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  :: Table of Contents - Current issue
Coverpage
January-March 2021
Volume 67 | Issue 1
Page Nos. 1-60

Online since Tuesday, February 9, 2021

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EDITORIAL  

Minimizing medical errors to improve patient safety: An essential mission ahead p. 1
S Karande, GA Marraro, C Spada
DOI:10.4103/jpgm.JPGM_1376_20  PMID:33533744
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EDITORIAL COMMENTARIES Top

Blended programmatic assessment for competency-based curricula: Is it the way forward? p. 4
PB Iyer
DOI:10.4103/jpgm.JPGM_1378_20  PMID:33565470
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Drusen-like deposits in systemic disorders: A point of convergence for nephrologists and ophthalmologists p. 6
S Sen
DOI:10.4103/jpgm.JPGM_1099_20  PMID:33565471
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ORIGINAL ARTICLES Top

New markers in predicting the severity of acute pancreatitis in the emergency department: Immature granulocyte count and percentage p. 7
C Bedel, M Korkut, F Selvi
DOI:10.4103/jpgm.JPGM_784_20  PMID:33533745
Background: Acute pancreatitis (AP) may vary in severity, from mild, self-limiting pancreatic inflammation to rapidly progressive life-threatening clinical course. If the severity of AP can be predicted early and treated quickly, it may lead to a decrease in morbidity and mortality rates. There?fore, we aimed to investigate the clinical utility of immature granulocyte count (IGC) and IGC percentage (IG%) in showing the severity of AP in this study. Methods: Two hundred and twenty-seven patients who were admitted to our emergency department and diagnosed with AP between March 1 and September 30, 2019, were included in the study. The patients were divided into two groups as mild and severe AP (MAP and SAP) according to the severity of the disease. Demographic characteristics of the patients, disease etiology, disease severity, and inflammation markers [white blood cell count (WBC), IGC, IG%, neutrophil–lymphocyte ratio (NLR), and C-reactive protein (CRP)] were recorded. Differences between the groups were statistically analyzed. Results: Of the patients included in the study, 183 (80.7%) were in the MAP group and 44 (19.3%) were in the SAP group. The mean WBC, NLR, CRP, IGC, and IG% levels were significantly higher in the SAP group compared to the MAP group. The power of IGC and IG% in predicting SAP was higher than other inflammation markers (WBC, NLR, and CRP) [(AUC for IGC: 0.902; sensitivity: 78.2%; specificity: 92.8%); (AUC for IG%: 0.843; sensitivity: 72.7%; specificity: 84.6%)]. Conclusion: IGC and IG% show the severity of AP more effectively than WBC, NLR, and CRP, which are traditional inflammation markers.
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The association of plasma acyl ghrelin level with alcohol craving in early abstinent alcohol dependent patients p. 12
L Sha, P Dey, CR Khess, KK Khitiz
DOI:10.4103/jpgm.JPGM_1018_20  PMID:33565472
Background: Craving plays an important role in maintenance of alcohol dependence. Earlier studies have analyzed the role of ghrelin in craving and their results have been heterogenous. Acyl ghrelin is its more active form as it crosses the blood brain barrier. Hence we aimed to examine the relationship between plasma acyl ghrelin and craving in Indian patients having alcohol dependence syndrome. Methods: The present study was a hospital-based prospective study. A total of 60 drug-naive patients of alcohol dependence and 30 healthy controls were included. After taking informed consent fasting blood samples were collected from them on day 1 and tested for plasma acyl ghrelin level. Fasting blood samples were repeated in all cases on day 14. During this time, we also assessed the patients' cravings by obsessive compulsive drinking scale, and alcohol craving questionnaire; and withdrawal by clinical institute withdrawal assessment for alcohol scale. These scales were repeated on day 14. Data analysis was done by SPSS version 25.0. Results: Plasma concentrations of acyl ghrelin increased significantly during early abstinence in patients from day 1 to day 14 (P < 0.0001). Pearson correlation test revealed a trend of positive correlation between plasma concentration of acyl ghrelin on day 14 and severity of craving on day 1. Conclusion: Our results suggest the plasma concentration of acyl ghrelin may be a predictor of severity of alcohol craving during early abstinence. Anti-craving drugs acting on acyl ghrelin level in brain may open an innovative avenue for optimum treatment of alcohol dependence.
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EDUCATION FORUM Top

Blended programmatic assessment for competency based curricula p. 18
R Mahajan, S Saiyad, A Virk, A Joshi, T Singh
DOI:10.4103/jpgm.JPGM_1061_20  PMID:33533748
The uncertainty in all spheres of higher education due to the COVID-19 pandemic has had an unprecedented impact on teaching–learning and assessments in medical colleges across the globe. The conventional ways of assessment are now neither possible nor practical for certifying medical graduates. This has necessitated thoughtful considerations in making adjustments to the assessment system, with most institutions transitioning to online assessments that so far have remained underutilized. Programmatic assessment encourages the deliberate and longitudinal use of diverse assessment methods to maximize learning and assessment and at present can be utilized optimally as it ensures the collection of multiple low-stake assessment data which can be aggregated for high-stake pass/fail decisions by making use of every opportunity for formative feedback to improve performance. Though efforts have been made to introduce programmatic assessment in the competency-based undergraduate curriculum, transitioning to online assessment can be a potential opportunity if the basic tenets of programmatic assessment, choice of online assessment tools, strategies, good practices of online assessments and challenges are understood and explored explicitly for designing and implementing online assessments. This paper explores the possibility of introducing online assessment with face-to-face assessment and structuring a blended programmatic assessment in competency-based medical education.
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CASE SERIES Top

Inclusion body fibromatosis – A report of four cases and review of literature p. 24
MA Agnihotri, PA Sathe
DOI:10.4103/jpgm.JPGM_774_20  PMID:33565473
Inclusion body fibromatosis (IBF) also called the “Reye tumor” is a rare spindle cell proliferation with distinct clinicopathological features. This is a report of four cases of IBF from a single institute. Typical location, age, size of the lesion, bland histology, and paranuclear inclusions are the distinguishing features of this entity. Medical literature search reveals very few series of cases of IBF, the remaining cases being in the form of case reports. The aim of this report is to highlight the typical features of this rare entity.
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GRAND ROUND CASE Top

Sudden unilateral visual loss in a healthy adult female p. 27
S Sanjay, P Mahendradas, A Kawali
DOI:10.4103/jpgm.JPGM_1052_20  PMID:33533742
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CASE REPORTS Top

A case of premature and recurrent myocardial infarction associated with ABCA.1 gene mutation p. 29
K Subramaniam, LA Babu, N Shah
DOI:10.4103/jpgm.JPGM_70_20  PMID:33380594
Coronary heart disease (CHD) is the most important cause of cardiovascular death and when premature, it affects the most productive population of the community. Premature CHD usually has a specific etiology, which on diagnosis, might help in the secondary prevention in that individual. We report a case of young adult with recurrent myocardial infarction, who on evaluation had mildly reduced HDL and Protein C levels with elevated serum homocysteine. Clinical exome identified a possibly pathogenic variant of ABCA1 gene, associated with Tangier disease.
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Systemic lupus erythematosus presenting with holocord myelitis p. 33
A Kumar, MB Singh, A Garg, VY Vishnu
DOI:10.4103/jpgm.JPGM_716_20  PMID:33380595
This is a report of a case of a 25-year-old woman, who presented with a rapidly progressive sensory-motor flaccid quadriparesis which had developed over a few days along with bladder and bowel involvement. She had a past history of photosensitive rash and joint pains along with mild-to-moderate grade fever; for which she had never been evaluated. Serological markers for systemic lupus erythematosus (SLE) were strongly positive and helped in establishing the diagnosis of SLE-related holocord myelitis. High-dose intravenous glucocorticoid followed by intravenous pulse cyclophosphamide was used to treat her and there was a significant improvement. In this case report, the diagnosis of SLE was made for the first time in a patient presenting with holocord myelitis.
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Glyphosate poisoning – a case report p. 36
T Kunapareddy, S Kalisetty
DOI:10.4103/jpgm.JPGM_766_20  PMID:33533750
Glyphosate is the most commonly used broad-spectrum, non-selective herbicide in the world. The toxicity is supposed to be due to uncoupling of oxidative phosphorylation and the surfactant polyoxyethylene amine (POEA)- mediated cardiotoxicity. Clinical features of this herbicide poisoning are varied, ranging from asymptomatic to even death. There is no antidote and aggressive supportive therapy is the mainstay of treatment for glyphosate poisoning. We present a 69-year-old female patient with suicidal consumption of around 500 ml of Glycel®. Initially, gastric lavage was done and intravenous fluids were given. Within two hours of presentation, the patient developed respiratory distress needing intubation, hypotension needing vasopressor support, and severe lactic acidosis. She also developed acute respiratory distress syndrome, hypokalemia, hypernatremia, and aspiration pneumonia. Our patient was critically ill with multiple poor prognostic factors, but with timely aggressive supportive management, the patient gradually recovered.
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Anesthetic challenges while performing emergency laparotomy in a patient having COVID-19 infection p. 39
ST Karna, S Kumari, P Singh, V Waindeskar
DOI:10.4103/jpgm.JPGM_790_20  PMID:33533746
An elderly hypertensive lady presented with fever, respiratory symptoms, and mild abdominal discomfort and was diagnosed to have COVID-19 pneumonia. Respiratory symptoms improved with steroids, awake proning, high flow nasal cannula oxygen therapy and antibiotics. After 4 days, she developed non-occlusive superior mesenteric artery thrombosis, which initially responded to anticoagulants but was complicated on tenth day by intestinal obstruction necessitating emergency surgery. Challenges encountered perioperatively were multi systemic involvement, pneumonia, ventilation- perfusion mismatch, sepsis along with technical difficulties like fogging of goggles, stuck expiratory valve on anesthesia machine, inaudibility through stethoscope and discomfort due to personal protective equipment. Perioperative focus should be on infection prevention, maintenance of hemodynamics, and optimization of oxygenation with preoperative high flow nasal cannula oxygen therapy. Ultrasound lung helps in correct placement of endotracheal tube. We recommend daily machine check, taping of N95 mask to face and ambient operation theatre temperatures of 20-22°C to reduce technical problems.
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Pembrolizumab-induced large duct cholangiopathy: Diagnosis and follow.up imaging p. 43
A Chatterjee, BK Bivas, A Gehani, S Sen
DOI:10.4103/jpgm.JPGM_793_20  PMID:33533751
Immune-checkpoint inhibitor mediated hepatobiliary injury is an emerging concern in cancer treatment. Most of these adverse reactions are attributed to nivolumab and are characterized by panlobular hepatitis. Large duct cholangiopathy related to these drugs is extremely rare. We present a case of adenocarcinoma of lung treated with pembrolizumab who developed biochemical and imaging features consistent with cholangiopathy characterized by common bile duct dilatation, wall enhancement, and gallbladder wall edema. On follow-up in the fourth month, the imaging features persisted despite the normalization of liver enzymes. To the best of our knowledge, this is the first description of diagnosis and follow-up imaging of pembrolizumab-related cholangiopathy in imaging literature.
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CASE SNIPPETS Top

Suppurative mediastinal lymphadenitis caused by Actinomyces odontolyticus: Successfully diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration p. 46
JJ Wu, JL Wang, CF Tung, JS Tseng
DOI:10.4103/jpgm.JPGM_739_19  PMID:33533749
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Pulmonary tuberculous pseudotumor in a pediatric patient––A diagnostic dilemma p. 49
S Mohakud, S Purkait, S Patel, AK Satapathy
DOI:10.4103/jpgm.JPGM_209_20  PMID:33380590
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Drusen-like deposits in a patient with multiple myeloma p. 51
S Handa, V Gupta, A Agarwal
DOI:10.4103/jpgm.JPGM_461_20  PMID:33463552
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Ischiopubic rami excision for mechanical dyspareunia due to malunited pelvic fracture secondary to hyperparathyroidism p. 53
S Rajaian, M Pragatheeswarane, SS Kumaran, JR Prasad
DOI:10.4103/jpgm.JPGM_453_20  PMID:33380593
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Large neck ulcer in an immunocompetent adult male p. 55
A Ray, I Agrawal, BS Singh, BR Kar
DOI:10.4103/jpgm.JPGM_816_20  PMID:33565474
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LETTERS Top

The power of subjectivity in competency-based assessment p. 57
M Gopalakrishnan, MK Garg
DOI:10.4103/jpgm.JPGM_1251_20  PMID:33533743
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Reply to Letter to Editor regarding the article, "The power of subjectivity in competency-based assessment" p. 59
A Virk, A Joshi, R Mahajan, T Singh
DOI:10.4103/jpgm.JPGM_1269_20  PMID:33565475
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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow