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   2004| October-December  | Volume 50 | Issue 4  
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Complex regional pain syndrome: A review
Babita Ghai, Gur Prasad Dureja
October-December 2004, 50(4):300-307
Complex regional pain syndrome (CRPS) is a challenging neuropathic pain state, quite difficult to comprehend and treat. Its pathophysiological mechanisms are unclear and its treatment is difficult. Multiple factors play a role in the generation and maintenance of CRPS. A close interdisciplinary collaboration amongst the psychologist, physical and occupational therapists, neurologist and pain medicine consultants is necessary to achieve optimal treatment effects. The primary goals of managing patients with this syndrome are to: 1) perform a comprehensive diagnostic evaluation, 2) be prompt and aggressive in treatment interventions, 3) assess and reassess the patient’s clinical and psychological status, 4) be consistently supportive, and 5) strive for the maximal amount of pain relief and functional improvement. This article reviews the different aspects of CRPS including definition, classification, epidemiology and natural history, clinical presentation, pathophysiology and management.
  36,353 1,833 19
Academic dishonesty in Indian medical colleges
B Gitanjali
October-December 2004, 50(4):281-284
Integrity is a necessary attribute expected in practitioners of medicine. Unfortunately there is evidence on hand that academic dishonesty is widely prevalent in many Indian medical colleges and that a proportion of students seem to think that there is nothing wrong in participating in such acts. This practice needs to be discouraged as those indulging in unethical acts during student days are likely to indulge in similar practices while dealing with their patients. It is, therefore, necessary that teachers in medical colleges show ‘zero tolerance’ to such acts. There is a need for faculty and administrators to be above board in their actions and be role models for ethical behaviour. Hence, acts of academic misconduct committed by faculty and administrators should also be dealt with quickly, fairly and firmly. A milieu of transparency, fairness and student awareness will go a long way in minimizing this pervasive malady.
  26,751 230 4
Post coital hematuria: presentation of an uncommon case
Rajeev Kumar, P Kesarwani, DN Shrivastava, AK Hemal
October-December 2004, 50(4):312-313
  26,112 171 2
Biological agents in rheumatoid arthritis
S Shankar, Rohini Handa
October-December 2004, 50(4):293-299
Rheumatoid arthritis (RA) is the commonest inflammatory joint disease with considerable morbidity and mortality. Conventional disease-modifying antirheumatic drugs like methotrexate form the cornerstone of therapy. However, they have several limitations in terms of slow onset of action, adverse effects and modest remission and retention rates. Several cytokines are involved in the pathogenesis of RA. Biological agents that specifically inhibit the effects of tumour necrosis factor-α (TNF-α) or Interleukin-1 (IL-1) represent a major advancement in the treatment of RA. By targeting molecules that are directly involved in the pathogenesis of RA, these therapies are proving to be efficacious, highly specific and better tolerated than standard therapies. The use of these agents needs to be monitored carefully for possible side-effects, including the development of infections. Additional anti-cytokine agents for the treatment of RA are under further development.
  22,916 766 22
A matched case-control study of risk factors for neonatal tetanus in Karachi, Pakistan
Syed Ahsan Raza, S Akhtar, BI Avan, H Hamza, MH Rahbar
October-December 2004, 50(4):247-251
Background: Previous studies have identified various risk factors for neonatal tetanus (NNT) in rural areas of Pakistan. The present matched case control study was conducted to further evaluate these risk factors in an urban setting. Aim: The study was carried out to identify risk factors for NNT in Karachi. Materials and Methods: Patients of NNT (n = 125) diagnosed from January 1998 to February 2001 were recruited through a surveillance system of Expanded Programme on Immunization (EPI). Two neighbourhood controls (n = 250) were matched for each case for gender and date of birth of the case. Statistical Analysis: Conditional logistic regression was performed to assess the independent effect of factors associated with NNT. Results: The final multivariable model identified subsequent application of substances on the umbilical cord (adjusted matched odds ratio [adj. mOR] = 5.1 [2.7-9.7]), home delivery (adj. mOR = 1.8; 95% CI: 1.1- 3.1) and illiterate mother (adj. mOR = 1.6; 95% CI: 1.0- 2.0) as risk factors for NNT after adjusting for other variables in the model. Population attributable risk per cent (PAR %) for subsequent cord application was 69% and PAR % for home delivery was 31%. Conclusion: Health planners, while formulating control strategies through immunization programmes should also take into account the impact of post-delivery practices, such as ‘subsequent cord application’ along with pre-delivery practices. Health awareness regarding appropriate post-delivery practices should be promoted and counselling of pregnant women for giving preference to health care setting for delivery is also crucial.
  16,121 312 12
A short biography on the life of the dedicated anatomist -Valsalva
Rehan Kazi, S Triaridis, P Rhys-Evans
October-December 2004, 50(4):314-315
  14,123 144 2
Recurrent syncopal attacks in a lady with rheumatoid arthritis
Samir Kubba, HK Bali, A Bahl, S Nand Kumar
October-December 2004, 50(4):291-292
  13,908 178 1
Assessment of left ventricular systolic and diastolic function in juvenile rheumatoid arthritis
Bishwa Bhushan B Bharti, Sudeep Kumar, Aditya Kapoor, Amita Agarwal, Ramnath Mishra, Nakul Sinha
October-December 2004, 50(4):262-267
Background and Aims: Recognizing the paucity of data regarding echocardiographic studies of Left ventricular (LV) systolic and diastolic function in patients with juvenile rheumatoid arthritis (JRA), a study was carried out to study these parameters in these subjects. Settings, Design and Methods: Thirty-five patients with JRA and an equal number of age- and sex-matched controls were studied by two-dimensional and Doppler echocardiography. Results: Patients with JRA had higher systolic and diastolic blood pressures, resting heart rates, LV systolic (26.9±4.3 vs. 22.4 ± 4.1 mm, p=0.001) and diastolic size (42.3±4.6 vs. 35.4±3.8 mm, p<0.001) and volumes. Though ejection fraction (EF) and fractional shortening (FS) were normal, they were lower in those with JRA as compared to controls (EF: 62.9±4.47 vs. 67.5±3.63 %, p<0.001; FS: 36.4±4.5 vs. 38.5 ± 6.87, p=0.2). On Doppler analysis the JRA group had lower peak E velocity, higher peak A velocity, higher A VTI and more prolonged IVRT. Male patients had higher A VTI and IVRT as compared to females. Those with longer duration of disease had larger LV systolic (r=0.517, p=0.01) and diastolic dimension (r=0.40, p=0.05) and lower FS (r=-0.506, p=0.01). Patients with polyarticular JRA had higher E and A VTI as compared to those with systemic or oligoarticular types. Conclusion: Despite an asymptomatic cardiac status, significant systolic and diastolic functional abnormalities exist in patients with JRA. The duration of the disease, mode of presentation, patient’s age and gender have a significant impact on the left ventricular systolic and diastolic functions in patients with JRA.
  12,507 219 6
Warfarin-induced necrosis of the breast: Case report
Kamran Khalid
October-December 2004, 50(4):268-269
Warfarin-induced necrosis of the breast is an unusual complication of warfarin therapy. Since its first description in 1943, up to 36 cases have been reported in the English literature. Close association between inherited or functional deficiency of protein C and S and warfarin therapy is frequently reported. A characteristic patient is an obese middle-aged female receiving anticoagulant treatment. The rapidly evolving painful lesion appears suddenly, usually within 3 to 6 days after initiation of warfarin therapy. Prevention may be achieved by identifying the high-risk patients–female gender, middle age, obesity, and avoiding large loading doses of warfarin. Early recognition and treatment are necessary to avoid significant long-term morbidity. Established necrosis necessitates debridement and sometimes mastectomy. A case of warfarin-induced necrosis of the left breast mimicking inflammatory cancer is reported. Current recommendations for the prevention and treatment of this uncommon condition are reviewed.
  12,387 220 4
Towards a dialogical ethics of interprofessionalism
Rob Irvine, I Kerridge, J McPhee
October-December 2004, 50(4):278-280
Contemporary medical practice brings a diverse range of professions and disciplines together in greater and closer contact. This situation of increasing complexity and changing professional roles gives rise to multifaceted ethical dilemmas and theoretical and practical concerns. In this essay we argue that for multidisciplinary relationships to be facilitated and to progress towards interdisciplinary teamwork, moral agents have to go beyond orthodox ethical systems and appeal to normative theory. We will argue that conceptualising ethics as a shared social practice may provide a useful starting point. This dialogic approach places greater emphasis on open deliberation and the articulation, negotiation, exploration and generation of new ethical perspectives in the here and now of clinical practice.
  12,076 228 2
Does I-131-MIBG underestimate skeletal disease burden in neuroblastoma?
Sukanta Barai, GP Bandopadhayaya, A Malhotra, S Agarwal, R Kumar, H Dhanapathi
October-December 2004, 50(4):257-261
Background: Controversy persists as to the need for both MIBG and bone scanning in routine evaluation of neuroblastoma. Aim: To compare the efficacy of I-131- metaiodobenzylguanidine (MIBG) scan against that of conventional Tc99m- methylene diphosphonate (MDP) bone scan for the detection of skeletal deposition of neuroblastoma. Methods and Material: The study included 57 patients (36 boys, 21 girls: age range 1-14 years) of neuroblastoma who underwent both bone scan with Tc99m-MDP and I-131-MIBG scan within 15 days of each other at presentation and during follow-up. Results: At presentation 11(19.2%) patients had evidence of skeletal metastases on MDP scan against 7 patients who showed bony secondaries on MIBG scan. Of the 7 patients, with positive MIBG and MDP scans, MDP scan detected 11 sites whereas MIBG scan detected 7 sites. On follow-up study, 3 patients with initial abnormal MDP scan but normal MIBG scan, developed skeletal metastases detectable on MIBG scan, whereas 3 of the 46 patients who had normal MDP and MIBG scan at presentation; developed skeletal metastases detectable on MDP scan. MIBG scan was concordant in 2 of them but was normal in the third patient. Conclusion: I-131-MIBG underestimates skeletal disease burden in neuroblastoma. Therefore, Tc99m-MDP bone scan should remain a part of routine assessment of patients with neuroblastoma.
  10,813 189 3
Pulmonary involvement in Niemann-Pick type B disease
Elkhalil Alymlahi, R Dafiri
October-December 2004, 50(4):289-290
  10,558 204 4
Carcinomatous meningitis occurring prior to a diagnosis of large cell neuroendocrine carcinoma of the uterine cervix
Sudhir Kumar, S Nair, M Alexander
October-December 2004, 50(4):311-312
  10,569 163 7
Duplication of vermiform appendix
Ankur A Kothari, KR Yagnik, VP Hathila
October-December 2004, 50(4):285-286
  10,152 208 1
The Golden Jubilee Conference: the outcome, success and opportunities
Sandeep B Bavdekar, N Gogtay
October-December 2004, 50(4):243-246
  10,127 157 4
Pneumocephalus associated with Bacteroides fragilis meningitis
Malvinder S Parmar
October-December 2004, 50(4):272-273
Gas within the intracranial cavity (pneumocephalus) commonly results from trauma or after surgery and rarely from infection by gas-forming organisms. The presence of pneumocephalus in the absence of injury or surgery should raise the suspicion of anaerobic infection of the central nervous system. I present a case of pneumocephalus associated with Bacteroides fragilis meningitis where the diagnosis was suspected after CT findings become available. Bacteroides fragilis meningitis is rare and often occurs in premature infants and neonates; only few cases are reported in adults. Pneumocephalus associated with Bacteroides fragilis meningitis is not described in the literature. This case also illustrates the absence of classic findings of meningeal irritation in the elderly. The literature is reviewed.
  9,803 223 8
Cutaneous metastasis from silent renal cell carcinoma
Preetha Rajasekharan, VS Kavishwar, P Butle
October-December 2004, 50(4):287-288
  8,882 183 6
Carcinoma prostate presenting as pleural effusion with metastatic pleural mass
Atul Gogia, PK Agarwal, Nandini Vasdev, VP Sachar
October-December 2004, 50(4):310-311
  8,723 165 -
Autosomal dominant polycystic kidney disease and pain: Radiologist’s perspective
Akshay K Saxena, A Karnatakam
October-December 2004, 50(4):308-308
  8,506 173 -
Unusual absence of neurologic symptoms in a six-year old girl with ataxia-telangiectasia
Georgios G Trimis, CK Athanassaki, MM Kanariou, AA Giannoulia-Karantana
October-December 2004, 50(4):270-271
Ataxia-telangiectasia (A-T) is a rare multisystem, neurodegenerative genetic disorder. We present a case of a 6-year-old girl who had a history of frequent respiratory infections and also had ocular and immunological features of this syndrome. The absence of neurological symptoms, which is very unusual for a patient of this age, raised many difficulties in the diagnosis of the disease. It is concluded that a normal neurological assessment must not exclude the diagnosis of A-T and delay the proper interventional measures.
  8,394 182 4
Cardiac function in juvenile rheumatoid arthritis
Monesha Gupta, P Syamasundar Rao
October-December 2004, 50(4):266-267
  7,896 141 -
New legislative regulations, problems, and future perspectives, with a particular emphasis on surgical education
George H Sakorafas, GG Tsiotos
October-December 2004, 50(4):274-277
Major changes in the residency-training systems are currently under way worldwide. New laws regulating the maximum number of work-hours per week are already enforced in the USA and are soon to be enforced in the European Union (EU); they apply to residents in training, as well as to practising specialists in the USA. These changes are expected to influence training imparted to resident doctors, quality of care given to hospitalised patients and functioning of hospitals, in general. The implications of the new regulations are likely to be magnified by the gradual decrease in the number of young people willing to take up Medicine as a career and even more so by the decrease in the number of medical graduates who choose to take up Surgery as their specialty. This communication describes the new situation that has developed (especially in general surgery) with the recent regulations and intends to suggest possible solution to the important problems that are likely to arise.
  7,748 189 7
Use of live nonhuman primates in research in Asia
J Hagelin
October-December 2004, 50(4):253-256
Background: Use of live non-human primates (NHPs) in biomedical research is a controversial issue in many parts of the world. Recent use of NHPs in research in Asian countries was surveyed. Aim: To elucidate the use of NHPs in research in Asian countries. Settings and design: The peer-reviewed literature was sampled according to the species used, area of research, research class and geographic location. Articles derived from database searches were scrutinised. Methods and Material: Studies were identified from the PrimateLit database. Results and Conclusion: Results suggested that NHP research was conducted in 16 countries, of which Japan accounted for two-thirds. About 55% of studies involved use of live animals, whereas the remaining 45% used some lower level of biological material. More than 70% of the studies using live NHPs included use of Old World monkeys. M. fuscata (18%), M. mulatta (17%) and M. fascicularis (10%) were the three most commonly used species. The most common research areas were neuroscience (44%), conservation (14%) and behaviour (11%). Due to high demand for NHPs, there is room for increased breeding of NHPs to be used for research in Asian countries.
  7,516 165 1
Colletotrichum dematium keratitis
J Joseph, M Fernandes, Savitri Sharma
October-December 2004, 50(4):309-310
  7,383 168 2
The challenges of eliminating neonatal tetanus
Joanne Katz
October-December 2004, 50(4):251-252
  5,634 156 -
Neuroblastoma: role of bone imaging
GT Krishnamurthy
October-December 2004, 50(4):260-261
  5,472 127 -
Cerebral infarction in a 17-year old boy – Is it truly primary APLA syndrome?
KK N Namboodiri, KM Krishnamoorthy, E Rajeev
October-December 2004, 50(4):309-309
  5,236 124 -
JPGM GoldCon from the eyes of a student
Prakash Shivesh, R Ujjwal
October-December 2004, 50(4):246-246
  4,805 120 -
A data base survey of primate research in Asia
Lise J Houde
October-December 2004, 50(4):256-256
  4,802 108 -
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