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  :: Table of Contents - Current issue
Coverpage
July-September 2020
Volume 66 | Issue 3
Page Nos. 119-178

Online since Tuesday, July 14, 2020

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EDITORIAL  

Ethics committees: Actions during pandemic and lockdown situations Highly accessed article p. 119
SB Bavdekar
DOI:10.4103/jpgm.JPGM_431_20  PMID:32675445
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EDITORIAL COMMENTARIES Top

Use and misuse of oxygen administration Highly accessed article p. 123
GA Marraro, C Spada
DOI:10.4103/jpgm.JPGM_499_20  PMID:32675446
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Send a ‘good camel’ to the tent: Health system responsiveness to advance universal health coverage Highly accessed article p. 125
C Lahariya
DOI:10.4103/jpgm.JPGM_600_20  PMID:32675447
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ORIGINAL ARTICLES Top

Impact of oxygen therapy algorithm on oxygen usage in the emergency department p. 128
KP Abhilash, H Acharya, J Dua, S Kumar, B Selvaraj, G Priya
DOI:10.4103/jpgm.JPGM_637_19  PMID:32675448
Background: Although oxygen is one of the oldest drugs available, it is still one of the most inappropriately administered drugs leading to over utilization of this very expensive resource. Materials and Methods: This prospective observational study was done in a large emergency department (ED) in India. The pattern of oxygen usage was studied before and after the strict implementation of an oxygen treatment algorithm. The algorithm was taught to all doctors and nurses and its implementation was monitored regularly. The main outcome measures were proportion of patients receiving oxygen therapy, inappropriate usage, and avoidable direct medical cost to the patient. Results: The 3-week pre-protocol observation phase in April 2016 included 3769 patients and the 3-week post-protocol observation phase in April 2017 included 4608 patients. The baseline demographic pattern was similar in both the pre-protocol and post-protocol groups. After the strict implementation of the algorithm, the number of patients receiving oxygen therapy decreased from 9.63% to 4.82%, a relative decrease of 51.4%. The average amount of total oxygen used decreased from 55.4 liters per person in pre-protocol group to 42.1 liters per person in the post-protocol group with a mean difference of 13.28 (95% CI 5.30-21.26; P = 0.001). Inappropriate oxygen usage decreased from 37.2% to 8.6%. There was a significant decrease in inappropriate oxygen use for indications like low sensorium (60.8% vs 21.7%) and trauma (88.5% vs 15.8%). The mortality rate in the pre-protocol phase was 2.7% as compared with 3.2% in the post-protocol phase. The total duration of inappropriate oxygen usage significantly decreased from 987 h to 89 h over the 21-day study period. Conclusion: The implementation of an oxygen therapy algorithm significantly reduces inappropriate oxygen use and decreases treatment cost to the patient with no additional mortality risk.
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Respectful maternity care during childbirth in India: A systematic review and meta-analysis p. 133
H Ansari, R Yeravdekar
DOI:10.4103/jpgm.JPGM_648_19  PMID:32675449
Background: Respectful maternity care is a rightful expectation of women. However, disrespectful maternity care is prevalent in various settings. Therefore, a systematic review and meta-analysis were conducted to identify various forms of ill-treatment, determinants, and pooled prevalence of disrespectful maternity care in India. Methods: A systematic review was performed in various databases. After quality assessment, seven studies were included. Pooled prevalence was estimated using the inverse variance method and the random-effects model using Review Manager Software. Results: Individual study prevalence ranged from 20.9% to 100%. The overall pooled prevalence of disrespectful maternity care was 71.31% (95% CI 39.84–102.78). Pooled prevalence in community-based studies was 77.32% (95% CI 56.71–97.93), which was higher as compared to studies conducted in health facilities, this being 65.38% (95% CI 15.76–115.01). The highest reported form of ill-treatment was non-consent (49.84%), verbal abuse (25.75%) followed by threats (23.25%), physical abuse (16.96%), and discrimination (14.79%). Besides, other factors identified included lack of dignity, delivery by unqualified personnel, lack of privacy, demand for informal payments, and lack of basic infrastructure, hygiene, and sanitation. The determinants identified for disrespect and abuse were sociocultural factors including age, socioeconomic status, caste, parity, women autonomy, empowerment, comorbidities, and environmental factors including infrastructural issues, overcrowding, ill-equipped health facilities, supply constraints, and healthcare access. Conclusion: The high prevalence of disrespectful maternity care indicates an urgent need to improve maternity care in India by making it more respectful, dignified, and women-centered. Interventions, policies, and programs should be implemented that will protect the fundamental rights of women.
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Willingness to quit tobacco and its correlates among Indian tobacco users—Findings from the Global Adult Tobacco Survey India, 2016–17 p. 141
SS Kar, P Sivanantham, T Rehman, P Chinnakali, S Thiagarajan
DOI:10.4103/jpgm.JPGM_408_19  PMID:32675450
Background: Willingness to quit in a tobacco user forms the basis for future quit attempts and quitting successfully. Objective: To determine the prevalence and correlates of willingness to quit among tobacco users in India using the Global Adult Tobacco Survey (GATS), India, 2016–2017. Methods: GATS, 2016–17 was a multistage geographically clustered sample survey done among 74,037 individuals aged 15 years and above across all the states and two of the Union Territories of India. Data of all those reported using any form of tobacco were studied for past attempts to quit tobacco, advised to quit by a health care provider, and exposure to anti-tobacco messages delivered through various media and the correlation of these with the willingness to quit using multivariate analysis. Results: Of the 21,085 current tobacco users in the survey, 11,679 (52.2%), were willing to quit all forms of tobacco. Multivariate analysis showed that those in younger age groups (OR: 1.39 [1.23–1.56]), higher education levels (OR 1.15 [1.05–1.18]), time of first tobacco use in the day being more than 60 min after waking up in the morning (OR 1.11 [1.03–1.2]), history of attempts to quit in the past 12 months (OR 1.78 [1.69–1.87]), those advised to quit by health care provider in the past 12 months (OR 1.11 [1.06–1.17]), those using single form of tobacco (OR 1.1 [1.05–1.17]), those exposed to anti-tobacco messages in newspapers/magazines (OR 1.1 [1.05–1.17]), and cinemas (1.14 [1.08–1.20]) were more willing to quit compared to their counterparts. Conclusion: Enhanced publicizing of anti-tobacco messages through the currently employed media, and ensuring that doctors give a brief advice to quit during any contact with a tobacco user could improve the willingness to quit and the consequent quit rate, especially among those tobacco users who are in younger age groups and who have attempted to quit earlier.
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REVIEW ARTICLE Top

Workplace violence against doctors: Characteristics, risk factors, and mitigation strategies p. 149
A Kumari, T Kaur, P Ranjan, S Chopra, S Sarkar, U Baitha
DOI:10.4103/jpgm.JPGM_96_20  PMID:32675451
Workplace violence is a major occupational issue concerning doctors that has a significant impact on their physical and psychological well-being. This ultimately affects the health care services of the country. Patient-led episodes of verbal violence are more prevalent in Asian countries, especially in the emergency department, psychiatric wards, and intensive care units, mostly faced by junior doctors and residents. Some common precursors of violence against doctors are patients and their attendants' dissatisfaction and low impulse control, poor administration, miscommunication, infrastructural issues especially differences in services between private and public hospitals, and negative media portrayal of doctors. The assessment of risk factors, development and implementation of workplace violence programs, and addressing underreporting of violent episodes have been suggested as some successful organizational mitigation strategies. Recommendations on the management of workplace violence include the development of participative, gender-based, culture-based, nondiscriminatory, and systematic strategies to deal with issues related to violence. This article aims to present a comprehensive review of workplace violence against doctors, discussing the prevalence, degree of violence, predictors, impact on physical and psychological health and intervention strategies to devise practical actions against workplace violence.
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CASE SERIES Top

Pulmonary microvascular metastases in cervical carcinoma: A case series p. 155
P Vaideeswar, Y Aswani, S Damani, S Singaravel
DOI:10.4103/jpgm.JPGM_243_20  PMID:32675452
Pulmonary microvascular tumor embolism (PMTE), pulmonary tumor thrombotic microangiopathy (PTTM), and lymphangitis carcinomatosis (LC) have an intricate pathophysiology and usually occur with cancers of breast, stomach, and lung. Microvascular pulmonary metastases attributable to cervical cancer are a rarity. Clinical presentation and autopsy findings of patients with microvascular pulmonary metastases in cervical cancers were studied with a review of literature. Four patients (mean age of 55.5 years) with carcinoma cervix showed microvascular metastases. Three of whom presented with respiratory symptoms, and the fourth case was unresponsive on presentation. Each patient succumbed to their illness shortly after admission. Autopsy examination performed on each patient depicted varying combination of PMTE, PTTM, and LC, all with squamous histology. This case series highlights the rare association of carcinoma cervix with the aforementioned microvascular phenomena. Besides, it underscores the sequential mechanism of occurrence of microvascular pulmonary metastasis and the associated guarded prognosis.
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CASE REPORTS Top

Ablation of atrioventricular-nodal-reentrant- tachycardia in a patient with left-sided superior vena cava and dilated coronary sinus p. 159
SA Deshpande, AR Udyavar
DOI:10.4103/jpgm.JPGM_626_19  PMID:32567577
Atrioventricular (AV)-nodal-reentrant-tachycardia is a rare association in a patient with persistent left-sided superior vena cava and dilated coronary sinus. There are a few inherent difficulties in ablation in this condition, viz., difficulty in localization of good site for ablation and difficulty in stabilization of the ablation catheter at the designated site, making it difficult to produce transmural lesions and increasing risk of producing AV block. We hereby present a case highlighting the difficulties and possible solutions for them.
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Plus-minus lid syndrome with ataxia and severe apathy—A rare manifestation of midbrain infarct p. 162
S Sheetal, R Thomas, AS Kumar, LG Tomy
DOI:10.4103/jpgm.JPGM_709_19  PMID:32675453
Plus-minus lid syndrome is a rare manifestation of midbrain infarct, characterized by ptosis of one eye and lid retraction in the other eye. It has also been described in ocular myasthenia gravis, orbital myositis, or after lesions of the oculomotor nerve. Our patient was a 55-year-old man with hypertension and atrial fibrillation, who presented to us with acute onset left-sided ptosis and right-sided eyelid retraction. He was apathic and had right-sided ataxia. His MRI of the brain showed acute infarct involving the paramedian midbrain. To our knowledge, severe apathy and resultant executive function disorder have not been described previously in a patient having plus-minus lid syndrome with ataxia.
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Saphenous vein graft aneurysm – Unusual cause of hemoptysis: A case report and review of literature p. 165
BJ Khan, U Khanolkar, V Raj, KG Ashok
DOI:10.4103/jpgm.JPGM_187_20  PMID:32675454
Hemoptysis due to saphenous venous graft (SVG) aneurysm is an extremely rare condition and published literature has described the role of conservative management, surgical resection, and covered stent. Here, we report a successful placement of a covered stent for SVG aneurysm in a 56-year-old male who presented with hemoptysis. He was a known diabetic and had undergone a coronary artery bypass grafting 5 years ago. Computed tomography (CT) chest and fiberoptic bronchoscopy performed in another local hospital had revealed blood in the left lingula with spillover into the left lung parenchyma. Hence, he had received empirical anti-tuberculosis medication for 2 months without any improvement. He was referred to our hospital for further management of hemoptysis. Multidetector CT (MDCT) angiography of the chest covering coronaries performed at our hospital revealed SVG aneurysm that was managed with covered stent placement.
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RESEARCH LETTER Top

How often is coarctation of aorta correctly diagnosed antemortem in children with fatal illnesses? A retrospective review of medical and autopsy records p. 169
S Karande, S Kumar, P Vaideeswar
DOI:10.4103/jpgm.JPGM_125_20  PMID:32675455
This retrospective study analyzed the level of concordance between clinical and autopsy diagnosis of coarctation of aorta over 10 years. Utilizing the Goldmann classification, the concordance rate was found to be 16%. Major discrepancies (Class I and II) were found in 56% cases and minor discrepancies (Class III and IV) in 28% cases.
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CASE SNIPPETS Top

Transient focal cerebral arteriopathy of childhood following dengue fever p. 172
S Sasidharan, KS Krishnasree
DOI:10.4103/jpgm.JPGM_524_19  PMID:32675456
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Uterine artery pseudoaneurysm: A rare complication of cesarean section p. 174
S Naik, S Singh, S Mohakud, S Jena
DOI:10.4103/jpgm.JPGM_625_19  PMID:32675457
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Isolated intracardiac recurrence of diffuse large B-cell lymphoma successfully treated with rituximab and bendamustine chemotherapy regimen p. 176
CH Chang, CS Lin, CL Ho
DOI:10.4103/jpgm.JPGM_683_19  PMID:32675458
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LETTER Top

Synovial chondromatosis of ankle in a child: A rare presentation p. 178
MD Al-Mendalawi
DOI:10.4103/jpgm.JPGM_275_20  PMID:32675459
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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