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   2015| July-September  | Volume 61 | Issue 3  
    Online since June 26, 2015

 
 
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EDITORIAL
Screening for gestational diabetes in India: Where do we stand?
V Mohan, S Usha, R Uma
July-September 2015, 61(3):151-154
DOI:10.4103/0022-3859.159302  PMID:26119432
  6,139 31 -
DRUG REVIEW
Sildenafil in pediatric pulmonary arterial hypertension
AK Dhariwal, SB Bavdekar
July-September 2015, 61(3):181-192
DOI:10.4103/0022-3859.159421  PMID:26119438
Pulmonary arterial hypertension (PAH) is a life-threatening disease of varied etiologies. Although PAH has no curative treatment, a greater understanding of pathophysiology, technological advances resulting in early diagnosis, and the availability of several newer drugs have improved the outlook for patients with PAH. Sildenafil is one of the therapeutic agents used extensively in the treatment of PAH in children, as an off-label drug. In 2012, the United States Food and Drug Administration (USFDA) issued a warning regarding the of use high-dose sildenafil in children with PAH. This has led to a peculiar situation where there is a paucity of approved therapies for the management of PAH in children and the use of the most extensively used drug being discouraged by the regulator. This article provides a review of the use of sildenafil in the treatment of PAH in children.
  5,729 35 -
ORIGINAL ARTICLES
Allergic Rhinitis: A neglected disease - A community based assessment among adults in Delhi
B Sinha, Vibha , R Singla, R Chowdhury
July-September 2015, 61(3):169-175
DOI:10.4103/0022-3859.159418  PMID:26119436
Background and Objectives: Allergic Rhinitis is rather erroneously viewed as a trivial disease. It is important in that it can significantly affect quality of life. There is paucity of community based prevalence studies on the disease in India. This study was planned to assess the prevalence of allergic rhinitis in adults, the proportion of asthmatics among them, risk factors associated and treatment seeking behaviour among the patients. Materials and Methods: A community based cross sectional study was conducted in Mehrauli, South Delhi among 1200 adults, aged 30 years and over selected by systematic random sampling from two randomly selected wards. A pre-tested questionnaire was used to collect information regarding symptoms, risk factors and treatment seeking behaviour. Allergic Rhinitis was diagnosed as per ARIA guidelines. Spirometry was done to diagnose asthma among them. Multivariate logistic regression analysis was done to find the association of risk factors with disease. Results: The prevalence of Allergic Rhinitis was found to be 11% (132 subjects) and 33.3% (44 patients) among them also had asthma. Overcrowding (aOR = 6.4), absence of cross-ventilation (aOR = 2.5), occupational exposure to dust/ smoke (aOR = 2.1), tobacco smoking (aOR = 2.1), family history of allergic diseases (aOR = 2.7) and clinical allergy (aOR = 10.2) were found to be independent risk factors associated with Rhinitis. More patients of Rhinitis with asthma (75%) took treatment, relative to those without asthma (40%) who, mostly relied on home remedies (42%) or, did not seek any treatment (18%) (P = 0.031). Interpretations and Conclusion: The burden of Allergic Rhinitis is high with a considerable overlap with asthma. These allergic diseases and emphasize the importance of early and regular treatment.
  5,452 29 1
Evaluation of the prevalence of gestational diabetes mellitus in North Indians using the International Association of Diabetes and Pregnancy Study groups (IADPSG) criteria
V Gopalakrishnan, R Singh, Y Pradeep, D Kapoor, AK Rani, S Pradhan, E Bhatia, SB Yadav
July-September 2015, 61(3):155-158
DOI:10.4103/0022-3859.159306  PMID:26119433
Objective: Currently, there is controversy regarding the diagnosis of gestational diabetes mellitus (GDM) as per the newer International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. We studied the prevalence and associations of GDM in North Indians, diagnosed by the IADPSG criteria. Patients and Methods: We conducted a cross-sectional study on 332 pregnant women, predominantly belonging to lower and middle socioeconomic strata. The women were screened for GDM between 24 weeks and 28 weeks of gestation by 75g oral glucose tolerance test (OGTT) and GDM diagnosed by the IADPSG criteria. Results: The prevalence of GDM was 41.9% [95% Confidence interval (CI) 36.6-47.2%]. Amongst the women diagnosed to have GDM, 91.4% had abnormal fasting plasma glucose (FPG), while 1-h and 2-h post-glucose (PG) levels were abnormal in 18.7% and 17.3% of women, respectively. No maternal factors were significantly associated with GDM. Birth weight of the neonates was similar in women with GDM as compared to those with normal glucose tolerance. In the entire group, fasting glucose levels were associated with the weight of the patient while 1-h PG levels were associated with weight, height, socioeconomic score, and parity. Conclusions: There is a very high prevalence rate of GDM using the IADPSG criteria in North Indian women of low and middle socioeconomic strata. Further studies are needed to assess the utility of applying these criteria in settings with limited resources.
  4,771 31 -
Toxicoepidemiology of acute poisoning cases in a secondary care hospital in rural South India: A five-year analysis
TH Indu, D Raja, S Ponnusankar
July-September 2015, 61(3):159-162
DOI:10.4103/0022-3859.159310  PMID:26119434
Objective: To ascertain the trend of poisoning cases admitted to the Government District Headquarters Hospital, a secondary care center in Udhagamandalam, Nilgiris District, Tamil Nadu, India, over a five-year period. Materials and Methods: The number of cases that presented to the hospital annually (incidence, mortality, and case fatality rates), socio-demographic pattern, and the nature of the poison were noted. Results: A total of 1860 poisoning cases (80 deaths) were reported during the period from October 2008 to September 2013. The incidence of poisoning was found to increase every year. The average incidence was 1.60 per 1000 population, while the average case fatality rate and mortality rates were 40.51 and 0.07, respectively. A total of 1148 (62%) were males. The majority of cases were seen in the 21-30 age group (41.24%). The poisonings were largely deliberate self-harm (n = 1,755; 94.35%), followed by accidental (n = 85; 4.57%). Agrochemicals were the main choice of poisoning agents and among these, organophosphates were the major cause. Conclusion: The data generated can help policy makers take decisions on the sale and availability of pesticides in this region.
  4,009 31 -
CASE REPORTS
A typical case of myoclonic epilepsy with ragged red fibers (MERRF) and the lessons learned
SR Chandra, TG Issac, N Gayathri, N Gupta, MM Abbas
July-September 2015, 61(3):200-202
DOI:10.4103/0022-3859.150905  PMID:26119441
Mitochondrial diseases have a special predilection to involve the brain in view of its high metabolic demand and the tendency for the formation of excitatory neurotransmitters when there is deficiency of intracellular ATP. These diseases have a great phenotypic variation and need a high degree of suspicion. However, some specific syndromes are well defined, both genotypically and phenotypically. Some of the drugs are potentially fatal mitochondrial poisons and an insight into that may be lifesaving as well as prevent serious morbidities.We report a typical case of myoclonic epilepsy with ragged red fibers (MERRF) with classical phenotype and genotype. There was rapid multiaxial deterioration with the introduction of sodium valproate which partly reversed on introducing mitochondrial cocktail and withdrawal of the offending drug.Sodium valproate, phenobarbitone, chloramphenicol and many anti-viral agents are mitochondrial poisons that increase the morbidity and mortality in patients with mitochondrial disease. More harm to the patient can be avoided with insight into this information.
  3,806 41 1
IMAGES IN CLINICAL MEDICINE
Symptoms of degeneration of the pyramidal tracts in conventional magnetic resonance imaging and diffusion tensor imaging in a young woman with primary lateral sclerosis
S Budrewicz, P Szewczyk, K Slotwinski, M Koszewicz
July-September 2015, 61(3):206-208
DOI:10.4103/0022-3859.150901  PMID:26119443
Primary lateral sclerosis (PLS) is one of the forms of motor neuron disease (MND), affecting only upper motor neurons. The diagnosis of PLS should be made on different diagnostic criteria, for example, Pringle or Gordon, but it is usually a diagnosis of exclusion. There are no characteristic findings in standard laboratory and electrophysiological assessment. We present details of a 31-year-old woman who had suffered from progressive paraparesis with right-side predominance. Conventional MRI of brain and spinal cord and diffusion tensor imaging (DTI) studies showed Hyperintense lesions in the upper part of the cervical spinal cord at the level C1 in lateral funicules, in the medulla oblongata at the pyramidal decussation and in the midbrain. Brain DTI revealed changes along the corticospinal tracts on fractional anisotropy (FA) maps. MRI of the thoracic spinal cord showed in T2-weighted images hyperintensive regions in the course of the lateral corticospinal tracts. This aided in PLS recognition.
  3,549 45 -
CASE REPORTS
A case of paraneoplastic bullous pemphigoid in association with squamous cell carcinoma of lung
A Das, S Das, SK Das, S Basuthakur
July-September 2015, 61(3):197-199
DOI:10.4103/0022-3859.150906  PMID:26119440
Bullous pemphigoid is a chronic, autoimmune, acquired subepidermal blistering disorder. It is idiopathic in origin, and mainly seen in elderly individuals. Association between bullous pemphigoid and internal malignancies is reported in the literature, but the exact causal relation is not established. Paraneoplastic bullous pemphigoid is rarely reported in lung cancers, especially in squamous cell variety. So their presence should raise the suspicion of various internal malignancies including lung cancer. It is presented mainly with tense, large blisters over the erythematous base or over normal skin. Subepidermal blisters with tissue eosinophilia are characteristic histopathological features of bullous pemphigoid. Direct immunofluorescence shows linear deposits of IgG - complement complex along the dermoepidermal junction. Conventional treatment of bullous pemphigoid along with treatment of lung cancer (surgery, chemotherapy, radiotherapy) may result in successful resolution of skin lesions. Here, we report a rare association of paraneoplastic bullous phemphigoid and squamous cell carcinoma of lung in a 76-year-old male to increase the awareness among the clinicians regarding this variety of cutaneous paraneoplastic manifestation of lung cancer.
  2,844 43 -
ORIGINAL ARTICLES
Short-term outcomes of a program developed to inculcate research essentials in undergraduate medical students
V Devi, K Ramnarayan, RR Abraham, V Pallath, A Kamath, S Kodidela
July-September 2015, 61(3):163-168
DOI:10.4103/0022-3859.159315  PMID:26119435
Background: Participation in research during undergraduate studies may increase students' interest in research and inculcate research essentials in them. Aims: The purpose of this study was to evaluate the effectiveness of the mentored student project (MSP) program. Settings and Design: In the MSP program, students in groups (n = 3 to 5) undertook a research project, wrote a scholarly report, and presented the work as a poster presentation with the help of a faculty mentor. To begin with, the logic model of the program was developed to identify short-term outcomes of the program on students, mentors, and the institution. A quasi-experimental design was used to measure the outcomes. Materials and Methods: A mixed method evaluation was done using a newly-developed questionnaire to assess the impact of the MSP on students' attitude, a multiple-choice question (MCQs) test to find out the impact on students' knowledge and grading of students' project reports and posters along with a survey to check the impact on skills. Students' satisfaction regarding the program and mentors' perceptions were collected using questionnaires. Evidence for validity was collected for all the instruments used for the evaluation. Statistical Analysis: Non-parametric tests were used to analyze data. Based on the scores, project reports and posters were graded into A (>70% marks), B (60-69% marks), and C (<59% marks) categories. The number of MSPs that resulted in publications, conference presentation and departmental collaborations were taken as impact on the institution. Results: Students' response rate was 91.5%. The students' attitudes regarding research changed positively (P = 0.036) and score in the MCQ test improved (P < 0.001) after undertaking MSP. Majority of project reports and posters were of grade A category. The majority of the items related to skills gained and satisfaction had a median score of 4. The MSPs resulted in inter-departmental and inter-institutional collaborations, 14 publications and 15 conference presentations. An area for improvement noted was to have the MSP implemented in the curriculum without increasing students' overall workload and stress. Conclusion: The study identified strengths and weaknesses of the MSP program. Our model of undergraduate research project may be incorporated in undergraduate medical programs to foster positive attitude and knowledge base about scientific research and to instil research skills among students.
  2,787 28 -
BRIEF REPORT
Postoperative coagulopathy after live related donor hepatectomy: Incidence, predictors and implications for safety of thoracic epidural catheter
ST Karna, CK Pandey, S Sharma, A Singh, M Tandon, VK Pandey
July-September 2015, 61(3):176-180
DOI:10.4103/0022-3859.159419  PMID:26119437
Background: Coagulopathy after living donor hepatectomy (LDH) may endanger donor safety during removal of thoracic epidural catheter (TEC). The present study was conducted to evaluate the extent and duration of immediate postoperative coagulopathy after LDH. Materials and Methods: A retrospective analysis of perioperative record of LDH over three years was conducted after IRB approval. Variables such as age, gender, BMI, ASA classification, liver volume on CT scan, preoperative and postoperative INR, platelet count (PC) and ALT of each donor for five days was noted. In addition, duration of surgery, remnant as percentage total liver volume (Remnant%), blood loss, day of peak in PC and INR were also noted. Coagulopathy was defined as being present if INR exceeded 1.5 or platelet count fell below 1 × 10 5 /mm 3 on any day. Data was analyzed using SPSS 20 for Windows. Between group comparison was made using the Student 't' test for continuous variables and chi square test for categorical variables. Univariate analysis was done. Multiple logistic regression analysis was used to find independent factor associated with coagulopathy. Results: Eighty four (84) donors had coagulopathy on second day (mean INR 1.9 ± 0.42). Low BMI, % of remnant liver and duration of surgery were independent predictors of coagulopathy. Right lobe hepatectomy had more coagulopathy than left lobe and low BMI was the only independent predictor. There was no correlation of coagulopathy with age, gender, blood loss, presence of epidural catheter, postoperative ALT or duration of hospital stay. High INR was the main contributor for coagulopathy. Conclusions: Coagulopathy is seen after donor hepatectomy. We recommend removal of the epidural catheter after the fifth postoperative day when INR falls below 1.5.
  2,698 24 -
CASE REPORTS
A successful twin pregnancy in a patient with HbE-β-thalassemia in western India
R Merchant, K Italia, J Ahmed, K Ghosh, RB Colah
July-September 2015, 61(3):203-205
DOI:10.4103/0022-3859.159427  PMID:26119442
Improvements in medical facilities have helped a large number of clinically severe hemoglobin E (HbE)-β-thalassemia patients reach adulthood. Consequently, there is a new challenge, that of managing women with HbE-β-thalassemia during pregnancy. In particular, they have a high risk of abortion, preterm delivery, intrauterine growth restriction, and thromboembolism. A 27-year-old HbE-β-thalassemia patient on regular transfusion, who was splenectomized and heptatitis C (HCV)-positive, conceived for the first time without any infertility treatment. However, there was incomplete abortion with heavy bleeding at 3 months of gestation, which required bilateral uterine artery angiography. The angiogram showed the left uterine artery to be moderately hypertrophied. This was embolized with 300-500 micron polyvinyl alcohol (PVA) to stop the bleeding. Soon after, she conceived again with a twin pregnancy, and at 33.3 weeks of gestation, there was a normal delivery of twin girls without any postpartum hemorrhage or perineal tear. Both babies were given prematurity care. The mother and children were both normal up till the last follow-up 18 months after delivery, and both the girls are HbE heterozygous. Thorough monitoring of endocrine functions along with proper management of transfusions and iron overload can help in reducing the complications related to pregnancy in these patients.
  2,631 26 -
CLINICOPATHOLOGICAL FORUM
Pulmonary choriostoma in a case of tuberous sclerosis complex
S Spalgais, D Gothi, AK Verma
July-September 2015, 61(3):193-196
DOI:10.4103/0022-3859.159426  PMID:26119439
A 52 years old lady was diagnosed to have Tuberous Sclerosis Complex (TSC) on the basis of 2 major and one minor criterion. She had family history of similar complaints in her sister and two sons. There was involvement of kidney in the form of angiomyolipoma, skin in the form of facial angiofibroma and teeth with a dental pit. She had an unusual lung involvement in the form of multiple small choristomas. Choristoma was diagnosed on transbronchial lung biopsy and was present in the form of disorganised striated muscles. The reported pulmonary manifestations of TCS i.e. lymphangioleiomyomatosis (LAM) and multifocal micronodular pneumocyte hyperplasia (MMPH) are types of hamartomas. Hamartomas and choristomas are both types of disorganized tissue. 'Choristoma'of lung in TSC however is not reported. Clinopathological correlation of pulmonary hamartoma and choristoma, and treatment in TSC has been discussed.
  2,537 26 1
IMAGES IN CLINICAL MEDICINE
Congenital bronchial atresia misdiagnosed as pulmonary tuberculosis
MK Panigrahi, VK Saka
July-September 2015, 61(3):209-210
DOI:10.4103/0022-3859.159428  PMID:26119444
  2,258 25 -
LETTERS
Echinacea-associated acute cholestatic hepatitis
I Gabranis, T Koufakis, I Papakrivos, S Batala
July-September 2015, 61(3):211-212
DOI:10.4103/0022-3859.159430  PMID:26119446
  2,210 31 -
Operation theatre utilization and efficiency
A Jena, A Samantaray, R Patnayak
July-September 2015, 61(3):212-213
DOI:10.4103/0022-3859.159431  PMID:26119447
  2,025 24 -
Surgical safety checklist: Productive, nondisruptive, and the "right thing to do"
EA Smith, I Akusoba, DM Sabol, SP Stawicki, MA Granson, EC Ellison, SD Moffatt-Bruce
July-September 2015, 61(3):214-215
DOI:10.4103/0022-3859.159434  PMID:26119449
  1,918 23 -
Performing audit in histopathology
SK Raina
July-September 2015, 61(3):213-213
DOI:10.4103/0022-3859.159432  PMID:26119448
  1,733 27 -
Challenges in the diagnosis of breast cancer in the elderly
AK Belli, G Memis, O Dere, O Nazli
July-September 2015, 61(3):211-211
DOI:10.4103/0022-3859.159429  PMID:26119445
  1,700 26 -
Authors' reply
KK Deodhar, B Rekhi, S Menon, B Ganesh
July-September 2015, 61(3):213-214
  1,208 25 -
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