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2021 | January-June | Volume 5 | Issue 1

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Richa Ghay Thaman

Public Health Infrastructure during COVID-19—Sharp focus

[Year:2021] [Month:January-June] [Volume:5] [Number:1] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/ctdt-5-1-vii  |  Open Access |  How to cite  | 



Vijinder Arora, Abhiraj Kakkar

Recognition of Injury Patterns in Transient Lateral Patellar Dislocation on Magnetic Resonance Imaging

[Year:2021] [Month:January-June] [Volume:5] [Number:1] [Pages:5] [Pages No:1 - 5]

Keywords: Medial patellofemoral ligament, Osteochondral injury, Transient lateral patellar dislocation (TLPD)

   DOI: 10.5005/jp-journals-10055-0117  |  Open Access |  How to cite  | 


Aims and Objectives: To determine the prevalence of various injury patterns in patient with transient lateral patellar dislocation (TLPD) on magnetic resonance imaging (MRI). Materials and methods: Thirty patients with clinical history pointing toward lateral patellar dislocation (LPD) were evaluated for the characteristic associated injury patterns including lateral femoral contusion, medial patellar contusion/osteochondral injury, medial retinaculum/medial patellofemoral ligament (MR/MPFL) injury, significant joint effusion, intraarticular loose bodies, medial collateral ligament (MCL) injury, and medial meniscus tear. Prevalence of all these findings was assessed. Results: Our study showed some commonly observed injury patterns in patients with TLPD. Of 30 patients, 25 (83.3%) had MR/MPFL tear in general. Fifty percentage (15 of 30 patients) showed MPFL tear at its patellar insertion, 16.6% (5 of 30 patients) at its mid-part, and 46.6% (14 of 30 patients) at its femoral insertion; 80% (24 of 30 patients) revealed contusions of the lateral femoral condyle, and 73.33% (22 of 30 patients) had contusion/osteochondral injury of medial patella. Other MRI findings in TLPD included significant joint effusion (20 [66.6%] of 30), patellar tilt (17 [56.6%] of 30), patellar subluxation (17 [56.6%] of 30), medial meniscal tear (7 [23.3%] of 30), medial collateral injury (3 [10%] of 30), and intraarticular bodies (2 [6.6%] of 30). Conclusion: Injury to the MR/MPFL, bony contusion involving lateral femoral condyle, and bony contusion/osteochondral injury involving medial aspect of patella are frequently associated with TLPD. Therefore, these findings should be used to diagnose TLPD. Clinical significance: These findings can reliably help in diagnosing TLPD, and it is essential for the radiologist to be aware of these so as not to miss the diagnosis.



A Study of COVID-19 Vaccine (COVISHIELD) Pharmacovigilance in Primary Healthcare Workers in Punjab, India

[Year:2021] [Month:January-June] [Volume:5] [Number:1] [Pages:6] [Pages No:6 - 11]

Keywords: Coronavirus, Covishield, Pharmacovigilance, SARS-CoV-2

   DOI: 10.5005/jp-journals-10055-0111  |  Open Access |  How to cite  | 


Aims and Objectives: Coronavirus disease-2019 (COVID-19) is caused by a novel RNA coronavirus that can cause lethal diseases, such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome. Symptom onset is from 3 to 5 days with mild- to high-grade fever, persistent cough, mild to severe dyspnea with fall in SpO2, anosmia, ageusia, and fatigue. The management of COVID-19 infection includes oxygen, antiviral drugs like lopinavir or ritonavir, remdesivir, oseltamivir, favipiravir, ventilatory support, antibiotics, etc. Unfortunately, 100% recovery rate is not seen, and many patients die due to complications, so the main emphasis is on vaccine administration for the induction of virus-neutralizing antibodies. This study was done to assess the safety of Covishield in primary healthcare workers so as to assess the risk assessment in general population. Materials and methods: Covishield (ChAdOx1 nCoV-19), a coronavirus vaccine (recombinant), is manufactured by the Serum Institute of India Pvt. Ltd. Pune, India. Covishield has been approved for emergency authorization against COVID-19 infection. Covishield during phase I vaccination drive after consent was given to the 1,054 healthcare workers of Sri Guru Ram Das Institute of Medical Sciences and Research (SGRDIMSAR), Amritsar, and safety data were generated in postvaccination phase. Results: It was observed that there were 97.3% of solicited reactions and 2.7% of unsolicited reactions. Most of the solicited reactions were pain at the injection site, mild fever, malaise, and headache with a duration of symptoms generally for 2–3 days. In the unsolicited reactions, mainly moderate- to high-grade fever followed by decreased appetite and dizziness with a duration of 2–3 days were observed. Only in one subject, an increase in liver function test occurred for 3 days. Conclusion: The findings of our study indicate that Covishield vaccine has provided excellent tolerability in health care subjects who willingly received the vaccine during phase I mass vaccination, and there was no report of any untoward side effects demanding attention in such patients. Clinical significance: The tolerability of Covishield vaccine observed in the present study can be used to extrapolate the safety in the general population. Thus, mass vaccination with Covishield is recommended in the general population without any fear of vaccine-related serious side effects.



Shubhdeep Kaur, Chanpreet K Nagi, Anita Kumari

Frequency of Postoperative Nausea and Vomiting after General Anesthesia in a Tertiary Care Hospital: A Comparison of Palonosetron and Dexamethasone

[Year:2021] [Month:January-June] [Volume:5] [Number:1] [Pages:4] [Pages No:12 - 15]

Keywords: Dexamethasone, Laparoscopic cholecystectomy, Palonosetron, Postoperative nausea and vomiting

   DOI: 10.5005/jp-journals-10055-0112  |  Open Access |  How to cite  | 


Introduction: Postoperative nausea and vomiting (PONV) is an unpleasant sensation often described as worse than postoperative pain. Various drugs, including scopolamine, gabapentin, dexamethasone, metoclopramide, promethazine, haloperidol, and serotonin receptor antagonists, have been used for prophylaxis of PONV, but none has been 100% efficacious. We hereby try to compare the effects of palonosetron and dexamethasone on the frequency of PONV. Aims and objectives: The aim of our study was to compare the frequency of PONV with palonosetron and dexamethasone in patients undergoing elective laparoscopic cholecystectomy surgery under general anesthesia. Material and methods: In this prospective, randomized, double-blind study, 50 patients scheduled for laparoscopic cholecystectomy were randomized into two groups receiving 8 mg dexamethasone or 0.075 mg palonosetron. The frequency of PONV in the two groups was compared. Results: Statistical analysis was done using SPSS version 20 (SPSS Inc., Chicago, Illinois, USA).The patients in the two groups were comparable in terms of mean age, body mass index, and gender distribution. At 4, 8, and 12 hours, the incidence of PONV was significantly less in patients receiving palonosetron than those receiving dexamethasone (p = 0.007, 0.001, 0.001, respectively). Conclusion: We can conclude from the present study that 0.075 mg palonosetron is more effective than 8 mg dexamethasone to reduce the incidence of PONV after laparoscopic cholecystectomy.



Shivika Aggarwal, Anita Kumari, Ruchi Gupta

Twenty-four-hour Requirement of Rescue Analgesia after Upper Limb Surgery under Supraclavicular Brachial Plexus Block: A Role of Nalbuphine as an Adjuvant to Levobupivacaine

[Year:2021] [Month:January-June] [Volume:5] [Number:1] [Pages:5] [Pages No:16 - 20]

Keywords: Analgesia, Levobupivacaine, Nalbuphine hydrochloride, Postoperative pain, Supraclavicular brachial plexus

   DOI: 10.5005/jp-journals-10055-0115  |  Open Access |  How to cite  | 


Background: Opioids have been used with peripheral nerve blocks for its synergistic effect to enhance the postoperative analgesic effectiveness of regional block. Nalbuphine, a newer opioid with an analgesic equivalence of morphine, has a ceiling effect on respiratory depression. The aim of the present study was to evaluate the effect of nalbuphine when used as an adjuvant to levobupivacaine on 24-hour postoperative analgesic requirement after brachial plexus block (BPB). Materials and methods: Sixty adult patients of either sex of American Society of Anesthesiologists (ASA) physical status I and II were randomized into two groups of 30 each to receive a total volume of 30 mL of study drug for supraclavicular brachial plexus block (SBPB): Group N—29 mL of 0.5% levobupivacaine with 1 mL of 10 mg nalbuphine; Group S—29 mL of 0.5% levobupivacaine with 1 mL of normal saline. Patients observed for 24-hour postoperative mean requirement of rescue analgesia, that is, diclofenac sodium, block characteristics, visual analog scale (VAS) scores, and the associated complications. Results: Demographic profile was comparable between the two groups. The mean dose of rescue analgesic required between the groups N and S was 127.5 ± 34.96 mg and 150 ± 37.5 mg (p = 0.000), respectively. The average VAS score at different time intervals was highly significant between the two groups (p <0.05). Similarly, block characteristics were statistically significant between the two groups; that is, onset was early, but the duration was prolonged in group N (p <0.05). Complications, although more in group N, were minor and statistically insignificant (p >0.05). Conclusion: Nalbuphine 10 mg as an adjunct to 0.5% levobupivacaine significantly reduced the requirement of rescue analgesia compared to placebo, with no significant major adverse effects.



Vandana , Supreet Kaur, Balwinder Singh, Sahib T Singh, Pallavi Prashar

An Evaluation of Osteoporosis as a Potential Risk Factor in Postmenopausal Women: A Clinicoradiographical Study

[Year:2021] [Month:January-June] [Volume:5] [Number:1] [Pages:5] [Pages No:21 - 25]

Keywords: Bone mineral density, Chronic periodontitis, Menopause, Osteoporosis, Panoramic radiography

   DOI: 10.5005/jp-journals-10055-0118  |  Open Access |  How to cite  | 


Background: Periodontitis is an inflammatory disease that leads to alveolar bone loss. Severe osteoporosis could be suspected as being an aggravating factor in the case of periodontal destruction. Osteoporosis is particularly high in postmenopausal women. Panoramic radiographs are usually advised to detect periodontal diseases and can be used to predict low bone mineral density. Aims and Objectives: To identify the role of osteoporosis in periodontal disease progression using panoramic radiographs. Materials and methods: The study population consisted of 80 female participants equally divided as group I—premenopausal women with chronic periodontitis, group II—premenopausal women with healthy periodontium, group III—postmenopausal women with chronic periodontitis, and group IV—postmenopausal women with healthy periodontium. Clinical parameters, viz. plaque index, gingival index, probing pocket depth, and clinical attachment level, were recorded, and to record the mental index (MI), panoramic mandibular index (PMI), and mandibular cortical index (MCI) scores, panoramic radiographs were used. Results: In all the groups, MI was observed to be varied with significant differences observed in group I and group II (p = 0.06), while the differences were highly significant in group III and group IV (p = 0.0039) and group I and group III (p = 0.0039). There were minimal differences in the mean PMI among the groups, but these differences were nonsignificant (p >0.05). MCI evaluation showed a greater prevalence of C2 and C3 patterns among postmenopausal women. Conclusion: It can be concluded that bone density is reduced in postmenopausal women putting them at a greater risk of periodontitis and osteoporosis.



Manbir Kaur, Anita Kumari, Sunil Chawla

Intravenous Clonidine with Lignocaine Nebulization to Attenuate the Hemodynamic Response to Laryngoscopy and Tracheal Intubation: A Comparative Study

[Year:2021] [Month:January-June] [Volume:5] [Number:1] [Pages:5] [Pages No:26 - 30]

Keywords: Clonidine, Hemodynamic response, Intubation, Laryngoscopy, Lignocaine, Nebulization

   DOI: 10.5005/jp-journals-10055-0124  |  Open Access |  How to cite  | 


Introduction: The present study was conducted to compare the efficacy of intravenous (i.v.) clonidine with that of lignocaine nebulization for attenuation of pressor response to laryngoscopy and tracheal intubation. Materials and methods: Fifty patients of either sex aged between 18 years and 60 years covered under American Society of Anesthesiologists health status classes I and II, undergoing elective surgery under general anesthesia requiring endotracheal intubation, were considered. Patients were randomly divided into two groups. Group A received i.v. clonidine 1 μg per kg and nebulization with 3 mg per kg of 4% lignocaine, and group B received i.v. normal saline and nebulization with 3 mg per kg of 4% lignocaine before intubation. Hemodynamic parameters were noted at baseline, after giving study drug, every minute after intubation for 10 minutes and then every 10 minutes thereafter till the end of the surgery. Results: It was noted that in group A, the rise of HR, SBP, DBP, and MAP 1 minute after intubation was found to be 85.4 bpm, 117.5, 70.6, and 86.2 mm Hg, and in group B, the rise of HR, SBP, DBP, and MAP 1 minute after intubation was found to be 93.9 bpm, 129.9, 85.2, and 100.1 mm Hg, respectively. Nebulized lignocaine was not found effective in attenuating hemodynamic response to intubation, and hemodynamic parameters were significantly high after intubation as compared to clonidine group. Conclusion: In our study, i.v. clonidine in a dose of 1 µg per kg administered 15 minutes before laryngoscopy, and intubation was far superior to nebulized lignocaine alone in attenuation of the hemodynamic response.



Savreen Kaur, Supreet Kaur, Gunmeen Sadana, Teena Gupta, Rashu Grover

Assessing the Prevalence of Dental Injuries while Playing Sports as well as Awareness of Preventive Measures in Schoolchildren of Amritsar City: A Cross-sectional Study

[Year:2021] [Month:January-June] [Volume:5] [Number:1] [Pages:5] [Pages No:31 - 35]

Keywords: Awareness, Mouthguards, Sports injury

   DOI: 10.5005/jp-journals-10055-0123  |  Open Access |  How to cite  | 


Aims and Objectives: To assess the prevalence of dental injuries while playing sports as well as awareness of preventive measures in school children of Amritsar city. Materials and methods: A study was conducted on 500 children aged between 6 and 16 years with a mean age of 13 years. A questionnaire was planned to evaluate the prevalence of dental injuries while playing sports and their awareness regarding the use of mouthguards while playing. The answering group consisted of 67.2% of male and 32.8% of female children. Results: Two-hundred and ninety (58%) children had participated in collision contact sports, 138 (28%) in impact contact sports, 58 (11%) in moderately strenuous contact, 9 (2%) in strenuous contact, and 5 (1%) in non- strenuous contact sports. While 149 (29.8%) experienced facial injury, the rest 51 (10.2%) had bone breakage injury while playing sports. Almost 31% of the participants thought wrapping in cotton or cloth is the best way to carry the avulsed tooth to the dental clinic, whereas only 14% had the knowledge that milk is the best-suited medium. The majority of the children [316 (63%)] were not aware that it was possible to reimplant the teeth. About 30% thought that teeth can be reimplanted after washing them with water and then immediately going to the dentist to reimplant them, and 25% thought that wrapping in paper and visiting the dentist immediately or the next day to reimplant the teeth. Out of the total participants, 160 (32%) used mouthguards and 340 (68%) had never used mouthguards, whereas 58.8% were aware of preventive measures and 41.2% had no such knowledge. Conclusion: The prevalence of dental trauma in three schools of Amritsar district was 20.20%, so education on preventive measures should be given to the trainers and trainees to prevent dental injuries while playing sports. The use of mouthguards should be made mandatory for school kids while playing.



Rajdeep Singh, Sita Sharma

Management of Rheumatoid Arthritis in Pregnancy: A Review Article

[Year:2021] [Month:January-June] [Volume:5] [Number:1] [Pages:6] [Pages No:36 - 41]

Keywords: Chronic inflammatory disease, Pregnancy outcomes, Rheumatoid arthritis

   DOI: 10.5005/jp-journals-10055-0121  |  Open Access |  How to cite  | 


Rheumatoid arthritis (RA) is a chronic inflammatory condition, usually affecting females three times more than the males. The peak age of onset is in the childbearing age-group i.e., 19–44 years. Females with RA face difficulties at the time of conception, during pregnancy, and in the lactation period. Certain drugs used for the management of RA have deleterious effects on pregnancy outcomes. Thus, it is increasingly becoming a topic of concern as well as discussion for healthcare providers and medical professionals to guide the affected females in planning for pregnancy, safer pharmacotherapies, and to overcome the phobia related with their disease effects.



Aaina Devgan, Sumanjeet Kaur

Atretic Cephalocele: Infrequent Cause of Cystic Scalp Swelling—A Case Report

[Year:2021] [Month:January-June] [Volume:5] [Number:1] [Pages:3] [Pages No:42 - 44]

Keywords: Atretic cephalocele, Magnetic resonance imaging, Scalp swelling

   DOI: 10.5005/jp-journals-10055-0113  |  Open Access |  How to cite  | 


The degenerative form of encephalocele is termed as atretic cephalocele, which can be primarily seen in infants in the form of cystic mass lesion in the head. Patient generally presents with midline scalp swelling. It is usually characterized by the presence of many associated underlying intracranial malformations; therefore, prognosis varies. A 1-year-old girl child presented with a midline painless scalp swelling in the occipital region since 6 months which progressed gradually. The child otherwise was asymptomatic with normal developmental milestones. Magnetic resonance imaging findings revealed midline extra-axial altered signal intensity lesion in the occipital region with no underlying parenchymal extensions. Lesion is causing smooth scalloping of inner table of occiput. There is minimal enhancement on postcontrast images with no dural venous sinuses communication.



Ripan Bala, Preet Kamal, Harleen Kaur, Amitoj Kaur, Shreya Thind

Bizarre Multiple Intravaginal Foreign Bodies: Challenges in Management—A Case Report

[Year:2021] [Month:January-June] [Volume:5] [Number:1] [Pages:3] [Pages No:45 - 47]

Keywords: Foreign bodies, Foul-smelling discharge, Uterine bleeding

   DOI: 10.5005/jp-journals-10055-0114  |  Open Access |  How to cite  | 


Foreign bodies in the vagina and reproductive tract have been reported by clinicians, though are quite rare. As the externally evident foreign bodies might arouse the suspicion of an assault, but many times the presenting symptom might be a foul-smelling discharge, uterine bleeding, uterine mass-like features, or penetration of the object into the surrounding viscera. Child abuse and psychiatric illness in adults might be the other causes of such an entity. Foreign bodies, when multiple, then thorough exploration of the entire genital tract is justified. The management of such patients becomes challenging as many times they get epithelized with granulation tissue growing around and attempt to remove them might cause perforations and fistulous communications with other organs. Careful inspection and retrieval under anesthesia remain the key. We present here a case of a middle-aged woman with multiple intravaginal foreign bodies. The approach and challenges in management are discussed.



Sarika Kapila, Ramandeep S Bhullar, Harsh D Singh

Rehabilitation of Deficient Anterior Maxilla with Three Novel Techniques: A Case Report

[Year:2021] [Month:January-June] [Volume:5] [Number:1] [Pages:5] [Pages No:48 - 52]

Keywords: Atrophic maxilla, Autogenous block graft, Implant-supported prosthesis, Osseodensification

   DOI: 10.5005/jp-journals-10055-0119  |  Open Access |  How to cite  | 


An implant-supported prosthesis offers a more predictable course of treatment as compared to other options available for rehabilitating edentulous arches and dental implants are a more acceptable treatment option to the dental fraternity and the public. Atrophic maxilla can be managed well utilizing autogenous bone grafts from intraoral donor sites, and the primary objective of this case was to use osseodensification as a means of acquiring more bone volume/density. We combined the use of three techniques, i.e., autogenous bone graft from symphysis, osseodensification drilling for implant placement, and Toronto prosthesis for rehabilitation of atrophic maxilla in a 35-year-old male patient. After 1 year of follow-up, the implant-based prosthesis is working well without any complication and established that autograft followed by osseodensification and rehabilitation with Toronto bridge gives good results. Block grafting followed by implant placement with osseodensification technique and Toronto prosthesis yielded great aesthetics and functional results.



Shray Dogra, Pawan Prasher

Congenital Aniridia Associated with Congenital Aphakia and Glaucoma: A Case Report

[Year:2021] [Month:January-June] [Volume:5] [Number:1] [Pages:2] [Pages No:53 - 54]

Keywords: Aniridia, Aphakia, Glaucoma, Keratopathy, Nystagmus

   DOI: 10.5005/jp-journals-10055-0120  |  Open Access |  How to cite  | 


Introduction: Congenital aniridia is a rare disease associated with absent irides and various other ocular and systemic conditions. We report an extremely rare incidence of congenital aniridia associated with congenital aphakia and glaucoma in a young man. Case description: A 28-year-old man presented with symptoms of ocular discomfort and low vision in his left eye. Visual acuity was finger counting at a half-meter, and examination showed the presence of aniridia, aphakia, nystagmus, and aniridic keratopathy, along with partial glaucomatous optic atrophy, poor foveal reflex, and a few white vitreous opacities in the fundus. The management was done conservatively with aphakic glasses, lubricants, and antiglaucoma drops. Conclusion: The management of congenital aphakia associated with other ocular anomalies should be aimed at the preservation of residual vision and prevention of sight-threatening complications.



Aaina Devgan, Sumanjeet Kaur

Intracranial Arteriovenous Malformation–Solitary Vascular Lesion: A Case Report

[Year:2021] [Month:January-June] [Volume:5] [Number:1] [Pages:3] [Pages No:55 - 57]

Keywords: Brain arteriovenous malformation, Nidus, Tortuous vascular channels

   DOI: 10.5005/jp-journals-10055-0122  |  Open Access |  How to cite  | 


Brain arteriovenous malformations (AVMs) are an abnormal vascular web that comprises the nidus, feeding arteries, and draining veins. The frequently used grading system is Spetzler-Martin grading. The majority of the brain AVMs are usually asymptomatic, but the common presentation can be headache, seizure, intracerebral hemorrhage, or focal neurological deficit. A 27-year-old male presented with the chief complaint of headache with episodes of ataxia over the course of 4–5 months. Magnetic resonance imaging (MRI) findings revealed multiple tortuous vessels with central nidus in the right posteroinferior cerebellar hemisphere. Also on contrast-enhanced computed tomography (CECT) brain angiography, area of the dilated tuft of vessels in the right posteroinferior cerebellar hemisphere with a nidus of vessels within brain parenchyma with arterial feeders and draining veins was observed. Computerized tomography (CT) of the brain angiography is a modality of choice for the depiction of feeding arteries and draining veins.



Concept-applied Physiology Thinking

[Year:2021] [Month:January-June] [Volume:5] [Number:1] [Pages:4] [Pages No:58 - 61]

Keywords: Cardiovascular, Concept-applied Physiology (CAP), Physiology, Renal, Respiratory

   DOI: 10.5005/jp-journals-10055-0116  |  Open Access |  How to cite  | 


Competency-based medical education has put the onus on students to comprehend, understand, and apply the competencies learned to get promoted to the next level and to ultimately graduate. I enjoy teaching my students physiological concepts by helping them put on their thinking concept-applied physiology (CAPs). My Microsoft PowerPoint may have few slides instead of jargon of every explanation already given and explained in textbooks. I lay forward concepts and questions and allow students to pause in between my lectures. This gives them ample time to wear their thinking CAP and decipher the enigma of the human body through CAP. As adult learners, we give them a platform to rationally think and make concepts for we also learn and redefine our role as facilitators and mentors and not only feed them for rote learning. I am taking you all through the Cardiorespiratory–Renal CAP ride through this article. Let us all think out of the box to stimulate the joy of learning.


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