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2020 | January-June | Volume 4 | Issue 1

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Hemant Sharma


[Year:2020] [Month:January-June] [Volume:4] [Number:1] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/ctdt-4-1-vii  |  Open Access |  How to cite  | 



Amneet Sandhu, Tejinder Kaur, Ramandeep S Bhullar, Balwinder Singh

Computed Analysis of Bone Density on Panoramic Radiographs Following Management of Benign Odontogenic Cystic Lesions

[Year:2020] [Month:January-June] [Volume:4] [Number:1] [Pages:10] [Pages No:1 - 10]

   DOI: 10.5005/jp-journals-10055-0082  |  Open Access |  How to cite  | 


Introduction: Cystic lesions are one the most common pathologies in the oral and maxillofacial region. A number of software are available to assess the progress of bone healing following their surgical management. Aim and objective: The aim and objective of this study was to assess the changes in size and bone density following treatment (either marsupialization or enucleation) of benign odontogenic cystic lesions in eight patients using computer analysis on pre- and postoperative panoramic radiographs. Materials and methods: The study was undertaken in 8 patients with mean age of 35.37 years (range = 11–50 years). The male–female ratio was 3:5. All lesions (n = 7) were present in the mandible except one that involved right maxilla. Out of the total eight cystic lesions, six cystic lesions were treated by marsupialization, and two cystic lesions were treated by enucleation. Results: There was a significant decrease in cystic volume postoperatively in all patients treated by marsupialization (n = 6) and also decrease in size of radiolucent (in all 8 patients) area radiographically, with progressive increase in bone density when compared to contralateral healthy side. The mean difference in bone density between preoperative and postoperative values was highly significant in the first 2 months, significant in third, fourth, and fifth month, and nonsignificant in the last 3 months. It was observed that the mean postoperative speed of shrinkage of the radiolucent areas was almost similar in the first 5 months and then decreased progressively over the next 4 months. The average speed of shrinkage was maximum for odontogenic keratocyst (OKC) (n = 3), followed by unicystic ameloblastoma (UAB) (n = 1), dentigerous cyst (DC) (n = 1), and was the least for residual cyst (n = 1). Conclusion: The study noted that there might be a direct relation between size of primary radiolucent area and postoperative speed of shrinkage. Hence, digitalized orthopantomograph can be considered as an economical alternative to assess postoperative bone regeneration along with the added benefit of reduced radiation exposure to the patient.



Jasleen Kaur, Harkanwal K Sekhon

Dermatoscopic Evaluation of Nail Patterns in Rare Papulosquamous Skin Disorders: A Diagnostic Bonanza

[Year:2020] [Month:January-June] [Volume:4] [Number:1] [Pages:6] [Pages No:11 - 16]

   DOI: 10.5005/jp-journals-10055-0089  |  Open Access |  How to cite  | 


Aim and objective: To dermatoscopically evaluate the specific nail patterns in rare papulosquamous disorders. Materials and methods: The present descriptive and observational study was conducted on seven patients with skin biopsy-proven Darier's disease, lichen striatus (LS), and pityriasis rubra pilaris (PRP) selected by stobe randomization. All the patients were first evaluated clinically for nail pattern changes and then dermatoscopy of nails was performed using both wet and dry techniques. The difference in both observations was then analyzed. Results: The specific nail patterns in Darier's disease were found to be longitudinal and transverse ridging and V-shaped nicking with onycholysis and alternating red and white lines. The nail patterns of LS include nail plate thinning fragmentation with splinter hemorrhages. The PRP patient showed nail plate thickening and distal brown discoloration of the nail plate. Conclusion: The dermatoscope has come out as a noninvasive useful tool for subsurface, nail bed changes, and chromonychias where clinical examination alone is not sufficient. Clinical significance: As these rare disorders present with specific nail patterns, knowledge of these nail patterns can aid in diagnosis.



Manish Chandey, Robin Kamboj, Aarti Vaid, Navdeep Singh

A Study of the Impact of Body Mass Index on Diastolic Function in Patients with Normal Left Ventricular Ejection Fraction

[Year:2020] [Month:January-June] [Volume:4] [Number:1] [Pages:4] [Pages No:17 - 20]

   DOI: 10.5005/jp-journals-10055-0095  |  Open Access |  How to cite  | 


Background: Obesity is a major public health epidemic and is associated with increased risk of heart failure and mortality. We evaluated the impact of body mass index (BMI) on the prevalence of diastolic dysfunction (DD). Materials and methods: Echocardiography was performed in 100 patients that showed normal left ventricular ejection fraction (LVEF). Diastolic dysfunction was assessed. Diastolic function was labeled as normal, stage 1, stage 2, or stage 3/4 dysfunction. Peak early and late transmitral diastolic flow velocities (E, A) and E/A were calculated. The study sample was including both nonobese (BMI <25.0 kg/m2) and obese (BMI >25.0 kg/m2). Results: Our study consisted of 100 patients with normal LVEF, in which DD was assessed. Fifty-five (55%) were females and 45 (45%) males. Majority of patients were in the age group of 4th to 6th decade of life. Diastolic dysfunction was present in 81 (81%) patients. Patients who had BMI >25, 21 out of 21 (100%) had DD. In this study, there was statistically significant correlation found between BMI and prevalence of left ventricular diastolic dysfunction (LVDD) with p value of 0.003. There was a linear increase in prevalence of DD with increasing age out of 100, 38 patients had left atrial (LA) size >40 mm. Conclusion: Increased BMI was associated with worse LV diastolic function independent of LV mass and associated risk factors. The increased risk of LVDD in obese individuals may account for the increased risk of heart failure.



Sidhant Sachdeva

Amitraz Poisoning: An Emerging and yet Underestimated Poison—A Review

[Year:2020] [Month:January-June] [Volume:4] [Number:1] [Pages:5] [Pages No:21 - 25]

   DOI: 10.5005/jp-journals-10055-0085  |  Open Access |  How to cite  | 


Background: Amitraz is a member of the formamidine family of pesticides. Its structure is 1,5 di-(2,4-dimethylphenyl)-3-methyl-1,3,5-triazapenta-1,4-diene. It is used as an agricultural insecticide for fruit crops and as an acaricide for dogs and livestock. Awareness about amitraz, its toxicity, and its management remains poor among physicians, which is probably the reason for underreporting of amitraz intoxication in remote rural areas. In this systematic review on amitraz intoxication, we focus on demographics, toxicokinetics, mechanisms of toxicity, clinical features, and treatment modalities in amitraz poisoning. Materials and methods: EmBase and Medline databases were searched for the following terms: “amitraz,” “intoxication,” “poisoning,” and “toxicity.” Case reports, case series, and original articles describing human cases of amitraz poisoning were included. Results: A total of 251 articles were retrieved after excluding citations common to the two databases. A total of 63 articles described human cases. The clinical manifestations varied from central nervous system (CNS) depression (drowsiness, coma, and convulsions), miosis or mydriasis, respiratory depression, bradycardia, hypotension, hyperthermia or hypothermia, hyperglycemia, polyuria, vomiting, and reduced gastrointestinal motility. Only six reported deaths have been reported (case fatality rate, 1.9%). The proposed lethal dose of the toxin was reported to be 200 mg/kg. Around 33% of patients developed respiratory failure and 20% of them needed mechanical ventilation. Interpretation and conclusion: Amitraz poisoning occurs in either accidental or suicidal manner and is more common in children than adults. There is no specific antidote for this toxin till date. It has an excellent prognosis with supportive management.



Deepika Arora, Gaganjot Kaur

Anesthetic Considerations in an Eclamptic Patient Undergoing Cesarean and Craniotomy Simultaneously: A Case Report

[Year:2020] [Month:January-June] [Volume:4] [Number:1] [Pages:3] [Pages No:26 - 28]

   DOI: 10.5005/jp-journals-10055-0083  |  Open Access |  How to cite  | 


Introduction: Eclampsia is an unpredictable multisystem disorder of pregnancy and is responsible for the large mortality rates due to acute cerebral complications. The estimated mortality of eclampsia-associated intracranial hemorrhage is 9–38%.The incidence being even higher in developing countries. Pregnancy-induced intracranial hemorrhage is a rare yet potentially devastating event in pregnancy. Case description: We report the case of a 34-year-old G4P3L1 female with period of gestation 34 weeks and acute-onset eclampsia. She had a GCS of E2V1M5 and presented with blood pressure of 200/100 mm Hg with right-sided weakness and seizures. Her pupils were bilaterally constricted and nonreactive. On further investigation, her magnetic resonance imaging showed frontoparietal hematoma with a midline shift of 11 mm, necessitating urgent neurosurgery. Due to her deteriorating condition, she was taken up for emergency lower segment cesarean section (LSCS) and simultaneous decompressive craniotomy. Further management and implications will be discussed. Discussion: Intracranial hemorrhage is an important cause of morbidity and mortality in pregnancy. This case demonstrated the need of emergency procedures when the life of both mother and fetus are at risk and the advantage of multispecialty approach for a better patient outcome.



Jasleen Kaur, Sukhman K Gill, Anita Kumari, Chiteshwar Walia, Harmandeep Kaur

Generalized Tonic-clonic Seizures Following Spinal Anesthesia Using Bupivacaine for Cesarean Section: A Case Report

[Year:2020] [Month:January-June] [Volume:4] [Number:1] [Pages:2] [Pages No:29 - 30]

   DOI: 10.5005/jp-journals-10055-0081  |  Open Access |  How to cite  | 


Background: Generalized seizures have been reported following epidural anesthesia but rarely after spinal anesthesia. Aim and objective: The aim and objective of our study is to create awareness about a rare possibility of bupivacaine-induced generalized tonic-clonic seizures. Case description: A 19-year-old primigravida with no history of any medical disease had episodes of generalized tonic-clonic seizures following spinal anesthesia. The patient lost consciousness and was immediately intubated after two episodes of seizures. Later on, she was shifted to the intensive care unit for mechanical ventilation. Conclusion: Although convulsions following spinal anesthesia are rare, parturients can develop complications such as generalized tonic-clonic seizures, respiratory depression, and loss of consciousness following spinal anesthesia. These patients require stringent and meticulous monitoring in perioperative period as those for general anesthesia.



Soni Kumar, Roshan Lal

Thyrotoxicosis Presenting First Time as Hypokalemic Paralysis: A Rare Case Report

[Year:2020] [Month:January-June] [Volume:4] [Number:1] [Pages:2] [Pages No:31 - 32]

   DOI: 10.5005/jp-journals-10055-0086  |  Open Access |  How to cite  | 


Thyrotoxicosis has various clinical manifestations, ranging from its usual features to some rare presentations. Thyrotoxicosis presenting as acute quadriplegia is a very rare phenomenon and is attributed to hypokalemia. Thyrotoxic hypokalemic periodic paralysis is a known but rare manifestation, and a first presentation is relatively unknown in the past. Here, we present a case of middle-aged Asian male in whom thyrotoxicosis presented for the first time as hypokalemic paralysis.



Vijinder Arora, Achal S Goindi

Optic Nerve Enlargement in Krabbe's Disease: A Case Report

[Year:2020] [Month:January-June] [Volume:4] [Number:1] [Pages:3] [Pages No:33 - 35]

   DOI: 10.5005/jp-journals-10055-0091  |  Open Access |  How to cite  | 


Krabbe's disease is an autosomal recessive leukodystrophy that presents clinically with increased body tone, regression of milestones, excessive irritability, and inconsolable crying. The pathologic basis of the disease is abnormal myelin metabolism resulting from a deficiency in the galactosylceramidase enzyme with subsequent white matter destruction. Infantile form is the most common subtype, occurring at about 6 months of age. Here, we report a case of Krabbe's disease in which there was associated enlargement of the intracranial optic nerves. The purpose is to acknowledge various imaging features of Krabbe's disease on computed tomography (CT) scan and magnetic resonance imaging (MRI) and to have Krabbe's disease included as one of the differential diagnosis in children with enlargement of the optic nerves. Imaging findings with Krabbe's disease include areas of increased attenuation in the region of thalamus on CT scans, areas of abnormal signal in the white matter on MR images, and white matter volume loss. Hypertrophy of optic nerves is an unusual finding rarely seen in Krabbe's disease. The diagnosis of Krabbe's disease is challenging because of the large number of demyelinating diseases and leukodystrophies as well as the similarities between their clinical and imaging findings. Specific neuroimaging findings and clinicobiochemical correlation may help to establish this diagnosis.



Srishti Nayyar

Severe Life-threatening Hypercalcemia in Skeletal Metastasis from Malignancy of Unknown Origin: A Rare Presentation

[Year:2020] [Month:January-June] [Volume:4] [Number:1] [Pages:2] [Pages No:36 - 37]

   DOI: 10.5005/jp-journals-10055-0094  |  Open Access |  How to cite  | 


Severe hypercalcemia is a life-threatening condition. Hypercalcemia of malignancy can occur as a result of 4 different mechanisms, the most common mechanism being humoral hypercalcemia of malignancy (HHM). The second most common mechanism that majorly concerns our case is osteolytic hypercalcemia. In patients with osseous metastases, increased cytokine activity in the region of lytic osseous metastatic lesions greatly stimulate the activity of osteoclasts in the bone. When compensatory mechanisms are exceeded, the serum calcium level rises causing hypercalcemia. Symptoms and signs include nausea and vomiting, fatigue, depression, confusion, psychosis, abdominal pain, constipation, acute pancreatitis, peptic ulceration, polyuria/nocturia, hematuria, renal colic, renal failure, bone pain, hypertension, and arrhythmias. We present this case of severe hypercalcemia to emphasize the severity of disease associated with lytic skeletal metastasis with an emphasis on early management, diagnosis, and interventions to prevent early mortality.



Manas Madan, Pavneet Bhatia, Manisha Sharma, Mridu Manjari

Mixed Adenoneuroendocrine Carcinoma: A Case Report

[Year:2020] [Month:January-June] [Volume:4] [Number:1] [Pages:3] [Pages No:38 - 40]

   DOI: 10.5005/jp-journals-10055-0088  |  Open Access |  How to cite  | 


Introduction: Mixed adenoneuroendocrine carcinoma (MANEC) is a rare tumor of the gastrointestinal tract which consists of a dual adenocarcinomatous and neuroendocrine differentiation, each component representing at least 30% of the tumor. Case description: A 60-year-old women presented with complaint of upper abdominal pain and difficulty in swallowing solid food. Endoscopy revealed linitis plastica. Contrast-enhanced computed tomography abdomen revealed a diffuse stomach wall thickening in region of fundus and body with enhancing nodular lesions likely mitotic etiology along with upper abdominal lymphadenopathy. Patient underwent total gastrectomy. Grossly there was a grey white growth at the antrum measuring 3.5 × 2 cm in size with multiple satellite nodules. Histopathological report revealed tumor cells, forming glandular pattern. Amidst these there was also present a second population of small monomorphic cells forming insular pattern. Twenty out of 25 lymph nodes showed secondary carcinomatous deposits. Diagnosis of MANEC was proposed which was confirmed on immunohistochemistry with immunopositivity for synaptophysin/chromogranin and immunonegativity for CK7/CK20/CEA. Patient received chemotherapy and 25 cycles of radiotherapy but presented again with hepatic deposits within 6 months. Conclusion: The case is worth reporting because of its rare presentation. Close attention should be paid to such patients, as MANEC can be a highly aggressive tumor, showing rapid progression and metastasis.



Nimisha Nagpal, Inderjit Kaur, Mridu Manjari, Pawan Prasher

Proliferating Trichilemmal Cyst Presenting as a Limbal Mass

[Year:2020] [Month:January-June] [Volume:4] [Number:1] [Pages:3] [Pages No:41 - 43]

   DOI: 10.5005/jp-journals-10055-0090  |  Open Access |  How to cite  | 


Limbal mass may present as a diagnostic dilemma to the ophthalmologist. Histopathology of the excised mass plays a critical role in establishing the diagnosis and has prognostic implications. Herein, we report a rare case of trichilemmal cyst presenting as a limbal mass involving the bulbar conjunctiva. A 25-year-old female presented with symptoms of ocular discomfort associated with a whitish-opalescent, mildly elevated, nodular nasal limbal lesion measuring 5 × 4 × 3 mm in greatest dimensions in left eye. Excisional biopsy of the mass, along with excision of surrounding 2 mm healthy conjunctiva followed by mitomycin 0.04% application, was carried out. Histopathology features were characteristic of trichilemmal keratinization, a heretofore undescribed metaplasia of the conjunctival epithelium. No recurrence was seen up to 3 years of follow-up.



Seema Mittal, Shipra Singla, Navjot Kaur

Verrucous Carcinoma of Vulva: A Report of Two Cases

[Year:2020] [Month:January-June] [Volume:4] [Number:1] [Pages:2] [Pages No:44 - 45]

   DOI: 10.5005/jp-journals-10055-0084  |  Open Access |  How to cite  | 


Vulvar cancer occurs in less than 1% of malignancies in women. Verrucous carcinoma of vulva is a rare histological variation occurring in less than 1% of vulvar cancer cases. It is generally locally invasive and is not associated with metastasis to distant organs. Lesions present in the form of a verrucous, ulcerated, and bleeding tumor that can reach large dimensions. The differential diagnosis is condylomata, both macroscopically and microscopically.



Anupama Mahajan, Rajeev Kumar Chaudhary, Baljit Singh Khurana

Ethical Challenges of Autopsy, Embalming, and Body Donation in the Context of Corona Virus Disease-19 Pandemic

[Year:2020] [Month:January-June] [Volume:4] [Number:1] [Pages:5] [Pages No:46 - 50]

   DOI: 10.5005/jp-journals-10055-0092  |  Open Access |  How to cite  | 


Corona virus disease-19 (COVID-19) is an acute respiratory illness caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that emerged in the month of December 2019 in Wuhan, Hubei province, China and has continued to spread to include over 100 countries. Most frequently, transmission is from symptomatic individuals with COVID-19 via respiratory droplets produced during sneezing and coughing, from infected fomites, and in some cases, stools have tested positive for COVID-19 RNA. The complete clinical picture of COVID-19 is not fully known. Illnesses have ranged from very mild (loss of taste or smell) to severe pneumonia resulting in death. Eighty percent of deaths were among adults >65 years and older, with severe outcomes in people 85 years and older. There is minimum risk of COVID infection from a dead body to health workers who follow standard precautions while handling the body. Embalming of COVID-19-infected dead body should not be allowed. In the absence of definitive treatment for COVID-19, many anatomists have questions about the impact of coronavirus pandemic on body donation. In the present scenario, anatomists need not to accept the probable/suspected/confirmed COVID-19-infected dead bodies through voluntary donation. Major challenges in the context of COVID-19 include a lack of safe, effective vaccine, and uncertainty regarding the pathogenesis, immunity, and transmission of the disease. Except symptom abolition supportive treatment, currently there is no specific drug to treat the coronavirus, although some specific antiviral drugs (remdesivir) are under the clinical trials. Nowadays, strategies are focused on accelerating the path to produce an effective and safe vaccine to curtail the morbidity and mortality associated with pandemic of SARS-CoV-2.



Meenakshi Gupta, Deepika Tikoo, Sakshita Pal

Assessment of Prescription Writing Skills and Impact of an Educational Intervention on Safe Prescribing among the First-year Postgraduate Medical Students of Tertiary Care Hospital

[Year:2020] [Month:January-June] [Volume:4] [Number:1] [Pages:9] [Pages No:51 - 59]

   DOI: 10.5005/jp-journals-10055-0087  |  Open Access |  How to cite  | 


Background: The main goal of the pharmacology curriculum is to enhance the prescription writing skills of the students and minimize the errors. This study evaluates the prescription writing skills of the first-year postgraduate (PG) student and need for emphasis on prescription writing during the various phases of learning process in medical undergraduates (UGs). Aims and objectives: The prime objective of this study was to evaluate the ability of the PG students to write a prescription and to assess the effectiveness of intervention on appropriate prescription writing. Materials and methods: The study included 58 PG students who were given pre-evaluated questionnaire addressing the issues of prescription writing and were also asked to write a prescription for a common ailment. An educational interventional session was conducted. Post-session students were asked to write prescription for the same case scenario. Their prescription (both pre-session and post-session) and feedback questionnaire were analyzed using simple descriptive statistics and the parameters were expressed in percentages. Results: A widespread lacuna was observed in the prescription writing skills of the PG students. Forty-nine percent of participants felt that their UG training had not prepared them for prescribing properly. Only, 17%, 7%, 5%, and 27% had written prescriber name, qualification, registration number, and signature, respectively. Patient name, age, gender, and address were not written in 69%, 73%, and 93% of the prescriptions. There was a significant improvement in all the above areas after the educational intervention. Handwriting was legible and comprehendible in 98% of the prescriptions. Conclusion: Our study concluded that educational intervention had improved the prescription writing skills of the first-year PG students. Therefore, such reinforcement sessions should be held at regular interval during the various phases of UG and PG teaching.


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