treatment. Children with severe asthma had activity limitation (P = 0.073) and no improvement in emotional score (P = 0.057). Children with uncontrolled asthma showed deterioration in QOL (P = 0.50). There was no difference in QOL among urban and rural residing children, family history of asthma/allergy, and socioeconomic status of parents (P > 0.05). Conclusions: Strategic asthma management in children improved symptoms, activity limitations, and emotional domains of QOL while, children with uncontrolled asthma showed deterioration in QOL.
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Multisystem inflammatory syndrome in children associated with 2019 novel coronavirus (SARS-CoV-2) infection p. 197
Raj Kumar Gupta, Gayatri Dhanger, Vishal Gupta, Manohar Lal Gupta, Alok Goyal
DOI:10.4103/cjhr.cjhr_19_21  
Background: MIS-C is a serious condition that appears to be linked to novel coronavirus disease 2019, which is increasingly being reported worldwide. Here we report 10 children diagnosed with MIS-C. Aims and Objective: To describe the clinical and laboratory findings along with treatment and outcome of hospitalized children with multisystem inflammatory syndrome in children (MIS-C) associated with 2019 novel corona virus at SPMCHI, Jaipur. Methods: This was an observational study of 10 children who presented with MIS-C during 10-week duration from 1 October to 20 December 2020. Results: The median age of study was7 years. 8 patients had antibody test positive, 1 antigen by RTPCR was positive and 1 patient was negative. 4(40%) required intensive care unit admission and inotropic support. All patients received steroids, 4 (40%) IVIg, out of 10, 8(80%) survived and 2 (20%) expired. Conclusion: Children with MIS-C present with varied clinical presentation. There was a low RT-PCR positivity with high SARS-CoV-2 antibodies positivity. High index of suspicion is required for this clinical emerging complication of corona in children.
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CASE REPORTS Top

An unusual finding of ipsilateral pantaloon hernia with contralateral direct inguinal hernia in a male cadaver p. 201
S John Bino, Sipra Rout
DOI:10.4103/cjhr.cjhr_146_20  
The presence of unilateral Pantaloon's hernia with contralateral direct hernia coexisting together is a rare occurrence. We noticed such a case, where in one male cadaver aged 78 years on routine cadaveric dissection. A case of unilateral Pantaloon hernia was observed where both direct and indirect hernial sac were observed in the inguinal region on the right side while on the left side a huge direct inguinal hernial sac was present with coils of sigmoid colon as its content. Here, we have discussed this rare occurrence of composite hernias with their contents in a single body in detail with the associated morphological distortions and possible complications.
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A case report of anesthetic management of a large tumor of the nape of neck in a child p. 205
Jerry Joseph Joel, Anita Shirley, Priyanka Daniel, Ekta Rai
DOI:10.4103/cjhr.cjhr_150_20  
Large tumors of the head-and-neck region pose a challenge for the anesthetist, as often the anatomy gets disturbed in the area leading to difficulty in the airway management. Here, we report the case of a 2-year-old child with small round cell sarcoma of the neck with a 20 cm × 30 cm mass over the nape of the neck, extending from the occipital protuberance to C7 level and from the lateral margin of one sternocleidomastoid to the other, who was posted for subtotal excision of the swelling over the occipital and posterior cervical region under general anesthesia. The airway management was sought by introducing fiberoptic bronchoscope, and an endotracheal (ET) tube insertion was attempted which failed even after multiple attempts. Hence, a laryngeal mask airway (LMA) was inserted through which bronchoscope and ET tubes (ETTs) were inserted and airway was secured. Anesthesia was maintained with isoflurane and 0.1 mg/kg of atracurium and adequate opioids were given for analgesia. Surgeons described the tumor tissue to have brain tissue like consistency which caused difficulty in catching the bleeding vessels, and hence, there was massive intraoperative blood loss. Eventually, the child recovered well in the postoperative period and was discharged after a few weeks. Through our experience, we would like to suggest that pediatric anesthesiologists plan for fiberoptic intubation through the LMA as the first intubation attempt in a child with a potentially difficult airway, using two ETT's secured through a cut ETT connector. We would also like to highlight the importance of preparedness to handle massive blood loss in a round cell sarcoma.
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Transition of failed cement-retained prosthesis to screw-retained implant prosthesis p. 208
Nirmal Kurian, Sumir Gandhi, Harit Talwar, Angleena Y Daniel, Kevin George Varghese
DOI:10.4103/cjhr.cjhr_86_20  
Prosthesis failures in cement-retained implant restorations can be managed by transforming the restorations into screw-retained prosthesis to meet the current implant treatment philosophies for large full-arch reconstructions. The challenges involved in this case report multiplied due to unavailability of components for older systems of implants and had to be managed with a framework which permits engagement of implant and abutment level connection simultaneously. The case report highlights the transition of failed cement-retained prosthesis to screw-retained prosthesis for predictable future retrievability and enhanced clinical performance.
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A rare case report of focal cement osseous dysplasia associated with recurrent periodontal abscess p. 212
Anushi Mahajan, Sonal Grover
DOI:10.4103/cjhr.cjhr_148_20  
Focal cemento-osseous dysplasia (FocCOD) is a fibro-osseous lesion of the jaw, which is usually asymptomatic. We report the case of FocCOD in association with recurrent periodontal abscess. A 58-year-old female reported a chief complaint of swelling of gums for 2 months. Periodontal abscess with respect to 35 and 36 tooth regions was noted with no associated tooth mobility. Panoramic view showed extensive generalized horizontal bone loss suggestive of generalized chronic periodontitis. There was a characteristic radio-opaque lesion in relation to apices of 34 and 35. The periodontal abscess was recurrently formed even after repeated scaling, curettage, and antibiotic coverage. The associated teeth were extracted along with the hard tissue mass, and the histopathological examination of the latter revealed FocCOD. This case report intends to highlight the diagnostic dilemma and management of a rare, symptomatic FocCOD associated with recurrent periodontal abscess.
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SHORT COMMUNICATION Top

Changes in decade-old reference standards by the national institute of nutrition 2020 p. 216
Lalithambigai Chellamuthu, Abhijit Vinodrao Boratne, Yogesh Arvind Bahurupi
DOI:10.4103/cjhr.cjhr_176_20  
The National Institute of Nutrition (NIN), Hyderabad, a prime research body under the apex body for biomedical research, Indian Council of Medical Research has been recognized globally for its eminent studies on diverse subjects of nutrition, with a special focus on protein–energy malnutrition. The first edition of “Dietary Guidelines for Indians-Manual” was published by NIN in 1998 and since then has undergone many changes till the year 2011. A decade later, the updated version of “Dietary Guidelines for Indians-Manual” has been introduced by NIN in 2020 that revised the decade-old standards on reference body weight, height, age, and recommended dietary allowances for an Indian adult which will be serving as a valuable source of information for all.
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LETTER TO EDITOR Top

Critical Comment on “Talk To Parents: Bridge the Knowledge Gap in Parents with Epileptic Children” p. 221
Radha Saini
DOI:10.4103/cjhr.cjhr_8_20  
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