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   Table of Contents - Current issue
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September-December 2022
Volume 49 | Issue 3
Page Nos. 219-360

Online since Tuesday, December 27, 2022

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EDITORIAL  

Health science exhibition as a tool for health awareness among schoolchildren and the general public Highly accessed article p. 219
Vishwanath M Pattanshetti
DOI:10.4103/jss.jss_285_22  
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REVIEW ARTICLES Top

Integrating geriatric competencies in the undergraduate medical education Highly accessed article p. 221
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.jss_42_21  
With the advancements in science and the field of medicine, it has become a reality that people are living longer in contrast to the earlier trends of life expectancy. The current review was carried out to explore the integration of geriatric competencies in the medical education curriculum. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of five articles were selected based upon the suitability with the current review objectives and analyzed. As it is quite obvious that in the years to come all the medical doctors will encounter a large number of elderly patients with physical, psychological, and other social concerns, it becomes indispensable to expose them to different geriatric competencies during the undergraduate period of training. We must also accept that elderly population requires a different approach and the better and long-term approach will be to expose the undergraduate medical students in this domain and prepare them for their future clinical practice. This integration into the existing curriculum has to start with the formulation of geriatric competencies that need to be covered in the undergraduation period followed by curriculum mapping. In conclusion, regardless of the rise in the number of the elderly, the medical education imparted to undergraduate medical students lacks alignment. This calls for the need to expose the medical students to different learning experiences in geriatrics and prepare them to not only meet the specific needs of the elderly but also address the concern of shortage of geriatricians.
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Coronavirus disease 2019-associated mucormycosis of the head-and-neck area: A new rise of dreaded black fungus in the current pandemic p. 223
Santosh Kumar Swain, Pragnya Paramita Jena
DOI:10.4103/jss.jss_56_21  
Coronavirus disease 2019 (COVID-19) pandemic is currently evolving and associated with more complications with invasive fungal infection like mucormycosis. Classically, uncontrolled diabetes mellitus (DM) and other immunosuppressive conditions like corticosteroid therapy are known risk factors for causing mucormycosis in COVID-19 patients. Mucormycosis is an invasive fungal infection which rapidly spread to the orbit and brain from the nasal cavity and paranasal sinuses. Mucormycosis in COVID-19 is a fatal to the patient. There is possibility of COVID-19 as a trigger factor for diabetic ketoacidosis which predisposes to invasive fungal infections such as mucormycosis. Patients with poorly controlled DM and immunocompromised conditions increase the risk for development of COVID-19 infections in COVID-19 patients. During the current COVID-19 pandemic, a myriad of clinical manifestations and complications are emerged. Rhino-orbital-cerebral mucormycosis is a fatal clinical entity associated with COVID-19 infections resulting in higher morbidity and mortality. The treatment includes both medical and surgical interventions. It requires early and adequate treatment with amphotericin B and surgical debridement and control of risk factors. A multidisciplinary approach by otorhinolaryngologists, ophthalmologists, neurologists, and dentists is successful for treatment of COVID-19 patients with mucormycosis in the head-and-neck region. Identification of the risk factors and early preventive measures will minimize the incidence of life-threatening mucormycosis in the head-and-neck area of COVID-19 patients.
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Strengthening the process of implementation of coaching in medical education settings p. 229
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.jss_55_21  
The branch of medicine is quite complex and it requires a wide range of teaching–learning innovations, student support activities, and faculty motivation to ensure that the goals of medical education are accomplished. The purpose of the current review is to explore the role of coaching in improving the learning and skill acquisition in the field of medical education. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of 22 articles were selected based on the suitability with the current review objectives. The ultimate aim of coaching in medical education is to unearth the real potential of the students to optimize their performance by helping them to learn instead of teaching them. Coaching is a strategy to help medical students to become competent and reflective practitioner. In addition, coaching plays an important role in the refinement of technical skills (like surgical skills) and nontechnical skills. To conclude, coaching in medical education has significant scope to improve the learning outcomes among students and even make them lifelong learners. The need of the hour is to implement a coaching system in each of the medical colleges after considering the local logistics and with the active support of faculty members.
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Success Rate of Reimplantation of Avulsed Primary Anterior Teeth in Children: A Systematic Review p. 233
Krishna S Kadam, Niraj S Gokhale, Shivayogi M Hugar, Riddhi Joshi, Nivedita Saxena Neha Kohli
DOI:10.4103/jss.jss_64_22  
Background: Avulsion of tooth is a grave traumatic injury that is associated with complete displacement from its socket. Lack of conclusive solid evidence and discord opinion is the main reason for the dentist to abstain reimplantation of avulsed primary teeth in children and there are hardy few case reports associated with it. A detailed systematic investigation of literature involving several databases is required to obtain additional evidence for the same. Aim: This systematic review aimed for emphasizing risks and benefits to guide dentists in implementing the best clinical decision for cases of reimplanting avulsed primary teeth. Method: A systematic search was conducted in databases PubMed, Cochrane, and Google Scholar (Embase) for the studies published from January 1, 2010, to December 31, 2021. Cross-references of the selected articles were also done by hand and electronic searching. Gray literature was also searched for the studies according to the relevance. Results: Through search strategy, 4623 articles were yielded. After screening through titles and abstracts, 46 articles remained which were further screened for full text. In the end, 8 articles were included in the systematic review according to the eligibility criteria. Conclusion: This systematic review concluded that reimplantation can be carried out in primary dentition too by following proper and immediate treatment protocols; however, adequate clinical studies are utmost required with longer follow-up for the establishment of substantial evidence that can usher clinicians regarding elite approach in treatment of primary tooth avulsion.
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Prioritizing training of undergraduate medical students in mental health competencies p. 242
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.jss_62_21  
Mental health has been acknowledged an integral component of maintenance of optimal health of individuals and communities. The purpose of the current review was to explore the teaching practices for mental health competencies and strengthen the same in undergraduate teaching period. An extensive search of all materials related to the topic was carried out in the PubMed search engine and a total of 19 articles were selected based on their suitability with the current review objectives. Amid the shortage of trained psychiatrists, it becomes an indispensable need that undergraduate medical students are trained in specific competencies in the subject so that they are empowered to manage basic psychiatric illnesses, especially at the primary level of health care. If we can train our medical undergraduate students, it will turn out to be the most cost-effective and feasible approach to meet the needs of the rural and remote sections of the society. As the imparted mental health training is grossly inadequate or incomplete, it is a must that we take specific steps to improve the existing scenario. In conclusion, psychiatry is an essential and integral component of medical training in the undergraduation period. However, the subject lacks the desired attention under the present circumstances, and thus there is an indispensable need to improve the training and assessment of psychiatric competencies so that students become competent in discharging their future clinical roles.
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Serum lactate levels in critically Ill patients: An early marker to be targeted p. 246
Ruchita Kabra, Sourya Acharya, Sunil Kumar
DOI:10.4103/jss.jss_113_22  
Hyperlactatemia (excess blood lactate) is common in severely unwell individuals. Although lactate levels are routinely used to indicate insufficient tissue oxygenation, they can also be elevated by mechanisms unrelated to tissue oxygenation. Increased glycolysis may be a major cause of hyperlactatemia, especially in critically sick individuals. Despite this, elevated lactate levels have serious consequences for the morbidity and mortality of hyperlactatemia individuals. Despite the widespread use of the phrase lactic acidosis, a substantial link between lactate and pH appears only at higher lactate levels. As a result, the phrase lactate-related acidosis is more suitable. In early resuscitation, two recent studies have emphasized the necessity of monitoring lactate levels and adjusting treatment to changes in lactate levels. Structured lactate measures should be included in resuscitation protocols since lactate levels may be assessed quickly at the bedside from a variety of sources.
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Advocating active and meaningful involvement of patients in the delivery of medical education p. 251
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.jss_80_21  
The onus of knowledge acquisition and learning has demonstrated a paradigm shift in the field of medical education. The present review has been carried out to explore and understand the role of patient involvement in the training of medical students. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of 26 articles were selected based on the suitability with the current review objectives. The involvement of patients in medical education has been linked with a wide range of proven benefits and learning progression. The patients can discharge multiple roles, namely a teacher, developing curriculum, assessor, and someone who can select students for the course. The role of actively involving patients in the teaching process is bound to have some challenges and barriers considering the different aspects in heterogeneous settings. The ideal approach to involve patients in medical education has to start with sensitizing the faculty members and the medical students about the benefits that can be derived out of such clinical interactions. The successful implementation will essentially require adequate resource support and faculty involvement. To conclude, the patient involvement in medical training is not a new practice, but the ground reality is that we are falling short to optimize the benefits of the overall practice. The need of the hour is to adopt a systematic approach and structure the overall program, so that we can derive tangible benefits out of the same and prepare the future generation of doctors in the delivery of patient-centered care.
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Serum calcium levels and its association with coronary artery disease p. 256
Mansi A Patel, Sachin Ratanlal Agrawal, Sourya Acharya, Sunil Kumar
DOI:10.4103/jss.jss_114_22  
Thousands of people took part in prospective studies lasting up to 30 years, and the results showed that circulating calcium is a risk factor for vascular disease. Other cardiovascular risk factors such as circulating lipid levels, blood pressure, and body mass index may partially mediate these relationships, but serum calcium appears to have a residual independent influence. Polymorphisms in calcium-sensing receptors connected to small elevations in serum calcium have also been linked to cardiovascular disease, suggesting that calcium is a causative component. Calcium supplements have been shown to increase mortality and/or accelerate vascular disease in dialysis patients and those with less severe renal failure, and meta-analyses of trials in adults without overt renal disease imply a similar effect. A strong interaction between baseline calcium supplement use and the effect of calcium randomization hampered the interpretation of the largest research. The fact that the study only looked at calcium-deficient people highlights the dangers that are always present. Observational studies of dietary calcium have not consistently demonstrated that it is deleterious to cardiovascular health, albeit exceptionally high or extremely low intakes may be harmful. As a result, eating calcium rather than taking supplements should be encouraged. The current systematic review addresses serum calcium levels and their relationship with coronary artery disease using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. For studies published through December 2021, electronic and manual data resources were reviewed using the following databases: PubMed/MEDLINE, Embase, ScienceDirect, Cochrane Library. The findings were filtered to exclude studies that were written in English.
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ORIGINAL ARTICLES Top

Evaluation of insulin resistance and beta-cell dysfunctions in newly diagnosed polycystic ovarian syndrome patients p. 260
Vikrant Ghatnatti, Shwetha Patil, Harpreet Kour
DOI:10.4103/jss.jss_4_21  
Introduction: Women with polycystic ovary syndrome (PCOS) are at increased risk of developing glucose intolerance and diabetes attributed to increased insulin resistance (IR). However, it is not clear whether β-cell dysfunction has a central role in pathogenesis. The distinction has important implications for the prevention of type 2 diabetes in PCOS with interventions that ameliorate IR. This study aimed to find if IR differs among the various phenotypes of PCOS and perform a quantitative estimation of β-cell dysfunction versus IR in patients of PCOS participants. Materials and Methods: This case–control study was conducted for 1 year in the Endocrinology and Gynaecology outpatient departments at Gauhati Medical College. Fifty women newly diagnosed with PCOS, as per the Rotterdam criteria, were considered cases. Fifty, age- and body mass index-matched healthy females were taken as controls. Fasting and postprandial blood glucose, serum insulin, testosterone, and oral glucose tolerance test values were taken. Impaired fasting glucose, impaired glucose tolerance (IGT), and type 2 diabetes mellitus T2DM were diagnosed according to ADA 2011 criteria. IR and β-cell function were determined by “homeostasis model assessment (HOMA)”. Results: We observed an altered relationship between IR and insulin secretion, consistent with an intrinsic β-cell defect, wherein IR led to a decreased amount of compensatory insulin secretion in PCOS compared with normal women. The correlation coefficients relating HOMA%B to HOMA-IR were lower in PCOS, indicating less compensatory insulin secretion for a given increment in IR. Conclusion: PCOS patients are at increased risk of developing glucose intolerance and diabetes.
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Prevalence, clinical profile, and maternal and perinatal outcomes of hyperglycemia in pregnancy in a tertiary care hospital in South India p. 265
Romana Khursheed, Jayanth Shivalingappa, Arif Maldar, Anita Dalal
DOI:10.4103/jss.jss_65_22  
Background: Hyperglycemia in pregnancy (HIP) is an umbrella term for any degree of carbohydrate intolerance in pregnancy which carries risk of transgenerational transfer of metabolic disorders. The present observational study was carried out to know the prevalence, clinical profile, and maternal and perinatal outcome in different categories of HIP, in a South Indian setup. Materials and Methods: The study was carried out for 1 year at KAHER's Dr Prabhakar Kore Charitable Hospital, Belagavi in South India. The HIP was diagnosed by Diabetes in Pregnancy Study Group of India criteria and further categorized into gestational diabetes mellitus (GDM), gestational glucose intolerance (GGI), and diabetes in pregnancy (DIP). The prevalence, clinical profile, and maternal and perinatal outcome were analyzed in three groups. Results: The prevalence of HIP among pregnant population was found to be 17.47% in 1 year. 222 women (75.5%) had GDM, followed by 49 (17%) and 23 women (8%) presented with GGI and DIP, respectively. The maternal outcomes among HIP were cesarean delivery 230 (78.2), preterm labor 53 (18.02%), preeclampsia 50 (17.01%), premature rupture of membranes 34 (11.56%), and infections 33 (11.22%). The perinatal outcome recorded were neonatal intensive care unit admissions in 107 neonates (36.39%), hyperbilirubinemia in 44 neonates (15%), hypoglycemia in 79 neonates (26.8%), respiratory distress syndrome in 43 neonates (14.46%), and macrosomia in 44 fetuses (15%). Conclusion: Degree of hyperglycemia affects pregnancy outcomes. Continued surveillance of women in preconceptional, antenatal, and postnatal period ensures early diagnosis and management of glucose intolerance and helps in delaying the onset of overt diabetes.
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Association of SNP rs163550 in IL5RA Gene with Risk of Preeclampsia p. 272
Nagarjuna Sivaraj, K Vijaya Rachel, Tarun Kumar Suvvari, Shilaja Prasad, Sriharsha Boppana, Vineetha Naidu, Pradeep Kumar Vegi, Youssef Aboufandi, LV Simhachalam Kutikuppala
DOI:10.4103/jss.jss_70_22  
Background: Several research have looked at the significance of SNPs in inflammatory mediator genes and their link to preeclamptic pregnancies, but the results have not been conclusive enough to explain why SNPs in inflammatory mediator genes may increase the risk of preeclampsia. The goal of this study is to analyze the IL5RA SNPs in order to learn more about the possible link between preeclampsia and inflammatory genes. Materials and Methods: A total of 304 pregnant participants were a part of this prospective observational case-control study, out of which 152 had preeclampsia, and the other 152 participants had normotensive pregnancies. The “polymerase chain reaction-restriction fragment length polymorphism” method was used to genotype SNP rs163550. Results: The commonness of the IL5RA rs163550G allele has been linked to an increased risk for preeclampsia with P value: 0.0230 and odds ratio: 0.6818 (95% confidence interval: 0.489–0.9505). Conclusion: A prominent association among the IL5RA rs163550 SNP and preeclampsia in comparison to nonpreeclampsia has been observed in the study. The study stands first to report IL5RA Polymorphism association with the pathogenesis of preeclampsia's among the Indian population.
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Role of proprioceptive neuromuscular facilitation exercises in post-COVID individuals: A randomized-control trial p. 277
Divya Gohil, Merin Shaji, Gaurang Baxi, Tushar J Palekar
DOI:10.4103/jss.jss_73_22  
Background: Pulmonary function, fatigue, and chest mobility are three important parameters which are impaired after COVID-19. Manual stretching procedures have the potential to improve pulmonary function, reduce fatigue, and improve chest mobility. However, evidence regarding their effectiveness in post-COVID-19 population remains unknown. This study explores the effectiveness of two different types of stretching techniques on pulmonary function, fatigue, and chest expansion in post-COVID-19 population. Materials and Methodology: Forty post-COVID-19 patients with mild and moderate impairment were divided into two groups (20 each). Group A received hold relax proprioceptive neuromuscular facilitation (PNF) pectoral stretching while Group B received chest mobility exercises for 20 min each for 7 sessions. The outcomes measures were pulmonary function test, fatigue, and chest expansion. Results: Significant within-group differences for all outcome measures were seen at the end of intervention. Between-group analysis showed a significant statistical difference in few parameters of pulmonary function testing and chest expansion in Group A than Group B. However, no statistical significance on Fatigue after the 7 sessions of intervention. Conclusions: In COVID-19 survivors with mild and moderate impairment, hold relax PNF stretching than chest mobility exercises has a significant effect on improving pulmonary function, reducing fatigue, and improving chest expansion.
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Perceptions about nonpharmacological interventions in the prevention of COVID-19 in the field practice area of jawaharlal nehru medical college p. 284
NS Manimaran, Deepti M Kadeangadi, Aniket D Manoli, MS Shivaswamy, Anjali J Patil
DOI:10.4103/jss.jss_81_22  
Introduction: COVID-19 pandemic is a major global public health threat. Coronavirus includes a large group of viruses, which infects both humans and animals. China reported the outbreak on December 31, 2019, to World Health Organization. Center for Disease Control and Prevention, USA, has published nonpharmacological interventions such as social distancing, zonal lockdown, rolling lockdown, wearing masks, and washing hands to combat the spread of COVID-19. The present study was conducted to assess the perceptions of people about nonpharmacological interventions in the prevention of COVID-19. Materials and Methods: A facility-based study was conducted among 220 participants from December 01, 2020, to February 28, 2021, among outpatients in the field practice area of urban primary health care Rukmini Nagar, under the administrative control of J. N. Medical College in Belagavi district, Karnataka. Results: A total of 220 participants were interviewed and analyzed for the study. Out of which, 36 (16.4%) were male and 184 (83.6%) were female. One hundred and seventy (77.2%) of the participants practiced good hand hygiene and personal hygiene. One hundred and forty-five (65.9%) of the participants always wore a face mask, when they were going outside. One hundred and eighty-one (82.2%) of the participants started drinking more fluids in the form of water compared with normal days. Conclusion: There was a lack of awareness about face protection and the use of hand sanitizer among the common public. Grassroots level health-care workers such as Accredited Social Health Activist, Anganwadi workers, and community volunteers should be trained for giving health education about nonpharmacological interventions to the public for COVID-19 prevention.
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Iron and zinc deficiency in children with febrile convulsions aged 6‒60 months ‒ A 1-year hospital-based case‒control study p. 288
Jyothirmai Mallela, Tanmaya Metgud, Mahesh Kamate, Deepti M Kadeangadi
DOI:10.4103/jss.jss_83_21  
Context: Febrile seizures are one of the most common seizures in childhood. Febrile seizures occur in 2%–5% of children who are younger than 5 years of age. Studies have shown that iron, zinc, selenium, copper, and magnesium play a significant role in febrile seizures. This study was intended to study the relationship between iron and zinc deficiency with febrile seizures. Aim: To find the association of febrile convulsions with iron and zinc deficiency. Methodology: This hospital-based casecontrol study was done in a tertiary care center in North Karnataka from January 2017 to December 2017. A total of 52 children fulfilling the inclusion criteria were included in case group. Control group contained 52 children who had fever without convulsions and matched for age, sex, and background disease with respective cases. Results: Both the groups were matched for age and gender. Majority of the children (76.92%) had a simple seizure. Cases had lower serum (Sr.) ferritin levels compared to controls with high odds ratio (OR) (25% vs. 1.92%; P < 0.001; OR = 17.00; P = 0.0075). Furthermore, cases had zinc deficiency compared to controls (84.62% vs. 25%; OR = 12.269; P < 0.001). The mean Sr. zinc levels (37.16 ± 22.07 vs. 75.75 ± 15.25 μg/dL; P < 0.001) were significantly low in cases. Conclusion and Interpretation: There was a significant association between febrile seizures with iron and zinc deficiency.
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Risk factors for cessation of viral RNA shedding in COVID-19 patients p. 294
Prasad Tukaram Dhikale, Smita Santosh Chavhan, Balkrishna B Adsul, Chinmay N Gokhale, Aniket R Ingale, Kirti V Kinge
DOI:10.4103/jss.jss_87_21  
Objectives: Our study aimed to evaluate the risk factors for the cessation of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) RNA detection in a cohort of inpatients of laboratory-confirmed coronavirus disease 2019 (COVID-19) cases. Materials and Methods: This was a hospital-based, cross-sectional study. All COVID-19 patients positive on the reverse transcription polymerase chain reaction (RTPCR) test of nasopharyngeal samples who were admitted in this Dedicated COVID Hospital (DCH) from April to June 2020 were included in this study. The deceased patients were excluded.Cessation of Viral RNA Shedding (CVS) was considered to have been achieved on the date of the first negative SARS-CoV-2 RTPCR result out of the two consecutive negative SARS-CoV-2 PCR results on nasopharyngeal swabs taken 24 h apart. Results: Of the 4632 COVID-19 patients, 3307 (71.4%) patients achieved CVS. Patients had a median (IQR) time from positive to negative PCR of 16 (11–23) days. In multivariate cox regression analysis, age group 41 − 60 years (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.63–0.91), age >60 years (HR [CI] = 0.63 [0.53–0.78]), female sex (HR [CI] = 1.08 [1.01-1.16]), cancer (HR [CI] = 1.87 [1.03–3.41]) were the independent risk factors for cessation of viral shedding. Conclusion: Patients older than 40 years, male patients were shedding viral RNA for more duration and can be considered for the isolation for a longer duration.
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Bibliometric study of placenta in pregnancy-induced hypertension p. 298
Mohammed Shafiqul Alam, Monirul Islam
DOI:10.4103/jss.jss_9_22  
Background: The placenta is a responsible organ for nourishing and protecting the fetus during pregnancy. It is a key limb for pregnancy evolution and fetal expansion that acts on maternal-fetal exchanges of gas and nutrients. Materials and Methods: This bibliometric analysis investigated the publications that were produced from 1977 to 2021 and indexed in PubMed database. The database was inspected for all documents related to placenta in pregnancy. About 298 documents were found and examined in database. The VOSviewer software was used to imagine the co-occurrence arrangement. Results: The analysis found the greatest publications resulted out from the “USA” (n = 282), “China” (n = 185), and “Australia” (n = 153). In addition, the results found that most of the publications are journal article (n = 222). “Pregnancy Hypertension” supplied the majority of documents. Almost all documents were produced in the last decade (2011–2021). The study found the most relevant affiliations where University of Melbourne ranked first (n = 80), King's College London ranked second (n = 54), and University of Mississippi Medical Center ranked third (n = 50). The study found Hannan NJ (n = 10, TC = 1.22) as the most productive author in the field. The co-occurrence scrutiny confirmed that the study formed five clusters. The study found that “pregnancy,” “female,” “human,” “pre-eclampsia,” and “adult” are the most useful keywords on the topic. Conclusion: Assessment of placenta is an enormously important interpreter, which helps to progress the result of pregnancy. This bibliometric study illustrates the overall research scenery, trends, growth, impact, and collaborative work among scholars in the field of placenta in pregnancy-induced hypertension.
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A single-center detection of adult patients with advanced periodontal disease using surgical assessment and cone-beam computed tomography p. 304
Ajay Chandran, Reghunathan S Preethanath, Khalid Gufran, Mohammad Shoyab Khan, Abdullah Saad Alqahtani, Meenakumari Chikkanna, C Swarnalatha, J Suresh Babu, Abhishek Singh Nayyar
DOI:10.4103/jss.jss_90_22  
Context: One of the major limitations of conventional radiological procedures is presence of considerable overlapping and lack of clear, three-dimensional information. Cone-beam computed tomography (CBCT) has emerged as an effective imaging modality in such situations offering high-quality images and lower radiation exposure to patients. Aim: The aim of the present study was to assess the role of CBCT in detection of intra-bony defects in patients with advanced periodontal disease. Settings and Design: The present study was designed as a prospective, observational study wherein patients aged between 35 and 55 years with advanced periodontal disease who were indicated for periodontal treatment in the form of periodontal surgeries were selected from the outpatient department based on defined inclusion and exclusion criteria. Materials and Methods: Sixty patients with chronic periodontitis with 12 teeth each including 6 anterior and 6 posterior teeth were selected for making measurements pre- and perioperatively while bone defects were measured first with the help of CBCT software installed in an individualized system devised to be used for storing and analyzing CBCT images and then during surgical intervention using standardized UNC-15 periodontal probe and compared. Statistical Analysis Used: Statistical analysis was done using SPSS version 18.0 (SPSS Inc., Chicago, IL, USA). The measurements obtained with the help of CBCT software installed in the personalized system and those obtained on surgical exploration were compared in each anterior and posterior tooth with the help of paired-sample t-test while Pearson's correlation® was used to test the correlation between the observed values. Level of statistical significance was set at P < 0.05. Results: The results were found to be highly significant both in terms of statistical (P value) and clinical® significance for various sites in the anterior and posterior teeth in all instances. Conclusions: From the observations made from the present study, it could be concluded that CBCT provided a highly precise assessment of bone topography equivalent to the judgment obtained during surgical exposure at the sites of interest preoperatively which helped in assessing the exact type and depth of defect present and helped optimizing surgical treatment planning.
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Microscopic structural changes in osteoarthritic menisci of the human knee joint p. 310
Sanjay Kumar Yadav, Veereshkumar S Shirol, Ramesh Chavan, Shilpa M Bhimalli
DOI:10.4103/jss.jss_93_22  
Background: Osteoarthritis (OA) is a degenerative joint disease for which there is currently no cure. It is characterized by degeneration of articular cartilage and changes in other joint tissues, including subchondral (substance) bone and menisci. It is one of the leading causes of chronic disability. Patients affected by this disease experience pain and loss of function. OA can be caused by a variety of factors, including diet, injury, stress, and genetic abnormalities. However, the molecular mechanisms driving the disease onset and progression are not fully understood. Therefore, this study is undertaken to estimate a large number of human OA menisci for microscopical structural changes in osteoarthritic menisci by histological techniques. Materials and Methods: Medial and lateral osteoarthritic menisci were collected from 110 human knee joints. After collecting the meniscal samples were stored in 10% formalin for 3–5 days. For each meniscus, three separate (anterior, middle, and posterior) parts were processed. The menisci were sectioned in two places vertically at 45° and 135° angles relative to the sagittal plane. After that, each part was sectioned along the horizontal plane from the inner border to the outer border. Then, tissues were fixed in 10% buffered formalin for 24 h. Tissue samples were brought in for routine tissue processing and studied for histological stain with hematoxylin and eosin (H and E) and Alcian blue pH 2.5, to find surface integrity, cellularity, fibrous organization and collagen orientation, and mucoid degeneration. Results: Meniscal degeneration begins with the tissue material rather than the surface. Tissue fibrillation and tears were first observed at the inner border, spread over time to the articular surface of the meniscus, and progressed to complete destruction or loss of meniscal tissue. The left side knee menisci have more OA than the right side. OA cases were more common in both legs, in the age group 60–69 years. Women and Hindus have higher OA cases than men and other religions, respectively. Nonvegetarian and physically inactive individuals were more susceptible to OA, and B +ve and O +ve were more prone to OA than other blood groups. Conclusion: Significant cellular and matrix differences were observed in the meniscus during degeneration. These findings may contribute to further understanding of knee OA and the search for biological treatments. OA was associated with religions, family history, dietary habits, exercise, blood types, and age groups. Hence, there is a need for a program on the care of dietary habits and physical activities for reducing the progression of OA.
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Clinical presentation and infection prevention control practices in health-care workers diagnosed with COVID-19 in a dedicated COVID hospital, Mumbai p. 318
Balkrishna B Adsul, Smita Santosh Chavhan, Prasad Tukaram Dhikale, Kirti V Kinge, Chinmay N Gokhale, Aniket R Ingale, Nilam Jadhav
DOI:10.4103/jss.jss_95_21  
Objectives: The objective of this study was to study the clinical presentation and infection prevention and control (IPC) measures in health-care workers (HCWs) diagnosed with COVID-19 in a Dedicated COVID Hospital (DCH). Materials and Methods: It was a prospective cohort study of HCWs in a DCH. The new cases found in HCWs from December 1, 2020, to January 31, 2021, were interviewed and followed up for 1 month. The study was part of an international multicenter study by the World Health Organization (WHO). The doctors, nurses, housekeeping, and other staff working in this DCH were considered as HCWs. WANTAI severe acute respiratory syndrome coronavirus 2 Ab ELISA provided by the WHO was used for qualitative testing antibody (IgM + IgG). Paired serology samples from cases were collected for serology testing – comprising one baseline serum sample taken during week 1 and another taken in the 6th week. Results: Out of the 1340 HCWs, 25 HCWs (including 15 doctors) developed COVID-19 in 60 days. Most (17, 68%) of the HCWs were from the age group of 21 to 30 years. All the HCWs reported receiving training in IPC. Most (21, 84%) of the HCWs reported following hand hygiene always, as recommended. Most (22, 88%) of the HCWs reported being using recommended personal protective equipment (PPE) always, as recommended. The duration of hospital stay was 10 ± 3.6 days (mean ± standard deviation) and the range was 4–18 days. There was no significant difference between infection prevention and control practices of doctors and other HCWs. In our study, all the patients had mild disease and the antibody titer was positive in 7 (28%) patients in the 1st week of illness and in 20 (80%) patients in the 6th week of illness. The most common symptoms were respiratory symptoms (60%), sore throat (52%), fever (48%), cough (44%), and joint ache (20%). Two (8%) HCWs were asymptomatic. Conclusion: The incidence of COVID-19 among HCWs can be kept low by proper IPC measures such as availability of PPE and training of HCWs in IPC.
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Jigsaw technique: An innovative teaching strategy in anatomy p. 322
Suma Dnyanesh, Sheetal Vishwanath Pattanshetti, Shilpa M Bhimalli, Daksha Dixit
DOI:10.4103/jss.jss_95_22  
Objectives: (1) To motivate students for self-directed learning and to enhance their communication skills. (2) To investigate jigsaw technique for its effectiveness in learning anatomy. Cooperative education is the prime aim of this teaching–learning intervention. The students rely on each other for a collective or combined learning experience. The onus of responsibility of the work done by the student and his/her team will be evaluated by the facilitator. We would like to know whether jigsaw cooperative learning would be considered as effective interventional teaching-learning measure compared to the traditional lecture method. Materials and Methods: Sixty students of first MBBS were involved in a jigsaw session to learn anatomy. The students were divided into groups of five and a total of 12 such groups were made. The study material was also divided into five topics. The students read the study material and after becoming well versed with their topic, they taught their topic to other students. The students were asked to give feedback on the session. A surprise MCQ test was also conducted between this group and a control group of students to assess their knowledge. The results of the MCQ test were statistically analyzed. Results: The students found the jigsaw session to be more engaging than traditional classes. MCQ scores were more in the study group than in the control group. Conclusion: The jigsaw technique is both an educational and enjoyable way of teaching. Due to its immense benefits, both students and teachers resolved to use this technique in the future as well.
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Cross-cultural adaptation and validation of gujarati version knee injury and osteoarthritis outcome score for patellofemoral subscale for early patellofemoral osteoarthritis population p. 326
Heta Pavan Patel, M Balaganapathy
DOI:10.4103/jss.jss_99_22  
Context: The condition of knee pain is common across Gujarat state but identification of joint structure involvement is burdensome in the early cases. The earliest symptom/s patients reported early are anterior knee pain and difficulty in weight-bearing activities. By reviewing the related literature, the researcher states that these symptoms frame the involvement of patellofemoral joints. A dialect tool is not available to evaluate the symptoms of Gujarati speaking population. Knee Injury and Osteoarthritis Outcome Score for patellofemoral (KOOS-PF) scale was developed in the year 2018 using COSMIN guidelines for spotting patellofemoral disorders. It was a valid tool published in the English language. Aims: The study aimed to cross-culturally adapt and validate of KOOS-PF scale in the Gujarati language for the early patellofemoral arthritis population. Settings and Design: This validation study was carried out in six regional orthopedic hospitals. Subjects and Methods: A translation and cross-cultural adaptation process was conducted using Beaton D. 2002 guidelines. It was administered to 144 early patellofemoral arthritis patients to determine the psychometric properties. Results: A total of 144 participants with a mean age of 46.61 ± 4.31 were recruited. The internal consistency measures showed low Cronbach's alpha (α = 0.124). The participants completed the second administration of the Gujarati version scale for good test–retest reliability, r = 0.938. There were no floor and ceiling effects. The convergent validity was confirmed with a moderate negative correlation with Gujarati version modified Western Ontario and McMaster Universities Arthritis Index (r = −0.527). Factor analysis explained that the scale was loaded on three factors. Conclusions: The analysis identified deficits in reliability and convergent validity of the Gujarati version of the KOOS-PF scale suggestive of the development of a new condition-specific tool for the early cases which can be used in research and clinical practice.
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Efficiency of matrix rhythm therapy on pain, strength, and quality of life in forward neck posture: A randomized controlled trial p. 331
Varun C Naik, Mayuri Kerkar, Sazney Mascarenhas
DOI:10.4103/jss.jss_102_22  
Objective: To determine and compare the effects of the Dynamic Exercise Program (DEP) and matrix rhythm therapy (MaRhyThe©) along with conventional physiotherapy in asymptomatic subjects with forward head posture (FHP) on a craniovertebral angle (CVA), strength, pain, and quality of life (QoL) using CVA, pressure biofeedback unit, pain algometer, and short form (SF-36), respectively. Methodology: Sixty-five people were screened for the study, of which 30 were included (18 females and 12 males) who participated in the study. The study participants were randomly allocated to Group A (DEP) or Group B (MaRhyThe©). Preintervention outcome measures used were CVA for the neck position, a craniocervical flexion endurance test for strength, a pain algometer for pain pressure threshold, and SF-36 for QoL. Postintervention outcome measures were recorded on the 6th day after intervention. Results: Data were analyzed descriptively with a priori establishment of success criteria of P < 0.05. Within-group analysis of both groups demonstrated statistically significant parameters of CVA, strength, and pain as P < 0.05. Between groups analysis demonstrated Group B to be statistically significant in all the outcome measures CVA (P < 0.0001), strength (P < 0.0001), and pain (P < 0.0001). SF-36 showed a positive effect on some subdomains as to emotional well-being (0.0320) and pain (0.0047*). Conclusion: It was determined that both deep exercise programs and MaRhyThe© when combined with conventional physiotherapy are effective in treating FHP. However, MaRhyThe© with conventional physiotherapy was found to be superior in reducing pain and improving range of motion, strength, and QoL.
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Correlation of pericoronal radiographic width with histopathology of dental follicle of impacted teeth using modified gallego's and H and E stain p. 339
Sandhya Tamgadge, Treville Pereira, Gokul Venkateshwar, Mandavi Waghmare, Hemant Bhutani, Charu Girotra, Siddharth Acharya
DOI:10.4103/jss.jss_105_22  
Background: Dental follicles are involved the development of tooth and periodontal structures. Dental follicles are known for pleuripotency and inductive changes but are also known for origin for various pathologies. Materials and Methods: Fifty eight asymptomatic dental follicle tissues were examined histologically and radiographically wherein orthopantomogram radiographic width was correlated with various histological parameters of dental follicle and evaluated for the presence of various pathologies using modified Gallego's stain. Observation and Results: There was evidence of pathological changes associated with asymptomatic dental follicle. We also found variations in epithelial lining, stromal calcifications, and variable compositions. Conclusion: We encourage researchers to examine this peculiar tissue as a unique model and explore its potential to avoid future complications.
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Knowledge and attitude toward dental stem cells among dental professionals: A questionnaire study p. 347
LJ Sai Lakshmi, Nadeem Jeddy, T Radhika, S Amutha, WR Gnanasagar
DOI:10.4103/jss.jss_117_22  
Introduction: Dental stem cells (DSCs) derived from tooth structures refer to adult stem cells. DSCs can be used to regenerate both dental tissues and nondental organs. DSC research is progressing at a rapid pace and hence it is imperative for dental professionals to possess adequate knowledge and a favorable attitude toward the same. The aim of this study was to assess the knowledge and attitude of dental professionals toward DSCs. Methodology: A cross-sectional, descriptive, questionnaire-based survey was conducted on a sample of 200 dental professionals from various dental colleges in Chennai. The questionnaire included a total of 15 questions to assess the knowledge and attitude toward DSCs. The Pearson's Chi-square test and percentages of the total were used for statistical analysis. Results: A total of 200 dental professionals completed the questionnaire survey; of which 42 (21%) were male and 158 (78%) were female. Maximum respondents were intern (n = 92, 46%), followed by dental practitioners (DP) (n = 58, 29%) and postgraduates (n = 50, 25%). Around 182 (91%) dental professionals are aware of the term stem cells. Overall, 66% of dental participants were not aware of ethical considerations and guidelines related to DSCs given by the Indian Council of Medical Research. The majority of dental participants (83%) were interested in attending workshop/conference/Continuing Dental Education (CDE) program on applications of stem cells. Conclusion: This study revealed that there was a generalized awareness of the term “DSCs” among the study participants. However, there was a huge lacuna in the knowledge of its types, ethical considerations, and the concept of stem cell banking and DSC banks in India. The results of the current study emphasize the need for improvement in knowledge of DSCs for dental professionals by promoting more CDE programs focusing on this subject.
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CASE REPORTS Top

Ameloblastoma, a tumor with an infamous notoriety for recurrence p. 352
Miheer Milind Jagtap, Samarth Shukla, Dhanushree Nair
DOI:10.4103/jss.jss_115_22  
Ameloblastoma is a locally invasive epithelial tumor of odontogenic origin comprising 1% or less of the cystic lesions and tumors arising in the jaws. It is a lesion most commonly seen in the molar region of the mandibular ramus. Ameloblastomas can be both benign and malignant and this can be differentiated by certain unique morphological features. In the older histology nomenclature, the term “adamantinoma” was used instead of ameloblastoma. The chances of recurrence can be high or low depending upon the surgical management. Curettages are associated with high recurrence rates while wide local excision tends to reduce recurrences.
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Maximal medical therapy in extensive subdural empyema of the brain and spinal cord p. 356
Fotis G Souslian, Tariq Janjua, Luis Rafael Moscote-Salazar
DOI:10.4103/jss.jss_116_22  
Severe subdural empyema (SDE) involving both the brain and spinal cord can be a life-threatening condition if not treated properly. We describe a malnourished patient with extensive spinal and intracranial SDE, whose poor prognosis prompted palliative care consultation. Surgical options were not possible. However, following maximal medical therapy, the patient's condition resolved completely in 1 year. This case highlights the important relationship between neurocritical care medical management and infection when surgical options are not possible.
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LETTERS TO EDITOR Top

Facial nerve palsy secondary to parotid abscess: Antibiotics, incision, and drainage p. 358
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara
DOI:10.4103/jss.jss_5_22  
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