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  :: Table of Contents - Current issue
Coverpage
July-September 2019
Volume 65 | Issue 3
Page Nos. 129-191

Online since Thursday, July 18, 2019

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EDITORIAL  

Predatory journals- Can we stem the rot? Highly accessed article p. 129
NJ Gogtay, SB Bavdekar
DOI:10.4103/jpgm.JPGM_266_19  PMID:31317875
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EDITORIAL COMMENTARY Top

‘Shining a light on invisibles’: Specific learning disabilities and Universal Health Coverage Highly accessed article p. 132
C Lahariya
DOI:10.4103/jpgm.JPGM_95_19  PMID:31317876
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ORIGINAL ARTICLES Top

Relationship between body mass index and percentage of body fat, estimated by bio-electrical impedance among adult females in a rural community of North India: A cross-sectional study Highly accessed article p. 134
P Misra, AK Singh, S Archana, A Lohiya, S Kant
DOI:10.4103/jpgm.JPGM_218_18  PMID:31169130
Introduction: Body adiposity measured by percentage of body fat (BF%) is found to be better predictor of cardiovascular morbidity and mortality than body mass index (BMI). Limited information exists showing relationship between BMI and BF% in North Indian population. Objectives: To study the relationship between BMI and BF% among North Indian adult females across various age strata and level of BMI. Materials and Methods: This was a cross-sectional study conducted at Ballabgarh Health and Demographic Surveillance Site (HDSS) among randomly selected females. BMI using standard techniques and BF% using bioelectrical impedance analysis was estimated. Linear regression was performed using general linear model with BF% as dependent variable and BMI as main independent variable. Results: Mean (±2 SD) age of participants was 41.3 ± 15.7 years. Mean BMI (±SD) was 23.3 (±4.6) kg/m2, whereas mean fat mass (±2 SD) and BF% (±95% CI) was 19.2 (±7.9) kg and 33.6 (±6.9) %. BMI and BF% were highly correlated among obese (r = 0.77), whereas least correlated (r = 0.32) in underweight females. Across age strata, correlation between BMI and BF% was maximum in 18–35 years age group (r = 0.95), whereas least in females ≥56 years (r = 0.67). Age and BMI together predicted 73% of variability in BF% in hierarchical linear regression model. Conclusions: In this population, we have found strong correlation between BMI and BF% particularly at higher level of BMI and in younger females. There is need to conduct more robust prospective longitudinal studies to assess BF%, which is a better predictor of cardiovascular morbidity and mortality.
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Patients with psoriasis have a higher risk of schizophrenia: A systematic review and meta-analysis of observational studies p. 141
P Ungprasert, K Wijarnpreecha, W Cheungpasitporn
DOI:10.4103/jpgm.JPGM_253_18  PMID:31169131
Background and Objectives: Patients with psoriasis are known to be at a higher risk of several comorbidities, but little is known about their risk of developing schizophrenia. Methods: A systematic review and meta-analysis of cohort and case–control studies that reported relative risk, hazard ratio, odds ratio (OR), or standardized incidence ratio comparing risk of schizophrenia in patients with psoriasis versus subjects without psoriasis was conducted. Pooled OR and 95% confidence interval were calculated using random-effect, generic inverse-variance methods of DerSimonian and Laird. Results: A total of five studies (one retrospective cohort study and four case–control studies) with more than 6 million participants met the eligibility criteria and were included in this meta-analysis. The pooled OR of schizophrenia in patients with psoriasis versus subjects without psoriasis was 1.41 (95% confidence interval, 1.19–1.66). The statistical heterogeneity was low with an I2 of 33%. Conclusion: This systematic review and meta-analysis demonstrated a significantly increased risk of schizophrenia among patients with psoriasis.
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Correlation of cumulative ST elevation with left ventricular ejection fraction and 30-day outcome in patients with ST elevation myocardial infarction p. 146
V Kiron, PV George
DOI:10.4103/jpgm.JPGM_364_18  PMID:31169133
Background: The electrocardiogram (ECG) is the first and often the only investigation available prior to definitive therapy in patients with ST elevation myocardial infarction (STEMI). A good prognostic marker is the left ventricular ejection fraction (LVEF) on ECG. Our aim was to assess the correlation between ST elevation (STE) in ECG and the LVEF and thereby aid the prognosis of patients with STEMI. Methods: This was a prospective cohort study of 230 patients with STEMI. A baseline 12-lead ECG was taken to calculate the sum of STE at the J point in all the leads showing elevation. The STE was measured 90 min after revascularization to calculate the ST resolution percentage (STR%). All patients underwent echocardiography, and the LVEF was measured using biplane Simpson's method. Results: A total of 136 patients with anterior myocardial infarction (MI), 35 with inferior MI, and 59 with inferoposterior MI were included in the study. Mean STE was 13 mm and was significantly higher among patients with anterior MI. There was a good inverse correlation between the STE and the LVEF with a correlation coefficient of −0.64. STR% had a correlation coefficient of 0.59 to the LVEF. A formula was generated to calculate the LVEF based on the STE as follows: LVEF = (37.34 − STE)/0.567. An STE ≥15 mm predicted an LVEF<35% with a sensitivity and specificity of 70%. Conclusion: The STE and STR% are useful surrogate markers in prognosticating patients irrespective of the type of STEMI.
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Economic burden of specific learning disability: A prevalence-based cost of illness study of its direct, indirect, and intangible costs p. 152
S Karande, S D'souza, N Gogtay, M Shiledar, R Sholapurwala
DOI:10.4103/jpgm.JPGM_413_18  PMID:31169134
Aims: The primary objective of the present study was to evaluate the economic burden of specific learning disability (SpLD) by estimating its direct, indirect, and intangible costs. A secondary objective was to assess the impact of variables on the economic burden. Settings and Design: Cross-sectional single-arm descriptive study. Setting: Learning disability clinic in a public medical college in Mumbai. Subjects and Methods: The study cases (aged ≥8 years) were recruited by non-probability sampling. A structured questionnaire was used to interview the parent/guardian to collect data related to direct and indirect costs. Intangible costs data were collected by documenting the willingness-to-pay value using the contingent valuation technique. Statistical Analysis Used: A quantile regression model was used to assess the impact of predictor variables on the costs. Results: The direct, indirect, and intangible costs due to SpLD were Indian Rupees (INR) 5,936,053, 29,261,220, and 42,295,000, respectively. Indirect costs comprised 83.1% of the total costs. Expenditure on tuitions and remedial education comprised 61.61% and 64.39% of the indirect and direct costs, respectively. The average annual learning disability clinic costs were INR 2,169,888. The average annual total costs per student were INR 90,773. Longer duration of poor school performance was predictive of higher direct, indirect, and total costs; and higher socioeconomic status was predictive of lower intangible costs. Conclusion: SpLD is a cost-intensive disability (intangible > indirect > direct costs). Tuitions, which are not the therapy for SpLD, are the most costly component of indirect costs. Remedial education is the most costly component of direct costs.
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Worldwide trend in measles incidence from 1980 to 2016: A pooled analysis of evidence from 194 WHO Member States p. 160
Y Krishnamoorthy, M Sakthivel, SK Eliyas, G Surendran, G Sarveswaran
DOI:10.4103/jpgm.JPGM_508_18  PMID:31169135
Background: Decline in measles cases has not been uniform across countries and regions. Hence, we assessed the trend of measles from 1980 to 2016 with respect to WHO regions, World Bank income groups, and globally. Methods: We have conducted secondary data analysis by using the data on measles incidence from Global Health Observatory. For clustering adjustment, random intercept modeling with negative binomial distribution was used. Results: Globally, there was decline in the measles incidence from 4211,431 in 1980 to 132,325 in 2016. This accounts for around 8% decline in the measles cases every year (IRR – 0.92, P < 0.001). The results showed that there was a true declining trend after adjusting for clustering at regional (IRR – 0.90, P < 0.001) and income group level (IRR – 0.91, P < 0.001). Conclusion: Current study showed that there was significant decline in the incident number of measles cases based on worldwide, regional, and income group estimates, but insufficient to achieve the measles elimination target by 2020.
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Validation of age and height based formulae to predict paediatric airway distances – a prospective observational study p. 164
P Mathew, V Ashok, MM Siraj, V Grover, D Sethuraman
DOI:10.4103/jpgm.JPGM_545_18  PMID:31169136
Background: Preoperative airway evaluation in children is an important part of routine preanesthetic evaluation before surgery. External airway measurements, viz., thyromental, mentohyoid, and sternomental distances, while being growth dependent, could identify pediatric patients with potentially difficult airways. Objectives: This study was conducted to validate the age- and height-based formulae, derived from a previous study conducted in our institute, to predict thyromental distance, sternomental distance, and mentohyoid distance in relation with the height and age of pediatric patients. Design: Prospective cross-sectional single arm observational study. Setting: Tertiary level university teaching hospital from July 2015 to December 2016. Patients: Children (202) in the age group of 3-15 years with no obvious external airway anomaly scheduled for elective surgery under general anesthesia. Outcomes Measured: The thyromental, mentohyoid, and sternomental distances were measured preoperatively. The same parameters were then calculated based on age- and height-related formulae derived in the earlier study. Results: Bland-Altman analysis of the sample patients showed a mean difference (bias) between measured and calculated values ranging from 0.14 to –0.60 (3 - 13%). Overall agreement in terms of bias were found to be more with height-based equation for mentohyoid distance and thyromental distance and age-based equation for sternomental distance. Conclusion: Our study validates the formulae derived in the earlier study to predict thyromental, mentohyoid, and sternomental distances in children with no obvious external airway anomalies. Further studies are needed to extend the applicability of these formulae in obese children and those with craniofacial anomalies coming for general anesthesia and surgery.
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STUDENTS CORNER Top

A graduate's perspective on medical student journals p. 169
A Abu-Zaid
DOI:10.4103/jpgm.JPGM_278_19  PMID:31267987
Medical student journals (MSJs) refer to a cluster of entirely student-led periodicals that publish student-authored articles. A recent review showed that MSJs characteristically employ a student-friendly and feeble peer review process, which is largely associated with poor quality of published articles. Herein, as a graduate medical student, I call on peer medical students to make an informed decision in refraining from submitting their research work to MSJs for four primary reasons. These reasons, generally, include: 1) opaque peer-review process, 2) lack of MEDLINE® indexing, 3) absence of official journal impact factor scores, and 4) poor article visibility and exposure to scientific community. Furthermore, I encourage students to take advantage of the existing opportunities provided by the professional MEDLINE®-indexed journals in disseminating their research work. These opportunities include: 1) the absolute welcoming calls for student-authored contributions, and 2) the designated 'student contribution corners'. Lastly, I succinctly highlight the joint duties of medical schools, undergraduate research committees, institutional review boards and mentors in publishing the student-authored research work in the professional journals, rather than the MSJs.
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GRAND ROUND CASE Top

Beta-thalassemia major complicated by intracranial hemorrhage and critical illness polyneuropathy p. 171
S Sanju, MS Tullu, S Karande, MN Muranjan, P Parekh
DOI:10.4103/jpgm.JPGM_127_19  PMID:31317877
Intracranial hemorrhage (ICH) is rarely seen in patients with thalassemia. A seven-year-old male, known case of beta-thalassemia major, on irregular packed cell transfusions (elsewhere) and non-compliant with chelation therapy, presented with congestive cardiac failure (Hb-3 gm/dl). He received three packed red cell transfusions over 7 days (cumulative volume 40 cc/kg). On the 9th day, he developed projectile vomiting and two episodes of generalized tonic-clonic convulsions with altered sensorium. He had exaggerated deep tendon reflexes and extensor plantars. CT-scan of brain revealed bilateral acute frontal hematoma with diffuse subarachnoid hemorrhage (frontal and parietal). Coagulation profile was normal. CT-angiography of brain showed diffuse focal areas of reduced caliber of anterior cerebral, middle cerebral, and basilar and internal carotid arteries (likely to be a spasmodic reaction to subarachnoid hemorrhage). He required mechanical ventilation for 4 days and conservative management for the hemorrhage. However, on the 18th day, he developed one episode of generalized tonic-clonic convulsion and his sensorium deteriorated further (without any new ICH) and required repeat mechanical ventilation for 12 days. On the 28th day, he was noticed to have quadriplegia (while on a ventilator). Nerve conduction study (42nd day) revealed severe motor axonal neuropathy (suggesting critical illness polyneuropathy). He improved with physiotherapy and could sit upright and speak sentences at discharge (59th day). The child recovered completely after 3 months. It is wise not to transfuse more than 20 cc/kg of packed red cell volume during each admission and not more than once in a week (exception being congestive cardiac failure) for thalassemia patients.
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CASE SERIES Top

INFIX/EXFIX: Innovation managing pelvic fractures in difficult scenarios p. 177
R Bagga, AP Shetty, RM Kanna, S Rajasekaran
DOI:10.4103/jpgm.JPGM_144_19  PMID:31317878
Pelvic fractures complicated by the presence of visceral injuries, open fractures and urethral or bladder injuries pose a significant challenge to treat. In these conditions internal fixation is usually contraindicated. External fixators, though a potential solution, have disadvantages like loss of reduction, pin tract infection and loosening. INFIX, a novel technique has been effective in managing anterior ring fractures and can be used as a substitute for internal fixation. We describe use of INFIX as EXFIX in three case scenarios where passing INFIX rod internally was precluded with favorable outcomes.
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CASE REPORT Top

Solving the conundrum. A migrainous infarction or an infarct-induced migrainous attack? p. 181
B Hebant, L Simmonet, J Le Moal, E Guegan-Massardier
DOI:10.4103/jpgm.JPGM_21_19  PMID:31210144
Solving the conundrum between a migrainous infarction (MI) and an infarct-induced migrainous attack (MA) is challenging. A 35-year-old woman with previous history of migraine with visual auras was addressed for acute aphasia followed by progressive right hemibody paresthesia and then by positive visual symptoms in her right visual field. These phenomena were followed by a migrainous headache. A perfusion CT performed during symptoms showed an extended hypoperfusion in the left temporo-occipital region corresponding to a migraine during an aura attack. An ASL sequence brain MRI undertaken 12 hours later (while the patient was only cephalalgic) showed an area of diffuse hyper-perfusion in the left hemisphere. DWI sequence showed a left middle cerebral artery territory infarction. We believe our case was most likely to have been an infarct-induced MA. To conclude, it is crucial to rule out cerebral infarction in cases where a patient experiences an atypical aura even in the context of established migraine.
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CASE SNIPPETS Top

Gerbode defect: A rare complication of infective endocarditis p. 184
GO Mert, M Dural, B Gorenek, KU Mert
DOI:10.4103/jpgm.JPGM_13_19  PMID:31267986
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Forgotten gauze piece will not be forgiven always p. 186
S Rajaian, M Pragatheeswarane, K Krishnamurthy, L Murugasen
DOI:10.4103/jpgm.JPGM_37_19  PMID:31317879
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Remitting symmetrical seronegative synovitis and pitting edema syndrome with concomitant adenocarcinoma of the lung p. 188
S Karahan
DOI:10.4103/jpgm.JPGM_237_19  PMID:31317880
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A rare cause of cold agglutinin hemolytic anemia- Histiocytic sarcoma p. 190
S Deme, N Gollakota, PK Vanka, TR Paul
DOI:10.4103/jpgm.JPGM_88_19  PMID:31317881
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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