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   Table of Contents - Current issue
Coverpage
October-December 2021
Volume 8 | Issue 4
Page Nos. 223-279

Online since Friday, May 27, 2022

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REVIEW ARTICLE  

Faculty development programs in dentistry: The need and the way forward!! Highly accessed article p. 223
Ritu Jain, Anushi Mahajan, Dinesh Kumar Badyal
DOI:10.4103/cjhr.cjhr_159_20  
Oral health-care delivery in India is rapidly evolving given the increasing awareness about oral health among the public, advances in dental science and technology, and the demand for high-quality care. The dental workforce needs to be trained to develop the required skills and attitudes for delivering quality dental care. Modifications are required in the dental curriculum to accommodate the changing needs of the society. There is an urgent need to incorporate advances in educational methods and technology in dental teaching/learning to prepare future dental practitioners for real-world challenges. The conventional training of dental faculty in India does not involve any training in educational methods and techniques. Faculty development programs organized on a regular basis in the institutions can be very helpful in training the teachers in the latest and evidence-based teaching/learning methods. This article highlights the current status of faculty development initiatives for improving dental education and also makes suggestions to improve faculty training in Indian dental institutions for future.
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ORIGINAL ARTICLES Top

Awareness of oral biopsy procedure among dentists: A web-based cross-sectional study p. 227
Shashi Keshwar, Sonal Grover, Deependra Prasad Sarraf, Daya Shankar
DOI:10.4103/cjhr.cjhr_108_20  
Introduction: Various diagnostic procedures are available to reach a diagnosis in case of oral lesions/conditions. Biopsy is one of the important tools for confirmatory diagnosis. Therefore, the dentist should have adequate awareness regarding oral biopsy procedures. Objectives: The objective of the study was to determine the awareness of oral biopsy procedure among dentists in Haryana. Materials and Methods: It was a cross-sectional study conducted among dentists in Haryana, India, using a 16-item close-ended questionnaire. Google Forms was prepared via docs.google.com/forms, and the link was sent to the participants via social media platforms such as WhatsApp and Viber. The filled questionnaires were extracted from Google Forms and exported to Microsoft Excel 2016. Descriptive statistics such as frequency and percentage were calculated to present the data using the Statistical Package for the Social Sciences software, version 21. Results: Out of 68, only 35.3% and 50% of the dental surgeons were aware that the removal of tissue by laser or electrosurgery can introduce artifacts or tissue distortion and punch biopsy generally produces few artifacts within the biopsied sample, respectively. Among the respondents, 35.3% and 11.8% responded that formaldehyde and normal saline also can be used for fixation of the biopsy sample. Conclusion: Awareness of oral biopsy technique was not up to date among majority of the dentists. Eminent steps should be taken to increase the awareness of biopsy procedure among them.
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A Study of the Clinical Characteristics and Severity of Amyotrophic Lateral Sclerosis from North India p. 232
Vinita Elizabeth Mani, Justin Thomas
DOI:10.4103/cjhr.cjhr_67_20  
Introduction: Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease, and severity of disease at presentation decides prognosis and therapeutic options. We aimed to study the clinical characteristics and severity of ALS, and establish a correlation between King's ALS clinical staging and revised ALS Functional Rating Scale (ALSFRS-R) scores. Materials and Methods: All patients with clinically definite ALS presenting to the outpatients clinic of a tertiary care institute in North India were included. Their demographic and risk factor profiles were noted, and patients were categorized according to King's ALS clinical staging and ALSFRS-R scores. Correlations between the two scores were done using appropriate statistical tests. All data were analyzed using IBM SPSS version 26 for Macintosh. Results: Sixty-three patients with clinically definite ALS were included; of which 42 (66.7%) were male, with a sex ratio of 2:1. The mean duration of symptoms was 11.9 ± 6.6 months (range 3–24 months). Forty-five patients (71%) had limb-onset, and 18 (29%) had bulbar-onset ALS. The mean ALSFRS-R score was 36.5 ± 6.3 (range 16-48), and the scores were significantly lower in females (33.76 ± 5.60 vs. 37.81 ± 6.31; P = 0.01). On correlating the King's ALS clinical staging and ALSFRS-R scores, we found a score of >41 on ALSFRS-R was predictive of Stage 1, 34–41 of Stage 2, and 16–34 of Stage 3 disease. Conclusions: ALS has a male preponderance, but females present with more severe symptoms. There is a definite correlation between King's ALS clinical Stages 1-3 and ALSFRS-R scores.
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Serum 25-Hydroxyvitamin D level estimation among patients with parkinson's disease in West Bengal, India, and its relationship with motor impairment p. 239
Uma Sinharoy, Shankar Prasad Saha
DOI:10.4103/cjhr.cjhr_63_20  
Context: Worldwide, the association of Vitamin D deficiency in Parkinson's disease (PD) has recently been proposed. However, to the best of our knowledge, such studies are lacking from eastern India. Aims: This study compares the prevalence of Vitamin D deficiency in a cohort of patients with PD with the prevalence in age-matched healthy controls. It also aimed at determining a significant correlation of the severity of the various motor manifestations in PD with low serum vitamin levels. Settings and Design: It was a prospective observational case–control study to estimate the level of serum 25-hydroxyvitamin D (25[OH] D) concentrations of the sample population. Subjects and Methods: One hundred consecutive PD patients were selected for this study between 2015 and 2018 from the patients attending neurology outpatient department. Control (n = 100) participants were randomly selected after matching for age sex, and geographic location. Statistical Analysis Used: Statistical Package for the Social Sciences version 15 with multivariate logistic regression (the Pearson correlation coefficient (r) and P value) was applied. Results: Among 100 PD patients 48, patients (48%) had Vitamin D deficiency, 34 patients (34%) had Vitamin D insufficiency, and 18 patients (18%) had normal Vitamin D level; whereas age- and sex-matched control population shows Vitamin D deficiency in 46% people, normal vitamin level in 42%, and insufficient Vitamin D level in 12% control population. The mean (standard deviation) 25(OH) D concentration in the PD cohort was significantly lower than in the control cohorts (20.72 [8.21] ng/mL vs. 25.56 [11.99] ng/mL, respectively; P = 0.001). There was major association between 25(OH) D levels and severity of motor scores (P = 0.028), tremor (P = 0.0001), bradykinesia (P = 0.001), and severity of freezing (P = 0.002), whereas no significant association was found between Vitamin D levels and rigidity (P = 0.05) and postural instability (P = 0.395). Conclusions: This study demonstrates a significantly higher prevalence of hypovitaminosis in PD versus healthy controls. The severity of motor scores, tremor, and bradykinesia and severity of freezing were found to have a direct inverse correlation with low serum Vitamin D levels which further emphasizes the provision of preventive and therapeutic supplementation of Vitamin D in PD.
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A community-based survey on evaluation of prevalence of domestic violence against women in the rural area of Pondicherry p. 245
P Kanagarajan, DR Bharati, MP Sharadha, A Lokeshmaran, Abhijit Vinodrao Boratne
DOI:10.4103/cjhr.cjhr_95_20  
Background: Domestic violence refers to type of family violence, which includes elder abuse, child abuse, wife abuse, and other forms of violence between family members. Not only is a women's physical and mental well-being perturbed by domestic violence but it also takes a toll on their child rearing attributes, thereby victimizing children as well. Various studies have shown the prevalence of domestic violence in different developed as well as developing countries. However, there are few studies available on the domestic violence among women in the rural areas of India. Therefore, the present study was designed to estimate the prevalence of domestic violence in the rural regions of Pondicherry. Materials and Methods: This community-based study was conducted on a total of 623 women in the age group of 15–49 years, which were recruited by following the inclusion/exclusion criteria given by demographic and health surveys. The selected population was further distributed based on the different demographic characteristics such as education, type of family, occupation, marital status, and type of marriage. The Chi-square test was used to analyze the observations. Results: A statistically significant association was noted between marital status and domestic violence with incidents of domestic violence being more in the married women (P = 0.01), especially those employed (P = 0.004). Women with alcoholic husbands and receiving dowry threats were more prone to domestic violence (P < 0.00001). Conclusion: This study indicates that, although an advanced educational status of women is a protective factors against domestic violence in both married and unmarried woman, employed woman are more often targets of violence exalting the need to upscale societal sensitization in tandem with educational programs for girl child.
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Evaluation of factors affecting the quantity and quality of platelet-rich plasma and platelet-derived growth factor-BB p. 250
Rahul Verma, Priyanka Sharma, Gita Negi, Abhishek Kandwal, Harish Chandra
DOI:10.4103/cjhr.cjhr_167_20  
Context: Platelet-rich plasma (PRP) releases growth factors (GFs) upon activation which accelerates the healing and regeneration in the target tissue. Wider applications of PRP warrant product standardization. PRP compositions may vary according to the patient's demographics and the constituents of PRP. Aims: Our study aimed to assess the correlations between age, gender, platelet counts, platelet indices, platelet yield, platelet dose, GF dose, and platelet-derived GF-BB (PDGF-BB) concentration. Settings and Design: This was an experimental study done in the Department of Pathology along with the Department of Dentistry at a tertiary care hospital in North India. Subjects and Methods: PRP was prepared from 40 ml of whole blood. Platelet counts, platelet indices (LH 750 coulter analyzer, Florida, USA), and PDGF-BB levels (enzyme-linked immunosorbent assay, Qayee Bio., Ltd, China) were measured. Platelet yield (%), platelet dose (×106), and GF dose (×1012) in PRP were also calculated. Statistical Analysis Used: All the parameters were analyzed using Pearson's correlation coefficient and linear regression. Paired t-test and Mann–Whitney test were used for two-group analysis. Results: Mean platelet count, PDGF-BB concentration, platelet yield, platelet dose, and GF dose in PRP were 1317 × 103/mm3, 30 ± 9.89 ng/ml, 71.62 ± 28.34%, 6.5 ± 3.5 × 109, and 159.62 ± 52.39 ng/ml, respectively. PRP platelet counts were positively correlated with PDGF-BB concentration, platelet yield, platelet dose, and GF dose. Conclusions: Of all the parameters, PDGF-BB concentration, platelet yield, platelet dose, and GF dose showed a positive correlation with PRP platelet count. Age, gender, and platelet indices had no significant influence.
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CASE REPORTS Top

Extending the lifeline of renal failure patients by endovascular fistula salvage p. 255
Ankita Khurana, Pranay Pawar, Amit Mahajan, Anil Luther, Timothy Rajamanickam
DOI:10.4103/cjhr.cjhr_109_20  
The establishment and maintenance of durable and functional access are a top priority in end-stage renal disease patients. The traditional method of treatment of failing arteriovenous fistula has been thrombectomy. Over the recent years, percutaneous methods for thrombus dissolution have become alternate treatment modalities. We would like to report a case series of endovascular fistula salvage.
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Ultra sound guided erector spinae plane block for perioperative analgesia in post coronary artery bypass grafting sternal dehiscence (Type 2b) patient posted for pectoralis major flap p. 259
Bhimala Naga Ramya, RV Ranjan, P Nagalakshmi, Sagiev Koshy George
DOI:10.4103/cjhr.cjhr_35_20  
Sternal dehiscence is a grave complication after cardiac surgery. Deep sternal dehiscence usually requires debridement and flap coverage as the mainstay of management. The perioperative period is considered very challenging and the anesthetic technique has a direct impact on the risk of perioperative complications. Perioperative pain management is usually carried out with the help of regional anesthetic techniques as they offer various benefits for this patient population, including the provision of high-quality analgesia, reduced requirements for opioids and nonsteroidal anti-inflammatory drugs, and reduced autonomic system activation. Conventionally, regional anesthesia techniques such as epidural and paravertebral blocks have been shown to provide effective analgesia and enhance postoperative recovery. However, these techniques were associated with minimal but unacceptable complications. Ultrasound-guided erector spinae plane (ESP) block is a recently described technique providing thoracic analgesia. This is the first case report to our knowledge, which describes the use of ESP block as perioperative analgesic technique for pectoralis flap in a high-risk cardiovascular patient.
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Pulmonary tuberculosis presenting as acute respiratory distress syndrome and pulmonary embolism p. 264
Nidhi Dhamecha, Qury Nagadia, Anurag Gupta, Nehal Patel, Rashmi Thanvi, Ghosha Pandav
DOI:10.4103/cjhr.cjhr_17_21  
This series describes six pediatric cases who presented as severe acute respiratory illness during the pandemic of COVID-19 with high D-dimer levels. All six patients tested negative for novel coronavirus. They were diagnosed as having tuberculosis (TB) on detailed investigations; high D-dimer levels are one of the most important indicators of the pulmonary embolism. Pulmonary embolism is a rare presentation of TB, and this study emphasizes the need of keeping TB as an important differential diagnosis of those who present as acute respiratory distress syndrome.
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Maxillary first and second molars having unusual palatal root canal morphology with spiral computed tomography findings: Two case reports p. 268
Gauri Malik, Saru Kumar Manchanda, Simranjeet Singh, Dheeraj Manchanda
DOI:10.4103/cjhr.cjhr_94_20  
A thorough knowledge of the basic root canal anatomy and its variations is necessary for the successful completion of the endodontic treatment. Maxillary first and second molars usually have three roots and three or four canals (two mesiobuccal canals, one distobuccal, and one palatal canal). The incidence of two palatal roots in maxillary molars is quite a rare dental anatomy. The article reports two palatal roots each in maxillary first and second molars found incidentally in two different cases. These cases provide an evidence of variations in the root canals in the palatal root of maxillary first and second molars. Clinicians should thoroughly examine the pulpal floor and radiographs for the possibility of additional canals.
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Cerebral hemiatrophy: Case series of three cases p. 272
Suhail Rafiq, Musaib Ahmad Dar, Obaid Ashraf, Inayat Ellahi
DOI:10.4103/cjhr.cjhr_57_20  
Pediatric cerebral hemiatrophy is a rare entity with widespread etiology. Imaging in form of computed tomography and magnetic resonance imaging is helpful in differentiating between the etiologies of hemiatrophy. We describe imaging findings in three different cases of hemiatrophy due to Sturge-Weber syndrome, Dyke-Davidoff-Masson syndrome, and Rasmussen encephalitis.
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Gossypiboma transduodenal migration causing partial gastric outlet obstruction p. 276
Rajesh Sharma, Vishal Bodh, Brij Sharma, RS Jhobta, Rajesh Kumar, Ajay Ahluwalia
DOI:10.4103/cjhr.cjhr_124_20  
The term “gossypiboma” denotes a mass of cotton that is retained in the body following surgery. It is a rare but serious complication which is seldom reported because of the medicolegal implications. Gossypiboma usually has varied and vague presentation and is also difficult to detect on radiological investigations. It can even remain silent and present years after the operation. We report a case of a 46-year-old female who presented with vague upper abdominal pain associated with postprandial fullness and occasional vomiting. She had a history of open cholecystectomy 16 years ago. Abdominal X-ray and ultrasonogram examination of the abdomen were inconclusive. Her contrast-enhanced computed tomography of the abdomen revealed thickening of the wall of the pyloric antrum with air containing thick-walled structure in relation to the pyloric antrum and the first part of the duodenum possibility of the duodenal diverticulum with inflammatory/neoplastic thickening was suggested. Her esophagogastroduodenoscopy revealed large cotton sponge embedded in the anterior wall of the first part of the duodenum. On exploratory laparotomy, she was found to have a large gossypiboma embedded in the first part of the duodenum with dense adhesions to surrounding structures. Although rare, gossypiboma should be kept in mind as a differential diagnosis in postoperative cases presenting as vague pain even years after the operation.
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LETTER TO EDITOR Top

Ocular scedosporiosis in an immunocompetent host p. 279
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/cjhr.cjhr_76_20  
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