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  :: Table of Contents - Current issue
Coverpage
April-June 2020
Volume 66 | Issue 2
Page Nos. 61-118

Online since Wednesday, April 1, 2020

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EDITORIAL  

Journal of Postgraduate Medicine 2016–2020: The editor's report Highly accessed article p. 61
S Karande
DOI:10.4103/jpgm.JPGM_165_20  PMID:32270776
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EDITORIAL COMMENTARIES Top

Predictors of outcomes of severe sepsis in children in the Indian subcontinent – What's the big picture? Highly accessed article p. 63
US Bhalala
DOI:10.4103/jpgm.JPGM_619_19  PMID:32270777
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Idiopathic CD4+ T lymphocytopenia: Still a long way to understand the disease Highly accessed article p. 65
K Ghosh
DOI:10.4103/jpgm.JPGM_595_19  PMID:32270778
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ORIGINAL ARTICLES Top

The predictors of outcome and progression of pediatric sepsis and septic shock: A prospective observational study from western India p. 67
S Shah, CT Deshmukh, MS Tullu
DOI:10.4103/jpgm.JPGM_171_19  PMID:31997781
Introduction: There is a paucity of studies on the progression and outcome of Systemic Inflammatory Response Syndrome (SIRS) with its determinants. Aims and Objectives: To determine the predictors of the outcome and progression of pediatric sepsis and septic shock. Materials and Methods: Prospective observational study of children fulfilling criteria of SIRS and their progression to sepsis, severe sepsis, and septic shock (clinically and biochemically) was conducted at a tertiary care center. Results: Totally, 200 children were recruited over a period of 21 months (from February 2016 to October 2017). Most cases (80, 40%) were infants. Of the total, 188 (94%) cases were of an infective etiology (mostly respiratory system). Temperature and heart rate were the two commonest SIRS parameters which were deranged. Blood cultures were positive in only 25 (12.5%) cases. Out of the total 200 children, 108 progressed to sepsis, of which 26 progressed to severe sepsis, of which 22 progressed to septic shock. Abnormal leukocyte count, culture positivity and severe acute malnutrition were significantly associated with progression of SIRS patients to septic shock (P = 0.001, 0.00001 and 0.002, respectively). Factors associated with mortality were positive blood culture, multiorgan dysfunction, late hospital admissions, severe acute malnutrition, and requirement of supportive care (P values-<0.0001, <0.0001, 0.03, <0.0001 and <0.0001, respectively). Conclusions: SIRS can progress to septic shock if not identified early. The predictors of mortality were positive blood cultures, multiorgan dysfunction, late hospital admissions, severe acute malnutrition, and requirement of supportive care. The predictors of progression to septic shock were abnormal leukocyte count, culture positivity, and severe acute malnutrition.
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Morbidity profile of communities in Bhopal city (India) vis-à-vis distance of residence from Union Carbide India Limited plant and drinking water usage pattern p. 73
N Banerjee, A Banerjee, Y Sabde, RR Tiwari, A Prakash
DOI:10.4103/jpgm.JPGM_391_19  PMID:32167062
Objective: A cross-sectional study was undertaken to assess the prevalence of morbidities in communities residing at variable distances from the closed down insecticide manufacturing plant premises of Union Carbide India Limited (UCIL), Bhopal, India and to determine association of morbidities, if any, with their drinking water usage pattern and distance of localities from the UCIL plant. Materials and Methods: A total of 10,827 individuals belonging to 2,184 families, residing within 0-1 km (Stratum I) and 2.5-5.0 km (Stratum II) radial distances from UCIL plant were surveyed and 9,306 of them (86%) were clinically examined. Data were analyzed to examine the association between the groups of morbidities, likely due to biological and chemical water contamination, and the distance of locality from the UCIL plant. Multiple logistic regression was used to explore the risk factors for morbidities. Results: Nearly similar prevalence (25.3% in stratum I, 25.8% in stratum II) and the trend of all-cause morbidities were recorded in the two strata. While morbidities related to gastrointestinal tract system (P < 0.05), auditory system (P < 0.01), neoplasm/cancers (P < 0.01) and congenital anomalies (P < 0.01) were significantly higher in stratum I, the prevalence of hypertension (6.4% stratum II, 4.7% stratum I; P < 0.01) and diabetes mellitus (3.4% stratum II, 2.0% stratum I; P < 0.001) was found significantly higher in stratum II. No association (P > 0.05) was observed between the prevalence of morbidities, likely due to the consumption of biologically or chemically contaminated drinking water, and the distance of locality/stratum from the UCIL plant. Discussion and Conclusion: By and large similar pattern of morbidities were recorded in the two strata suggesting that the communities, irrespective of the distance of their residences from UCIL plant or sources of their drinking water, are equally vulnerable to various morbidities.
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Prevalence of hypertension among professional drivers: Evidence from 2000 to 2017—A systematic review and meta-analysis p. 81
Y Krishnamoorthy, G Sarveswaran, M Sakthivel
DOI:10.4103/jpgm.JPGM_297_19  PMID:32134003
Background: Hypertension is one of the leading causes of premature deaths worldwide. Drivers have an additional risk of hypertension when compared to the general population because of the nature of their profession. Hence, the current review was done to estimate the global burden of hypertension among professional drivers. Methods: We conducted a systematic search for articles on the prevalence of hypertension among drivers published from 2000 to 2017 in Medline and Embase. Meta-analysis was performed using the random-effects model and pooled prevalence of hypertension was reported. Heterogeneity was assessed using the likelihood ratio (LR) test and publication bias was assessed using Egger's test. Results: In total, 26 studies with 15,702 drivers were included. The pooled prevalence of hypertension among the drivers worldwide was 34% (95% confidence interval [CI]: 27–40%). World Health Organization (WHO) region-wise estimates showed that prevalence was highest among the drivers in the Western Pacific region (56%) and lowest in the Eastern Mediterranean and African region (21%). Studies showed significant evidence of heterogeneity (χ2 = 1816.1,P < 0.001) but there was no significant publication bias (P = 0.967). Conclusion: More than one-third of drivers have hypertension globally which is in excess of the general population. Hence, more focus needs to be given for allocating resources and developing workplace interventions for prevention and control of hypertension.
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Is routine pre-entry chest radiograph necessary in a high tuberculosis prevalence country? p. 90
A Jasper, S Gibikote, H Kirupakaran, DJ Christopher, P Mathews
DOI:10.4103/jpgm.JPGM_462_19  PMID:32270779
Context: Chest radiographs have been used worldwide as a screening tool before employment and training, by various healthcare and other government and nongovernment institutions. Many studies done in the past have demonstrated a relatively low yield for tuberculosis detection and therefore, the authors have questioned this practice. Aims: To compare the value of the preadmission/employment chest radiograph in two groups, namely, those who have been previously exposed to a healthcare setting (post-exposure group) and those who have not been exposed (pre-exposure group) and to determine if there is a significant difference in tuberculosis detection between these two groups. Settings and Design: A retrospective review of the reports of the chest radiographs of all candidates appearing for admission to various undergraduate and postgraduate courses in our institute between 2014 and 2017 was performed. Materials and Methods: The various abnormalities detected were recorded and the findings in the two groups were compared. Statistical Analysis Used: Chi-square test was used to compare between two group proportions. Results: Thirty out of 4333 (0.69%) candidates in the pre-exposure group and 53 out of 3379 (1.57%) candidates in the post-exposure group showed abnormalities on chest radiographs involving the lung parenchyma, mediastinum, heart, or pleura. In the pre-exposure group, six (0.14%) were found to have underlying cardiac disease and one (0.02%) had tuberculosis. Among the six candidates in the post-exposure group who underwent further investigations in our institute, five (0.15%) were diagnosed to have tuberculosis. Although there was no statistically significant difference in tuberculosis detection between the groups (P = 0.051), there is a trend towards higher detection of tuberculosis in the post-exposure group. Conclusions: In a country where the prevalence of tuberculosis is high, the pre-employment chest radiograph may still have a role in detecting tuberculosis in the post-exposure group.
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TECHNOLOGY REVIEW Top

Aleatory and epistemic uncertainties can completely derail medical research results p. 94
A Indrayan
DOI:10.4103/jpgm.JPGM_585_19  PMID:32134004
Aleatory uncertainties are generated by intrinsic factors such as studying a sample rather than the whole population and the source of epistemic uncertainties is extraneous such as limitations of knowledge. These uncertainties inflict all the findings in empirical medical research, but they are rarely appreciated. This article highlights these uncertainties and shows with the help of an example how apparently valid and reliable findings can completely derail due to these uncertainties. We conclude that aleatory and epistemic uncertainties should get due consideration while drawing conclusions and before the results are put into practice. Methods to reduce their impact on results are also presented.
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CASE SERIES Top

Fulminant amebic colitis: An unusual postoperative complication of intraabdominal malignancy p. 99
S Misra, P Sakhuja, AK Agarwal, A Javed
DOI:10.4103/jpgm.JPGM_605_19  PMID:32134005
Amebiasis caused by protozoa Entamoeba histolytica (EH) is the third leading parasitic cause of human mortality. Although amebiasis is endemic in India, only about 10% of the infected individuals manifest disease. Clinical spectrum of amebiasis ranges from asymptomatic colonization to amebic colitis to hemorrhagic and fulminant colitis. Factors causing an invasive infection are not completely understood. Pathogen virulence, host immunity, and ability of the pathogen to evade host immune response play vital role in determining the disease course. Host factors such as immunocompromised states may make an individual susceptible to develop symptomatic infection. Malignancies usually result in chronic debilitation which may make the individual prone to develop invasive amebiasis with rapid progression. We report two cases of invasive amebiasis which developed a fulminant course in the immediate postoperative period after abdominal surgeries for visceral malignancies.
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CASE REPORT Top

Idiopathic CD4+ T lymphocytopenia: A case report p. 102
S Umamaheshwari, MN Sumana, MS Shetty, S Gopal
DOI:10.4103/jpgm.JPGM_324_19  PMID:31898594
Idiopathic CD4+ T lymphocytopenia (ICL) is a very rare immunodeficiency syndrome with an unexplained depletion of CD4+ T lymphocytes and no evidence of Human Immunodeficiency Virus (HIV) infection. Here we report a 29-year-old male patient who had severe ulcerative colitis with low level CD4+ count of 254 cells/mm3, and had no evidence of HIV or Human T cell Lymphotrophic virus type I or II infections. He had recurrent Candidiasis infection and his CD4 count was just 53 cells/mm3 after 3 months. The cause for the decline of CD4 T lymphocytes was unknown.
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ADR REPORT Top

Multiple widespread fixed drug eruption caused by rabeprazole p. 105
S Gupta, S Gupta, A Mahendra, A Yadav
DOI:10.4103/jpgm.JPGM_542_19  PMID:32270780
Fixed drug eruption is one of the most common forms of cutaneous adverse drug reactions. Analgesics and antibiotics are the most common drugs causing fixed drug eruption. Here, we report a case of multiple widespread fixed drug eruption caused by rabeprazole.
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CASE SNIPPETS Top

Congenital absence of the left atrial appendage p. 108
P Vaideeswar, S Karande
DOI:10.4103/jpgm.JPGM_671_19  PMID:32134007
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Phantom hernia following percutaneous nephrolithotomy p. 110
S Rajaian, M Pragatheeswarane, K Krishnamurthy
DOI:10.4103/jpgm.JPGM_608_18  PMID:32167061
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Synovial chondromatosis of ankle in a child: A rare presentation p. 112
P Sathe, M Agnihotri, C Vinchu
DOI:10.4103/jpgm.JPGM_628_19  PMID:32270781
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Discal cyst: A rare cause of low backache p. 114
SP Yadav, HA Kale, DD Roy, VB Nakshiwala
DOI:10.4103/jpgm.JPGM_549_19  PMID:32270782
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LETTER Top

Pharmacovigilance of biosimilars - Why is it different from generics and innovator biologics? p. 116
Ranjan Gupta
DOI:10.4103/jpgm.JPGM_651_19  PMID:32134006
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ERRATA Top

Erratum: Systemic lupus erythematosus presenting as acute lupus pneumonitis in a young female p. 117

DOI:10.4103/0022-3859.169759  PMID:32270783
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Erratum: Facial cutaneous metastases of advanced rectal malignancy masquerading as lip cancer p. 117

DOI:10.4103/0022-3859.169764  PMID:32270784
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Erratum: Laron syndrome p. 118

DOI:10.4103/0022-3859.169761  PMID:32270785
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Erratum: The peculiar case of a blue man p. 118

DOI:10.4103/0022-3859.169505  PMID:32270786
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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow