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   Table of Contents - Current issue
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January-June 2021
Volume 12 | Issue 1
Page Nos. 1-58

Online since Friday, September 3, 2021

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ORIGINAL ARTICLES  

Epidemiological trends of oral squamous cell carcinoma – An institutional study Highly accessed article p. 1
Cathy Babu, Treville Pereira, Subraj Shetty, Gotmare Swati Shrikant, AK Anjali, Rutuja Gajanan Vidhale
DOI:10.4103/mjmsr.mjmsr_5_21  
Background: Oral squamous cell carcinoma (OSCC) is an important cause of morbidity and mortality worldwide with an incidence rate that varies widely by geographic location. Even within one geographic location, the incidence varies among groups categorized by age, gender or race. Aims and Objectives: The purpose of this retrospective study was to identify the trends in the age, gender, habits, sites involved and the histopathological grading which are given to patients diagnosed with OSCC in D.Y. Patil University School of Dentistry, Navi MumbaI. Materials and Methods: The study covered a period from July 2003 to July 2019. OSCC cases were retrospectively analysed for age, gender, habit, site of the lesion and histopathological grading given to patients diagnosed with OSCC. Charts were made, analysis was done and the results were formulated. Correlation was also done comparing gender vs habit, gender vs site of the lesion and gender vs histopathological grading given to the OSCC cases to check for statistical significance. Results: The study revealed a male to female ratio of ~ 0.7 : 0.3 with the largest number of OSCCs developing in the fourth and sixth decades of life. Overall, Buccal Mucosa (40%) was the most common site involved while floor of the mouth (2.8%) showed the least incidence. Other sites involved were gingiva (34%), tongue (12%), palate (4%) and labial mucosa (3%) respectively. Smokeless tobacco habit was more prevalent than smoking tobacco in both men as well as women. We even observed that 58% of cases were diagnosed with Well differentiated squamous cell carcinoma (WDSCC), 39% with Moderately differentiated squamous cell carcinoma (MDSCC) and 2% with Poorly differentiated squamous cell carcinoma (PDSCC). Correlation between gender vs habit, gender vs site of the lesion and gender vs histopathological grading of OSCC was done using chi square test and all the three parameters turned out to be statistically significant. Conclusion: An alarming rise in the number of OSCC cases over the years was observed from this 15-year retrospective study. Measures must be taken to make people aware about the ill effects of tobacco and the prolonged usage & the availability of treatment options should be made known to the affected individuals. Race, ethnicity and age cannot be altered; however, lifestyle behaviour such as use of tobacco and alcohol are amenable to change.
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The role of high-resolution computerized tomography as a diagnostic tool in the evaluation and planning of management of patients with chronic otitis media p. 6
Monali Mitra, Priti Ashok Thakare, Berton Craig Monteiro, Dnyanesh B Amle
DOI:10.4103/mjmsr.mjmsr_30_21  
Context: Chronic otitis media (COM), a major cause of hearing impairment and its associated morbidity and mortality can be avoided with proper diagnosis and planned management. High-resolution computerized tomography (HRCT) is accessible and possesses role in the detection of COM. Aims: This study aims to evaluate the role of HRCT as a diagnostic tool in the evaluation and planning of management of patients with COM. Settings and Design: Prospective observational study. Subjects and Methods: The study included 100 subjects presenting with COM planned for detailed otorhinolaryngological and otoscopic examination, pure tone audiomentry, non-contrast HRCT of bilateral temporal bones and were exposed to initial medical management of symptoms and surgical management. Statistical Analysis Used: Data were expressed as percentage and mean ± standard deviation Kolmogorov–Smirnov analysis was performed for checking linearity of the data. Fischer's exact test or Chi-square test was used to analyze the significance of the difference between frequency distribution of the data. Results: For soft tissue attenuation, HRCT was 100% sensitive and specific for the presence of soft tissue mass. HRCT found to be 100% accurate in predicting cholesteatoma presence and was found to be sensitive in the range of 83.3%–100% and specific in range 87.04%–100%. For bony erosion, HRCT was found to be fairly accurate. These comparisons were found to be highly significant with P < 0.0001. Conclusions: HRCT of the temporal bone in subjects with COM can be a gold standard tool for diagnosis, surgical interventions, and follow-up.
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Reference values of dorsal sural sensory nerve action potential: A useful tool to diagnose peripheral neuropathy p. 13
Manoranjan Acharya, Sunil Kumar Jena
DOI:10.4103/mjmsr.mjmsr_8_21  
Background: Dorsal sural sensory nerve is the most distal nerve of the lower limb for which its sensory nerve action potential (SNAP) could be helpful for the diagnosis of early and subclinical peripheral neuropathy. The objective of this study was to estimate the age and sex reference data of amplitude (Amp), onset latency (OL), and conduction velocity (CV) of SNAP. Materials and Methods: A prospective cross-sectional study was conducted among 50 healthy subjects (28 male and 22 female). Participants were stratified into Group A (≤50 years) and Group B (>50 years) according to their age. Student's t-test was used to compare the data between Group A and B, between male and female and Pearson correlation was used to analyze the correlation between age and SNAP parameters. Results: OL of Group A and Group B was 2.80 ± 0.36 ms and 3.11 ± 0.55 ms, respectively (P = 0.037). CV of Group A and Group B was 45.6 ± 3.33 m/sec and 39.5 ± 1.17 m/sec, respectively (P = 0.000). Amp of Group A and Group B was 6.63 ± 0.73 μV 4.99 ± 0.47 μV, respectively (P = 0.000). OL of male and female was 2.59 ± 0.28 ms 3.34 ± 0.25 ms, respectively (P = 0.000). Pearson correlation coefficient “r” between “age– OL,” “age– CV,” and “age– Amp” was 0.135 (P = 0.351), −0.759 (P = 0.000), 0.953 (P = 0.000), respectively. Conclusion: This study provides age and sex reference values of dorsal sural SNAP in the eastern part of the Indian population.
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Did the fear of contagion deter patients from reporting serious conditions during the COVID-19 pandemic lockdown? A report from South India p. 17
YM Prasanth, PP Kumar, SM Rao, B Ganaraja
DOI:10.4103/mjmsr.mjmsr_48_20  
Context: Severe acute respiratory syndrome coronavirus-19 has had a devastating effect on the common man's life. Aim: To study whether the fear of contracting covid19 infection deter the patients from seeking medical help? Setting and Design: Retrospective study from hospital data were obtained from the medical record departments of four major hospitals. Materials and methods: Number of admissions for eight serious illnesses in the month of April in 2020 compared to 3 preceding years. Statistical analysis: The data were analyzed by applying multiple measures ANOVA and descriptive statistics. Results: There was a significant decrease in the number of admissions in each of the eight listed illnesses during April 2020 compared to the same period in the previous 3 years. There was no significant change in the number of deaths reported in the district during this period, as suggested by the government data. Conclusion: From the observed results, it is evident that there was a marked decline in the hospitalization for serious illnesses during the lockdown period in south India. This result is in agreement with the data from similar studies, published from hospitals worldwide.
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Comparative evaluation of steroid sensitivity in various dermatoses with control group through histopathological examination and patch testing p. 21
Ayushi Lodha, Shylaja Someshwar
DOI:10.4103/mjmsr.mjmsr_18_21  
Background: Topical corticosteroids are widely used for treating various dermatoses. People have been self-medicating them for fungal infections, pigmentary disorders, and for many other dermatoses. This overzealous and irrational use of corticosteroid makes individuals susceptible for its adverse effects. Aim: The aim of this study was to evaluate steroid sensitivity in various dermatoses. Materials and Methods: Patch testing with Indian standard series and corticosteroid series was performed in sixty subjects where thirty patients were cases and thirty were controls. Histopathological examination and As it is (ASIS) were done only for the case group. Patches were applied on the back for 48 h and reading was done on day 2, day 4, and day 7 according to the International Contact Dermatitis Research group grading. Results: The maximum cases were in the age group of 20–30 years (33.3%) while 31–40 years was the most common age range (50%) among controls. Among the case group, 60% were male and 40% were female. Maximum patients affected in the case group were homemakers (36.7%) followed by laborers (13.3%). The case group showed 16.7% positive patch test reactions while none were positive in the control group. Thiomersal was positive in 13.3% of cases and neomycin in 3.3% of cases. ASIS was negative in all cases. Thiomersal is commonly used as a preservative in topical medicaments, cosmetics, and vaccines. Conclusions: Steroid sensitivity is hard to diagnose clinically, thereby causing difficulty in managing such cases. Patch test is a noninvasive gold standard procedure without major adverse effects and helps in treating the dermatoses with appropriate class of corticosteroid by avoiding the suspected allergen.
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A survey of out patient department prescriptions of selected departments of a tertiary care hospital on treatment practices of infections p. 26
Sharan Shyam, Sanjay Jaiswal, Arun Jayabalan, S PS Shergill
DOI:10.4103/mjmsr.mjmsr_44_20  
Introduction: India is the largest consumer of antibiotics in the world. Antimicrobial agents (AMA) are also the most misused and excessively prescribed therapeutic agents. Objectives: A survey of output patient department (OPD) prescription chits of a tertiary care government hospital was carried out to describe the current treatment practices in the management of infections. Subjects and Methods: Thousand and five hundred OPD prescriptions were analyzed for the prevalence of antimicrobials prescribed by each specialist OPD and the systemic infections which were treated by using these AMA. The data of antibiotic susceptibility tests for the year 2018 were obtained for the analysis on current treatment practices of hospital infections. Results: About 24.4% of all 1500 OPD prescriptions encountered from the seven departments of the hospital contained an antibacterial. The highest proportion of AMA was seen in the dental OPD (66.6%) followed by ENT and surgical OPD (36.8% and 36%, respectively) and the least AMA were prescribed in gynecology and obstetrical OPD (11%). Out of the 367 AMA prescriptions, 92 prescriptions had 2 or more antibacterials. About 54.7% of these AMA prescribed were generic oral drugs and only two prescription counts were of injectable AMA. 62% of the AMA prescriptions were for the duration of use between 5 and 10 days. 53.4% of the AMA prescription counts belonged to the ACCESS group of antibiotics, 44.1% to the WATCH group and 2.5% to the RESERVE group as classified by WHO. Conclusions: The present study emphasizes the need to re-formulate local guidelines of antimicrobial use in OPD patients based on hospital antibiotic susceptibility tests.
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Internal derangement of the temporomandibular joint: Can clinical and magnetic resonance imaging features predict the prognosis? p. 33
Omair Ashraf Shah, Tahleel Altaf Shera, Mudasir Bhat, Naseer Ahmad Choh, Tariq Ahmad Gojwari
DOI:10.4103/mjmsr.mjmsr_16_21  
Purpose: To evaluate the role of magnetic resonance imaging (MRI) in the diagnosis of internal derangement and to assess the complimentary role of MRI and clinical assessment in prognostication. To assess the role of MRI in demonstrating disc displacement and reduction. Methods: A total of 34 patients (28 cases and 6 controls) with clinical features of temporomandibular joint (TMJ) internal derangement underwent a dedicated MRI at our institution. MRI was assessed for disc displacement, morphology, and reduction on open-mouth imaging. For analysis, the patients were divided into those with disc displacement with reduction (WR) and those without reduction (WOR). Clinical and MRI grading of internal derangement were done in all patients and correlated with each other. Prognostication was attempted using the clinical and MRI features, and patients were followed up over a mean period of 6 months. Results: Most of the patients were females (n = 20 71%) in the child-bearing age group (third decade). MRI demonstrated disc displacement in all but two patients in whom disc was not visible. Fourteen (54%) patients were placed in WR group, whereas 10 (38%) were in WOR group. In two (8%) patients, stuck disc was diagnosed. Patients in WR group responded to conservative treatment alone while those in WOR group needed conservative management in some (n = 8 57%) and surgical intervention in others (n = 6 43%). Both patients with stuck disc failed conservative management. Conclusion: MRI is an essential component of TMJ evaluation and helps in diagnosing and staging internal derangement together with disc assessment. Patients with disc displacement WOR and those with higher grades of derangement on MRI including stuck disc require surgical intervention if conservative management fails.
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BRIEF REVIEW Top

Justifying the inclusion of audience response system for the delivery of medical education p. 39
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjmsr.mjmsr_4_21  
Didactic lectures have been acknowledged as one of the most important aspects of teaching-learning in the field of medical education. In general, a traditional didactic lecture tends to facilitate passive learning, wherein the students just receive the information provided by the teacher, in the absence of any sort of active engagement. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of four studies similar to the current study objectives were selected based on the suitability with the current review objectives. The audience response system has been looked upon as a tool to improve the overall effectiveness of the didactic lectures in classroom settings. In this method, the teacher can engage the large group of medical students by including questions during the session and thereby improve the amount of interaction. In conclusion, the audience response system is an effective approach to improve the overall learning in and facilitates the transition from passive to active learning in the medical college set up. Moreover, the system encourages collaboration between teacher and student and active engagement of students, which makes it extremely useful.
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REVIEW ARTICLES Top

Drug interactions of ivermectin with a focus on COVID-19 treatment p. 42
Padmaja Udaykumar, Bhavya Shetty, Anurag Kundapur
DOI:10.4103/mjmsr.mjmsr_19_21  
Treatment of COVID-19 largely depends on previously used drugs as there is no cure available coupled with shortage of effective vaccine with doubts about its long-term protection due to rapid viral mutations. Ivermectin, a derivative of avermectin, introduced as an antiparasitic agent, is effective against onchocerciasis, strongyloidiasis, ascariasis, filariasis, scabies, malaria, and has a good safety profile. Ivermectin is being promoted for the treatment of COVID-19, although US Food and Drug Administration has not approved its use for any viral infection. With increasing evidences indicating the efficacy of ivermectin in COVID-19 and post-COVID-19 syndrome, there is a need to focus on the drug interactions with the dose used for indication as most of the documented interactions are with the dose used for parasitic infections. As majority of the COVID-19 patients have comorbidities and on multiple drugs, it is necessary to understand the drug interactions of ivermectin.
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Inculcating the practice of reflection among medical students: Role of teachers p. 49
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjmsr.mjmsr_11_21  
Over the years, different regulatory and professional organizations have emphasized the need for medical students to reflect upon their daily learning or clinical interactions to ensure deep learning. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of seven articles were selected for the review. However, we must admit that the practice of reflection is not easy to inculcate, and amid the packed curriculum, it becomes the responsibility of the medical teachers to create opportunities for the students to reflect upon on a regular basis. The best approach for encouraging reflection by medical students will be to not make reflection as an add-on activity, but as a strategy which will enhance meaningful learning and improvement in daily clinical interactions. In conclusion, reflection is an important approach to ensure deep learning among medical students. However, it is the responsibility of all teachers to first teach them about reflection and then use the tool of reflection for the betterment of the students in the entire training period.
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CASE REPORT Top

Kindler syndrome: A rare case report p. 52
Shweta Satyanarayan Kandikatla, Shylaja Someshwar, Pranjal Ahire
DOI:10.4103/mjmsr.mjmsr_6_21  
Kindler syndrome is a very rare genodermatosis with an autosomal recessive pattern and about 250 cases have been reported worldwide. The mutant gene is Fermitin family homolog 1 gene (KIND1), located on chromosome 20p12.3, which encodes for focal adhesion protein “Fermitin family homologue 1 protein” or Kindlin-1. It is characterized clinically by acral blistering in infancy, photosensitivity improving with age, progressive poikiloderma, cutaneous atrophy, dental problems, and various forms of mucosal involvement. Histologically, it is characterized by flattened and atrophic epidermis, edematous dermoepidermal junction, vacuolar degeneration of basal cells, pigmentary incontinence, and sparse perivascular lymphocytic infiltrate. Here, we report a case with classic skin manifestations in a 13-year-old female without photosensitivity.
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SHORT COMMUNICATION Top

Understanding the significance of patient safety and designing a novel curriculum using Kern's six-step approach p. 56
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/mjmsr.mjmsr_15_21  
The branch of medicine and provision of clinical care is quite complex and challenging owing to the involvement of a number of stakeholders and parameters. The available global estimates suggest that the incidence of adverse events is one the rise and it has been identified as one among the 10 most frequent reasons for death and disability worldwide. Considering that significant developments have been made in modern medicine, it is quite unacceptable. The ideal and cost-effective approach that is expected to make it as a long-term behavior among the future generation of doctors, is by exposing the undergraduate medical students to patient safety curriculum during their training period. At present, the need of the hour is to design a comprehensive patient safety curriculum and as it is a novel topic, we can adopt Kern's six-step approach for the same. In conclusion, patient safety is an integral aspect of clinical medicine and being a health care professional, it is our primary responsibility to not only deliver quality assured care but also take care of patient safety. Thus, it is high time that steps are taken at the medical college level to design a formal patient safety curriculum and then implement the same in collaboration with the Curriculum Committee and the Medical Education Unit.
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