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  Citation statistics : Table of Contents
   2013| October-December  | Volume 59 | Issue 4  
    Online since December 17, 2013

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Association of B12 deficiency and clinical neuropathy with metformin use in type 2 diabetes patients
AK Singh, A Kumar, D Karmakar, RK Jha
October-December 2013, 59(4):253-257
DOI:10.4103/0022-3859.123143  PMID:24346380
Context: Long-term metformin use has been hypothesized to cause B12 deficiency and neuropathy in Type 2 diabetes patients. However, there is a paucity of Indian data regarding the same. Aim: To compare the prevalence of B12 deficiency and peripheral neuropathy in patients with Type 2 diabetes mellitus treated with or without metformin. Materials and Methods: We recruited patients with Type 2 diabetes and divided them into metformin exposed and nonmetformin exposed groups. We measured baseline demographic variables like age, sex, vegetarian status, and HbA1c levels in both groups. We compared vitamin B12 levels and severity of peripheral neuropathy (using Toronto Clinical Scoring System (TCSS)) in both groups. Definite B12 deficiency was defined as B12 <150 pg/ml and possible B12 deficiency as <220 pg/ml. The difference in vitamin B12 levels and TCSS was calculated in both groups using independent samples t-test. Spearman's rank correlation between cumulative metformin use and B12 level was calculated. Odds ratio of vitamin B12 deficiency in metformin exposed group was also estimated. Results: Mean serum B12 levels was significantly lower in metformin exposed group (n=84) compared with nonmetformin exposed group (n=52) (410±230.7 versus 549.2±244.7, P=0.0011). Mean neuropathy score was significantly higher in metformin exposed group. (5.72±2.04 versus 4.62±2.12, P=0.0064). Odds ratio for possible B12 deficiency was 4.45 (95% CI 1.24-15.97). There was significant negative correlation between cumulative metformin dose and vitamin B12 level (r=−0.68, P<0.0001). Conclusion: Metformin use is associated with vitamin B12 deficiency and clinical neuropathy in Type 2 diabetes patients.
  8 11,686 81
Oral paracetamol in treatment of closure of patent ductus arteriosus in preterm neonates
B Jasani, N Kabra, RN Nanavati
October-December 2013, 59(4):312-314
DOI:10.4103/0022-3859.123164  PMID:24346391
We herewith report a case series of six premature neonates with hemodynamically significant paten ductus successfully treated with oral paracetamol. This is a first case series describing the use of oral paracetamol treatment patent ductus in preterm neonates from India. Further prospective randomized-controlled trials are needed to evaluate the efficacy and safety of oral paracetamol in the treatment of patent ductus in preterm neonates.
  4 6,514 42
Do geriatrics require dose titration for antidiabetic agents?
R Shastry, P Adhikari, A Kamath, M Chowta, S Ullal, MRSM Pai
October-December 2013, 59(4):271-274
DOI:10.4103/0022-3859.123153  PMID:24346383
Objective: To evaluate the antidiabetic drug dosage differences between geriatric and nongeriatric diabetics with reference to duration of disease and creatinine clearance (Crcl). Materials and Methods: Prospective study conducted for 6 months in a tertiary care hospital. Patients with type 2 diabetes mellitus were grouped into geriatric (age ≥60 years) and nongeriatric (age <60 years). Patients' demographic data, duration of diabetes, medication, and serum creatinine were recorded. Crcl was calculated using Cockcroft-Gault formula. Doses of sulfonylureas (SU) were converted into equivalent doses, taking glibenclamide as standard. Univariate analysis was done for comparison of drug doses between groups. Result: A total of 320 geriatric and 157 nongeriatric diabetics completed the study. The duration of diabetes and Crcl adjusted dose reduction of glibenclamide (mean dose: Geriatrics 7.2±0.4 mg, nongeriatrics 9.6±0.7 mg; P=0.01) and gliclazide (mean dose: Geriatrics 85.5±11.5 mg, nongeriatrics 115.3±32.7 mg; P=0.42) was 25%, glimepiride (mean dose: Geriatrics 1.62±0.13 mg, nongeriatrics 2.1±0.18 mg; P=0.06) was 22%. Glipizide did not require dose reduction. Mean converted equivalent dose of sulfonylurea monotherapy was significantly lower in geriatrics than nongeriatrics (3.2±0.5 vs 6.4±1.02 mg; P=0.01) and showed 50% dose reduction. Mean dose of metformin was lower in geriatrics (901±32.2 mg vs 946.7±45.8 mg; P=0.45) and showed 5% reduction in dosage. There was no difference in the mean drug doses of thiazolidinediones and insulin between the groups. Conclusion: A substantial dose reduction of glibenclamide (25%), gliclazide (25%), glimepiride (22%), and metformin (5%) in geriatrics compared to nongeriatrics was observed. Smaller dosage formulations like 0.75 mg glibenclamide, 0.5 mg glimepiride, 20 mg gliclazide, and 250 mg metformin may be of value in geriatric diabetic practice.
  4 3,772 20
Does first line antiretroviral therapy increase the prevalence of cardiovascular risk factors in Indian patients?: A cross sectional study
RAB Carey, P Rupali, OC Abraham, D Kattula
October-December 2013, 59(4):258-262
DOI:10.4103/0022-3859.123145  PMID:24346381
Context: Antiretroviral therapy (ART) is associated with a myriad of metabolic complications which are potential cardiovascular risk factors. Early detection of these risk factors could help in alleviating morbidity and mortality in human immunodeficiency virus (HIV) infected patients on ART. Aims: To study the prevalence of cardiovascular risk factors in patients on a combination of nucleoside reverse transcriptase inhibitors (NRTIs) and non-NRTIs (NNRTIs) - the standard combination first line ART regimen used in tertiary referral center. Settings and Design: The prevalence of cardiovascular risk factors in HIV infected subjects with stage 1t disease on standard first line ART for at least 1 year, HIV infected subjects with stage 1 disease and not on ART and HIV negative subjects was assessed. The study was a cross-sectional study design. Materials and Methods: Basic demographic data was collected and patients were examined for anthropometric data and blood was collected for analysis of blood glucose, serum lipids, and fasting insulin levels. Statistical Analysis: Chi-square test was used to calculate significance. Statistical Package for Social Sciences (SPSS) software version 16.0 was used for data analysis. Results: The prevalence of hypercholesterolemia and hypertriglyceridemia was higher in the patients on ART when compared to patients not on ART (P<0.001). There was no difference in the prevalence of abnormal glycemic status, obesity, abdominal obesity, insulin resistance, and hyperinsulinemia between patients on ART and those not on ART. Conclusions: First line ART is associated with increased prevalence of dyslipidemia. Early detection and treatment of dyslipidemia should help in reducing the cardiovascular morbidity in patients on ART.
  3 4,376 42
Fatal acute pancreatitis in a patient with visceral leishmaniasis during miltefosine treatment
K Pandey, D Singh, CS Lal, VNR Das, P Das
October-December 2013, 59(4):306-308
DOI:10.4103/0022-3859.123161  PMID:24346389
Pancreatitis is a known side effect of the once commonly used drug, sodium stibogluconate, for treatment of visceral leishmaniasis (VL). In India, miltefosine has recently been introduced as the first-line drug. Its side effects include loose motions, vomiting, and teratogenicity. We report here a case of a 41-year-old parasitologically confirmed male case of VL, who developed acute pancreatitis during treatment with miltefosine. On the 13 th day of treatment, he presented with abdominal pain and vomiting. The biochemical, hematological, and radiological features were suggestive of acute pancreatitis. The patient was put on conservative treatment for pancreatitis at the specialized center but succumbed to renal failure and septicaemia.
  2 3,053 17
Ruptured ectopic pregnancy associated with tubal schistosomiasis
L Sahu, A Tempe, S Singh, N Khurana
October-December 2013, 59(4):315-317
DOI:10.4103/0022-3859.123166  PMID:24346392
Endemic in major parts of Africa and Middle East, Schistosoma haematobium is a common cause of recurrent urogenital infections and obstetric complications such as spontaneous abortions, ectopic pregnancies, and low birth weight babies. The involvement of fallopian tubes is not rare in endemic areas and may predispose to ectopic pregnancy and infertility. Indian subcontinent is a very lowrisk region for schistosoma infection. Tubal schistosomiasis is not exceptional in endemic zones, but is rarely found in India. The species most often isolated is S. haematobium. Contamination occurs via vascular anastomoses between the bladder and the genital organs. We report a case of tubal schistosomiasis presenting as ruptured ectopic pregnancy discovered on a surgical specimen after salpingectomy.
  1 3,351 14
Isolated familial pneumothorax in a Taiwanese family with Birt-Hogg-Dubé syndrome
CY Yang, HC Wang, JS Chen, CJ Yu
October-December 2013, 59(4):321-323
DOI:10.4103/0022-3859.123169  PMID:24346394
Primary spontaneous pneumothorax usually occurs as a sporadic event, but may be clustered in certain families with an underlying inherited disorder. Birt-Hogg-Dubι (BHD) syndrome is a rare autosomal dominant disease accounting for familial pneumothorax. BHD syndrome, caused by mutation of the folliculin gene, is characterized by skin fibrofolliculoma, pulmonary cysts, pneumothorax, and renal cancer. We describe a BHD-affected Taiwanese family with clinical and genetic study. A rare mutation of the folliculin gene was detected in the patient and members with pulmonary cysts or pneumothorax, but no skin or renal lesions were found. This mutation was reported in a Taiwanese family and might indicate a pneumothorax-predominant phenotype. Isolated pneumothorax is an uncommon initial presentation of BHD syndrome. Family history should be carefully reviewed when managing a patient with pneumothorax.
  1 3,934 13
Marine stingray injuries to the extremities: Series of three cases with emphasis on imaging
S Srinivasan, JIE Bosco, R Lohan
October-December 2013, 59(4):309-311
DOI:10.4103/0022-3859.123163  PMID:24346390
Stingray injuries are usually reported from coastal regions. The injury is caused by the tail spine of the stingray, which can penetrate deep into the soft tissues, and the venom in the tail can cause extensive tissue damage. Imaging plays a very important role in patients with stingray injuries, especially to detect the presence of retained foreign bodies and its complications. We present three cases of stingray injuries to the extremities, with a special emphasis on radiographic findings. Embedded foreign bodies that were radiographically visualized were removed in two of the patients (one patient was discharged at request and was lost to follow-up). We also discuss the types of injuries, clinical presentation, importance of imaging and management considerations in stingray injuries.
  1 5,760 17
"DREEM" comes true - Students' perceptions of educational environment in an Indian medical school
HS Kiran, Basavana H Gowdappa
October-December 2013, 59(4):300-305
DOI:10.4103/0022-3859.123159  PMID:24346388
Background: The accomplishment and contentment of students depends upon their educational environment. Very few studies in India have looked at the impact of educational environment on students, there are few such studies in our country despite having a large number of medical schools. Objective: This study was performed to assess the undergraduate students' perceptions of medical education in general and educational environment in our medical school in particular. Materials and Methods: The Dundee Ready Education Environment Measure (DREEM), a validated inventory was distributed among undergraduate students in final Bachelor of Medicine and Bachelor of Surgery (MBBS) (2010-2011) and students who were undergoing internship (2010-2011) and various scores were calculated and the means were compared using Mann-Whitney test. Results: The mean total DREEM score was found to be 121.5/200 for final MBBS students (n = 115) and 118.4/200 (n = 109) for the internship batch students. There was no statistically significant difference between the scores of the two batches. The overall DREEM score for our Medical School during the academic year 2010-2011 (for the final MBBS and internship batch) was 120/200 (n = 224), which showed that the students' perceptions were more positive. Conclusion: The study showed that the students' perception of the educational environment was positive. There was no statistically significant difference between the scores of the two batches (final MBBS and internship). This study helped us to introspect and identify remediable areas in the educational environment of our medical school and hence we could suggest some measures to modify them.
  1 5,996 24
Cardiotoxicity in OPC poisoning: Time to think differential diagnosis
S Senthilkumaran, N Balamurugan, S Jayaraman, P Thirumalaikolundusubramaniam
October-December 2013, 59(4):337-337
DOI:10.4103/0022-3859.123183  PMID:24346402
  1 3,188 11
Thyroid storm: An early clinical diagnosis and multidrug approach to therapy
K Chatterjee, C Sen, GC Ghosh
October-December 2013, 59(4):339-340
DOI:10.4103/0022-3859.123187  PMID:24346404
  1 4,190 23
Challenges in the diagnosis and treatment of a case of acute intermittent porphyria in India
RS Jain, K Nagpal, A Vyas
October-December 2013, 59(4):338-339
DOI:10.4103/0022-3859.123185  PMID:24346403
  1 2,805 17
Eschar in scrub typhus: A valuable clue to the diagnosis
SK Raina
October-December 2013, 59(4):342-343
DOI:10.4103/0022-3859.123191  PMID:24346407
  1 2,317 12
Methodological aspects in the use of scoring and multivariable logistic regression as predictive model
R Kumar
October-December 2013, 59(4):343-344
DOI:10.4103/0022-3859.123193  PMID:24346408
  1 2,544 13
Risk factors for delirium and inpatient mortality with delirium
S Grover, D Ghormode, A Ghosh, A Avasthi, S Chakrabarti, SK Mattoo, S Malhotra
October-December 2013, 59(4):263-270
DOI:10.4103/0022-3859.123147  PMID:24346382
Background: There is limited on the risk factors and mortality in patients with delirium from India. Aim: This study aimed to evaluate the risk factors associated with delirium and inpatient mortality rates of patients diagnosed with delirium by psychiatry consultation liaison services. Materials and Methods: Three hundred and thirty-one patients diagnosed as delirium by the psychiatry consultation liaison services were examined on standardized instruments: Delirium Rating Scale Revised 98 version (DRS-R-98), amended Delirium Motor Symptom Scale (DMSS), Delirium Etiology Checklist (DEC), Charlson Comorbidity index, and a checklist for assessment of risk factors. Results: More than three medications as a risk factor and metabolic/endocrine disturbances as cause were observed to play largest role in development of delirium. The inpatient mortality rate was 12.4%. Compared to the survivor group, those who died were more likely to be young (<65 years), had significantly high rate of alcohol dependence and were more frequently restrained prior to development of delirium; of these only age <65 years and use of restraints emerged as the significant predictors of mortality in regression analysis. Conclusion: Age and use of restraints appears to be an important predictor mortality in patients with delirium.
  1 8,253 25
Preinduction incentive spirometry versus deep breathing to improve apnea tolerance during induction of anesthesia in patients of abdominal sepsis: A randomized trial
M Tripathi, A Subedi, A Raimajhi, K Pokharel, M Pandey
October-December 2013, 59(4):275-280
DOI:10.4103/0022-3859.123154  PMID:24346384
Background: Abdominal sepsis is associated with varied degree of hypoxemia and atelactasis in the lung and can enhance the onset of desaturation of arterial blood during apnea. Aims : This study looked at methods to improve safety margin of apnea during induction of anesthesia in these high-risk patients. Settings and Design: It was a randomized, single blind study on adult patients presenting for emergency laparotomy due to peritonitis in a university teaching hospital setting. Materials and Methods: In group 1 (IS) (n = 32), three sessions of incentive spirometry (IS) were performed within one hour before induction of anesthesia. In group 2 (DB) (n = 34), patients were subjected to deep breathing sessions in a similar manner. All patients received preoxygenation (100%) by mask for 3 min, followed by rapid-sequence induction of anesthesia using fentanyl, thiopental, and suxamethonium and endotracheal intubation. Patients were subjected to a period of apnea by keeping the end of the endotracheal tube open to air till they developed 95% hemoglobin saturation (SpO 2 ) by pulse oxymetry. Positive pressure ventilation was resumed at the end. We observed for hemodynamic changes, apnea time, and SpO 2 (100%) recovery time on resuming ventilation. Arterial blood gas samples were taken before intervention, after IS or DB, after preoxygenation, and at the end of apnea. Statistical analysis used: One-way analysis of variance (ANOVA), X 2 test, Kaplan-Meier graph, and log-rank tests were applied to compare the two study groups. Results: Oxygenation level in group 1 (265 ± 76.7 mmHg) patients was significantly (P < 0.001) higher than in group 2 (221 ± 61.8 mmHg)at the end of preoxygenation. The apnea time (median: lower bound - upper bound Confidence Interval apnea time) (272:240-279 s) in group 1 (IS) patients was significantly higher P < 0.05) than in group 2 (180:163-209 s) patients. Saturation recovery time (35:34-46 s) in group 1 (IS) patients was also quicker than in group 2 patients (48:44-58 s). Conclusions: IS in the preoperative period is superior to deep breathing sessions for improving apnea tolerance during induction of anesthesia in abdominal sepsis patients.
  1 5,062 25
Genetic instability in urinary bladder cancer: An evolving hallmark
N Wadhwa, BB Mathew, SK Jatawa, A Tiwari
October-December 2013, 59(4):284-288
DOI:10.4103/0022-3859.123156  PMID:24346386
Bladder cancer is a major health-care concern. A successful treatment of bladder cancer depends on its early diagnosis at the initial stage. Genetic instability is an essential early step toward the development of bladder cancer. This instability is found more often at the chromosomal level than at the nucleotide level. Microsatellite and chromosomal instability markers can be used as a prognostic marker for screening bladder cancer. Bladder cancer can be distinguished in two different categories according to genetic instability: Cancers with chromosomal level instability and cancers with nucleotide level instability. Deoxyribonucleic acid (DNA) mismatch repair (MMR) system and its correlation with other biologic pathway, both are essential to understand the basic mechanisms of cancer development. Microsatellite instability occurs due to defects in DNA MMR genes, including human mutL homolog 1 and human mutL homolog 2. Chromosomal alterations including deletions on chromosome 3, 8, 9, 11, 13, 17 have been detected in bladder cancer. In the current review, the most recent literature of genetic instability in urinary bladder cancer has been summarized.
  1 4,413 21
Recurrent hypoglycemia…: A less well-known presentation of Sheehan's syndrome
RV Dosi, NR Bhatt, RD Patell, RR Raj
October-December 2013, 59(4):318-320
DOI:10.4103/0022-3859.123167  PMID:24346393
Sheehan's syndrome is a rare cause of recurrent hypoglycemia. We present a case of a middle aged woman who presented with recurrent life threatening hypoglycemia. Based on a past history of severe post partum hemmorhage and a clinical picture of myxedema and secondary amennorhea, laboratory and neuroimaging was undertaken to confirm a diagnosis of Sheehan's syndrome. The patient responded to treatment with thyroxine and steroids in replacement doses. The case report emphasises the importance of early suspicion and management of this easily missed and treatable condition.
  - 4,735 17
Erdheim-Chester disease: A clinical and radiological masquerade
V Wadhwa, RW Marcus, JA Carrino, A Chhabra
October-December 2013, 59(4):326-327
DOI:10.4103/0022-3859.123173  PMID:24346395
  - 3,086 15
Primary spontaneous pneumothorax and the Birt-Hogg-Dubé syndrome
PA Koul
October-December 2013, 59(4):324-325
  - 2,800 19
Paracetamol to close the patent ductus arteriosus: From serendipity toward evidence based medicine
K Allegaert
October-December 2013, 59(4):251-252
DOI:10.4103/0022-3859.123141  PMID:24346379
  - 6,327 78
Urticaria and hydropneumothorax as an exceptional cause of ruptured hydatid cyst of lung
AE Atay, M Oruc, T Sayin, MN Gullu
October-December 2013, 59(4):328-330
DOI:10.4103/0022-3859.123174  PMID:24346396
  - 3,440 22
A rare cause of intraoperative nasogastric tube obstruction
P Kumar, S Yadav, S Saini, V Arora
October-December 2013, 59(4):331-332
DOI:10.4103/0022-3859.123176  PMID:24346397
  - 3,598 16
Soy milk toxicity: Additional concern
V Wiwanitkit
October-December 2013, 59(4):333-333
DOI:10.4103/0022-3859.123177  PMID:24346398
  - 2,772 14
Hyperkalemia due to fertilizer (N:P:K) poisoning
MB Korade, SA Sangle, NS Deshpande, SV Dhadke
October-December 2013, 59(4):333-334
DOI:10.4103/0022-3859.123179  PMID:24346399
  - 3,925 14
An uncommon cause of chest pain with electrocardiographic changes
MP Ranjith, KF Rajesh, K Muneer, CG Sajeev, MN Krishnan
October-December 2013, 59(4):334-335
DOI:10.4103/0022-3859.123181  PMID:24346400
  - 1,668 13
Pachydermodactyly does not need rheumatologic work-up
NK Sinha, SP Ling, SK Nema, DR Pai
October-December 2013, 59(4):335-336
DOI:10.4103/0022-3859.123182  PMID:24346401
  - 3,372 14
Author's reply
P Joshi
October-December 2013, 59(4):337-338
  - 1,817 11
Authors' reply
S Kumar, N Moorthy, S Yadav, A Kapoor, DC Dale
October-December 2013, 59(4):340-341
  - 1,752 12
Clues to non-organic sensory symptoms in neurology
C Sen, K Chatterjee
October-December 2013, 59(4):341-342
DOI:10.4103/0022-3859.123189  PMID:24346405
  - 3,603 12
Respiratory Hoover's sign
E Garcia-Pachon, I Padilla-Navas
October-December 2013, 59(4):342-342
DOI:10.4103/0022-3859.123190  PMID:24346406
  - 2,786 11
Authors' reply
PV Pradeep, K Ramalingam, B Jayashree
October-December 2013, 59(4):344-345
  - 1,898 12
Methemoglobinemia following ingestion of a weedicide
J Wadhwa, RS Kumar, NS Ramasubramanian, A Hamide
October-December 2013, 59(4):345-346
DOI:10.4103/0022-3859.123195  PMID:24346409
  - 3,152 12
Authors' reply
KPP Abhilash, AJJ Jonathan, SD Nathaniel, GM Varghese
October-December 2013, 59(4):343-343
  - 1,731 11
Authors' reply
RV Dosi, AP Ambaliya, RD Patell, NN Sonune
October-December 2013, 59(4):339-339
  - 1,562 11
Utilization of operating room time in a cancer hospital
P Ranganathan, P Khanapurkar, JV Divatia
October-December 2013, 59(4):281-283
DOI:10.4103/0022-3859.123155  PMID:24346385
Background: Appropriate usage of operating room (OR) time can improve efficiency of utilization of resources and help to decrease surgical waiting lists. Aims: This study was conducted to evaluate the pattern of usage of OR time in a tertiary referral cancer hospital. Setting and Design: This was a prospective audit carried out over 2 months in 11 major ORs in a cancer hospital. Materials and Methods: OR anesthesiologists filled a standard form for all patients undergoing elective surgery and documented the following times: entry into OR, start of anesthesia, handover to surgeon, incision, start of reversal, end of anesthesia, and shifting out of patient. Statistical Analysis: Median time utilized for various OR processes was calculated. Results: An average of two surgeries were performed per OR session (828 surgeries in 407 OR sessions). Anesthesia and surgery-related processes contributed to 17% and 79%, respectively, of total OR time, with turnover time between cases accounting for the remaining 4%. Fifteen percent (60 out of 407) OR sessions started more than 10 min later than the planned start time, and 17% (70 of 407) of OR sessions ended more than 2 h after the scheduled finish time. An anesthesia procedure room was utilized in only 15% of cases where it could potentially have been used. Conclusion: This audit identified patterns of OR usage in a cancer hospital and helped to detect areas of inefficient utilization. Anesthesia-related processes contributed to 17% of the total OR time.
  - 3,641 19
Renal angioplasty for atherosclerotic renal artery stenosis: Cardiologist's perspective
AS Gulati, AN Patnaik, R Barik, R Kumari, S Srinivas
October-December 2013, 59(4):289-299
DOI:10.4103/0022-3859.123157  PMID:24346387
Atherosclerotic renal artery stenosis (ARAS) is frequently associated with concomitant coronary and peripheral arterial disease with a significant impact on cardiovascular morbidity and mortality. Renal angioplasty of ARAS is more challenging because of increased incidence of technical failures, complications, and restenosis; while there is barely perceptible control of hypertension and only marginal improvement in renal function. This is because most of the patient population in recent randomized trials had unmanifested or clinically silent renovascular disease. Manifestations of RAS should be looked for and incorporated in the management plan particularly before deciding for revascularization. In the absence of clinical manifestation like renovascular hypertension, ischemic nephropathy, left ventricular failure, or unstable coronary syndromes; mere presence of RAS is analogous to presence of concomitant peripheral arterial disease which increases risk of adverse coronary events. Dormant-RAS in the absence of any manifestations can be managed with masterly inactivity. Chronological sequence of events and clinical condition of the patient help in decision making by identifying progressive renovascular disease. Selecting patients for renal artery stenting who actually will benefit from revascularization shall also decrease the unnecessary complications inherent with any interventional procedure. The present review is an attempt to analyze the current view on the diagnostic and management issues more specifically about the need and rationale behind angioplasty.
  - 4,580 29
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