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   Table of Contents - Current issue
July-December 2021
Volume 7 | Issue 2
Page Nos. 1-68

Online since Monday, December 6, 2021

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From the Editor's Desk p. 1
Tripta S Bhagat
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Effect of coronavirus disease 2019 outbreak on the specialty of maxillofacial surgery p. 2
Sanjeev Tomar, Amit B Lall, Mayank Singhal, Akshat Mediratta
The outbreak of coronavirus disease 2019 (COVID-19) has specific implications for oral and maxillofacial surgeons due to an accrued risk of exposure to the virus throughout surgical procedures involving the aerodigestive tract. Maxillofacial surgical procedures due to direct contact with oral and nasal mucosa that area unit thought of areas of high risk of infection in virtue of viral charge and great risk of exposure to COVID-19. Maxillofacial surgery represents associate example of a specialty that has had to adapt to the present outbreak, due to the subspecialties of medical specialty and medicine. Considering the numerous sociopolitical things in every country, the oral and maxillofacial surgery model was thought of acceptable to evaluate the safety measures taken by the healthcare establishments.
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Nanotechnology in periodontics: A review p. 6
Deepali Singhal, Priyanka Aggarwal, Shweta Bali, Kirti Pal
Nanotechnology or nanoscience is the research and development of an applied science at the atomic, molecular, or macromolecular levels (i.e., molecular engineering and manufacturing). Periodontitis is one of the most common diseases involving tooth and it's supporting structures. Management of which is important for improving the quality of life of the patient that has it's impact on the overall health of an individual. With upsurge of various treatment methodologies for the treatment of periodontitis, nanotechnology has evolved as a promising mode of treatment. Applications of nanotechnology in medical and dental fields have only approached the horizon with opportunities and possibilities for the future that can only be limited by our imagination. This paper provides an early glimpse of nanotechnology applications in dentistry and also illustrates the potential of different nanomaterials and their impact on clinical practice.
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Significance of surgical margins assessment in head-and-neck squamous cell carcinoma: A surgeon's perspective p. 11
Sanjeev Tomar, Upma Tomar, Akshat Mediratta, Manish Gupta, Shivani Bhandari
Head-and-neck squamous cell carcinoma (HNSCC) is the most common malignant tumor of the oral cavity. HNSCC can be treated by surgery, radiation therapy, chemotherapy and sometimes combinations of all these modalities, and among all these modalities, surgery is the most accepted line of treatment. The purpose of cancer surgery is achieving complete resection of the tumor, and its success depends on not leaving any residual neoplastic cell. Despite all the recent advances in the diagnosis and treatment of these patients, HNSCC is showing increasingly high recurrence rates. The surgical margins (SMs) or resection margins are the margins or boundaries of resection specimen, which is excised by the surgeon. The goal of this review was to evaluate the significance of SMs in adequate and proper treatment of HNSCC along with minimum recurrence.
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Assessment of post-COVID 19 symptoms: An observational cohort study from a level 3 COVID hospital p. 15
Prachi Saxena, Eshutosh Chandra, Sanjay Sahay, CS Mahendran, Pooja Das, Jijo Varghese Jose, Bhaskar Reddy, Sarath Sivaji
Introduction: A substantial number of patients continue to have symptoms even after testing negative for COVID 19. Ours is a single-center, observational, cross-sectional study that describes the prevalent symptoms in patients who have recovered from mild-to-moderate COVID 19 disease. Materials and Methods: In a span of 3 months, from November 2020 to January 2021, we collected self-reported data from all post-COVID patients who consulted the post-COVID 19 outpatient department. Data on the pertinent history related to their diagnosis of COVID-19 disease like the date of reverse transcriptase-polymerase chain reaction positive and negative reports and length of stay in hospital were collected. Self-reported data were collected in simple Yes/No format for the presence of common respiratory and general post-COVID-19 symptoms. The final data were analyzed and presented using the using R software version 4.0.2. Results: The mean age of the patients was 42.89 years with majority being from the age group of above 50 years of age. The mean duration of hospital stay was found to be 14 ± 7 days. A higher percentage were admitted for >10 days among all age groups, more predominantly among >60 years of age. Only 5 male patients gave a history of receiving noninvasive ventilation. Significantly a greater number of females complained of fatigue. Other symptoms that were found more commonly in females were headache, loss of hearing, and wheeze. Conclusion: In our study, fatigue is the most common presenting symptoms followed by cough and breathlessness. Further evaluation and regular follow-up required to substantiate this observation.
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Study of the lipid and lipoprotein activity in various grades of untreated hypertension p. 20
Shivani Bansal, Ashok Kumar, Tanzeel Wani, Tanuraj Tyagi
Introduction: Hypertension is an important medical and public health problem both in developed and developing countries. Abnormalities in serum lipid levels (dyslipidemia) are recognized as a major risk factor for cardiovascular disease (CVD) and essential hypertension. Lipid profile is earliest marker for coronary heart disease and includes total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and very LDL (VLDL). The role of lipoprotein (a) (Lp[a]) as an independent biomarker of vascular disease risk has been investigated for more than 20 years, but recently the European Atherosclerosis Society has issued a new consensus statement endorsing routine measurement of Lp(a) among patients with moderate-to-high-risk CVD. The aim of the study is to find out lipid profile and lipoprotein activity in various grades of untreated hypertension. Materials and Methods: This was a cross-sectional study conducted at a tertiary care setting in Ghaziabad. The study was conducted from February 2017 to February 2018 and 125 subjects were included after the detailed history, physical examination, and inclusion and exclusion criteria. All patients were evaluated for their lipid profile along with Lp(a) and other routine investigations. Results: There was a statistically significant rising level on TC, TG, LDL, VLDL, and Lp(a) (P ≤ 0.0001) excluding HDL statistically not significant (P = 0.343). This study showed that lipid and lipoprotein cholesterol abnormalities exist and even worsen with severity of hypertension. It is important that investigations in patients with hypertension should include lipid profile and lipoprotein. Conclusion: Serum lipid profile can serve as an important marker for screening hypertensive patients for CVD and their early detection can reduce cardiovascular morbidity and mortality. In this study, TC, LDL-C, TG, VLDC-C, Lp(a), and body mass index were found to be abnormal in hypertensive patients, but HDL-C did not show any significant variation with hypertension.
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Vitamin D in defense against the terrorism of coronavirus disease 2019: A meta-analysis p. 26
Preeti Sharma, Trpta S Bhagat, Bhumija Sharma, Pradeep Kumar
Background: Coronavirus disease 2019 (COVID-19) pandemic was also spread during winter time in December from Wuhan the city of China to worldwide. Various studies conducted throughout the world have indicated the possible relationship between Vitamin D and COVID-19 infection. Aim: This narrative review is designed to support Vitamin D role and its efficacy in managing COVID-19 menace. Materials and Methods: Latest 50 articles for Vitamin D, and COVID-19 relationship and management were scrutinized to summarize this article from data bases of PubMed and Google scholar in English language. Diagrams were created by biorender.com to summarize pictorial relations. Conclusions: Higher mortality is associated with countries of high-level Vitamin D deficiencies. Many studies have found a significant relation between Vitamin D deficiency and COVID-19 complications and related comorbidities. It is highly supported by many literature to recommend daily dose of Vitamin D3 10,000 IU/day for a few weeks to rapidly increase 25-hydroxyvitamin D levels above 40–60 ng/mL, in population at higher risk.
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The role of working memory as a significant determinant of academic performance p. 34
Mathew Varghese, Srivastava Rani, Anil K Nair
Context: Working memory plays a crucial role in determining the overall academic performance of a child irrespective of whether the child is learning disabled or not. Aims: The aim of the study is to explore the cognitive profile of the three categories of children: specific learning disability (SLD), Non-learning disabled (NLD), and scholastically poor children. Settings and Design: In the present study, three groups of children in the age range of 8–11 years studying in three to seventh standard, were selected as the sample for the study. Subjects and Methods: The three categories of children selected are SLD children, NLD children, and children who are scholastically poor. The three categories of children were administered with the Wechsler Intelligence Scale for Children-IV (Indian adaptation) test to analyze the cognitive profile. The cognitive pattern of each group is analyzed and compared. Statistical Analysis: Independent sample t-test was used for statistical analysis. Results and Conclusions: The results show that there is a gross and specific deficit in the domain of working memory among the SLD and scholastically poor children, which indicates that working memory plays a determining role in academic performance.
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Knowledge and attitude regarding noncommunicable diseases among school-going girls in Ghaziabad: An interventional study p. 38
Neha Jetli, Deepika Agrawal, A Revanth Kumar, Anupama Singh, Ashish Gaur, Gajendra Kumar Gupta
Introduction: Noncommunicable diseases (NCDs) are chronic health conditions that do not spread from person to person. Once considered the epidemic of the affluent, now they are gripping low- and middle-income countries. Disability caused by NCDs has risen from 21% of the total disease burden in 1990 to 34% by 2019. Major causes include poor nutrition, physical inactivity, unregulated usage of tobacco and alcohol, inaccessible healthcare, and unhealthy environment. Therefore, giving the correct information about the long-term effects of adopting unhealthy habits should be emphasized among adolescents. Objectives: The objective is to study the impact of awareness session on knowledge and attitude regarding NCDs among school-going girls in Ghaziabad city. Materials and Methods: A School-based intervention study was conducted in a selected Government School in Ghaziabad city. A predesigned, semi-structured questionnaire was administered to the students to assess their baseline knowledge and attitude. After the awareness session, the same questionnaire was administered again. The data were compiled and analyzed using MS Excel 2016, and appropriate statistical method like McNemar's test was applied. Results: Among the 216 study participants, 75.9% could differentiate between Communicable and NCDs correctly which increased to 89.8% after the session. Regarding the identification of major NCDs pre- and post-session proportions were 59% and 68%, respectively. The attitude of majority of the students (99%) remained positive from the starting. They believed that these diseases are preventable and lifestyle modifications are protective. Conclusion: Considerable improvement was observed in the awareness levels of the school students regarding NCDs after attending the health awareness session. When correct information is imparted, students develop a positive attitude and are encouraged to develop a healthy lifestyle. Hence, it is recommended that regular awareness sessions should be organized in schools to build a healthy nation.
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Post-COVISHIELD™ vaccination symptoms among health-care workers – A multicentric survey p. 43
Mahima Lakhanpal, Ritesh Kumar, Debapriya Sarkar
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Tocilizumab for treatment of severe COVID morbidly obese patient with comorbidities p. 45
Ankita Aggarwal, Isha Yadav, Mahima Lakhanpal
COVID-19, caused by the novel severe acute respiratory coronavirus 2, emerged in Wuhan, China, in 2019 and has resulted in the current pandemic. The disease continues to pose a major therapeutic challenge. Patient mortality is ultimately caused by acute respiratory distress syndrome (ARDS). Because interleukin-6 (IL-6) is known to play a key role in inflammation, IL-6 receptor inhibitors such as tocilizumab may potentially treat COVID-19 by attenuating cytokine release. Tocilizumab is a recombinant humanized monoclonal antibody that serves as an IL-6 receptor inhibitor. Tocilizumab is beneficial for the treatment of inflammatory and autoimmune conditions and rheumatoid arthritis, giant cell arteritis, and systemic juvenile idiopathic arthritis. It is also under used in the treatment of severely ill patients with COVID-19. Patients with moderate-to-severe disease with progressively increasing oxygen requirements, with inadequate response to corticosteroids, and with raised levels of inflammatory markers (MoHFW, June 2020). It is used in dose of 8 mg/kg in 100 ml NS over 60 minutes (maximum dose 800 mg/infusion). It can be repeated once after 12 − 24 hours if needed. Careful monitoring for secondary infection and neutropenia should be done. It is contraindicated in people with HIV, active infections, tuberculosis, active hepatitis, ANC is <2000/mm3 and platelet count <100,000/mm3. We present the first case of our institution in which we administered tocilizumab, a 57-year-old female with moderate-to-severe COVID-19, on the verge of meeting intubation requirements, who needed progressive oxygen support for respiratory distress. The patient was treated with tocilizumab to prevent the cytokine storm. We chose early administration of an IL-6 inhibitor because of the gradually increasing levels of inflammatory markers and her deteriorating respiratory status. The treatment was well-tolerated in conjunction with standard drug therapies for COVID-19 (hydroxychloroquine, tazar, and zinc). The patient subsequently experienced marked improvements in his respiratory symptoms and overall clinical status over the following days. We believe that tocilizumab played a substantial role in her ability to overcome clinical decline, particularly the need for mechanical ventilation. Ultimately, the patient was shifted from the intensive care unit (ICU) and discharged within few days. We highlight the potential of IL-6 inhibitors to prevent the progression of respiratory disease to a point requiring ventilator support. This case underscores the potential importance of early serial measurements of IL-6 and cytokine storm-associated inflammatory markers, such as serum ferritin, D-dimer, and C-reactive protein, in guiding clinical decision-making in the management of patients with suspected COVID-19. The early identification of inflammatory markers should be implemented in the treatment of COVID-19 in order to screen for a primary contributor to mortality − the cytokine storm. This screening, when followed by aggressive early treatment for cytokine storm, may have optimal therapeutic benefits and obviate the need for mechanical ventilation, thereby decreasing mortality. In addition, we review current evidence regarding cytokine release syndrome in COVID-19 and the use of IL-6 receptor inhibition as a therapeutic strategy and examine other reported cases in the literature describing IL-6 antagonist treatment for patients with COVID-19.
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Caudal anesthesia for hemorrhoidectomy in a patient with ankylosing spondylitis: A case report p. 53
Mahima Lakhanpal, Ritesh Kumar, Isha Yadav, Debapriya Sarkar, Ankita Aggarwal
Ankylosing spondylitis has always been a challenge to anesthesiologists due to its multisystem involvement. Both airway management and regional anesthesia administration is quite difficult as vertebral and ligaments fusion makes spine stiff and neck movements difficult. We report a case of a 42-year-old male posted for hemorrhoidectomy with a stiff spine and negligible neck movement. The successful caudal epidural block was administered after failure to reach subarachnoid space in multiple attempts.
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Idiopathic scrotal calcinosis: Cytodiagnosis of a rare case p. 56
Swati Singh, Mayurika S Tyagi, Malay Bajpai, Prem Garg, Abhishek Pathre
A 38-year-old male presented with multiple, painless, tense, soft-to-firm nodules within the scrotal skin for the past 5 years with a provisional clinical diagnosis of a sebaceous cyst of the scrotum. Fine-needle aspiration cytology (FNAC) was performed from the scrotal lesions. Fine-needle aspiration smears showed amorphous, basophilic, calcified material without any epithelial cells. Hence, a diagnosis of idiopathic calcinosis of the scrotum was suggested. Histopathological examination of the resected specimen reaffirmed the diagnosis. We report this case highlighting the role of FNAC as a tool for preoperative diagnosis of idiopathic scrotal calcinosis.
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Dermatosis neglecta mimicking macular amyloidosis p. 59
Pravesh Yadav, Anuja Yadav, Soumya Agarwal
Few cases of dermatosis neglecta have been reported in the medical literature, although the diagnosis is well-known to dermatologists. It is characterized by dirty brown-grey cutaneous patches and plaques that can simply be eradicated by rubbing with alcohol pads. In most of the cases, it is associated with a local pathology due to which the patient is afraid to clean the area or any debilitating systemic illness which makes the patient incapable of proper cleansing. Herein, we present a mentally normal, obese male with reticulate hyperpigmentation involving the mid scapular region mimicking macular amyloidosis without any underlying local pathology which turned out to be dermatosis neglecta.
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Surgical management of carcinoma of buccal mucosa abutting mandible and involving skin of the face: A case report p. 61
Gyanendra S Mittal, Tripta Bhagat, Shalabh Gupta, Sagar D Sharma, Nithin R Pillai
Squamous cell carcinoma (SCC) of the oral cavity is the most common site of head-and-neck carcinoma in India. It grows in the vicinity and penetrates through adjacent anatomical structures; surgical resection of the tumor becomes more challenging in the head-and-neck region. As important anatomical structures are closely packed and to resect the tumor with safe margins being an issue, thus raising specific considerations for reconstruction relative to the extent of resection. The present case describes the management of a 64-year-old man with SCC of the left buccal mucosa, invaded into the skin of the cheek. It was managed surgically, with resection and flap reconstruction in the same sitting done in Santosh Medical College and Hospital, Ghaziabad.
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Mucoepidermoid carcinoma p. 66
Shivani Bhandari, Seema Sharma, Manu Gupta, Kanika Bhalla, Upma Tomar
Mucoepidermoid carcinoma (MEC) is the most common malignant neoplasm of the major salivary glands. It represents 5%–10% of all salivary gland tumors and rarely arises within the jaws. It is the second most common minor salivary gland tumor (12%–40% globally). It mainly occurs in the parotid gland and appears as an asymptomatic swelling in minor salivary glands, mostly on the palate. The treatment protocol of MEC is surgical excision followed by postoperative radiotherapy as in most types of salivary gland malignancies. Here, we present a case of MEC in a male patient aged 65 years with emphasis on the importance of early diagnosis so that the malignant neoplasm can be identified early and treated efficiently.
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