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  :: Table of Contents - Current issue
Coverpage
October-December 2018
Volume 64 | Issue 4
Page Nos. 195-259

Online since Wednesday, October 10, 2018

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EDITORIAL  

Enzyme replacement therapy in India: Lessons and insights Highly accessed article p. 195
M Muranjan, S Karande
DOI:10.4103/jpgm.JPGM_41_18  PMID:29848835
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EDITORIAL COMMENTARIES Top

Tele-evidence comes to the rescue of overburdened medical doctors Highly accessed article p. 200
A Aggrawal
DOI:10.4103/jpgm.JPGM_154_18  PMID:30306965
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Measles-Rubella vaccination campaign: A trust deficit? Highly accessed article p. 202
A Sreedevi
DOI:10.4103/jpgm.JPGM_104_18  PMID:30306966
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Proptosis with hemiplegia: Unusual presentation of multiple myeloma p. 204
K Ghosh
DOI:10.4103/jpgm.JPGM_119_18  PMID:30306967
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ORIGINAL ARTICLES Top

Tele-evidence: A videoconferencing tool as a viable alternative to physical appearance of doctors for the judicial summons p. 206
S Bari, P Arora, AK Gupta, M Singh, AK Aggarwal
DOI:10.4103/jpgm.JPGM_243_17  PMID:29943747
Introduction: The role of physicians often extends beyond provision of direct patient care and includes appearance in courts as professional or expert witnesses to give their testimony in various legal cases. This often consumes precious time and resources of the doctors and the hospitals. This study was taken up to evaluate the present system of the physical appearance of the doctors to various courts and compare it with the videoconferencing mode of giving testimony (tele-evidence). Materials and Methods: Available records of summons and vehicles used were analyzed to calculate the cost involved and man-hours consumed in honoring the court summons. Telemedicine facility, available in our institute, was used for conducting tele-evidence with selected courts of the two states as a pilot, which was later expanded. A survey was also done to assess the experience of the physicians with physical appearance and videoconferencing using structured questionnaire after approval from the Institute's Ethics Committee. Likert scale of 0–10 points was used to measure satisfaction. Results: There was 43% drop in the monthly mileage of vehicles, 49% reduction in the fuel cost per month, and 28% savings in terms of time consumed for court duties. Satisfaction score for parameters of time consumed, physical strain, mental strain, communication with Honorable Judges, and overall experience was 87% through tele-evidence as compared to 31% with physical appearance. Conclusion: Tele-evidence is an acceptable and implementable mode of testifying and has led to tremendous resource savings in our tertiary care setting. The model needs to be replicated for deliverance of justice and is in consonance with Government's push toward Digital India.
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Social capital, trust in health information, and acceptance of Measles–Rubella vaccination campaign in Tamil Nadu: A case–control study p. 212
B Palanisamy, V Gopichandran, K Kosalram
DOI:10.4103/jpgm.JPGM_249_17  PMID:29943738
Background: Parents' decision about vaccination of children is influenced by social relationships and sources of information. The aim of this study was to assess the influence of social capital and trust in health information on the status of Measles–Rubella (MR) vaccination campaign in Tamil Nadu. Materials and Methods: This was a case–control study carried out in Kancheepuram district in Tamil Nadu where the MR vaccination campaign offered by Government of Tamil Nadu had poor acceptance. Cases were parents of children who had refused the MR vaccine and controls were parents having children in the same age group who had accepted the vaccine. Data on social capital and trust in health information were collected by using social capital scale developed by the researchers and trust in the source of information was measured by using simple questions on the level of trust in the information source. Results: Nonadministration of MR vaccine was high among young parents and parents of younger children. Vaccine acceptance was higher when it was offered at school (P < 0.000) and also among parents who trusted school teachers (P < 0.003) and other school children (P < 0.014) as source of information. MR vaccine acceptance was less among parents who trusted social media and WhatsApp information. Greater levels of health-related physical social capital led to greater vaccine hesitancy. Multivariate analysis revealed that greater the age of the child, better parental attitudes toward vaccination, poorer health-related physical social capital, and greater trust in health information provided by school teachers led to overall greater acceptance of the MR vaccine. Conclusion: Strong homogeneous bonding social capital had a negative influence on MR vaccine acceptance. Schools and school teachers played a vital role in influencing parental decision to vaccinate.
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Peripheral arterial disease and risk of hip fracture: A systematic review and meta-analysis of cohort studies p. 220
P Ungprasert, K Wijarnpreecha, C Thongprayoon, W Cheungpasitporn
DOI:10.4103/jpgm.JPGM_685_17  PMID:30004038
Background: Previous studies have suggested an increased risk of hip fracture among patients with peripheral arterial disease (PAD), however, the results have been inconsistent. This meta-analysis was conducted with the aim to summarize all available evidence to better characterize the risk of incident hip fracture among these patients. Materials and Methods: A comprehensive literature review was conducted using the MEDLINE and EMBASE databases through October 2017 to identify all cohort and case-control studies that compared the risk of subsequent hip fracture between patients with PAD and individuals without PAD. Effect estimates of the included studies were extracted and combined using the random-effect, generic inverse variance method of DerSimonian and Laird. Results: The systematic review process yielded six eligible cohort studies comprising 15,895 patients with PAD. There was a significant association between incident hip fracture and PAD with the pooled relative risk (RR) of 1.64 (95% CI, 1.17–2.29; I2, 80%), comparing patients with PAD and individuals without PAD. Subgroup analysis by study design revealed significant results for both prospective studies (pooled RR 1.60; 95% CI, 1.12–2.28; I2, 0%) and retrospective studies (pooled RR 1.72; 95% CI, 1.07–2.77; I2, 92%). The funnel plot is relatively asymmetric suggesting publication bias. Conclusion: This study found a significant association between PAD and hip fracture with the pooled RR of 1.64 (95% CI, 1.17–2.29) on comparing patients with PAD and individuals without PAD. Major limitations include high between-study heterogeneity, possibility of publication bias, and lack of data on the characteristics and type of hip fracture which may limit the clinical significance of the observations.
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REVIEW ARTICLE Top

Predatory journals: The rise of worthless biomedical science p. 226
H Sharma, S Verma
DOI:10.4103/jpgm.JPGM_347_18  PMID:30306968
In today's world when biomedical science is experiencing continuous threats from various sources, publication of research articles in predatory journals has created a major havoc. These predatory journals are publishing worthless biomedical science which will haunt genuine researchers and keen readers of authentic biomedical journals for several decades. Hence, researchers of various disciplines and academic experience should be continuously made aware of these predatory publishers and potential ways to recognize them. The main aim of this article is to discuss the issues related to predatory publishing, techniques and strategies used by these publishers to prey young inexperienced researchers, and disadvantages of publishing in predatory journals.
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CASE SERIES Top

Primary osteogenic sarcoma of the skull: Report of two cases with review of literature p. 232
R Singh, K Jha, I Pant, D Satti
DOI:10.4103/jpgm.JPGM_706_17  PMID:30264740
Primary calvarial (excluding jaw) osteosarcoma is rare. We report two cases highlighting their unusual presentation and histopathologic variability – a 30-year-old female who presented with progressively increasing headache and a rapidly growing frontal swelling and a 16-year-old girl who had a rapidly growing mass in the left frontoparietal region which had recurred thrice but was otherwise asymptomatic. The lesions were osteolytic on neuroimaging and histopathological examination confirmed osteosarcoma. These two unusual cases are discussed along with a brief review of literature.
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CASE REPORTS Top

Bilateral massive pneumonia as an unusual manifestation of Puumala hantavirus infection p. 237
HT Gozdas, D Menemenlioğlu, Y Coşgun, G Çelebi
DOI:10.4103/jpgm.JPGM_283_17  PMID:30136660
Renal involvement due to European Puumala virus (PUUV) is frequent but pulmonary involvement is quite rare. We present here, a 24-year-old male with atypical clinical presentation of acute PUUV infection with gross pulmonary and minimal renal involvement. Severe pulmonary manifestations of PUUV infection, in this case, highlights that hantavirus infection should be considered in the differential diagnosis of atypical pneumonia.
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Moyamoya syndrome in hemoglobin E-beta thalassemia: A rare presentation and association p. 240
PN Doctor, A Choudhari, M Verma, RH Merchant
DOI:10.4103/jpgm.JPGM_468_17  PMID:29943740
Moyamoya disease is an idiopathic, nonatherosclerotic, noninflammatory, chronic progressive cerebrovascular disease characterized by bilateral stenosis or occlusion of the arteries around the circle of Willis, typically the supraclinoid internal carotid arteries, followed by extensive collateralization, which are prone to thrombosis, aneurysm, and hemorrhage. Secondary moyamoya phenomenon or moyamoya syndrome (MMS) occurs in a wide range of clinical scenarios including prothrombotic states such as sickle cell anemia, but the association with other hemoglobinopathies is less frequently observed. We describe a case of a 25-year-old female with hemoglobin E-beta thalassemia who had a rare presentation of MMS in the form of choreoathetoid movements in the left upper and lower extremities. We describe this association, primarily to emphasize thalassemia as an extremely rare but a potential etiology of MMS. Since MMS is a progressive disease, it is important to diagnose and initiate treatment to prevent worsening of the disease and recurrence of stroke.
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Proptosis and hemiplegia as an initial manifestation of multiple myeloma p. 243
N Tahiliani, P Kataria, A Patel, P Kendre
DOI:10.4103/jpgm.JPGM_623_17  PMID:30117481
Multiple myeloma (MM) is a monoclonal gammopathy, also known as the malignant proliferation of plasma cells, presenting with typical complications such as hypercalcemia, osteolytic bone lesions, anemia, renal insufficiency, and frequent infections. Central nervous system (CNS) involvement in MM in the form of parenchymal involvement is very uncommon and has been reported only in 1% of patients. CNS involvement as an initial presentation is very rare and has poor prognosis. Also specific treatment guidelines do not exist for the treatment of such patients. We present here a case of a 40-year-old female patient, with complaints of headache and left eye proptosis followed by left-sided hemiparesis, who after complete workup was diagnosed as a de novo case of stage III extramedullary MM with CNS involvement. Patient was treated with whole brain radiation followed by BCD regimen (injection of bortezomib, injection of cyclophosphamide, and tablet dexamethasone). After three cycles of chemotherapy, patient succumbed in view of consolidation and renal failure.
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Neonatal hyperlipidemia with pancreatitis: Novel gene mutation of lipoprotein lipase p. 247
MH Shah, R Roshan, R Desai, SS Kadam
DOI:10.4103/jpgm.JPGM_731_17  PMID:30147083
Lipoprotein lipase (LPL) deficiency is an autosomal recessive metabolic disorder with varying presentation in infancy and childhood, whereas clinical manifestations are rare in neonatal period. The estimated prevalence is one in a million births. A 23-day-old baby was admitted with complaints of fever, vomiting, and lethargy. Blood sample drawn appeared lipemic. Lipemia retinalis was noted on funduscopic examination. Biochemical analysis revealed abnormal lipid profile with severe hypertriglyceridemia (10,300 mg/dL) and elevated serum lipase level (517 IU/L) indicative of LPL deficiency with acute pancreatitis. LPL deficiency was suspected and was confirmed by molecular genetic testing, which revealed a novel mutation in LPL gene. Dietary management and gemfibrozil were started following which serum triglyceride level decreased and serum lipase level normalized. The patient is following up regularly for growth and development monitoring.
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Early presentation of ruptured post-traumatic hepatic artery pseudoaneurysm p. 250
MS Patel, V Shetty, A Shelake, AA Deshpande
DOI:10.4103/jpgm.JPGM_81_18  PMID:29943746
Visceral artery aneurysms (VAA) are an uncommon but well recognized condition. Hepatic artery aneurysms (HAA) represent 14-20% of all visceral artery aneurysms. Post traumatic hepatic artery pseudoaneurysm is an uncommon delayed complication of blunt liver trauma. Here we present a case of a 27 year old male with blunt abdominal trauma who developed a post traumatic pseudoaneurysm of the hepatic artery just proximal to its bifurcation into the left and right branches. The pseudoaneurysm ruptured within 12 hours of injury and he required double ligation of the hepatic artery as well as right and left hepatic arteries . However, the bleeding continued through the retrograde flow from the gastroduodenal artery and hence, ligation of gastrodudenal artery was also done. The decision of complete devasularisation of liver was taken as an emergency lifesaving procedure. The patient recovered and was discharged without sequel.
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Corkscrewing of retinal arterioles leading to diagnosis of coarctation of aorta p. 253
A Shaik, KV Praveen Kumar, P Chiranjeevi, S Abdul Khader
DOI:10.4103/jpgm.JPGM_137_18  PMID:30264739
Coarctation of aorta (CoA) usually leads to elevation of blood pressure above the site of obstruction and this elevated blood pressure probably gets transferred and is reflected in the retinal arterioles producing certain signs of hypertensive retinopathy. Fundus examination helps in differentiating hypertension due to CoA from other causes of juvenile hypertension, as corkscrewing of retinal arterioles is seen only in CoA but not in other conditions. A 16 year hypertensive male who was on antihypertensive treatment presented for routine checkup. On examination his visual acuity was 6/6 in both eyes. Funduscopy of both eyes revealed a normal optic disc with generalised narrowing of arterioles and broadened light reflex. The arterioles showed corkscrew tortuosity (U shaped arterioles). Based on the fundus findings, CoA was suspected and the patient was referred for cardiac evaluation. Echocardiogram revealed post ductal CoA. In juvenile hypertension, careful examination of the fundus can provide a clue to the systemic diagnosis and this case highlights the importance of ophthalmoscopic examination in diagnosing a potentially fatal systemic disease.
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Plasmacytoma of the mesentery p. 255
SM Thambi, SG Nair, R Benson
DOI:10.4103/jpgm.JPGM_296_18  PMID:30207325
Extramedullary plasmacytoma represents 3%–5% of all plasma cell neoplasms. Plasmacytomas of the mesentery are extremely rare. We report the case of a 56-year-old man who presented with an abdominal mass and was diagnosed to have plasmacytoma of the mesentery. A literature review was also conducted on publications pertaining to solitary mesenteric plasmacytomas. These patients present late by which time the abdominal mass has reached a significant size. Radiation as a modality for local control has a limited role in treating mesenteric plasmacytomas. Surgery is the preferred modality for local control. Patients must be kept on a regular follow-up as there is a risk of transformation to multiple myeloma.
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CLINICAL IMAGE Top

Adult teratoid Wilm's tumor - a diagnostic dilemma p. 258
S Rajaian, MK Ramani, NS Kekre
DOI:10.4103/jpgm.JPGM_204_18  PMID:30226479
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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