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   2014| July-September  | Volume 60 | Issue 3  
    Online since August 14, 2014

 
 
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CLINICAL SIGNS
Hoover's sign: Clinical relevance in Neurology
MM Mehndiratta, M Kumar, R Nayak, H Garg, S Pandey
July-September 2014, 60(3):297-299
DOI:10.4103/0022-3859.138769  PMID:25121372
Hoover's sign was described by Dr. Charles Franklin Hoover more than 100 years back to differentiate between the organic and functional weakness of pyramidal origin. This test is usually performed in the lower limbs and is valuable when on bedside one is not sure about the nature of hemiparesis. A subject with hemiparesis of organic cause while asked to flex the hip of normal leg against resistance will not exert pressure on the hand of examiner placed under the heel on the affected side while in hysterical weakness heightened pressure will be felt on the examiner's hand. The presumed genesis of this sign could be the crossed extensor reflex or the principle of synergistic contraction. It is a useful clinical test in differentiating functional and organic paresis with moderate sensitivity (63%) and high specificity (100%), but there are some limitations which should be kept in mind while evaluating a patient.
  13,767 30 2
ORIGINAL ARTICLES
A prospective study of prevalence and association of peripheral neuropathy in Indian patients with newly diagnosed type 2 diabetes mellitus
HK Gill, SB Yadav, V Ramesh, E Bhatia
July-September 2014, 60(3):270-275
DOI:10.4103/0022-3859.138750  PMID:25121366
Background: Diabetic peripheral neuropathy (DPN) predisposes to foot ulceration and gangrene. It has been reported that DPN is lower in Indians relative to Caucasians. Studies among recent onset patients with type 2 diabetes mellitus (T2DM) are very few. We studied the prevalence and risk factors of DPN in patients with newly diagnosed T2DM. Materials and Methods: We prospectively studied 195 consecutive patients over age 30 with a duration of diabetes ≤6 months. All underwent a clinical and biochemical evaluation and were screened for DPN using Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS) as well as the vibration perception threshold using a biothesiometer. We compared the prevalence of peripheral neuropathy (PN) in 75 age- and sex-matched healthy controls. Results: The cases had a mean age of 47.6 ± 10.2 years (59% males) and duration of symptoms of 5.9 ± 8.2 months prior to presentation. The overall prevalence of DPN was 29.2% [95% CI 22.8-35.7]. PN among matched control was 10.7% (95% CI 3.5-17.8). The prevalence of DPN showed an increasing trend with age (trend chi-square 11.8, P = 0.001). Abnormal vibration perception threshold was present in 43.3% (95% CI 36.3-50.3) of cases and had a significant correlation with NDS (P = 0.000). Abnormal monofilament testing was present in 6.1% of cases (95% CI 2.7- 9.5). A logistic regression analysis showed that DPN was independently associated with age (P = 0.002) and duration of diabetes prior to presentation (P = 0.02) but not with body mass index, plasma glucose, or HbA1c. Conclusions: Our study showed high prevalence of PN in recently diagnosed patients with T2DM, which was independently associated with age and duration of symptoms of diabetes prior to the diagnosis. Screening for DPN at diagnosis of diabetes is warranted, especially among older subjects.
  9,018 31 -
CASE REPORTS
Hyperkalemia induced pseudo-myocardial infarction in septic shock
SE Pothiawala
July-September 2014, 60(3):338-340
DOI:10.4103/0022-3859.138828  PMID:25121383
Hyperkalemia is an acute life-threatening disorder presenting to the emergency department. Patients with hyperkalemia may manifest characteristic electrocardiographic changes including tented T waves, widening of the QRS complex and loss of P waves, sine wave pattern and eventually asystole. There have been only few reports of hyperkalemia causing ST segment elevation on electrocardiogram simulating an acute myocardial infarction. This case describes pseudo-myocardial infarction due to hyperkalemia and septic shock. Rapid determination of serum potassium levels by bedside blood gas analyzers serves to be a useful guide. ST segment elevation related to hyperkalemia will resolve with successful reduction of the serum potassium levels by appropriate therapy. It is important for physicians to be aware of this condition as this will aid in initiating correct therapy and prevent the patient from unnecessary interventions and the associated risk of complications.
  5,435 24 -
Chanarin-Dorfman syndrome: Clinical report and novel mutation in ABHD5 gene
PM Tamhankar, S Iyer, S Sanghavi, U Khopkar
July-September 2014, 60(3):332-334
DOI:10.4103/0022-3859.138826  PMID:25121381
Chanarin-Dorfman syndrome (CDS) is a multisystem, autosomal recessive genetic disorder characterized by congenital non-bullous ichthyosiform erythroderma with accumulation of lipid droplets in granulocytes and basal keratinocytes. An 18-month-old female child presented with typical dermatological features of CDS. She was born as a collodion baby. Liver biopsy showed micronodular cirrhosis along with macrovesicular hepatic steatosis. Sequencing of all exons and exon-intron boundaries of the ABHD5 gene showed that the patient was homozygous for a novel mutation g.24947delG (c.773 + 1delG) in intron 5. This is the first Indian child with mutation proven CDS.
  4,746 21 2
DRUG REVIEW
Bedaquiline: A novel antitubercular drug for multidrug-resistant tuberculosis
H Nagabushan, HS Roopadevi
July-September 2014, 60(3):300-302
DOI:10.4103/0022-3859.138772  PMID:25121373
Multidrug-resistant and extensively drug-resistant tuberculosis (TB) are emerging global health threats. Bedaquiline is a new antituberculous drug belonging to the diarylquinoline class that efficiently inhibits the adenosine triphosphate synthase enzyme of Mycobacterium tuberculosis. It is a bactericidal and long-acting drug. It inhibits both dormant as well as replicating bacterial sub-populations and thus shortens the duration of TB treatment. This drug has been approved by the Food and Drug Administration in December 2012 for the management of multidrug resistant-TB. The drug marks the introduction of a new addition to the TB armamentarium after four decades.
  4,612 24 2
NARRATIVE REVIEWS
Telomeres and telomerase: Understanding basic structure and potential new therapeutic strategies targeting it in the treatment of cancer
K Sekhri
July-September 2014, 60(3):303-308
DOI:10.4103/0022-3859.138797  PMID:25121374
The impact of cancer on humanity is huge and a great deal of research is going on worldwide to find novel therapeutic targets. Telomerase is one such exciting target. Increased telomerase activity provides cancer cells with unlimited proliferative potential and is one of the hallmarks of cancer. This article provides a basic understanding of telomere and telomerase in cancer and summarizes various potential therapeutic approaches used for strategic targeting of telomerase enzyme. Medline, Medscape, EMBASE, Cochrane database, Scopus and clinicaltrials.gov were searched using terms like "telomeres", "telomerase" and "targeted cancer therapy". Journal articles published from 2005 to 2013 describing telomerase-based cancer therapy were screened.
  4,513 24 3
Arthritis, a complex connective and synovial joint destructive autoimmune disease: Animal models of arthritis with varied etiopathology and their significance
SR Naik, SM Wala
July-September 2014, 60(3):309-317
DOI:10.4103/0022-3859.138799  PMID:25121375
Animal models play a vital role in simplifying the complexity of pathogenesis and understanding the indefinable processes and diverse mechanisms involved in the progression of disease, and in providing new knowledge that may facilitate the drug development program. Selection of the animal models has to be carefully done, so that there is morphologic similarity to human arthritic conditions that may predict as well as augment the effective screening of novel antiarthritic agents. The review describes exclusively animal models of rheumatoid arthritis (RA) and osteoarthritis (OA). The development of RA has been vividly described using a wide variety of animal models with diverse insults (viz. collagen, Freund's adjuvant, proteoglycan, pristane, avridine, formaldehyde, etc.) that are able to simulate/trigger the cellular, biochemical, immunological, and histologic alterations, which perhaps mimic, to a great extent, the pathologic conditions of human RA. Similarly, numerous methods of inducing animal models with OA have also been described (such as spontaneous, surgical, chemical, and physical methods including genetically manipulated animals) which may give an insight into the events of alteration in connective tissues and their metabolism (synovial membrane/tissues along with cartilage) and bone erosion. The development of such arthritic animal models may throw light for better understanding of the etiopathogenic mechanisms of human arthritis and give new impetus for the drug development program on arthritis, a crippling disease.
  4,152 24 2
ORIGINAL ARTICLES
Association of polymorphisms of CYP2C9, CYP2C19, and ABCB1, and activity of P-glycoprotein with response to anti-epileptic drugs
SR Taur, NB Kulkarni, PP Gandhe, BK Thelma, SH Ravat, NJ Gogtay, UM Thatte
July-September 2014, 60(3):265-269
DOI:10.4103/0022-3859.138739  PMID:25121365
Background and Objective: Epilepsy, the most common neurological disorder, has treatment failure rate of 20 to 25%. Inter-individual variability in drug response can be attributed to genetic polymorphism in genes encoding different drug metabolizing enzymes, drug transporters (P-gp), and enzymes involved in sodium channel biosynthesis. The present study attempted to evaluate association of polymorphisms of CYP2C9, CYP2C19, and ABCB1, and P-gp activity with treatment response in patients with epilepsy. Materials and Methods: Patients with epilepsy on phenytoin and/or phenobarbital and/or carbamazepine were categorized into responders and non-responders as per the International League Against Epilepsy. Plasma drug concentration was estimated by high-performance liquid chromatography. P-gp activity was measured by flow cytometry using rhodamine efflux. The polymerase chain reaction (PCR-RFLP) was used to study polymorphisms of ABCB1 (C3435T), CYP2C9 (416 C > T, and 1061 A > T), and CYP2C19 (681 G > A and 636 G > A). Results: Of total 117 patients enrolled in this study, genotype data was available for 115 patients. P-gp activity was higher in non-responders (n = 68) compared to responders (n = 47) (P<0.001). No association of 416 C > T and 1061 A > T in CYP2C9 or 681 G > A and 636 G > A in CYP2C19 was observed with response phenotype in genotypic analysis. Significant genotypic (odds ratio, OR = 4.5; 95% CI, 1.04 to 20.99) and allelic association (OR = 1.73; 95% CI, 1.02 to 2.95) was observed with ABCB1 C3435T and response phenotype. Conclusions: The response to antiepileptics seems to be modulated by C3435T in ABCB1 or P-gp activity. At present, role of other genetic factors in treatment responsiveness in epilepsy appears limited, warranting analysis in a larger cohort.
  3,827 23 3
Outcomes of surgical site infections in orthopedic trauma surgeries in a tertiary care centre in India
N Rajkumari, AK Gupta, P Mathur, V Trikha, V Sharma, K Farooque, MC Misra
July-September 2014, 60(3):254-259
DOI:10.4103/0022-3859.138731  PMID:25121363
Background: Surgical site infections (SSIs) still cause significant morbidity and mortality despite advances in trauma care. We have studied in this paper the rate of SSIs, their outcomes in patients undergoing interventions for trauma and SSI trends in developing countries. Materials and Methods: A 16-month study (May, 2011- August, 2012) was carried out. Patients undergoing interventions for orthopedic trauma were followed and assessed for SSIs and their outcomes and antimicrobial sensitivity patterns of the micro-organisms isolated were noted and correlated. Results: A total of 40 (4.4%) confirmed cases of SSIs were identified among 852 patients of orthopedic trauma. Based on the new CDC criteria, after ruling out cellulitis, only 24 (2.6%) were found to have SSIs. A total of 12.5% of the SSIs were detected during follow-up. Acinetobacter baumannii was the predominant organism as also Staphylococcus aureus. Outcomes observed included changes in antibiotic regime, revision surgery, readmission to hospital and deaths. Conclusion: SSI is prevalent in orthopaedic trauma patients and an active surveillance program will help in early management and prevention.
  3,794 23 -
IMAGES IN MEDICINE
Laron syndrome
S Guleria, J Sharma, SL Kaushik
July-September 2014, 60(3):322-323
DOI:10.4103/0022-3859.138816  PMID:25121377
  3,664 22 -
OBITUARY
Dr. Vidya Acharya
NK Hase
July-September 2014, 60(3):354-354
PMID:25121393
  3,544 17 -
GUEST EDITORIAL
Anaphylactic cardiac collapse, sudden death and the Kounis syndrome
NG Kounis, GD Soufras, G Hahalis
July-September 2014, 60(3):227-229
DOI:10.4103/0022-3859.138704  PMID:25121360
  3,452 27 -
BRIEF REPORTS
Prevalence of gastro-esophageal reflux disease in patients with difficult to control asthma and effect of proton pump inhibitor therapy on asthma symptoms, reflux symptoms, pulmonary function and requirement for asthma medications
V Sandur, M Murugesh, V Banait, PM Rathi, SJ Bhatia, JM Joshi, A Kate
July-September 2014, 60(3):282-286
DOI:10.4103/0022-3859.138754  PMID:25121368
Background: The hypothesis that GER can trigger or exacerbate asthma is supported by several clinical trials that have shown amelioration in asthma symptoms and/or an improvement in pulmonary function after antireflux therapy. Aims: To investigate the prevalence of GER in patients with difficult to control asthma and to determine the effect of omeprazole on asthma symptoms, reflux symptoms, pulmonary function and on the requirement of asthma medications. Materials and Methods: Patients with difficult to control asthma were recruited into the study. All patients underwent esophageal manometry and 24 hour esophageal pH monitoring. Pulmonary function tests were done before and after treatment. The severity of asthma and reflux was assessed by a 1 week pulmonary symptom score(PSS) and reflux symptom score(RSS) respectively before and after treatment. Those who had an abnormal pH study (pH <4 in the distal esophagus for >5% of the time) underwent anti-GER treatment with lifestyle changes, and a proton pump inhibitor (omeprazole 40 mg, bid) for 3 months. Asthma medications were added or deleted based on severity of asthma. Results: Out of 250 asthmatic patients screened, forty patients fulfilled the inclusion criteria. Twenty eight of 40 patients(70%) were diagnosed to have GERD. Of the patients 28 with GER, 8 patients(28.5%) had no reflux symptoms. On 24 hr pH metry, the percentage time pH <4.0 was 10.81 ± 4.72 and 1.11 ± 1.21; Deemester score was 37.65 ± 14.54 and 4.89 ± 6.39 (p-value is 0.0001) in GERD and non-GERD patients respectively.In GERD group, post treatment reflux symptom score(RSS) improved from 22.39 ± 14.99 to 1.04 ± 1.07, pulmonary symptom score(PSS) improved from27.14 ± 7.49 to 13.82 ± 4.21and night time asthma symptom score(NASS) improved from 6.71 ± 1.80 to 3.04 ± 1.23 (p-value <0.0001). After treatment, FEV1 and PEFR increased from 1.38 ± 0.57 and 4.14 ± 1.97 to 1.47 ± 0.54 and 5.56 ± 1.72, respectively (p-value 0.00114). Conclusions: PPI therapy improves nocturnal asthma symptoms, daytime asthma symptoms, pulmonary function and decreases requirement of asthma medications in these patients.
  3,395 31 1
CASE REPORTS
Dengue infection presenting as acute hypokalemic quadriparesis
N Gupta, A Garg, P Chhabra
July-September 2014, 60(3):327-328
DOI:10.4103/0022-3859.138824  PMID:25121379
Dengue infection is one of the most common viral hemorrhagic fevers seen in the tropical countries, including India. Its presentation varies from an acute self-resolving febrile illness to life-threatening hemorrhagic shock and multiorgan dysfunction leading to death. Neurological presentations are uncommon and limited to case reports only. Most common neurological manifestations being encephalitis, acute inflammatory demyelinating polyradiculoneuropathy, transverse myelitis, and acute disseminated encephalomyelitis.Hypokalemic quadriparesis as a presenting feature of dengue is extremely rare. Here, we report this case of a 33-year-old female, who presented with hypokalemic quadriparesis and was subsequently diagnosed as dengue infection.
  3,157 21 1
NARRATIVE REVIEWS
Age appropriate screening for cancer: Evidence-based practice in the United States of America
TS Pandey
July-September 2014, 60(3):318-321
DOI:10.4103/0022-3859.138813  PMID:25121376
Cancer screening is a well established and integral part of routine care in the Western world including United States. Men and women are recommended to get age-specific screening for common cancers like breast, cervical, prostate, and colon. The goal of screening is primary and secondary prevention. Cancer prevention and early detection of cancers has been shown to improve survival rates and decrease mortality by prompt appropriate treatment. This article serves to outline the current guidelines in the United States for cancer screening and the evidence for them as well as discusses the possibility of a similar model of care in India as well as barriers to such a screening program for cancer. The evidence was mostly obtained from systematic reviews done by the United States Preventive Services Task Force guidelines and other peer institutions like American Cancer Society and Agency for Healthcare Research and Quality.
  2,998 25 2
ORIGINAL ARTICLES
A pilot study on expression of toll like receptors (TLRs) in response to herpes simplex virus (HSV) infection in acute retinal pigment epithelial cells (ARPE) cells
S Moses, M Jambulingam, HN Madhavan
July-September 2014, 60(3):243-247
DOI:10.4103/0022-3859.138720  PMID:25121361
Introduction: Toll like receptors (TLRs) have been proven to play an important role in mounting the innate immune response in an infected host. The expression of TLRs against herpes simplex virus (HSV) have not been studied in retinitis. Therefore, the current study was undertaken to determine the same using the retinal pigment epithelial (ARPE-19) cell line. Materials and Methods: APRE cells cultured in vitro were challenged with HSV 1 and 2 standard strains and 20 other clinical isolates. The cells were observed for cytopathic changes. The cell culture harvest was subjected to RNA extraction using a Total RNA mini kit. The RNA was subjected to reverse transcriptase polymerase chain reaction (PCR) for the amplification of TLRs 3, 4 and 9 and GAPDH housekeeping gene. The amplified products were subjected to electrophoresis on a 2% agarose gel and viewed under a transilluminator. Results: TLR 3 and 4 were expressed by ARPE treated with all the 22 isolates. TLR 9 expression was seen in 16 of the 22 isolates. Bacterial contamination was ruled out by subjecting the harvests to PCR amplification of 16sRNA gene amplification of the eubacterial genome. Conclusions: The expression of TLR 4 has been reported for the first time in HSV infection. TLR 4 along with TLR 3 and 9 is responsible for the antiviral response in HSV infections.
  2,946 24 -
VIEW POINT
Pioglitazone: Hype and hope
SS Jadhav, VK Shivane, AR Lila, TR Bandgar, NS Shah
July-September 2014, 60(3):293-296
DOI:10.4103/0022-3859.138765  PMID:25121371
  2,574 27 -
LETTERS
Pure yolk sac tumor of testis in an adult: A rare occurrence
S Khan, S Jetley, M Pujani, S Neogi
July-September 2014, 60(3):351-353
PMID:25121392
  2,573 18 -
CASE REPORTS
Subcutaneous Panniculitis like T Cell Lymphoma associated with erythromelalgia
J Thomas, BV Maramattom, PM Kuruvilla, J Varghese
July-September 2014, 60(3):335-337
DOI:10.4103/0022-3859.138827  PMID:25121382
Erythromelalgia is a rare disorder that simulates a small fiber neuropathy and patients often have painful erythematous extremities during episodes. It is of two types: A primary or inherited form that is sometimes associated with a Na channel mutation or a secondary disorder associated with an underlying systemic disorder. We present a 19-year-old boy who presented to us with erythromelalgia and a febrile illness with systemic rash. Detailed work-up revealed another unusual condition: Subcutaneous panniculitis like T cell lymphoma (SPTCL). This is the first report of an association of erythromelalgia with SPTCL.
  2,466 21 -
Hyperparathyroidism complicating pregnancy: A diagnostic challenge?
SN Jibhkate, AG Valand, S Ansari, BM Bharambe
July-September 2014, 60(3):329-331
DOI:10.4103/0022-3859.138825  PMID:25121380
Primary hyperparathyroidism (PHPT) is a rare etiology of hypercalcemia-induced pancreatitis, contributing about 0.4% to 1.5% of cases in the general population and up to 13% of cases during pregnancy. PHPT that occurs during pregnancy is a challenging diagnosis as the physiological changes in calcium homeostasis mask the symptoms of hypercalcemia. PHPT during pregnancy often remains undiagnosed and untreated, and may result in serious clinical implications for the mother and fetus. Most clinicians consider surgery within the second trimester of pregnancy as the treatment of choice in this group of patients. This article refers to a case of a 24-year married woman in whom PHPT was diagnosed for the first time in postpartum period. She succumbed to complications on Day 20 postpartum. Pathological findings revealed metastatic calcification in lungs, pancreas and uterine vessels, chronic pancreatitis and renal cortical necrosis.
  2,442 23 -
CASE SERIES
Needle in a haystack: Intraoperative breakage of pediatric minimal access surgery instruments
SV Parelkar, BV Sanghvi, SR Shetty, H Athawale, SN Oak
July-September 2014, 60(3):324-326
DOI:10.4103/0022-3859.138823  PMID:25121378
The search for tiny bits of broken pediatric minimal access surgery (MAS) instruments in an operative field is akin to the search for a needle in a haystack. With the extension of MAS to the pediatric age group, instruments are becoming smaller and equitably more prone to breakage. When breakages occur, retrieval, especially in the pediatric abdominal cavity, can be challenging. Inability to do so would affect patient safety and also lead to a web of medico legal and ethical issues. We present two cases of intraoperative breakage: An eyeless 3-0 polyamide suture needle and a 2-mm grasper blade both of which were successfully retrieved and fortuitously escaped becoming retained surgical items.
  2,338 22 -
LETTERS
Esophageal perforation and death following glyphosate poisoning
Wadhwa Jyoti, MM Thabah, S Rajagopalan, A Hamide
July-September 2014, 60(3):346-347
DOI:10.4103/0022-3859.138834  PMID:25121387
  2,245 22 -
Scalp hematoma: An atypical presentation of neurofibromatosis and a cause of hemorrhagic shock
T Samra
July-September 2014, 60(3):349-350
DOI:10.4103/0022-3859.138836  PMID:25121389
  2,204 19 -
ORIGINAL ARTICLES
Influence of alcohol on condom use pattern during non-spousal sexual encounter in male migrant workers in north India
SA Rizwan, S Kant, K Goswami, SK Rai, P Misra
July-September 2014, 60(3):276-281
DOI:10.4103/0022-3859.138752  PMID:25121367
Context: Migrant workers constitute an important risk group for Human Immunodeficiency Virus/Acquired Immuno-Deficiency Syndrome transmission in India. Alcohol consumption before sexual intercourse has been postulated to influence condom use practices. This study aimed to assess this association with regard to non-spousal sexual encounters among male migrant workers in northern India. Materials and Methods: A cross-sectional facility-based survey was conducted in 2011. Male migrant workers aged ≥18 years, who were born outside Haryana, who had moved to the current location after 15 years of age,had worked in the current factory for at least 1 year, who were willing to participate and were able to give written, informed consent were included in the study. A consecutive sampling was performed. Descriptive, bivariate and multiple logistic regression analyses were carried out. Results: A total of 162 participants reported having experienced non-spousal sexual encounters in the last 1 year. The proportion of men who reported not having used a condom at their last non-spousal sexual encounter was 59.3%, and 78.4% of the men reported having consumed alcohol in the last 1 year. About 48.1% of men reported having consumed alcohol before their last non-spousal sexual encounter. Men who consumed alcohol were three times more likely to not use a condom at their last non-spousal sexual encounter (OR = 3.1, 95% CI: 1.5-6.4). This association persisted even after adjusting for relevant confounders. Conclusion: Alcohol consumption had a negative influence on condom use during non-spousal sexual encounter among male migrant workers. An integrated approach to promote condom use and reduce alcohol consumption among migrant men needs to be undertaken through targeted intervention strategies.
  2,017 23 -
COMMENTARIES
Diabetic peripheral neuropathy in India: Underestimated and overlooked?
R Patell, S Prakash
July-September 2014, 60(3):235-236
  1,999 19 -
ORIGINAL ARTICLES
Outcome of surgically treated octogenarians with breast cancer
LHM Tan, J Bate, K McNamara, AR Carmichael
July-September 2014, 60(3):248-253
PMID:25121362
Context: Breast cancer is the commonest cancer in women worldwide and its incidence increases with increasing age. In an era of evidence-based practice, there is a paucity of evidence relating to the management of breast cancer in an oncogeriatric population. The authors define oncogeriatrics as cancer in patients aged 80 years or more. Aim: The study aimed to evaluate the survival benefit of surgically managed octogenarians with breast cancer. Materials and Methods: This was a retrospective study of octogenarians diagnosed with breast cancer over a 5-year period and who were treated surgically. Kaplan-Meier survival analysis was used to determine the overall survival. The differences in survival were tested using the logrank (Mantel-Cox) test. A P-value of <0.05 was considered to be statistically significant. Results: One hundred patients were included (median age- 84 years, median follow up 3.3 years). A validated adult comorbidity evaluation-27 (ACE-27) index score system was used to characterize patient comorbidities. Fourteen percent of patients had severe comorbidities, 55% nonsevere, 11% no comorbidities, and 20% with unknown comorbidities. The estrogen receptor was positive in 67% of tumors. Eighty-four percent had mastectomy and 15% had wide local excision. Sixty-eight percent had axillary lymph node dissection, 10% had sentinel lymph node biopsy, and 5% had no axillary surgery. The majority (72%) of the tumors were pathologically T1 or T2 tumor. The Nottingham Prognostic Index (NPI) mean score was 4.4. The Kaplan-Meier survival analysis showed a median survival of 5 years. Forty-eight percent died during the observation period, with 54.2% of this group dying of causes unrelated to breast cancer. Conclusion: The surgically treated octogenarians in our sample had an acceptable survival outcome
  1,954 23 -
Lower levels of serum high-density lipoprotein cholesterol are associated with a worse Duke treadmill score in men but not in women
AF Erkan, B Ekici, GG Demir, HF Töre
July-September 2014, 60(3):260-264
DOI:10.4103/0022-3859.138734  PMID:25121364
Background: High-density lipoprotein cholesterol (HDL-C) levels are inversely related to the atherosclerotic burden and are higher in women than in men. We aimed to investigate the sex-specific relationship between serum HDL-C levels and the Duke treadmill score (DTS) in this study. Materials and Methods: A total of 111 patients (59 men, 42 women) with suspected coronary artery disease (CAD) who underwent exercise treadmill test (EST) were included. Fasting blood samples were obtained for the assessment of serum lipid levels. DTS was calculated for each patient based on EST findings including ST segment deviation and symptoms. Results: Patients were categorized into a moderate to high risk group based on the DTS score (group-I: 38 patients) and a low risk group (group-II: 63 patients). There was a significant positive correlation between serum HDL-C levels and DTS (r = 0.230; P=0.021). The mean HDL-C level was significantly higher in group-II relative to group-I (49.25 ±11.21 vs. 44.43 ± 11.18, respectively, P = 0.04). An HDL-C level less than the cut-off value of 41.39 mg/dL predicted a moderate to severe risk DTS with 65% sensitivity and 69% specificity in men (area under curve = 0.732, P = 0.004), but not in women (area under curve = 0.505, P = 0.958). After adjustment for traditional CAD risk factors (age, sex, and smoking status), the relationship of DTS to HDL-C remained significant. (P = 0.030; adjusted OR = 0.948 [95% CI, 0.904-0.995]). Conclusion: Low HDL-C levels may be associated with a moderate to high risk Duke treadmill score in men, but not in women. Further research is required to clarify the sex-specific relationship between HDL-C and DTS.
  1,904 21 -
BRIEF REPORTS
Brachial plexus injury in live related donor hepatectomy: A chart review
ST Karna, CK Pandey, VK Pandey, A Singh
July-September 2014, 60(3):287-289
DOI:10.4103/0022-3859.138758  PMID:25121369
Retrieval of the partial liver graft is a complicated and time-consuming procedure and reported to be associated with brachial plexus injury. We present a case series of brachial plexus injury in live related donor hepatectomy of 95 donors analyzed retrospectively. Seven donors suffered from brachial plexus injuries of varying severity and duration. Out of these, one donor had residual paresis. The reasons could be application of retractors, which may have led to traction and compression above the nerve roots.
  1,845 21 -
LETTERS
Internal jugular vein medial to carotid artery
TC Anandaswamy, GC Rajappa
July-September 2014, 60(3):350-350
DOI:10.4103/0022-3859.138837  PMID:25121390
  1,789 21 -
CASE SNIPPET
An unusual complication of stroke thrombolysis
EP Venkatesan, K Ramadoss, R Balakrishnan, B Prakash
July-September 2014, 60(3):341-342
DOI:10.4103/0022-3859.138829  PMID:25121384
  1,671 19 1
LETTERS
Valgus deformity caused by dysplasia epiphysealis hemimelica in the knee
AA Salunke, GI Nambi, J Shah, C Dhamne
July-September 2014, 60(3):351-351
DOI:10.4103/0022-3859.138838  PMID:25121391
  1,396 18 -
Paediatric malignant peripheral nerve sheath tumor with osteoid, rhabdomyosarcomatous, and liposarcomatous differentiation
CW Devadoss, AR Rau, S Manjari, MK Hasaf
July-September 2014, 60(3):348-349
DOI:10.4103/0022-3859.138835  PMID:25121388
  1,387 19 -
Understanding correlation in the context of outliers
SK Raina
July-September 2014, 60(3):343-344
DOI:10.4103/0022-3859.138830  PMID:25121385
  1,288 19 -
COMMENTARIES
Outcomes of surgical site infections in orthopedic trauma surgeries in developing countries: Need for baseline data and identification of risk factors
GM Shetty, A Poojary
July-September 2014, 60(3):230-231
  1,156 21 -
Monitoring to prevent brachial plexus injury
MR Thatte
July-September 2014, 60(3):241-242
  1,121 20 -
LETTERS
Impact of midday meals- have all variables been considered?
K Kaushal
July-September 2014, 60(3):345-345
DOI:10.4103/0022-3859.138832  PMID:25121386
  1,109 19 -
COMMENTARIES
Breast cancer in the Geriatric population
Akshita Singh, Vani Parmar
July-September 2014, 60(3):232-232
  1,084 20 -
Combating the spread of HIV among Indian migrants
SV Mishra, KS Jethwani
July-September 2014, 60(3):233-234
  988 21 -
Toll like receptors and acute retinal necrosis syndrome- evaluating the association
S Pathak
July-September 2014, 60(3):237-238
  959 19 -
LETTERS
Authors' reply
SC Nooyi, MN Srinivasa, S Shivanajiah, D Rajaram, SN Somanna, SS Puttajois
July-September 2014, 60(3):345-346
  921 18 -
COMMENTARIES
ABCB1 variant provides important leads for pharmacogenetics of epilepsy
MN Phani, K Satyamoorthy
July-September 2014, 60(3):239-240
  918 20 -
LOOKING BACK
Giambattista Canano and his myology
G Štrkalj
July-September 2014, 60(3):290-292
DOI:10.4103/0022-3859.138761  PMID:25121370
Giambattista Canano was a sixteenth century Italian anatomist and physician. He was educated at the University of Ferrara where, upon graduation, he was appointed professor of anatomy. While at the university, Canano carried out a pioneering study of skeletal muscles. This study was to be published in a multi-volumed book entitled Musculorum Humani Corporis Picturata Dissectio. However, only the section on the muscles of the upper limb was published, as Canano stopped the printing of his book. It is hypothesized that he met Vesalius at the time and saw the proofs of his Fabrica which he assessed as far superior and, consequently, decided to abort his project. The preserved copies of the Dissectio, however, show that the standards of Canano's work surpassed most of the anatomical studies published up to that time. Canano subsequently left the academic position and made a notable career as a physician. His appointments included prestigious positions of physician to the Pope and protomedicus of the House of Este in Ferrara.
  813 0 -
LETTERS
Authors' reply
S Kalra, V Singh
July-September 2014, 60(3):344-344
  776 18 -
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
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