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  :: Table of Contents - Current issue
Coverpage
January-March 2020
Volume 66 | Issue 1
Page Nos. 1-60

Online since Monday, January 13, 2020

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EDITORIAL  

Peer reviewing an original research paper Highly accessed article p. 1
MS Tullu, S Karande
DOI:10.4103/jpgm.JPGM_492_19  PMID:31898597
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EDITORIAL COMMENTARIES Top

Maternal risk markers of postnatal depression p. 7
MS Bhatia
DOI:10.4103/jpgm.JPGM_350_19  PMID:31898595
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Towards competency-based learning in medical education: Building evidence in India p. 9
N Rege
DOI:10.4103/jpgm.JPGM_749_19  
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ORIGINAL ARTICLES Top

Maternal anthropometric determinants as risk markers of suicidality and severity of illness in women with postnatal depression p. 11
AS Nayak, HB Nachane
DOI:10.4103/jpgm.JPGM_541_18  PMID:31898598
Context: Studies have shown nutrition to play a role in etiology of postnatal depression, but few risk markers have been developed for the same. Anthropometric determinants have not been sufficiently researched in relation to suicidality and severity of illness in women with postnatal depression. Aim: The present study assesses the efficacy of anthropometric determinants as risk markers of severity of illness and suicidal ideations in postnatal depression. Methods and Materials: 100 women were screened at 6 weeks postnatal for the presence of postnatal depression and suicidal ideation using the Edinburgh Postnatal Depression Scale. Anthropometric determinants assessed were height, weight, weight gain in pregnancy, weight at first antenatal visit, body mass index and waist-to-hip ratio. Univariate and multivariate analysis were done for risk estimation using Spearman's rank correlation and multiple regression analysis, respectively. Results: In total, 39% of the women showed the presence of postnatal depression. Out of these 39 women, 31% had suicidal ideations. The waist-to-hip ratio was the most significant factor in all the models, having a negative correlation with suicidality and severity of depression (P < 0.05). The multiple regression model using anthropometric determinants could significantly assess risk of both suicidality (P = 0.03, adjusted R2 = 0.08) and postnatal depression (P = 0.04, adjusted R2 = 0.07). Conclusions: The study concludes that anthropometric determinants can be used effectively as risk markers for suicidality and severity of illness in women with postnatal depression. The most significant risk factor was found to be waist-to-hip ratio in both the models.
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Introduction of case-based learning aided by WhatsApp messenger in pathology teaching for medical students p. 17
S Grover, B Garg, N Sood
DOI:10.4103/jpgm.JPGM_2_19  
Aims: The present study was carried out for comparative evaluation of case-based learning (CBL) aided with WhatsApp and didactic lectures (DL) while teaching a pathology topic to second-year medical students. In addition, the acceptability of WhatsApp as an aid to CBL was assessed. Material and Methods: After obtaining informed consent, 70 second-year Bachelor of Medicine and Bachelor of Surgery (MBBS) students were exposed to six sessions of CBL aided by case scenarios for one set of topics of anemia posted on WhatsApp groups. This was followed by six sessions of DL for separate set of topics in anemia. The multiple-choice questions (MCQ) test scores obtained pre and postintervention, of CBL and DL sessions, were compared to paired t-test (within the groups) and Student's t-test (between the groups). Categorical data were analyzed using Chi-square (χ2) test. Student's self-administered questionnaires and focus group discussions (FGDs) were used to collect student perceptions and analyzed quantitatively, as well as qualitatively. Results: The mean MCQ scores obtained postintervention in CBL topics were significantly higher compared to DL (22.78 ± 2.99 vs 17.78 ± 3.35; P < 0.001). Students perceived that CBL enhanced their curiosity; hence, the acquired knowledge through various resources was retained better. It enhanced their analytical skills and interest in learning pathology. In FGDs, the students appreciated the use of WhatsApp as an aid to CBL for its ease of sharing scenario-related additional information and prior discussions among themselves in chat groups at their convenience. Conclusion: CBL aided by WhatsApp helped students acquire knowledge, discuss and learn actively, score more, and retain better than DL. Using WhatsApp as a platform helped them to interact at their ease and seek guidance from their mentors without resistance and hesitation.
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A cross-sectional study of alexithymia in patients with relapse remitting form of multiple sclerosis p. 23
J Stojanov, A Stojanov
DOI:10.4103/jpgm.JPGM_499_19  
Background: Alexithymia is one's incapacity to identify, comprehend, and describe emotions. There is almost no literature data about the levels of alexithymia among patients with relapse remitting type of multiple sclerosis. Aim: The objective of the present study was to assess the levels of alexithymia in patients with relapse remitting type of multiple sclerosis in relation to their sociodemographic variables and clinical characteristics of the disease. Methods: This cross-sectional study included 106 consecutively assessed patients with relapse remitting type of multiple sclerosis. In addition to the data regarding disease duration, number of demyelinating relapses, and degree of neurological disability, assessed by the expanded disability scale score (EDSS), we used Toronto alexithymia scale (TAS), fatigue severity scale (FSS) and, Hamilton scale for the assessment of anxiety and depression and sociodemographic questionnaire. Results: Study included 74 female and 32 male patients, with a median age of 44 years, median disease duration 90 months, and median EDSS 4. About 29.55% of patients had alexithymia and borderline alexithymia was observed in 31.15% patients. Alexithymia correlated with anxiety and depression (P < 0.01) on all TAS subscales. Higher levels of neurological disability based on EDSS, severe fatigue based on FSS scores, and severe relapse remitting type of multiple sclerosis with more relapses and longer disease duration correlated with alexithymia (P < 0.01), depression (P < 0.01), and anxiety (P < 0.01). Higher rates of alexithymia were noticed in older, unemployed, single patients, and those having fewer children. Conclusions: Alexithymia was found in a relatively high percentage in patients with relapse remitting type of multiple sclerosis.
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REVIEW ARTICLE Top

Over-the-counter medicines: Global perspective and Indian scenario p. 28
PA Marathe, SK Kamat, RK Tripathi, SB Raut, NP Khatri
DOI:10.4103/jpgm.JPGM_381_19  PMID:31898596
Patients often approach a pharmacist instead of visiting a doctor for minor ailments such as cough, cold, allergies, pain, fever, acidity, diarrhea, and skin-related conditions. Purchase of specific medicines over the counter is legally recognized in most countries. 'Over-the-Counter (OTC) Medicines' means drugs which are legally allowed to be sold by pharmacists without need for a prescription. The term does not have a legal definition in India. Technically, drugs are OTC unless they are specifically stated as prescription only drugs. OTC drugs allow faster and cheaper access to healthcare; however, their misuse and adverse health effects cause concerns. This article describes concept of OTC medicines and practices in India against the background of globally prevalent regulations and practices. A recognized category of OTC medicines by law, patient awareness programs, and support of pharmacists and pharmaceutical companies are required to optimize the use of OTC medicines in India.
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STUDENTS CORNER Top

Supplements to increase trainee-authored publications pertaining to medical education: A graduate's viewpoint p. 35
A Abu-Zaid
DOI:10.4103/jpgm.JPGM_403_19  
Medical trainees (i.e., students and residents) provide relevantly insightful perspectives pertaining to their 'medical education' at both undergraduate (i.e., medical school) and graduate (i.e., residency training) levels. Therefore, promoting related trainee-authored publications about such matters is critically important. However, unfortunately, not many medical trainees are able to voice their important education-related research findings in peer-reviewed journals. 'Journal-level' proposals to increase trainees' scientific scholarship are always warranted. Herein, medical journals are called to play an innovative pivotal role in further promoting the desired trend of trainee-authored publications. To that end, periodically throughout the year, mainstream (general or education-focused) medical journals are encouraged to facilitate supplements entirely dedicated to trainee-authored research contributions in the field of 'medical education'. The grounds, dynamics, challenges and benefits of this supplement-based approach are discussed.
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CASE REPORTS Top

Calvarial involvement in disseminated rhinosporidiosis – A case report and literature review p. 38
B Dewangan, R Naik, R Membally, M Dewangan
DOI:10.4103/jpgm.JPGM_131_19  PMID:31898592
Rhinosporidiosis is a chronic granulomatous infection caused by Rhinosporidium seeberi and mainly involves nasal and ocular mucosa. Bony involvement in rhinosporidiosis is very rare. A young male, previously operated for nasal rhinosporidiosis, presented with two bony swellings on the forehead and multiple subcutaneous lesions on the right lower limb. The diagnosis of disseminated cutaneous rhinosporidiosis with frontal bone involvement was made with the help of fine needle aspiration cytology (FNAC), histopathology, and computed tomography (CT) scan head. Wide excision of the bony lesion was performed. To the best of our knowledge, this is the first radiologically proven case of frontal bone involvement in disseminated rhinosporidiosis. Early diagnosis can be established with a good clinicopathological and radiological correlation. It also emphasizes the importance of CT scan for the evaluation of any subcutaneous skull lesion.
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Atrial tachycardia from an unusual site—Left atrial appendage tachycardia: Challenges in ablation p. 42
SA Deshpande, AR Udyavar
DOI:10.4103/jpgm.JPGM_361_19  
Left atrial appendage (LAA) tachycardia are rarely encountered in clinical practice (2.1% of focal atrial tachycardia). Out of these, the ones arising from the distal part of LAA are difficult to ablate due to higher risk of LAA perforation and thromboembolism. We hereby present a patient with LAA tachycardia mapped to the tip of LAA with the help of the CARTO system and ablated. This case highlights the inherent challenges faced in such a scenario.
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Seeing beyond the gut: An unusual cause of massive hematemesis p. 45
S Giragani, AR Kasireddy, MV Rao, CR Deevaguntla
DOI:10.4103/jpgm.JPGM_424_19  
We report the clinical details, imaging findings, and management of a 74-year-old male who had recurrent episodes of massive hematemesis secondary to rupture of a cavernous internal carotid artery (ICA) aneurysm. Ruptured ICA aneurysms may present with epistaxis. However, intracranial aneurysmal rupture with hematemesis as the presenting complaint has not been described previously in the literature. In this case report we describe the pathophysiology of cerebral aneurysm as a cause of hematemesis and its management.
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Mucormycosis-induced ileocecal perforation: A case report and review of literature p. 48
R Poyuran, BS Dharan, S Sandhyamani, D Narasimhaiah
DOI:10.4103/jpgm.JPGM_420_19  
Gastrointestinal mucormycosis is a rare form of invasive mucormycosis with high fatality rate due to difficulty in establishing its diagnosis. The classic risk-factors include immunosuppression and metabolic derangement. A case of ileocecal mucormycosis following intracardiac repair of congenital heart disease in a 17-year-old boy is described here who lacked the typical risk-factors for mucormycosis. Ileocecal mucormycosis affecting an individual without the classic risk-factors is uncommon.
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Anesthetic management of a patient with Sheehan's syndrome and twin pregnancy while undergoing a cesarean section p. 51
G Arora, N Sahni
DOI:10.4103/jpgm.JPGM_473_19  
Sheehan's syndrome (SS) is caused by infarction of the pituitary gland usually precipitated by hypotension due to massive uterine hemorrhage during the peripartum period. Once SS develops, it becomes a major comorbidity for the young females and predisposes them to further medical, obstetric, and anesthetic complications. Herein, we report the perioperative anesthetic management of a 28-year-old female, already diagnosed with SS precipitated by urosepsis and septicemic shock in a previous pregnancy, now presenting with twin pregnancy for elective cesarean section. Her magnetic resonance imaging brain revealed pituitary apoplexy and she had hypothyroidism with gestational diabetes mellitus. The overall successful perioperative management of the patient is described along with an emphasis on aggressive management of hypotension due to any cause in the peripartum period to prevent infarction/necrosis of anterior pituitary gland.
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CASE SNIPPETS Top

Doxycycline-induced staining of teeth and malar rash in a child p. 54
G Joshi, D Dhingra, SS Pandav, S Kaushik
DOI:10.4103/jpgm.JPGM_454_19  
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Penile carcinoma with isolated expansile skull metastasis p. 55
S Rajaian, M Pragatheeswarane, P Boopesh, D Jain
DOI:10.4103/jpgm.JPGM_264_19  PMID:31898593
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Intramedullary osteoid osteoma in an 11-month-old child p. 57
S Gupta, S Sinha, A Narang, RK Kanojia
DOI:10.4103/jpgm.JPGM_326_19  
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ERRATUM Top

Erratum: Muckle–Wells syndrome in an Indian family associated with NLRP3 mutation p. 59
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DOI:10.4103/0022-3859.169506  
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Erratum: Chanarin-Dorfman syndrome: Clinical report and novel mutation in ABHD5 gene p. 59
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DOI:10.4103/0022-3859.169758  
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Erratum: Pulmonary choriostoma in a case of tuberous sclerosis complex p. 60
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DOI:10.4103/0022-3859.169760  
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Erratum: Esophageal perforation and death following glyphosate poisoning p. 60
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DOI:10.4103/0022-3859.169763  
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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