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   Table of Contents - Current issue
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January-April 2020
Volume 47 | Issue 1
Page Nos. 1-58

Online since Tuesday, June 23, 2020

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EDITORIAL  

The impact of COVID-19 on medical education in India Highly accessed article p. 1
Vishwanath M Pattanshetti, Sheetal V Pattanshetti
DOI:10.4103/jss.JSS_49_20  
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REVIEW ARTICLE Top

Calcifying odontogenic cyst – A review p. 3
Bhupender Singh Negi, Iftekhar Danish, Preeti Gupta, Robin Sabharwal
DOI:10.4103/jss.JSS_13_20  
Calcifying odontogenic cyst (COC), also known as “Gorlin cyst,” is a rare developmental odontogenic lesion, introduced by Gorlin in 1962. COC exists either as a cystic or a solid variant. This lesion has been known by different names and classified into various subtypes. The World Health Organization classified (2005) COC as a neoplasm and used the term calcifying cystic odontogenic tumor for benign cystic type, the dentinogenic ghost cell tumor for the benign solid type lesions which occur centrally or peripherally, and the malignant one as ghost cell odontogenic carcinoma. COC mimics other odontogenic cysts clinically as well as radiologically, and a definitive diagnosis can be made only by histological means. The present article discusses the various terminologies, classification, histopathology, and immunohistochemistry of COC.
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ORIGINAL ARTICLES Top

The effect of structured training program on awareness and behavior regarding breast self-examination among community health workers of South Delhi p. 8
Mamta Parashar, Blessy Joseph, Jasleen Kaur, Mitasha Singh
DOI:10.4103/jss.JSS_37_19  
Background: Breast cancer is one of the malignant diseases where early diagnosis and treatment leads to a good prognosis. Breast self-examination (BSE) is the most cost-effective screening technique. Objective: The objective of the study is to assess the effect of training on awareness and behavior of BSE among the community health workers (CHWs). Methodology: A community-based interventional study was conducted among 148 Accredited Social Health Activist and Anganwadi Workers of the selected wards of South Delhi district in the year 2018. The study was done in three phases: baseline survey followed by intervention in the form of training session, which involved the use of nursing manikins for the demonstration of BSE technique and video demonstration, depicting proper performance of BSE. After a period of 2 weeks, the same questionnaire and training models were used on the same CHWs to assess the effect of the intervention on their awareness and behavior. Results: Although most of the CHWs were in the age group of 20–40 years and educated till higher secondary and above, only 40% had ever heard of self-breast examination and an even lesser number had ever performed self-breast examination before. The intervention helped in the increase of knowledge about the symptoms of breast cancer considerably. The confidence levels among CHWs and barriers seeking help in CHWs also improved and more people approached their doctors regarding changes seen in the breast, mainly lumps on self-examination. Conclusion: It was determined that the awareness and behavior change after training was positive. There is also effective improvement seen in confidence level and health-seeking behavior.
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Kidney disease screening among a low-income group of hospital staffs who have less opportunity Highly accessed article p. 13
MA Kashem, Rajat Sanker Roy Biswas, Shaikh Md Hasan Mamun
DOI:10.4103/jss.JSS_2_20  
Background: The prevalence of chronic kidney disease (CKD) has been rapidly increasing worldwide, and its early screening is vital to prevent the development of end-stage renal failure. Population-based studies on detection at early stage of kidney disease and its prevalence are scanty in our country. Hence, taking advantage of the observance of the World Kidney Day 2019, we conducted a screening program for kidney disease organized at the Chattagram Maa-O-Shishu Hospital premises among a low-income group of hospital staffs. Methods: This was a cross-sectional observational study among a low-income group of hospital staffs, working at our hospital. Age, body weight, height, body mass index (BMI), and blood pressure were documented, and urinary protein and serum creatinine were measured at a single sitting. Kidney function was estimated by calculating the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease formula. Kidney function was classified according to the estimated GFR (eGFR) and Kidney Disease Outcomes Quality Initiative guidelines. Results: A total of 101 hospital staffs were studied. Majority of the participants (38%) were in the age group of 30–39 years. Among all, 24% of the participants had proteinuria (trace to ≥1 plus). The distribution of eGFR was symmetrical, with the majority (79%) of participants in the 60–89 ml/min category, 6.9% in the 30–59 ml/min category, and only 13.9% of the study population had eGFR >90 ml/min. An inverse relation between eGFR and age and a direct relation between eGFR and BMI were observed. Conclusion: Proteinuria, low GFR levels, and consequently the possibility of high burden of CKD are prevailing in the studied participants, and further targeted population-based studies are warranted to clarify these issues.
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Kidney disease screening among a low-income group of hospital staffs who have less opportunity Highly accessed article p. 13
MA Kashem, Rajat Sanker Roy Biswas, Shaikh Md Hasan Mamun
DOI:10.4103/jss.JSS_2_20  
Background: The prevalence of chronic kidney disease (CKD) has been rapidly increasing worldwide, and its early screening is vital to prevent the development of end-stage renal failure. Population-based studies on detection at early stage of kidney disease and its prevalence are scanty in our country. Hence, taking advantage of the observance of the World Kidney Day 2019, we conducted a screening program for kidney disease organized at the Chattagram Maa-O-Shishu Hospital premises among a low-income group of hospital staffs. Methods: This was a cross-sectional observational study among a low-income group of hospital staffs, working at our hospital. Age, body weight, height, body mass index (BMI), and blood pressure were documented, and urinary protein and serum creatinine were measured at a single sitting. Kidney function was estimated by calculating the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease formula. Kidney function was classified according to the estimated GFR (eGFR) and Kidney Disease Outcomes Quality Initiative guidelines. Results: A total of 101 hospital staffs were studied. Majority of the participants (38%) were in the age group of 30–39 years. Among all, 24% of the participants had proteinuria (trace to ≥1 plus). The distribution of eGFR was symmetrical, with the majority (79%) of participants in the 60–89 ml/min category, 6.9% in the 30–59 ml/min category, and only 13.9% of the study population had eGFR >90 ml/min. An inverse relation between eGFR and age and a direct relation between eGFR and BMI were observed. Conclusion: Proteinuria, low GFR levels, and consequently the possibility of high burden of CKD are prevailing in the studied participants, and further targeted population-based studies are warranted to clarify these issues.
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How does age affect clinicopathology and survival in non-small-cell lung cancer? An institutional retrospective analysis from North-East India Highly accessed article p. 17
Srigopal Mohanty, Yumkhaibam Sobita Devi, Vimal Sekar, James Chongthu, Deiwakor Chyrmang
DOI:10.4103/jss.JSS_47_19  
Context: Worldwide, lung cancer is the most common type of cancer and the most frequent cause of cancer-related mortality. There are limited numbers of studies on the prognostic impact of age on non-small cell lung cancer (NSCLC) in developing countries such as India. Aims: The aim was to compare the clinicopathology and survival between younger and older age NSCLC. Subjects and Methods: A retrospective review was carried out on 780 diagnosed cases of NSCLC, treated between 2007 and 2015. The patients were divided into two age groups, younger (<50 years) and older (≥50 years) age groups. Results: Younger NSCLC patients constituted 6.2% of the total study population and were found to have greater proportion of female patients (P = 0.000), lesser prevalence of smokers (P = 0.000), higher rate of positive family history of lung cancer (P = 0.000), metastatic disease at presentation (P = 0.009), adenocarcinoma as the most common histopathology (P = 0.000), greater proportion of patients received combined modality treatment (P = 0.001), and had better overall survival (P = 0.04), whereas older age NSCLC patients were diagnosed more frequently with poor performance status (Eastern Cooperative Oncology Group 3 or 4) (P = 0.000), more likely to be smokers (P = 0.000), higher prevalence of comorbidities, i.e., diabetes mellitus (P = 0.012), hypertension (P = 0.067), bronchial asthma or chronic obstructive pulmonary disease (P = 0.018), squamous cell carcinoma as the most common histopathological subtype, and greater proportion of patients received either single modality treatment or no treatment (P = 0.000). Multivariate analysis revealed age to be an independent prognostic factor (P = 0.019). Conclusions: Younger NSCLC patients, in spite of aggressive disease at diagnosis, are good candidates for combined modality treatment and have better survival.
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Cell block versus fine-needle aspiration cytology in the diagnosis of breast lesions p. 23
Sakshi Kawatra, S Sudhamani, Sonal Hemanth Kumar, Prakash Roplekar
DOI:10.4103/jss.JSS_12_20  
Background: Breast cancer is the most common cancer worldwide. Fine-needle aspiration cytology (FNAC) is an outpatient simple procedure, which gives a quick cytological diagnosis for breast lesions. Cell blocks prepared from the aspirated material of these breast lumps not only serve as useful adjunct to FNAC, but also give tissue diagnosis comparable to breast biopsies. Aims and Objectives: This study was undertaken to assess the utility of cell block technique in diagnosing various breast lesions in correlation with FNAC findings. Subsequent histopathology diagnosis was obtained and compared with cytological diagnosis wherever possible. Materials and Methods: A prospective cross-sectional study was done for a period of 2 years. A total of 130 cases of breast lumps were studied with both FNAC and cell block techniques. The cell block findings were then correlated with FNAC diagnosis and statistically analyzed. Histopathology findings of subsequent biopsy or excision specimen of breast lumps were obtained wherever possible. Results: Out of the total 130 cases, most of the cases were benign lesions (58%), with fibroadenoma being the most common (97%). Among malignant tumors, invasive mammary carcinoma of no special type was the most common type (94.7%). Cell blocks were more accurate (88.8%) compared to FNAC (69.2%) in diagnosing both benign and malignant lesions. Conclusion: Cell block method is superior to FNAC in the diagnosis of both benign and malignant tumors of the breast and helps to eliminate the need for invasive breast biopsies
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Impact of obstetric cholestasis on fetal outcome – An observational study p. 28
Sheema Posh, Shaheera Ajaz, Beenish Jeelani, Rabia Khurshid
DOI:10.4103/jss.JSS_18_20  
Background: Intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis (OC), while classified as a pregnancy dermatosis, is in fact the most common liver disease of pregnancy associated with significant fetal mortality and morbidity, as well as lifelong health risks for the offspring. Older studies using biochemical abnormalities to diagnose OC have reported a perinatal mortality rate of 10%–15%. This has been reduced to 3.5% or less in more recent studies using policies of active management. ICP is relatively benign to women, but it has been reported to have important fetal implications with increased risk of respiratory distress, preterm delivery, low birth weight, meconium staining of amniotic fluid, fetal bradycardia, fetal distress, and fetal demise. Objective: The objective was to study the impact of OC on fetal outcome. Materials and Methods: The present study was a comparative study carried out on 55 pregnant patients who presented with OC of pregnancy between 30 weeks and 40 weeks of gestation. It was conducted in the Department of Obstetrics and Gynaecology, SKIMS, Soura, Srinagar, from June 2019 to November 2019. The study participants were classified into Group A: total bile acid level (TBA) <40 μmol/l and Group B: TBA >40 μmol/l. The fetal outcome was studied in terms of respiratory distress, low birth weight, stillbirth, and intrauterine fetal demise (IUFD). Results: Out of 55 patients diagnosed with ICP, 35 patients belonged to Group A with TBA <40 μmol/l and 20 patients belonged to Group B with TBA >40 μmol/l. In Group A, only five (14.2%) cases of fetal complications were reported, among which three (60%) fetuses had respiratory distress and two (40%) had low birth weight. Most of the fetal complications occurred in Group B patients with TBA >40 μmol/l, among which ten (55.5%) fetuses had respiratory distress, five (27.7%) fetuses had low birth weight, and there was one (5.5%) stillbirth and two (11.1%) IUFDs. Conclusion: ICP is a relatively common condition that occurs in pregnancy as a consequence of the cholestatic effect of raised estrogen and progesterone in genetically susceptible women. Most of the fetal complications occur in those with higher bile acid pool. The agents that reduce maternal bile acids may reduce fetal complications, but if the mechanism of fetal death involves bile salt-induced fetal arrhythmias without any placental insufficiency, it may be that such monitoring will not be effective in preventing ICP-associated fetal loss.
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Role of amniotic fluid echogenicities in the prediction of fetal outcome p. 33
Sheema Posh, Suhail Rafiq, Musaib Ahmad Dar, Rasiq Aslam, Shabir Ahmad Bhat
DOI:10.4103/jss.JSS_9_20  
Background: The amniotic fluid (AF) is a highly complex and dynamic system that is studied as a data point to interpret fetal well-being. Homogeneously, echogenic AF is due to the presence of innumerable echogenic particles in the fluid and is an uncommon finding. Echogenic AF has been attributed to meconium, blood, and vernix caseosa. The current study was undertaken to evaluate the significance of echogenic AF in the assessment of fetal outcome. Objective: The objective was to study the significance of echogenic AF in the assessment of fetal outcome. Materials and Methods: The present study was a prospective observational study conducted in the Department of Obstetrics and Gynaecology, SKIMS, Soura, Srinagar, from May 2019 to December 2019. A total of 34 participants with ultrasonographic evidence of echogenic liquor were included in the study. They were followed till the delivery for the determination of the fetal outcome. The fetal outcome was studied in terms of Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score; neonatal intensive care unit (NICU) admission rate; and stillbirth rate. Results: Out of 34 participants, 18 participants had vernix caseosa, 8 had meconium, 6 had blood, and 2 had clear liquor amnii. Out of 18 participants with vernix, all 18 fetuses had APGAR score >7/10 with no NICU admission and no stillbirth. Out of eight participants with meconium, six babies had APGAR score <7/10, out of which three had NICU admission, and there was one stillbirth. Out of six participants with blood-stained liquor, four babies had APGAR score <7/10, out of which one had NICU admission, and there was no stillbirth. Conclusion: Our study suggests that when abnormalities of AF exist, appropriate workup to uncover the underlying etiology should be initiated as adverse fetal outcomes are sometimes associated with these variations from normalcy. However, ultrasonography cannot reliably differentiate meconium in AF from other causes of hyperechogenicity. If meconium and blood can be reliably identified prenatally, then it has a significant impact on the fetal outcome. Hence, a change in the management of pregnancy cannot be justified simply due to the detection of hyperechogenic AF.
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CASE REPORTS Top

Augmented anastomotic urethroplasty with ventrally placed buccal mucosal graft p. 37
RB Nerli, Sushant Deole, Shishir Devraju, Shridhar C Ghagane, Murigendra B Hiremath, Neeraj S Dixit
DOI:10.4103/jss.JSS_6_20  
The most common site of anterior urethral stricture is the bulbar urethra. The etiology of these strictures could be either idiopathic (40%), iatrogenic (35%), inflammatory (10%), or traumatic (15%) causes. Several techniques and approaches with/without buccal mucosal graft have been described. We report a modification to the standard anastomotic urethroplasty, wherein following excision of a 2.0-cm bulbar urethral stricture, we performed a roof strip anastomosis followed by ventral buccal mucosal augmentation urethroplasty.
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Verrucous hyperplasia of the penis mimicking a malignant lesion p. 41
Rajendra B Nerli, Shridhar C Ghagane, Sreeharsha Nutalapati, Priyeshkumar Patel, Rajeshkumar Gupta, Neeraj S Dixit
DOI:10.4103/jss.JSS_7_20  
Verrucous lesions of the penis are rare and difficult to classify. Superficial biopsy in any of the verrucous lesions shows only hyperkeratosis, acanthosis, and papillomatosis. Therefore, an adequate biopsy is a must to show the rete pegs that extend into the deeper tissues. Deeper biopsies are always required for an accurate diagnosis. These nonneoplastic lesions of the penis need to be differentiated from cancer which is associated with high morbidity. We report a case of a verrucous lesion of the penis in a 38-year-old male.
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A case of multiple brain abscesses with unknown sources p. 43
Rajat Sanker Roy Biswas, Moinuddin Mahmud Ellius, Shaikh Md Mamun
DOI:10.4103/jss.JSS_17_20  
Brain abscess is a common neurosurgical condition in developing countries like Bangladesh. Usually, it has some etiology. The present case was a 25–year-old male with poor socioeconomic status from a rural area of Chittagong, Bangladesh, and was admitted in our hospital and diagnosed as a case of multiple brain abscesses. He was investigated as per available facility and resources in our hospital, but no sources of abscesses were found. Planning of surgery was done at the 4th day of admission after getting all the reports, but on the 5th day, the patient died and the source and etiology of abscesses were unexplored as no provision of postmortem study is available in our country for such patients.
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Herpes zoster laryngitis p. 45
Santosh Kumar Swain, Satyabrata Acharya, Nibi Shajahan, Rohit Agrawala
DOI:10.4103/jss.JSS_10_20  
Herpes zoster infection is due to reactivation of the latent varicella zoster virus. It is often seen in persons with impaired immunity or stress and characterized by one-side herpetic vesicular eruptions and neuralgia. A 45-year-old male presented with sore throat, hiccups, voice changes, and dry cough. Laryngeal examinations showed edema and eruptions over the left side of the larynx. He had herpetic vesicles over the left concha and external auditory canal. Elevated complement fixation titer confirmed the diagnosis of the herpes zoster. The patient was treated with acyclovir and steroid. Patients improved symptomatically after 10 days of treatment. This clinical condition should be kept in mind when the patient will present with unilateral sore throat, voice changes, and hiccups.
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Vocal fold schwannoma in a 13-year-old girl p. 48
Santosh Kumar Swain, Smrutipragnya Samal, Somadatta Das, Rabindranath Padhy
DOI:10.4103/jss.JSS_45_19  
Laryngeal neurogenic tumors are extremely rare clinical entity. It is a benign and slowly growing neoplasm. Schwannoma of the larynx often arises from the aryepiglottic fold and false vocal cord. Schwannoma of the larynx particularly at the true vocal fold is extremely uncommon. Laryngeal schwannoma typically presents with hoarseness of voice and globus sensation. If the tumor is increases to bigger size, it may lead to dyspnea and stridor. It has an excellent prognosis with low potential for malignant transformation. It should be considered as a differential diagnosis of sublingual pathologies such as salivary gland lesions such as vocal fold polyp. Surgical excision of the tumor is the primary treatment of choice in case of lingual schwannoma. The endoscopic transoral route is considered as the most commonly used approach for vocal fold schwannoma. We report a case of vocal fold schwannoma in a 13-year-old girl which was excised endoscopically.
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Radical orchidectomy – operative steps p. 51
RB Nerli, Manas Sharma, Priyeshkumar Patel, Shridhar C Ghagane, Neeraj S Dixit
DOI:10.4103/jss.JSS_15_20  
A radical orchiectomy is one aspect of the definitive treatment of testicular cancer. Testicular cancer generally affects young men between puberty and about 40 years. Successful treatment incorporates a number of modalities, including radical orchiectomy, retroperitoneal lymph node dissection, chemotherapy, and radiation.
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SHORT COMMUNICATION Top

Implementation of a student-centered curriculum: Challenges ahead and the potential solutions p. 53
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.JSS_38_20  
The competency-based medical education curriculum advocates for the shifting of curriculum from the teacher-centric to the student-centric curriculum. A student-centered curriculum is the one, in which students themselves are accountable for the teaching–learning process, including the framed policies and the decisions taken. However, the path to implement a student-centric curriculum is quite challenging, and a wide range of challenges have been identified from the perspectives of different involved stakeholders. In order to successfully implement a student-centric curriculum, we have to do a lot many things which essentially includes, designing of the curriculum based on well-defined and specific competencies, very much in advance. It is very important to sensitize all the stakeholders involved, and all of them have to understand the need of the same and then work together as a team. In conclusion, the successful implementation of a student-centric curriculum requires extensive planning, preparation, and involvement. The road ahead is quite challenging, but it is not impossible, and it just requires dedicated efforts from all the concerned stakeholders.
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Adoption of the population-based sero-epidemiological protocol to effectively respond to the coronavirus disease 2019 pandemic p. 55
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.JSS_30_20  
The ongoing Coronavirus Disease-2019 (COVID-19) outbreak has been declared as a pandemic and has created a global public health concern. The primary reason due to which COVID-19 outbreak became a public health emergency of international concern was its novel nature. In order to enhance our understanding about the novel infection, five epidemiological protocols have been already developed and the World Health Organization has designed another protocol to conduct investigations pertaining to the disease on the basis of the population and age-stratification. It is expected that this protocol will aid in knowing about the magnitude of the infection in the community, age-specific incidence, infection attack rate, case fatality ratio, ratio of severe disease, detection of high-risk population groups, and the proportion of people having an asymptomatic infection. In conclusion, the adoption of the recently formulated epidemiological protocol by the nation's public health authorities will be a significant step in shaping the battle of mankind against the COVID-19 disease. The protocol will enable the standardized collection of information and thus will help us in understanding crucial clinical, virological and epidemiological attributes of the novel infection.
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Coronavirus disease 2019 outbreak: Targeting preparedness, readiness, and risk response attributes globally p. 57
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.JSS_16_20  
The Coronavirus Disease-2019 (COVID-19) outbreak, which started from a single city in China has been detected in 104 nations and territories. However, based on the epidemiological results obtained from the action response plan in China and some other nations, definite evidence is available to suggest that the risk of transmission can be effectively interrupted using non-pharmacological interventions. The need of the hour is to be ready with the emergency response teams, enhance the capacity of the health system to improve detection and care facilities, improve the human resource-logistics-infrastructure, and facilitate research activities for the development of drugs/vaccines. In conclusion, in the global battle against the COVID-19 outbreak, only our preparedness, readiness and response plan will be our biggest weapons and thus we have to improve ourselves in all the dimensions and mount a well-coordinated response.
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