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  Citation statistics : Table of Contents
   2009| July-September  | Volume 55 | Issue 3  
    Online since November 2, 2009

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MS Tullu
July-September 2009, 55(3):225-230
DOI:10.4103/0022-3859.57411  PMID:19884755
Oseltamivir, a selective neuraminidase enzyme inhibitor, has gained worldwide attention in view of Influenza A (H1N1) pandemic. It is one of the most important drugs effective against the novel influenza virus. Oseltamivir is used for the treatment of uncomplicated acute illness due to influenza infection. Early initiation of treatment with the drug provides greater clinical benefits. The drug can also be effectively used for prophylaxis. Oseltamivir is readily absorbed from the gastrointestinal tract and is converted to the active metabolite- oseltamivir carboxylate, which has a wider distribution in the body. Oseltamivir carboxylate is eliminated in the urine with a half-life of 6-10 h. The drug is generally well-tolerated and does not have many clinically significant drug interactions. Nausea and vomiting are the commonest adverse effects associated with its use. The standard adult dose for treatment is 75 mg twice a day for five days and the dose for prophylaxis is 75 mg once daily for at least seven days following contact with an infected individual. The dose needs to be adjusted in patients with renal failure but no adjustments are required in patients with hepatic impairment. Although most of the influenza virus strains are sensitive to oseltamivir, development of drug resistance may limit the clinical utility of the drug in the future.
  24 13,677 627
Inducible clindamycin resistance in Staphylococcus aureus: A study from North India
V Gupta, P Datta, H Rani, J Chander
July-September 2009, 55(3):176-179
DOI:10.4103/0022-3859.57393  PMID:19884741
Background : The resistance to antimicrobial agents among Staphylococci is an increasing problem. The resistance to macrolide can be mediated by msr A gene coding for efflux mechanism or via erm gene encoding for enzymes that confer inducible or constitutive resistance to macrolide, lincosamide and Type B streptogramin. Aim : The present study was aimed to find out the percentage of Staphylococcus aureus having inducible clindamycin resistance (iMLS B ) in our geographic area using D-test. Also, we tried to ascertain the relationship between Methicillin-resistant Staphylococcus aureus (MRSA) and inducible clindamycin resistance, association of these iMLS B isolates with community or nosocomial setting and treatment options for these iMLS B isolates. Settings and Design : A total of 200 non-duplicate Staphylococcus aureus isolates from various clinical samples from both outdoor and indoor patients were studied. Materials and Methods : Susceptibility to routine antimicrobial agents was carried out using Kirby Bauer method. Methicillin resistance was detected by oxacillin disc on Mueller Hinton agar (MHA) supplemented with 2% NaCl. D-test was performed on all erythromycin-resistant and clindamycin-sensitive Staphylococcus aureus strains to detect inducible clindamycin resistance. Results : Among 200 Staphylococcus aureus strains, 50 (25%) were found to be MRSA and 36 were D-test positive. Also, MRSA isolates showed both higher inducible resistance and constitutive resistance to clindamycin as compared to Methicillin-sensitive Staphylococcus aureus (MSSA). Out of 36 isolates of Staphylococcus aureus showing inducible clindamycin resistance, 24 were from the outpatient department and 12 were recovered from indoor patients. All isolates of Staphylococcus aureus showed 100% sensitivity to vancomycin and linezolid. Conclusions : Clindamycin is kept as a reserve drug and is usually advocated in severe MRSA infections depending upon the antimicrobial susceptibility results. We have reported a higher incidence of iMLS B from both community (66.67%) as well as hospital (33.33%) setup. Therefore clinical microbiology laboratory should report inducible clindamycin resistance routinely.
  24 7,713 265
Amikacin-induced type 5 Bartter-like syndrome with severe hypocalcemia
A Chrispal, H Boorugu, AT Prabhakar, V Moses
July-September 2009, 55(3):208-210
DOI:10.4103/0022-3859.57407  PMID:19884751
Aminoglycoside-induced renal toxicity is well known and may manifest with nonoliguric renal failure or renal tubular dysfunction. Aminoglycoside-induced renal tubular dysfunction could result in diffuse damage or manifest as a Fanconi-like syndrome, Bartter-like syndrome, or distal renal tubular acidosis. We discuss a patient who developed severe renal tubular dysfunction secondary to short-term therapy with Amikacin, resulting in refractory hypokalemia, hypocalcemia, hypomagnesemia, metabolic alkalosis, and polyuria. This constellation of biochemical abnormalities mimic Type 5 Bartter's syndrome, where there is activating mutation of the calcium sensing receptor in the thick ascending loop of Henle and the distal tubule. In this case this activation of the calcium sensing receptor was triggered by amikacin. This phenomenon has been described with gentamicin though never with amikacin. Recovery of the tubular dysfunction took 15 days following cessation of the offending drug, Amikacin.
  19 8,554 174
Effect of amitriptyline vs. physiotherapy in management of fibromyalgia syndrome: What predicts a clinical benefit?
MN Joshi, R Joshi, AP Jain
July-September 2009, 55(3):185-189
DOI:10.4103/0022-3859.57399  PMID:19884743
Context : Fibromyalgia is a chronic disabling condition, and physicians treat it using a number of different treatment modalities. It is not known if one or more of such modalities are better than the others. We compared the efficacy of physiotherapy and amitriptyline in disability reduction in patients of fibromyalgia syndrome in a rural tertiary care hospital in Central India. Design : Open-label alternate patient treatment allocation. Materials and Methods : A six-month follow-up was done to assess the benefit of amitriptyline and physiotherapy for disability reduction in patients with fibromyalgia syndrome. Primary outcome measure was improvement in fibromyalgia impact questionnaire (FIQ) score. Statistical Analysis Used : Predictors of benefit were determined using multivariate logistic regression. Results : A total of 175 outpatients were assigned to either amitriptyline (n=87) or structured physiotherapy (n=88) treatments. There was a significant but similar (P=0.82) improvement in disability in both groups. High FIQ score at baseline and low socioeconomic status scores were significant predictors of benefit. Conclusions : Therapy with amitriptyline or physiotherapy is equally effective in improving outcome in patients of fibromyalgia over a period of six months.
  18 7,901 191
Tracheal necrosis with surgical emphysema following thyroidectomy
A Chauhan, M Ganguly, N Saidha, P Gulia
July-September 2009, 55(3):193-195
DOI:10.4103/0022-3859.57401  PMID:19884745
Tracheal necrosis after thyroidectomy is an extremely rare event with only a few published reports. We present a case of a 65-year-old male who developed rapidly progressive surgical emphysema of face and upper thorax on the seventh day following total thyroidectomy. Prompt surgical exploration of neck revealed a tracheal rent at the level of the second tracheal ring. This hole was then refashioned into a formal tracheostomy. Patient had an eventful recovery. Tracheostomy was closed by the 14 th day. The complication was probably related to tracheal injury sustained due to electro-coagulation and subsequent secondary infection.
  14 5,708 105
Anxiety levels in mothers of children with specific learning disability
S Karande, N Kumbhare, M Kulkarni, N Shah
July-September 2009, 55(3):165-170
DOI:10.4103/0022-3859.57388  PMID:19884739
Background : Parents of children with specific learning disability (SpLD) undergo stress in coping with their child's condition. Aim : To measure the levels of anxiety and find out the cause of anxiety in mothers of children with SpLD at time of diagnosis. Settings and Design : Prospective rating-scale and interview-based study conducted in our clinic. Materials and Methods : One hundred mothers of children (70 boys, 30 girls) with SpLD were interviewed using the Hamilton anxiety rating scale (HAM-A) and a semi-structured questionnaire. Detailed clinical and demographic data of mothers were noted. Statistical Analysis : Chi-square test or unpaired student's t-test was applied wherever applicable. Results : The mean age of mothers was 40.14 years (±SD 4.94, range 25.07-54.0), 73% belonged to upper or upper middle socioeconomic strata of society, 67% were graduates or postgraduates, 58% were full-time home-makers, and 33% lived in joint families. Levels of anxiety were absent in 24%, mild in 75%, and moderate in 1% of mothers. Their mean total anxiety score was 5.65 (±SD 4.75, range 0-21), mean psychic anxiety score was 3.92 (±SD 3.11, range 0-13), and mean somatic anxiety score was 1.76 (±SD 2.05, range 0-10). Their common worries were related to child's poor school performance (95%), child's future (90%), child's behavior (51%), and visits to our clinic (31%). Conclusion : Most mothers of children with SpLD have already developed mild anxiety levels by the time this hidden disability is diagnosed. These anxieties should be addressed by counseling to ensure optimum rehabilitation of these children.
  14 11,140 143
Treatment of leprosy in India
VP Gautam
July-September 2009, 55(3):220-224
DOI:10.4103/0022-3859.57410  PMID:19884754
Introduction of multi-drug therapy (MDT) into the National Leprosy Eradication Program (NLEP) of India has brought a decline in both the burden of the disease and the detection of new cases in the country. Despite this success, MDT has had many problems like remarkable relapse rate, non-adherence to the MDT and the emergence of drug resistance associated with it. Moreover, there is no new MDT regimen at present, which could solve all these problems. The current situation suggests that we should look for alternative solutions in the delivery of leprosy-related services. With the introduction of Accredited Social Health Activists under the National Rural Health Mission, there is an opportunity to control some of these problems associated with MDT. Besides, District Nucleus should take initiatives and actively participate in establishment of coordination between departments of Health, Social welfare and justice, education and various non-governmental agencies working in the field of leprosy and disability in order to deliver the best of services to the persons affected by leprosy.
  12 13,107 236
Patient-based not problem-based learning: An Oslerian approach to clinical skills, looking back to move forward
AD Franklyn-Miller, EC Falvey, PR McCrory
July-September 2009, 55(3):198-203
DOI:10.4103/0022-3859.57404  PMID:19884748
Context : There have been significant changes in the past decade in both the curriculum and its delivery, in undergraduate medical education. Many of these changes have been made simultaneously, preventing clear assessment of outcome measures. The move away from a pre-clinical science grounding, to an integrated 'problem-based learning (PBL) approach' has been widespread in many countries across the world. Purpose : One effect of these changes has been the way in which clinical skills, in particular history and examination are taught. By integrating clinical scenarios earlier in the undergraduate course, clinical skills are increasingly taught in tutorials. This approach, when used in the pre-clinical setting may have shortcomings in the development of the ability to construct a differential diagnosis. There has been little evidence that PBL improves problem-solving ability and this is critical to the differential diagnostic process. The concurrent decline in anatomical teaching and understanding contributes to this difficulty. Discussion : The authors outline a model which clinicians can re-emphasize to students and juniors based on the fundamentals of clinical practice. The apprenticeship is more important than ever in the days of small group learning. The relinquishing of the traditional model of undergraduate medicine is of concern. The effects of educational reform should be examined by further research into the competencies of graduates entering higher professional training, before it is accepted that this change has been for the better.
  6 8,251 257
Antiphospholipid antibodies in young Indian patients with stroke
MN Mishra, S Rohatgi
July-September 2009, 55(3):161-164
DOI:10.4103/0022-3859.57387  PMID:19884738
Background : Stroke may be caused by antiphospholipid antibodies (APL), especially in young persons without other risk factors. Aim : The aim of this study was to determine the prevalence of two clinically significant APL-anticardiolipin antibody (ACL) and lupus anticoagulants (LA) in young patients presenting with sudden neurological deficit. Settings and Design : A case-control study performed in a large tertiary care government hospital. Materials and Methods : Ten milliliters of blood was collected from 51 consecutive young patients (age less than 45 years) diagnosed as ischemic stroke and 50 healthy age- and sex-matched controls. Statistical Analysis : Statistical analysis was done using Epi Info TM 6 software. Results : Overall, the risk factor profile was: Smoking (23.5%), positive family history (13.7%), hyperlipidemia (8%), and diabetes mellitus (3.6%). APL (LA and ACL) were present in 29.4% of the samples and in 4% of controls. The 'P' value for ACL and LA was 0.03 and 0.02 respectively, but the maximum level of ACL was 25 GPL units only. One-fourth of the patients were smokers and one-sixth had a family history of thrombosis ( P = 0.048 and 0.036, respectively). Conclusions : APL, positive family history and smoking were significantly associated with stroke in the young. We advocate screening for APL in all young patients with stroke.
  5 4,702 184
Plexiform schwannoma in schwannomatosis
SV Shinde, DK Tyagi, HV Sawant, GV Puranik
July-September 2009, 55(3):206-207
DOI:10.4103/0022-3859.57406  PMID:19884750
  4 4,112 104
Granulomas in association with neoplasm: A reaction or a different primary process?
S Chhabra, H Mohan, A Bal
July-September 2009, 55(3):234-236
DOI:10.4103/0022-3859.57398  PMID:19884761
  4 8,054 77
Granulomatous cheilitis secondary to tuberculosis in a child
M Bhattacharya, K Rajeshwari, K Sardana, P Gupta
July-September 2009, 55(3):190-192
DOI:10.4103/0022-3859.57400  PMID:19884744
Granulomatous cheilitis is a chronic granulomatous inflammation of the lips that can be secondary to various etiologies. A few infectious agents including Mycobacterium tuberculosis have been implicated in its etiology. It can be the clinical presentation of a tuberculide resulting from a hypersensitivity reaction to an underlying focus of tuberculosis such as pulmonary tuberculosis. This case report describes a child with granulomatous cheilitis with pulmonary tuberculosis, who responded to anti-tubercular treatment. This is probably the first pediatric case of this rare condition.
  3 4,449 136
Blue Peter: On a shoe string budget for laparoscopic training
I Singh, N Panesar, A Haq
July-September 2009, 55(3):233-234
DOI:10.4103/0022-3859.57396  PMID:19884759
  3 2,596 75
Treatment options for ophthalmoplegic migraine
LIG Granado, G Guillen
July-September 2009, 55(3):231-231
DOI:10.4103/0022-3859.57389  PMID:19884756
  3 5,214 104
Prevalence of RET/PTC expression in papillary thyroid carcinoma and its correlation with prognostic factors in a north Indian population
A Mishra, V Agrawal, N Krishnani, SK Mishra
July-September 2009, 55(3):171-175
DOI:10.4103/0022-3859.57390  PMID:19884740
Context : The prevalence of Rearranged during Transfection/Papillary Thyroid Carcinoma (RET/PTC) rearrangement in papillary thyroid carcinoma (PTC) varies in different geographic regions and its prognostic significance remains unclear. Aim : The aim of this study was to recognize the prevalence of RET/PTC expression in PTC from the endemically iodine-deficient region in Northern India and to correlate the expression with the clinicopathologic prognostic factors. Settings and Design : Retrospective. Archival tissue used. Materials and Methods : Immunohistochemistry was performed to look for activated RET protein expression in 50 cases of PTC. No patient had any history of prior irradiation . Statistical Analysis Used : Chi-square method, Student t test, and binary regression method. A P value of < .05 was considered significant for all the tests. Results : The prevalence of RET expression was 44%. Twenty-six (52%) cases showed RET immunoreactivity in histiocytes. Immunoreactivity was the highest in the classic variant of PTC (47.5%), followed by tumors with poorly differentiated areas (25%) and follicular variant (16.7%). RET expression was more prevalent in young patients (45.5 vs. 35.3%), females (43.3 vs. 40.0%), small tumors (33.3 vs. 26.7%), multicentric tumors (36.8 vs. 33.3%), tumors with extrathyroidal invasion (38.9 vs. 32.4%), and regional lymphadenopathy (55.2 vs. 22.2%), while it was less in cases with distant metastases (20 vs. 43.9%). There was no significant correlation of immunoreactivity with any prognostic factor. However, when the cases having immunoreactivity within histiocytes (n=26) and histiocytes + tumor tissue (n=28) were considered, then the expression was significantly more in cases with lymphadenopathy (P values=.009, in both instances). However, the exact clinical significance of RET/PTC positive histiocytes remained unexplained. Conclusions : Prevalence of RET/PTC in our study was consistent with the reported prevalence from other geographic areas. There was no significant correlation with the clinicopathologic factors. However, uniform techniques of detection and large international collaborative studies could clear the uncertainties regarding the prognostic importance of RET/PTC.
  3 4,488 121
Co-existence of viral hepatitis with malaria
SA Zaki, S Asif, D Dadge, P Shanbag
July-September 2009, 55(3):233-233
DOI:10.4103/0022-3859.57395  PMID:19884760
  2 3,089 133
Evaluation of intracranial space-occupying lesion with Tc99m-glucoheptonate brain single photon emission computed tomography in treatment-naïve patients
S Jaiswal, S Barai, Rajkumar , S Gambhir, M Ora, AK Mahapatra
July-September 2009, 55(3):180-184
DOI:10.4103/0022-3859.57397  PMID:19884742
Background : Glucoheptonate is a glucose analog with strong affinity for neoplastic brain tissues. Though extensively used as a tracer for detection of brain tumor recurrence, it's utility for characterization of intracranial lesions as neoplastic or otherwise has not been evaluated in treatment-naοve patients. Aim : The study was conducted to determine if glucoheptonate has sufficient specificity for neoplastic lesions of brain so that it can be utilized as a single photon emission computed tomography (SPECT)-tracer for differentiating neoplastic intracranial lesions from non-neoplastic ones in treatment-naοve patients. Settings and Design : A cross-sectional analysis of treatment-naοve patients with intracranial space-occupying lesion done in a tertiary care hospital. Materials and Methods : Fifty-four consecutive patients with clinical and radiological features of space-occupying lesion were included in this study. Glucoheptonate brain SPECT was performed before any definitive therapeutic intervention. Histopathological verification of diagnosis was obtained in all cases. Statistical Analysis Used : Descriptive statistics and student's 't' test. Result : Increased glucoheptonate uptake over the site of radiological lesion was noted in 41 patients and no uptake was noticed in 13 patients. Histopathology of 12 out of the 13 glucoheptonate non-avid lesions turned out to be non-neoplastic lesion; however, one lesion was reported as a Grade-2 astrocytoma. Histology from all the glucoheptonate concentrating lesions was of mitotic pathology. The sensitivity, specificity and accuracy of glucoheptonate for neoplastic lesion was 97.6%, 100% and 98.1%. Conclusions : Glucoheptonate has high degree of specificity for neoplastic tissues of brain and may be used as a tracer for SPECT study to differentiate neoplastic intracranial lesions from non-neoplastic ones.
  2 4,279 77
A 25-year-old man with progressive left-sided weakness and a mass lesion on brain imaging
T Franco, C Roque, S Khorasanizadeh, LD McCullough
July-September 2009, 55(3):214-219
DOI:10.4103/0022-3859.57409  PMID:19884753
  1 4,553 121
Silent percutaneous migration of plastic biliary stent through ileum
MA Joshi, BA Thakur, TG Dhopade, RS Kamble
July-September 2009, 55(3):196-196
DOI:10.4103/0022-3859.57402  PMID:19884746
  - 2,657 75
Auer rod-like inclusions in reactive plasmacytosis seen with acute myeloid leukemia
S Sharma, P Malhan, M Pujani, M Pujani
July-September 2009, 55(3):197-197
DOI:10.4103/0022-3859.57403  PMID:19884747
  - 3,620 88
Tripod sign
JC Suvarna, VS Keskar
July-September 2009, 55(3):211-213
DOI:10.4103/0022-3859.57408  PMID:19884752
"Tripod Sign" or "Amoss's Sign" is a sign of meningeal irritation. Although useful in diagnosing meningitis, it is not pathognomic and may be seen in a variety of clinical conditions. Infants < 1 year of age and immunocompromised individuals may not demonstrate signs of meningeal irritation. Since elicitation of the sign requires voluntary sitting up, it is of limited use in patients with marked altered sensorium and young infants.
  - 32,003 213
JPGM 2007-09: Report card
SB Bavdekar
July-September 2009, 55(3):157-158
DOI:10.4103/0022-3859.57384  PMID:19884735
  - 3,367 241
Single-photon emission computed tomography for the characterization of intracranial lesions
GA Alexiou
July-September 2009, 55(3):159-159
DOI:10.4103/0022-3859.57385  PMID:19884737
  - 3,017 134
Beneficial treatment of fibromyalgia
K Lawson
July-September 2009, 55(3):159-160
DOI:10.4103/0022-3859.57386  PMID:19884736
  - 5,508 333
Missed aortic dissection - The Class 3 lesion
P Vaideeswar, LY Patil, P Mishra
July-September 2009, 55(3):204-205
DOI:10.4103/0022-3859.57405  PMID:19884749
  - 3,132 124
Authors' reply
A Borade, AS Prabhu
July-September 2009, 55(3):231-232
  - 1,825 48
Medical education in India: From fact-based learning to effective communication
H Iyer
July-September 2009, 55(3):232-232
DOI:10.4103/0022-3859.57392  PMID:19884758
  - 2,393 90
Primary prevention of diabetic retinopathy for the rural population
V Wiwanitkit
July-September 2009, 55(3):232-233
DOI:10.4103/0022-3859.57394  PMID:19884757
  - 2,436 91
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