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   2007| April-June  | Volume 53 | Issue 2  
 
 
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REVIEW ARTICLE
Adult mesenchymal stem cells: Differentiation potential and therapeutic applications
L Jackson, DR Jones, P Scotting, V Sottile
April-June 2007, 53(2):121-127
DOI:10.4103/0022-3859.32215  PMID:17495381
Adult mesenchymal stem cells (MSCs) are a population of multipotent cells found primarily in the bone marrow. They have long been known to be capable of osteogenic, adipogenic and chondrogenic differentiation and are currently the subject of a number of trials to assess their potential use in the clinic. Recently, the plasticity of these cells has come under close scrutiny as it has been suggested that they may have a differentiation potential beyond the mesenchymal lineage. Myogenic and in particular cardiomyogenic potential has been shown in vitro . MSCs have also been shown to have the ability to form neural cells both in vitro and in vivo , although the molecular mechanisms underlying these apparent transdifferentiation events are yet to be elucidated. We describe here the cellular characteristics and differentiation potential of MSCs, which represent a promising stem cell population for future applications in regenerative medicine.
  35,663 3,254 115
Polycystic ovary syndrome: A component of metabolic syndrome?
JP Vignesh, V Mohan
April-June 2007, 53(2):128-134
DOI:10.4103/0022-3859.32217  PMID:17495382
In 1935, Stein and Leventhal first described the polycystic ovary (PCO) as a frequent cause of irregular ovulation in women seeking treatment for subfertility. Although the initial management was surgical with wedge resection of ovary, the availability of radioimmunoassay and increased clinical use of ultrasound made it clear that many women had the ultrasound characteristics of PCO with or without the biochemical or clinical features of PCOS and therefore that PCO were not associated with a single syndrome. The association between increased insulin resistance and PCOS is a consistent finding in all ethnic groups. Obesity is a common factor in the majority of women with PCOS. It is postulated that a woman may be genetically predisposed to developing PCOS but it is only the interaction of environmental factors (obesity) with the genetic factors that results in the characteristic metabolic and menstrual disturbances. Weight loss, altered diet and exercise have been shown to be effective in the management of PCOS. Importance of early recognition, proper intervention, long-term monitoring and health implications needs more concern.
  23,281 2,242 31
IMAGES IN RADIOLOGY
Post-thoracentesis trapped lung
H Khan, ER Fernandez-Perez, SM Caples
April-June 2007, 53(2):119-120
DOI:10.4103/0022-3859.32214  PMID:17495380
  15,586 624 -
CASE REPORTS
Pott's puffy tumor following an insect bite
V Raja, C Low, A Sastry, B Moriarty
April-June 2007, 53(2):114-116
DOI:10.4103/0022-3859.32212  PMID:17495378
Pott's puffy tumor, a feature of osteomyelitis of the frontal bone, is a rare entity, especially in adults. Sir Percival Pott originally described this condition as a complication of trauma to the frontal bone. This is also a recognized complication of fronto-ethmoidal sinusitis. We present a rare case of Pott's puffy tumor caused by an insect bite presenting initially as a preseptal cellulitis and explore its pathogenesis and management.
  14,909 637 26
ORIGINAL ARTICLE
Translation and validation of brief patient health questionnaire against DSM IV as a tool to diagnose major depressive disorder in Indian patients
PH Kochhar, SS Rajadhyaksha, VR Suvarna
April-June 2007, 53(2):102-107
DOI:10.4103/0022-3859.32209  PMID:17495375
Context: Depression is frequently encountered in the primary care setting but is often unrecognized and hence untreated. There is a need for a uniform user-friendly screening instrument for depression for primary healthcare personnel in India. Aims: Translation and validation of the brief patient health questionnaire (BPHQ) as a screening tool for depression in major Indian languages. Materials and Methods: This was a prospective study conducted at 18 sites, in psychiatric and general clinics. The English version of the BPHQ was translated into 11 Indian languages. The translations were reviewed by experts and volunteers and proofread for the final translated BPHQ. The validation exercise included more than 3000 subjects. A psychiatrist and a psychiatry social worker / coordinator conducted the study under the supervision of the principal investigator. For each language, the presence or absence of major depressive disorder (MDD) as diagnosed with the help of a patient-completed BPHQ and the psychiatrist DSM-IV diagnosis was matched. The kappa coefficient was used as a measure of inter-observer agreement between the two diagnostic methods. Results: Seven languages failed the primary validation exercise. These translations were reviewed and the updated versions, after proofreading were re-run for validation. The self-administered BPHQ was successfully translated and validated for diagnosis of MDD against DSM-IV diagnosis made by a psychiatrist, in English, Hindi, Marathi, Oriya, Malayalam, Assamese, Gujarati, Kannada, Telugu, Bengali and Tamil. Conclusions: BPHQ is a simple, quick and reliable instrument, which facilitates rapid and accurate diagnosis of depression in the primary care setting in our country.
  14,026 740 23
EXPERTíS COMMENTS
Stress in the workplace amongst medical professionals
J Stebbing, T Powles
April-June 2007, 53(2):83-84
DOI:10.4103/0022-3859.32202  PMID:17495368
  12,835 1,763 1
ORIGINAL ARTICLE
Bullying among trainee doctors in Southern India: A questionnaire study
KL Bairy, P Thirumalaikolundusubramanian, G Sivagnanam, S Saraswathi, A Sachidananda, A Shalini
April-June 2007, 53(2):87-90
DOI:10.4103/0022-3859.32206  PMID:17495372
Background: Workplace bullying is an important and serious issue in a healthcare setting because of its potential impact on the welfare of care-providers as well as the consumers. Aims: To gauge the extent of bullying among the medical community in India; as a subsidiary objective, to assess the personality trait of the bullying victims. Settings and Design: A cross-sectional, anonymous, self-reported questionnaire survey was undertaken among a convenient sample of all the trainee doctors at a Government Medical College in Tamil Nadu, India. Materials and Methods: A questionnaire, in English with standard written explanation of bullying was used. Basic information like age, sex, job grade and the specialty in case of Postgraduates (PGs) were also collected. Statistical Analysis: The results were subjected to descriptive statistical analysis and Chi-square test for comparison of frequencies. Results: A total of 174 doctors (115 PGs and 59 junior doctors), took part in the study with a cent percent response. Nearly half of the surveyed population reported being subjected to bullying. Nearly 54 (53%) of the men and 35 (48%) of women were subjected to bullying. Significant proportions ( P <0.0001) of medical personnel and paramedical staff bullied the PGs and junior doctors, respectively. More than 85 (90%) of bullying incidents went unreported. A significant ( P <0.0001) percentage of PGs and junior doctors revealed a personality trait towards bully. Conclusions: Workplace bullying is common among trainee doctors and usually goes unreported.
  12,773 817 12
CASE REPORTS
Severe nitrofurantoin lung disease resolving without the use of steroids
S Bhullar, SM Lele, S Kraman
April-June 2007, 53(2):111-113
DOI:10.4103/0022-3859.32211  PMID:17495377
We report a case of an elderly woman who developed a severe, chronic pulmonary reaction to nitrofurantoin therapy that she had taken continuously for three years to prevent urinary tract infections. The patient was taking no other drug known to cause lung disease but the diagnosis was delayed by failure to recognize the association between nitrofurantoin and adverse drug reactions affecting the lung. When originally seen, the patient was unable to care for herself due to dyspnea. Bronchoscopy with biopsy ruled out other causes of her pulmonary disease. Immediate withdrawal of nitrofurantoin led to substantial, sustained improvement and disappearance of symptoms over several months without administration of corticosteroids. Nitrofurantoin toxicity should always be considered in any person taking that drug who develops bilateral infiltrates.
  12,016 751 12
ORIGINAL ARTICLE
Study of association between use of complementary and alternative medicine and non-compliance with modern medicine in patients presenting to the emergency department
VM Jose, A Bhalla, N Sharma, D Hota, S Sivaprasad, P Pandhi
April-June 2007, 53(2):96-101
DOI:10.4103/0022-3859.32208  PMID:17495374
Context: Complementary and alternative medicines (CAMs) are extensively used by the public. Noncompliance is an important cause of therapy failure. Aim: This study was done to determine prevalence of emergency admission due to noncompliance with modern medicine following switching over to CAM and to identify any significant association for CAM use among noncompliers. Setting and Design: This cross-sectional study was conducted in the emergency unit of a tertiary healthcare institute. Materials and Methods: Demographic factors and system affected were compared between compliers and noncompliers. Prevalence, reasons and nature of noncompliance were determined. Age, gender, outcome, relation strength and potential preventability of noncompliance, precipitating and previous disease and noncompliant drugs were compared for significant association between CAM using and other noncompliers. Statistical Analysis: Student's 't' test, Chi square test and odds ratio were used. Results: Of the 506 patients interviewed 168 (33%) were noncompliant. In 160 (95%) patients noncompliance was due to under-dosing. Lack of knowledge and CAM use constituted 144 (86%) noncompliance-related admissions. Thirty-three (7%) admissions were strongly related to noncompliance and CAM use. Age, gender, outcome, drug use and diseases except chronic obstructive pulmonary disease (COPD) and asthma showed no association while relation strength and potential preventability of emergency admission was less with CAM-using noncompliers. Noncompliance was observed for hypertension, diabetes, COPD and asthma, seizure disorder, tuberculosis and hemophilia besides hepatic and renal failure. The CAM noncompliers used CAM more for modern medicine incurable or unaffordable than curable diseases. Conclusion: Advice for regular treatment and frequent monitoring can decrease CAM use-related noncompliance admissions.
  11,186 962 19
VIEW POINT
A new approach to the study of diet and risk of type 2 diabetes
Fu Jinlin, W Binyou, C Terry
April-June 2007, 53(2):139-143
DOI:10.4103/0022-3859.32219  PMID:17495384
Type 2 diabetes mellitus (T2DM) is a polygenetic disorder resulting from interaction of both hereditary and environmental factors. Diet is an important environmental factor in the development of T2DM. However, there existed inconsistent conclusions among previous studies. The validity of a study of associations between diet and diabetes depends on the method used in the study. Associations between individual nutrients/foods and T2DM have been explored even till today, but the controversy is still unsolved due to the limitations of the study methods such as interactions among nutrients. Emergence of analyses on dietary patterns and diabetes shows its popularity in the studies of associations of dietary patterns with T2DM, but only a few articles have been published. In this review, dietary-pattern-related studies since 1990 were identified by searching through Medline and PubMed in order to analyze methods used in the studies of diabetes. A dietary pattern approach was introduced as an alternative complementary way used to test associations of diet with risk of T2DM and the advantages of the studies of T2DM using this new approach are also explored. It is concluded that the dietary pattern approach shows its advantages over that using individual nutrients or foods in studies on associations between the diet and diabetes, but its reproducibility and validity for such effects, however, need to be further verified in different ethnic population-based on diverse eating habits. The long-term effects of a beneficial dietary pattern on T2DM also require clarifying in future studies.
  10,178 753 18
DRUG REVIEW
Exemestane: A milestone against breast cancer
YC Shetty, PN Chakkarwar, SS Acharya, VD Rajadhyaksha
April-June 2007, 53(2):135-138
DOI:10.4103/0022-3859.32218  PMID:17495383
Rapid advances in the treatment of breast cancer, especially in the form of hormone therapy have truly increased the hope of longer and better disease-free survival for these patients. Exemestane, a third generation aromatase inhibitor has been extensively evaluated in metastatic as well as adjuvant therapy of breast cancer. It has also been evaluated for its safety profile, especially on bone and lipids. Exemestane provides hope to the patients with breast cancer both in early and metastatic disease. This review analyzes all the aspects of exemestane therapy.
  8,027 707 2
EXPERTíS COMMENTS
Does immunoglobulin A nephropathy affect long-term graft outcome after kidney transplantation?
D Cattaneo
April-June 2007, 53(2):84-84
DOI:10.4103/0022-3859.32203  PMID:17495369
  6,752 1,482 -
CASE REPORTS
Bilateral pleural effusions following central venous cannulation
PL Tan, CLH Chan
April-June 2007, 53(2):117-118
DOI:10.4103/0022-3859.32213  PMID:17495379
We describe a patient who developed bilateral pleural effusions as a delayed complication following central venous catheter insertion. Respiratory distress should not only raise the clinical suspicion of a pneumothorax but also of erosion and perforation of the central vein. The mechanism, diagnosis, management and prevention of this complication are discussed.
  6,703 586 3
ORIGINAL ARTICLE
Outcomes of renal transplantation in patients with immunoglobulin A nephropathy in India
B Chacko, JT George, N Neelakantan, A Korula, JK Chakko
April-June 2007, 53(2):92-95
DOI:10.4103/0022-3859.32207  PMID:17495373
Background: There is a paucity of data on the course of renal transplant in patients with immunoglobulin A (IgA) nephropathy (IgAN) from India. While the natural history of IgAN in the Indian context is rapidly progressive, the post-transplant course remains speculative. Aim: To study the graft survival in renal transplant recipients whose native kidney disease was IgAN and the incidence and correlates of recurrent disease. Settings and Designs: Retrospective case control study from a Nephrology unit of a large tertiary care center. Materials and Methods: The outcomes of 56 transplant patients (58 grafts) with biopsy-proven IgAN and of 116 patients without IgAN or diabetic nephropathy, transplanted during the same period were analyzed. Correlates of biopsy-confirmed recurrent disease were determined. Statistical Analysis: Means were analyzed by Student's t test and Mann-Whitney test; proportions were determined by Chi-square analysis and graft survival curves were generated using the Kaplan-Meier. Results: Five-year graft survival for IgA patients was not significantly different from that in the reference group (90% and 79%, P = 0.6). During a mean follow-up of 42 months (range, 1-144), 28 event graft biopsies were required in 20 grafts of IgAN. Histological recurrence was diagnosed in five of the 20 available biopsies (25%) after a mean duration of 28 months. Recurrence did not correlate with donor status, HLA B35 and A2, recipient age, gender or immunosuppression. Conclusions: Renal transplantation is an appropriate treatment modality for IgA nephropathy patients with end-stage renal disease in India, despite the potential for recurrent disease. The posttransplant course is an indolent one when compared to the malignant pretransplant phase.
  6,386 749 7
CASE REPORTS
Melioidosis presenting as genitourinary infection in two men with diabetes
BS Viswaroop, V Balaji, E Mathai, NS Kekre
April-June 2007, 53(2):108-110
DOI:10.4103/0022-3859.32210  PMID:17495376
Melioidosis is an infectious disease caused by Burkholderia pseudomallei . It occurs predominantly in tropical regions. The manifestations are protean which include pneumonia, visceral abscesses, septic arthritis, osteomyelitis, acute suppurative and chronic granulomatous lesions with involvement of almost all organ systems. Fulminant sepsis is much more common and is associated with high mortality. Hence prompt recognition and early treatment is warranted. We report unusual presentations of urinary tract melioidosis in two diabetic men.
  6,159 702 11
EXPERTíS COMMENTS
Noncompliance with conventional medicine and use of complementary/alternative medicine
E Ernst
April-June 2007, 53(2):85-85
DOI:10.4103/0022-3859.32204  PMID:17495371
  5,708 794 7
The validation of an instrument to diagnose depression: Beyond the yes/no question
R Fraguas, SG Henriques
April-June 2007, 53(2):85-86
DOI:10.4103/0022-3859.32205  PMID:17495370
  5,334 748 1
LETTERS
Successful treatment of palmar-plantar erythrodysesthesia possibly due to temozolomide with dexamethasone
O Kanat, BE Baskan, E Kurt, T Evrensel
April-June 2007, 53(2):146-146
DOI:10.4103/0022-3859.32222  PMID:17495388
  5,732 254 10
Ofloxacin-induced reversible arthropathy in a child
SK Dolui, M Das, A Hazra
April-June 2007, 53(2):144-145
DOI:10.4103/0022-3859.32220  PMID:17495385
  5,357 297 4
Prenatal diagnosis of a case of pentalogy of Cantrell with spina bifida
C Dane, B Dane, M Yayla, A Cetin
April-June 2007, 53(2):146-148
DOI:10.4103/0022-3859.32223  PMID:17495387
  5,217 259 13
Blocked or delayed atrioventricular nodal conduction due to concealed conduction due to interpolated ventricular ectopics
AR Udyavar, UM Pandurangi
April-June 2007, 53(2):148-149
DOI:10.4103/0022-3859.32224  PMID:17495389
  4,060 182 -
Mania associated with interferon
A Banerjee, G Jain, S Grover, J Singh
April-June 2007, 53(2):150-150
DOI:10.4103/0022-3859.32226  PMID:17495391
  3,671 240 4
An unusual cause of colitis
JN Panicker, J Philip
April-June 2007, 53(2):145-145
DOI:10.4103/0022-3859.32221  PMID:17495386
  3,687 206 2
STUDENTS CORNER
Crossing international frontiers: A medical student's perspective on the London international youth science forum 2006
HS Kulkarni
April-June 2007, 53(2):127-127
  3,398 293 -
LETTERS
Usefulness of prenatal detection of RhD typing by molecular analysis in Indians
SS Kulkarni, AC Gorakshakar, RB Colah, SC Gupte, D Mohanty
April-June 2007, 53(2):149-149
DOI:10.4103/0022-3859.32225  PMID:17495390
  2,956 183 1
Correspondence-middle-aged man with acute onset quadriparesis
N Kumar, N Choudhary, B Kaul, SR Ahlawat
April-June 2007, 53(2):150-151
DOI:10.4103/0022-3859.32227  
  2,830 140 -
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