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  :: Table of Contents - Current issue
Coverpage
April-June 2023
Volume 69 | Issue 2
Page Nos. 65-124

Online since Monday, April 3, 2023

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EDITORIAL  

Neuroendocrine neoplasm: Current understanding p. 65
AR Lila, SS Memon
DOI:10.4103/jpgm.jpgm_51_23  PMID:36960525
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EDITORIAL COMMENTARIES Top

Lessons learnt from therapeutic drug monitoring of levetiracetam p. 68
NN Rege
DOI:10.4103/jpgm.jpgm_706_22  PMID:36695249
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Littoral cell neoplasm: A least understood splenic tumour p. 70
K Ghosh
DOI:10.4103/jpgm.jpgm_694_22  PMID:36930543
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ORIGINAL ARTICLES Top

Therapeutic drug monitoring of levetiracetam: Method validation using high-performance liquid chromatography-ultraviolet detector technique and usefulness in patient care setting p. 72
RP Munshi, JV Vishwakarma, NR Gawde
DOI:10.4103/jpgm.jpgm_467_21  PMID:36255019
Objectives: To develop and validate a modified HPLC-UV method for the estimation of serum levetiracetam levels and to assess the usefulness of serum levetiracetam estimation in epileptic patients. Materials and Methods: Modification of a previously existing HPLC-UV method was performed using liquid– liquid phase extraction and processing using reverse phase analytic HPLC-UV detector technique followed by method validation. Serum samples of patients attending our hospital's Therapeutic Drug Monitoring Outpatient Department services were analyzed for levetiracetam levels using the study method. Data of the past 6 years (2015–2020) were descriptively analyzed. Results: The modified HPLC-UV method was validated as per ICH Q2 (R1) 2005 guidelines. Usefulness of levetiracetam estimation was assessed in 1383 patients (635 children, 683 adults, 40 elderly, and 25 pregnant women). Levetiracetam levels were within the therapeutic range (TR) in 520 children, 543 young adults, 35 elderly patients, and nine pregnant women. In 112 of 232 patients with low levetiracetam levels, poor compliance was elicited. Of 641 patients on polytherapy, 446 patients had levetiracetam values within TR, whereas 29 had values above and 166 patients had values less than TR. Sodium valproate, phenytoin sodium, and carbamazepine affected levetiracetam levels when given concomitantly. Levetiracetam dose was adjusted in 61 patients with abnormal levels for better clinical response. Good seizure control was noted in 913 (82.47%) patients whose levels were within TR, whereas 136 (58.62%) patients with low levels reported an increase in seizure frequency. Conclusions: The modified HPLC-UV method is simple, rapid, efficient, and reliable for assaying serum levetiracetam.
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A spectrum of viral diseases in Odisha state, eastern India: An evidence-based analysis from 2010–2017 p. 81
J Sabat, S Subhadra, LM Ho, B Dwibedi
DOI:10.4103/jpgm.jpgm_1152_21  PMID:36571329
Introduction: Emerging and re-emerging viral diseases are a major threat to public health. Odisha, being one of the coastal states in the country, reports many viral illnesses due to its typical geographical location. This study focuses on the prevalence of different viral diseases in the state of Odisha, India, from 2010–2017. Material and Methods: A total of 43,397 patients with clinical suspicion of viral diseases were screened for different viral etiologies during 2010–2017. The laboratory diagnosis was conducted by serology (ELISA) and RT-PCR for 24 different viruses, i.e., dengue, chikungunya, Japanese encephalitis, hepatitis A virus, hepatitis E virus, hepatitis B virus, hepatitis C virus, rotavirus, herpes simplex virus-1 and herpes simplex virus-2, Epstein-Barr virus, cytomegalovirus, and respiratory viruses. Patients were enrolled from sporadic hospital admissions and outbreaks under different categories as per clinical diagnoses like fever with rash, diarrhoea, encephalitis, jaundice, respiratory illness, and fever of unknown etiology. Results: The majority of patients belonged to exanthematous group, i.e., fever with rash (32.24%). The number of males was more in all categories except fever with rash, where females (53.34%) were more. Children <16 years of age were found to be the predominant age group for suspected viral diarrhoea (85.26%), encephalitis (76.96%), fever of unknown origin (40.16%), and respiratory infections (27.23%). Conclusion: Not only vector-borne diseases pose a threat to the Odisha state, but other viral illnesses have also emerged. This detailed report of different viral diseases in the state of Odisha will support public health management.
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Self-perceived anxiety symptoms in school students with borderline intellectual functioning: A cross-sectional questionnaire-based study in Mumbai, Maharashtra, India p. 89
S Karande, NJ Gogtay, N Shaikh, R Sholapurwala, T More, P Meshram
DOI:10.4103/jpgm.jpgm_956_22  PMID:36930546
Background and Objectives: Students with borderline intellectual functioning (“slow learners”) underperform in all school subjects. The primary objective of this study was to evaluate the self-perceived anxiety symptoms of slow learners. Its secondary objective was to analyze impact of sociodemographic variables on their symptoms. Settings and Design: Cross-sectional single-arm questionnaire-based study was conducted in the learning disability clinic of a public medical college in Mumbai. Subjects and Methods: One hundred slow learners aged ≥8 to <18 years were recruited by non-probability sampling. Their anxiety symptoms scores were measured using the Screen for Child Anxiety Related Disorders-Child version (SCARED-C) instrument. Statistical Analysis: Multivariate regression analysis was performed for determining the “independent” impact that variables had on the SCARED-C (“individual subscales” and “overall”) scores. Results: Symptoms of “separation anxiety” were present in 40%, followed by “social anxiety” in 32%, “generalized anxiety” in 31%, “panic” in 26%, “significant school avoidance” in 24%; and “overall anxiety” in 38% of slow learners. Multivariate analysis revealed that: (i) co-occurring attention-deficit/hyperactivity disorder was significantly associated with having panic symptoms (P = 0.040), and, (ii) studying in a Secondary School Certificate or Higher Secondary Certificate educational board-affiliated school was significantly associated with having symptoms of “generalized anxiety,” “social anxiety,” and “overall anxiety” (P = 0.009, P = 0.026, and P = 0.046, respectively). Conclusions: Many slow learners in our city have symptoms of anxiety disorders and overall anxiety. There is an urgent need to screen them for anxiety disorders to facilitate their optimum rehabilitation.
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ADR REPORT Top

Bullous hemorrhagic dermatosis: A rare cutaneous reaction of heparin p. 97
N Dhattarwal, R Gurjar
DOI:10.4103/jpgm.jpgm_282_22  PMID:36861545
Bullous hemorrhagic dermatosis is a rare cutaneous reaction of heparin, a commonly used anticoagulant. Exact etiopathogenesis remains elusive but immune related mechanisms as well as dose dependent relationship have been proposed. Clinically, it is characterized by asymptomatic, tense hemorrhagic bullae on extremities or abdomen occurring 5-21 days after initiation of therapy. We report bilateral symmetrically grouped lesions, in a previously unreported distribution of this entity in both the forearms in a 50-year-old male admitted with acute coronary syndrome on oral ecosprin, oral clopidogrel and subcutaneous enoxaparin. The condition is self-resolving and discontinuation of drug is not required.
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CASE REPORTS Top

Regions of homozygosity and a novel variant in Steel syndrome: An added dilemma to diagnosis p. 99
S Thakur, P Paliwal, KK Saxena
DOI:10.4103/jpgm.jpgm_1153_21  PMID:36695248
Steel syndrome is an autosomal recessive disorder that is caused by mutations in COL27A1 gene. The majority of reported cases have been of Puerto Rican origin, with few reports from India. The present case adds to the repertoire of homozygous recessive disorders from non-consanguineous Indian families. With the present case, a 4-year-old girl, we wish to signify that although mutations in several genes are known to cause skeletal abnormalities, identification of underlying mutations is important as it not only helps with the ascertainment of diagnosis but also aids in determining the role of surgical interventions which is particularly true for Steel syndrome, where the outcome of surgical intervention is usually dismal.
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A rare case of primary retroperitoneal extraovarian granulosa cell tumor p. 102
A Menon, L Singla, SG Pujari, CV Kantharia
DOI:10.4103/jpgm.jpgm_13_22  PMID:36511019
Extraovarian granulosa cell tumors (GCTs) are rare neoplasms. They arise from the ectopic gonadal tissue along the embryonal route of genital ridge. We present a case of an extraovarian tumor in an elderly female who presented with lump in the abdomen occupying the pelvic region. She was operated and the mass was excised with intact capsule. Histopathology revealed the mass to be an adult granulosa cell tumor. Extraovarian granulosa cell tumors are very rare with only 13 such cases reported in literature to date. The present case is the largest primary retroperitoneal adult granulosa cell tumor reported till date.
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Native tricuspid valve endocarditis presenting as pyrexia of unknown origin p. 105
S Singh, A Goel
DOI:10.4103/jpgm.jpgm_194_22  PMID:36453387
Native tricuspid valve endocarditis is quite rare without any predisposing factors and poses a diagnostic challenge because of fewer cardiac symptoms and lesser peripheral manifestations. This is a case report of a 25-year-old female who presented with high-grade fever, dry cough, decreased appetite, and weight loss for 1 month with no history of intravenous drug use or evidence of underlying cardiac abnormality and was diagnosed with native tricuspid valve endocarditis.
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Splenic surprise in a case of renal cell carcinoma: Unusual case or association? p. 108
T Agrawal, S Epari, G Prakash, S Menon
DOI:10.4103/jpgm.jpgm_285_22  PMID:36891941
Littoral cell angioma (LCA) is a rare benign tumor originating exclusively from the venous sinus lining cells of the splenic red pulp. These cells are unique in having a distinctive hybrid endothelial/histiocytic phenotype. Also, there are reports of the association of LCA with internal malignancies. We present a case report highlighting an unusual association of LCA with conventional renal cell carcinoma (RCC), masquerading as a metastatic lesion. Knowledge of such an association is necessary to avoid misdiagnosis and prevent potential overtreatment.
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Recurrent syncope in an 84-year-old man p. 111
C Jiang, W Tang, X Hou, H Li
DOI:10.4103/jpgm.jpgm_414_22  PMID:36861546
An 84-year-old man with hypertension and type 2 diabetes presented with recurrent transient loss of consciousness within 2 hours after dinner at home. Physical examination, electrocardiogram, and laboratory studies were unremarkable except hypotension. Blood pressures were measured in different postures and within 2 hours after meal, but neither orthostatic hypotension nor postprandial hypotension was detected. Further, history taking revealed that the patient was tube-fed with a fluid food pump with an inappropriate rapid infusion rate of 1500 mL per minute at home. He was eventually diagnosed as having syncope due to postprandial hypotension, which was caused by the inappropriate way of tube feeding. The family was educated about appropriate way of tube-feeding and the patient did not develop any episode of syncope during a two-year follow-up. This case highlights the importance of careful history taking in the diagnostic evaluation of syncope and the increased risk of syncope due to postprandial hypotension in the elderly.
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CASE SNIPPETS Top

Tuberculous enteritis-induced small intestinal bleeding in a kidney transplant recipient p. 114
JW Chou, KC Chang, YH Wu, PJ Huang
DOI:10.4103/jpgm.jpgm_122_22  PMID:36453386
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A 75-year-old man with transbronchial broncholithiasis followed up for 9 years! p. 116
S Okauchi, H Satoh
DOI:10.4103/jpgm.jpgm_156_22  PMID:36930547
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Primary cutaneous neuroendocrine tumor with axillary lymph node metastasis: A clinical masquerade p. 118
P Manimaran, R Shah, P Trivedi, S Mehta
DOI:10.4103/jpgm.jpgm_254_22  PMID:36751760
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Pulsatile bleeding varicose veins due to tricuspid regurgitation successfully treated with foam sclerotherapy p. 120
D Chandran, PM Abraham, PP Mufsil, S Rajendran
DOI:10.4103/jpgm.jpgm_433_22  PMID:36537397
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LETTERS Top

Competency-based medical education and the McNamara fallacy: Assessing the important or making the assessed important? p. 122
A Indrayan
DOI:10.4103/jpgm.jpgm_828_22  PMID:36930544
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Reply to Letter to Editor regarding the article, “Competency-based medical education and the McNamara fallacy: Assessing the important or making the assessed important?” p. 124
T Singh, N Shah
DOI:10.4103/jpgm.jpgm_919_22  PMID:36930545
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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