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   2014| April-June  | Volume 60 | Issue 2  
    Online since May 13, 2014
 
 
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EDUCATION FORUM
Understanding your student: Using the VARK model
IJ Prithishkumar, SA Michael
April-June 2014, 60(2):183-186
DOI:10.4103/0022-3859.132337  PMID:24823519
Background: Students have different preferences in the assimilation and processing of information. The VARK learning style model introduced by Fleming includes a questionnaire that identifies a person's sensory modality preference in learning. This model classifies students into four different learning modes; visual (V), aural (A), read/write (R), and kinesthetic (K). Materials and Methods: The 16-point multiple choice VARK questionnaire version 7.1 was distributed to first year undergraduate medical students after obtaining permission for use.Results: Seventy-nine students (86.8%) were multimodal in their learning preference, and 12 students (13.8%) were unimodal. The highest unimodal preference was K-7.7%. Surprisingly, there were no visual unimodal learners. The commonest learning preference was the bimodal category, of which the highest percentage was seen in the AK (33%) and AR (16.5%) category. The most common trimodal preference was ARK (8.9%). The total individual scores in each category were V-371, A-588, R/W-432, and K-581; auditory and kinesthetic being the highest preference. Visual mode had the lowest overall score. There was no significant difference in preference between the sexes. Conclusion: Students possess a wide diversity in learning preferences. This necessitates teachers to effectively deliver according to the needs of the student. Multiple modalities of information presentation are necessary to keep the attention and motivation of our students requiring a shift from the traditional large-group teacher-centric lecture method to an interactive, student-centric multimodal approach.
   104,173 66 33
ORIGINAL ARTICLES
Reference values for peak expiratory flow in Indian adult population using a European Union scale peak flow meter
RR Kodgule, V Singh, R Dhar, BG Saicharan, SJ Madas, JA Gogtay, SS Salvi, PA Koul
April-June 2014, 60(2):123-129
DOI:10.4103/0022-3859.132311  PMID:24823509
Background: Reference values of peak expiratory flow (PEF) in Indian adults have to date been derived locally, using an old (Wright) scale peak flow meter. There are thus no reliable reference values for PEF for Indians and this formed the aim of the study. Materials and Methods: A European Union (EU) scale peak flow meter (PFM) was used for the study. A respiratory health and demographic questionnaire was administered to 1000 male and female adults from randomly selected locations in the country in this multi centric study. The locations represented different geographic, ethnic, and socioeconomic backgrounds. Patients were stratified according to height and age. The PEF values were measured using the Breathometer™ (Cipla Ltd., India) with EU scale. Reference equations were derived from multiple regression analysis. Results: A total of 3608 participants were excluded. In 80% of the remaining 6138 healthy adults (M: 3720; F: 2418), the predicted regression equations were derived. Gender, age, and height were the significant determinants of PEF. The equations in L/minute are: Females: PEF = -1.454 (Age) + 2.368 (Height) Males: PEF = -1.807 (Age) + 3.206 (Height). The derived equation was validated by comparing the predicted PEF values with the measured values in the remaining sample of 20% (Mean ΔPEF: M = 1.85 L/minute, CI = -2.76, 6.47; F = 1.64, CI = -2.89, 6.18). An Indian adult with average height and age was found to have approximately 30% lower PEF compared to the corresponding European adult using the Nunn and Gregg equation. Conclusion: We derived reference values of PEF for Indian adults using a validated EU scale peak flow meter.
   19,355 41 7
NARRATIVE REVIEWS
Media and mental illness: Relevance to India
SK Padhy, S Khatana, S Sarkar
April-June 2014, 60(2):163-170
PMID:24823515
Media has a complex interrelationship with mental illnesses. This narrative review takes a look at the various ways in which media and mental illnesses interact. Relevant scientific literature and electronic databases were searched, including Pubmed and GoogleScholar, to identify studies, viewpoints and recommendations using keywords related to media and mental illnesses. This review discusses both the positive and the negative portrayals of mental illnesses through the media. The portrayal of mental health professionals and psychiatric treatment is also discussed. The theories explaining the relationship of how media influences the attitudes and behavior are discussed. Media has also been suggested to be a risk factor for the genesis or exacerbation of mental illnesses like eating disorders and substance use disorders. The potential use of media to understand the psychopathology and plight of those with psychiatric disorders is referred to. The manner in which media can be used as a tool for change to reduce the stigma surrounding mental illnesses is explored.
   18,832 29 -
LETTERS
Spider bite from South India
KAM Jegaraj, RS Saurabh, PS Rakesh
April-June 2014, 60(2):216-217
DOI:10.4103/0022-3859.132377  PMID:24823536		   18,547 29 1
EDITORIAL
Impact of the mid-day meal scheme in India
S Karande, NJ Gogtay
April-June 2014, 60(2):113-115
DOI:10.4103/0022-3859.132302  PMID:24823506		   13,018 123 -
BRIEF REPORT
Intended intramuscular gluteal injections: Are they truly intramuscular?
L Dayananda, VV Belaval, A Raina, R Chandana
April-June 2014, 60(2):175-178
DOI:10.4103/0022-3859.132334  PMID:24823517
Context: In patients with obesity, intramuscular injections may be deposited subcutaneously due to an increase in gluteal fat. We aimed to use abdominal CT done in our institute for gluteal fat thickness to test our hypothesis. Materials and Methods: After IRB approval, CT scans of the abdomen and pelvis of the past 6 months were analyzed. The thickness of gluteal region subcutaneous fat was measured in a standardized manner. Results: Out of 700 CT scans, studied, 476 were males and 224 were females. The average gluteal fat thickness was 2.34 cm +/- 1 cm. The average fat thickness in males was 1.98 cm +/- 0.98 cm whereas in females was 3.0 cm +/- 1.2 cm. Subcutaneous granulomas were seen in 17 cases and one injection granuloma in the intramuscular plane. Conclusion: A significant number of female patients had increased gluteal fat thickness beyond the reach of routinely used needles. The medications in these patients will thus be unintentionally injected to subcutaneous plane, possibly altering the pharmacokinetics.
   10,937 42 8
ORIGINAL ARTICLES
Comparison of nutritional status of rural and urban school students receiving midday meals in schools of Bengaluru, India: A cross sectional study
CN Shalini, NS Murthy, S Shalini, R Dinesh, NS Shivaraj, SP Suryanarayana
April-June 2014, 60(2):118-122
DOI:10.4103/0022-3859.132309  PMID:24823508
Background: The objective of the study was to assess the impact of the mid day meal program by assessing the nutritional status of school students aged 5-15 years receiving midday meals in rural schools and compare them with those in urban schools in Bengaluru, India. Materials and Methods: This cross sectional study involved a sample of 4378 students from government and aided schools. Weight and height were measured and compared with ''means'' and ''percentiles'' of expected standards as endorsed by the Indian Association of Pediatrics. Regression coefficients were also estimated to assess the rate of growth. Results: In all age groups and in both sexes, the observed mean weight and height were below the expected standards. The study findings showed that 13.8% and 13.1% of the studied students were underweight and stunted, respectively (below the third percentile for weight and height for age). A higher proportion of rural students were below the third percentile for both weight and height compared with urban students (weight: 16.3% and 11.5%; height: 17.0% and 10.0%; P < 0.05 for both weight and height). Only 2.4% and 3.1% were above 97 th percentile for weight and height. The rate of growth of height for weight showed a declining trend with increasing age in all the groups. Discussion: The authors believe that the magnitude of the burden of undernourished students as seen in this study would have been much greater in the absence of the midday meal program. Conclusion: Greater involvement of the private sector to assist the government would help augment nutrition in children and indirectly impact school performance, attendance and literacy.
   9,824 132 5
Surveying Indian gay men for coping skills and HIV testing patterns using the internet
KS Jethwani, SV Mishra, PS Jethwani, NS Sawant
April-June 2014, 60(2):130-134
DOI:10.4103/0022-3859.132315  PMID:24823510
Background: Surveying vulnerable and incarcerated populations is often challenging. Newer methods to reach and collect sensitive information in a safe, secure, and valid manner can go a long way in addressing this unmet need. Homosexual men in India live with inadequate social support, marginalization, and lack legal recognition. These make them less reachable by public health agencies, and make them more likely to continue with high-risk behaviors, and contract human immunodeficiency virus (HIV). Aims: To understand coping skills and HIV testing patterns of homosexual men versus heterosexual men. Materials and Methods: An internet based study using a secure web platform and an anonymised questionnaire. The brief COPE Inventory was used to assess coping styles. Results: A total of 124 respondents were studied. Homosexual men used negative coping skills such as behavioral disengagement and tested for HIV significantly more often than heterosexual men. Heterosexual respondents used positive coping skills more often. The most commonly used coping skill by heterosexual men was instrumental coping and by homosexual men was acceptance. Discussion: Overall, homosexual men used negative coping mechanisms, like behavioral disengagement more often. The Indian family structure and social support is probably responsible for heterosexual men's over-reliance on instrumental coping, while resulting in disengagement in homosexuals. Conclusion: The lack of legal and social recognition of homosexuality has negatively impacted lives of gay men in India. This is strongly linked to harmful psychological and public health implications for HIV prevention and mental health for homosexual men.
   7,981 32 4
Microalbuminuria: A biomarker of sepsis and efficacy of treatment in patients admitted to a medical intensive care unit of a tertiary referral center
RR Bhadade, R deSouza, MJ Harde, B Sridhar
April-June 2014, 60(2):145-150
DOI:10.4103/0022-3859.132320  PMID:24823513
Background: The outcome of sepsis is significantly affected by early institution of goal-directed therapies and hence, the search for an early marker of sepsis continues. Aims and Objectives: To observe microalbuminuria levels between patients with sepsis and those without sepsis s admitted to the medical intensive care unit (MICU) of a tertiary referral centre (primary) as also to assess the change in microalbuminuria levels in the first 24 hours as a predictor of mortality and morbidity relative to the APACHE II and SOFA scores. Materials and Methods: This was a prospective observational study where 125 patients with sepsis and 38 without were assessed. Trend of microalbuminuria was assessed from the change of ACR value within 6 hours of admission (ACR1) to the ACR value at 24 hours (ACR2) in both groups of patients. Results and Conclusion: Significantly higher levels of microalbuminuria were found among patients with sepsis as compared to those without sepsis. The levels decreased in survivors with sepsis after 24 hours, whereas they continued to remain almost at the same levels among those without sepsis. The change in microalbuminuria levels over 24 hours can be used to measure the effectiveness of therapy. Persistence of high levels or increasing trend of microalbuminuria levels over 24 hours was found to be a predictor of a poor outcome. A high level of microalbuminuria at 24 hours and increasing trend of microalbuminuria also predicted mortality better than APACHE II and SOFA scores.
   7,319 49 5
GRAND ROUND CASE
A rare case of nephrotic syndrome: 'Nailed' the diagnosis
S Agarwal, C Divecha, MS Tullu, CT Deshmukh
April-June 2014, 60(2):179-182
DOI:10.4103/0022-3859.132335  PMID:24823518
An 18-month-old female child presented to us with clinical features suggestive of nephrotic syndrome. Her physical examination and detailed family history highlighted the familial occurrence of abnormal nails, suggesting a diagnosis of the Nail-Patella syndrome. Nail-Patella syndrome is a rare cause of nephrotic syndrome in children. This case highlights the importance of a detailed history, including pedigree and a thorough examination of the patient.
   7,088 51 2
CASE SERIES
The dangerous gamble of heparinization within two weeks of nonoperative traumatic acute subdural hematoma in patients with increased stroke risk: A case series
S McClelland, SJ Mackey, SS Kim
April-June 2014, 60(2):194-197
DOI:10.4103/0022-3859.132344  PMID:24823523
Background: In traumatic acute subdural hematoma (aSDH) management, systemic anticoagulation is contraindicated, particularly during the first 2 weeks. We present two cases of patients with nonoperative aSDH whose stroke risk led to heparinization within 2 weeks of the initial hemorrhage and examine their outcomes to illustrate the risks and benefits associated with systemic anticoagulation. Materials and Methods: Two elderly males, on warfarin at baseline who developed traumatic nonoperative aSDH were heparinized within 2 weeks of aSDH onset. Results: One patient showed a decreased SDH volume on Day 19. The second patient developed sudden onset headache with fixed/dilated pupils on Day 5. In this patient, a CT scan of the brain revealed marked enlargement of the aSDH from 0.9 to 2.4 cm with midline shift of 1.5 cm, and uncal herniation that was incompatible with life. Conclusion: Heparinization within two weeks of aSDH may cause SDH enlargement resulting in rapidly fatal neurologic deterioration. Further study is needed to more definitively address this issue.
   6,950 43 3
ORIGINAL ARTICLES
Correlation between measures of hypoglycemia and glycemic improvement in sulfonylurea treated patients with type 2 diabetes in India: Results from the OBSTACLE hypoglycemia study
S Kalra, MC Deepak, P Narang, V Singh, A Maheshwari
April-June 2014, 60(2):151-155
DOI:10.4103/0022-3859.132322  PMID:24823514
Background: This study aimed to assess correlation between measures of hypoglycemia and glycemic control in patients with type 2 diabetes mellitus (T2DM) treated with sulfonylureas. Materials and Methods: T2DM patients being initiated on a sulfonylurea (SU) on background of a failing oral antihyperglycemic regimen were followed up for 12 weeks. (HbA1c) was measured at baseline and end of follow-up. Hypoglycemia was assessed using Stanford Hypoglycemia Questionnaire at week 12. Results: Of the total 1069 patients enrolled, 950 were considered evaluable. A weak negative correlation was observed between end of follow-up HbA1c values and hypoglycemia score, using both linear regression analysis (correlation coefficient -0.12; P = 0.0002) and negative binomial regression (β slope -0.09; P = 0.0010). A similar correlation was also observed between change in HbA1c from baseline and hypoglycemia score (β slope -0.07; P = 0.0048). Mean HbA1c reduction was lowest (0.65 ± 2.27%) in patients not reporting any hypoglycemia and highest (1.28 ± 2.40%) in patients with hypoglycemia score greater than median of 2 (P = 0.0031). There was no correlation between hypoglycemia frequency and end of follow-up HbA1c values (P = 0.4111). Conclusion: With addition of SU on a background of a failing oral anti-hyperglycemic regimen, the extent of glycemic control correlates directly with measures of patient reported hypoglycemia.
   6,444 46 4
ADR REPORTS
Cardiovascular abnormalities with single dose of tapentadol
A Vachhani, M Barvaliya, V Naik, CB Tripathi
April-June 2014, 60(2):189-191
DOI:10.4103/0022-3859.132341  PMID:24823521
This case represents the development of dizziness, palpitation, tightness in chest, flushing, and tremor on consumption of a single dose of tapentadol (100 mg) for acute lower back pain. The patient was admitted in the intensive cardiac care unit for continuous monitoring. At admission, electrocardiogram showed tachycardia (140/min) along with ST segment elevation in second chest lead (V 2 ). The patient was monitored and advised not to take further doses of tapentadol. He was discharged after 36 hours of admission. Tapentadol should be used cautiously in patients with cardiovascular diseases and receiving sympathomimetic drugs.
   6,426 61 2
LETTERS
Methemoglobinemia and bedside diagnostic test: Ready for prime time
S Senthilkumaran, N Balamurugan, C Ananth, P Thirumalaikolundusubramanian
April-June 2014, 60(2):213-214
DOI:10.4103/0022-3859.132374  PMID:24823534		   6,427 32 2
ADR REPORTS
Vemurafenib-induced bilateral facial palsy
FNU Shailesh, M Singh, U Tiwari, LF Hutchins
April-June 2014, 60(2):187-188
DOI:10.4103/0022-3859.132339  PMID:24823520
The United States Food and Drug Administration (FDA) approved Vemurafenib in August 2011, for treatment of melanoma with BRAF V600 mutation. It has shown improvement in the median overall survival of melanoma patients. The most common adverse effects of vermurafenib are arthralgia, rash, alopecia, photosensitivity and fatigue. Other infrequent and severe adverse reactions reported in patients include keratocanthomas, hypersensitivity, Stevens Johnson Syndrome, toxic epidermal necrolysis, uveitis, QT prolongation, and hepatotoxicity. We hereby present a case of bilateral facial palsy as an adverse effect of vemurafenib therapy, seen after six weeks of commencement of the drug. Complete resolution of the symptoms was seen when the patient was taken off vemurafenib.
   6,259 51 7
ORIGINAL ARTICLES
Is Cystatin-C superior to creatinine in the early diagnosis of contrast-induced nephropathy?: A potential new biomarker for an old complication
AE Ebru, A Kilic, FS Korkmaz, R Seker, H Sasmaz, S Demirtas, Z Biyikli
April-June 2014, 60(2):135-140
DOI:10.4103/0022-3859.132317  PMID:24823511
Background/Aims: The aim of this study was to assess whether changes in Cystatin C (CyC) after 48 h post contrast media exposure was a reliable indicator of acute kidney injury and the validity of a risk scoring tool for contrast-induced acute kidney injury (CI-AKI). Materials and Methods: We enrolled 121 patients for whom diagnostic coronary angiography were planned. The risk score for CI-AKI was calculated and serum creatinine (sCr) and CyC were measured before and 48 h post coronary angiography. CyC and sCr based AKI was calculated as a 25% increase from baseline within 48 h from contrast media exposure. Results: Mean serum CyC and creatinine concentrations were 0.88 ± 0.27 mg/dL and 0.79 ± 0.22 mg/dL, respectively before the procedure and 1.07 ± 0.47 mg/dL and 0.89 ± 0.36 mg/dL, respectively 48 h after contrast media exposure (P < 0.001). CyC based AKI occured in 45 patients (37.19 %) and sCr based AKI occured in 20 patients (16.52%) after the procedure. Mean risk score was found to be 4.00 ± 3.478 and 3.60 ± 4.122 for CyC based AKI and sCr based AKI, respectively and was significantly increased in CyC based AKI group (P < 0.001). Conclusions: CyC measured 48 h after contrast media exposure may be a more sensitive indicator of CI-AKI relative to creatinine and Mehran risk scoring is in good correlation with CyC increase.
   6,101 56 4
LETTERS
Performing multi stage random sampling in community based surveys
SK Raina
April-June 2014, 60(2):221-222
DOI:10.4103/0022-3859.132385  PMID:24823540		   5,806 25 2
ORIGINAL ARTICLES
IL-21 and other serum proinflammatory cytokine levels in patients with multiple myeloma at diagnosis
O Mehtap, EB Atesoglu, P Tarkun, A Hacihanefioglu, I Dolasik, MM Musul
April-June 2014, 60(2):141-144
DOI:10.4103/0022-3859.132319  PMID:24823512
Background: IL-6, IL1-β, TNF-α and IL-21 have been identified in the growth, progression and dissemination of multiple myeloma. To dte, there is no published data about serum levels of IL-21 in patients with multiple myeloma. In the present study we have investigated circulating levels of cytokines, such as IL-6, IL-1β, TNF-α, IL-21 and the association of these levels with the disease stage in newly diagnosed multiple myeloma patients. Materials and Methods: Twenty healthy controls and 44 newly diagnosed multiple myeloma patients were evaluated. Patients were classified according to Durie-Salmon criteria, international staging system (ISS) and bone disease. Quantification of cytokine levels in serum were performed by using ELISA. Results: The levels of cytokines in patients' serum are found elevated than healthy controls. However, only the serum levels of IL-1β and TNF-α were found statistically significant. TNF-α levels of patients with ISS stage 3 were significantly higher than patients with ISS stage 1 and 2 (P 0.000). IL-1β was significantly elevated in advanced stage patients (stage II-III) (P 0.040). There was no correlation between IL-1β, TNF-α, IL-21 levels and bone lesions. IL-6 levels were significantly elevated who have at least three visible lytic bone lesions and/or bone fracture in comparison to patients who have one or two visible or no visible lytic bone lesions (P 0.048). Conclusion: It appears that there is no association of serum IL-21 level with multiple myeloma in contrast to the other cytokines such as IL-6, IL-1β, TNF-α.
   5,623 49 8
LETTERS
A rare microscopic finding in an early abortion specimen
MY Leong, M Gudi, TE Chang, C Kwan
April-June 2014, 60(2):214-216
DOI:10.4103/0022-3859.132375  PMID:24823535		   5,600 27 -
CASE REPORTS
Acute infectious purpura fulminans due to probable spotted fever
A Kundavaram, NR Francis, AP J Jude, GN Varghese
April-June 2014, 60(2):198-199
DOI:10.4103/0022-3859.132345  PMID:24823524
Purpura fulminans (PF) is associated with several infections, most notably with meningococcus, staphylococcus, and streptococcus infections. However, there are few reports of association of this entity with spotted fever from India. We report the case of a 55-year-old man who presented with fever, headache, and myalgia. On the seventh day of fever he developed nonblanching purple hemorrhagic purpura on the trunk and most prominently on the extremities consistent with purpura fulminans. Immunofluorescent assay confirmed the diagnosis of spotted fever. PF though common with rocky mountain spotted fever (RMSF) is rarely seen in association with Indian tick typhus, the usual cause of spotted fever in India.
   5,459 39 7
GUEST EDITORIAL
Homosexuality and its discontents
D Bhugra, V Vahia
April-June 2014, 60(2):116-117
DOI:10.4103/0022-3859.132303  PMID:24823507		   5,375 119 -
IMAGES IN MEDICINE
Pedal edema in a female of RS3PE
K Hattori, T Konoshita, S Wakahara, I Miyamori
April-June 2014, 60(2):211-211
DOI:10.4103/0022-3859.132369  PMID:24823531		   5,062 48 -
Verrucous carcinoma of the larynx presenting as a hairy lesion
S Triaridis, A Christoforidou, T Zarampoukas, V Vital
April-June 2014, 60(2):209-210
DOI:10.4103/0022-3859.132356  PMID:24823530		   5,013 39 2
NARRATIVE REVIEWS
Medical simulation: A virtual world at your doorstep
SN Oak
April-June 2014, 60(2):171-174
PMID:24823516
Medical simulation has come a long way in Western health care; however, in developing world, health education sectors have not adequately addressed its significance and role in preparing and updating heath care personnel. Validification, standardization, paucity of trainers, deficiency of a structured syllabus, and cost of equipments need to be overcome in the next decade. Despite these problems, worldwide acceptance of the concept of medical simulation is growing. It is undoubtedly the wave of future. Multidisciplinary, interprofessional, and multimodal simulation training is possible. Virtual worlds are increasing the vistas of training, making the actual health care dispensing more skilled and safe.
   4,900 37 -
CASE REPORTS
Splenogonadal fusion mimicking a testis tumor
P Sountoulides, F Neri, R Bellocci, L Schips, L Cindolo
April-June 2014, 60(2):202-204
DOI:10.4103/0022-3859.132350  PMID:24823526
The presence of ectopic splenic tissue in the scrotum is attributed to splenogonadal fusion, a rare congenital anomaly. This ectopic splenic tissue can be an incidental finding or less often present as a scrotal mass later in adult life. Given the rarity of splenogonadal fusion, especially in the adult population, this case highlights the clinical characteristics of the condition, with a special focus on the signs and findings that might help prevent unnecessary orchiectomy.
   4,762 32 3
LETTERS
Paracetamol in osteoarthritis: NICE guidelines or not so nice
A Kamath
April-June 2014, 60(2):212-212
DOI:10.4103/0022-3859.132370  PMID:24823532		   4,416 45 -
A novel treatment modality for extensive subcutaneous emphysema
JC Suri, A Ray, A Khanna, NS Chitte
April-June 2014, 60(2):217-218
DOI:10.4103/0022-3859.132378  PMID:24823537		   4,337 31 2
CASE SNIPPETS
Use of cognitive therapy for management of nocturnal panic
N Aslam
April-June 2014, 60(2):206-207
DOI:10.4103/0022-3859.132353  PMID:24823528		   4,224 30 -
CASE REPORTS
Increasing serum calcium levels and recent return from transplantation as clues to the tuberculous nature of refractory peritoneal dialysis peritonitis
L Rodriguez-Osorio, B Fernandez-Fernandez, C Martin-Cleary, A Ortiz
April-June 2014, 60(2):200-201
DOI:10.4103/0022-3859.132348  PMID:24823525
Peritoneal tuberculosis is an uncommon complication of peritoneal dialysis in Europe. It is more common in Asian immigrants. A delayed diagnosis is frequent and impairs patient outcomes. We present two cases of peritoneal tuberculosis with common features that may help suspect the disease early countries with a low incidence. Both patients were females (of Spanish origin) who had recently restarted peritoneal dialysis following kidney transplantation. Both developed bacterial peritonitis clinically that was refractory to conventional antibiotics, despite clearance of bacteria. Both stopped calcium-containing phosphate binders because of increasing serum calcium that in one case led to frank hypercalcemia that persisted despite low calcium dialysate. Peritoneal biopsy was the first positive test in both cases. This report emphasizes the recent return from transplantation and rising serum calcium levels as features that should alert the physician of a potential underlying tuberculous peritonitis.
   4,057 30 -
CASE SNIPPETS
Fronto-ethmoid osteoma: Addressing surgical challenges
JV Lodha, JP Dabholkar, H Dhar
April-June 2014, 60(2):207-208
DOI:10.4103/0022-3859.132355  PMID:24823529		   3,986 30 1
LETTERS
Radiation-induced intracranial osteosarcoma: A case report
RD Patel, NM Gadgil, M Khare, N Majethia
April-June 2014, 60(2):218-219
DOI:10.4103/0022-3859.132379  PMID:24823538		   3,866 36 4
Lung herniation post cardiopulmonary resuscitation
S Aggarwal, M Loehrke
April-June 2014, 60(2):212-213
DOI:10.4103/0022-3859.132371  PMID:24823533		   3,871 29 3
In defence of Girdlestone excision arthroplasty: A comment on 'Unusual way of loosened total hip arthroplasty treatment with an Austin Moore endoprosthesis'
NK Sinha, A Bhardwaj, M Poduval, BS Rao
April-June 2014, 60(2):222-223
DOI:10.4103/0022-3859.132388  PMID:24823541		   3,733 36 -
CASE SNIPPETS
Learning difficulty and pachydermoperiostosis
MP Gajre, RP Khubchandani, K Mahathi, R Mendadkar
April-June 2014, 60(2):205-206
DOI:10.4103/0022-3859.132351  PMID:24823527		   3,611 31 -
LETTERS
Risk factors for drug-induced hepatitis with first-line antituberculosis drugs in hospitalized patients of pulmonary tuberculosis
SM Pore, KB Shinde
April-June 2014, 60(2):225-226
DOI:10.4103/0022-3859.132391  PMID:24823543		   3,499 32 -
Patient trust and satisfaction: Ways to make a difference
K Walsh
April-June 2014, 60(2):220-220
DOI:10.4103/0022-3859.132381  PMID:24823539		   3,421 31 -
A comment on "Does first line antiretroviral therapy increase the prevalence of cardiovascular risk factors in Indian patients?: A cross sectional study"
SK Raina
April-June 2014, 60(2):226-226
DOI:10.4103/0022-3859.132392  PMID:24823544		   3,149 32 -
Comments on 'Risk factors for drug induced hepatitis with first-line antituberculosis drugs in hospitalized patients of pulmonary tuberculosis'
R Animesh
April-June 2014, 60(2):224-225
DOI:10.4103/0022-3859.132390  PMID:24823542		   3,146 29 -
COMMENTARIES
OBSTACLE hypoglycemia: Targeting a major hurdle in diabetes management!
RD Patell, RV Dosi
April-June 2014, 60(2):161-162		   2,940 26 -
Acute kidney injury biomarkers: Need to move from bench to bedside
TE Jamale, NK Hase
April-June 2014, 60(2):160-160		   2,897 26 -
Microalbuminuria: Nature, importance, significance, and limitations
SS Emara
April-June 2014, 60(2):158-158		   2,833 31 -
ADR REPORTS
Gastrointestinal bleeding under dabigatran
C Stöllberger, K Lindner, J Finsterer
April-June 2014, 60(2):192-193
DOI:10.4103/0022-3859.132343  PMID:24823522
Dabigatran-absorption is dependent on the intestinal P-glycoprotein (P-gp)-system, and P-gp activity is modulated by several drugs. We report an 83-old female with atrial fibrillation who developed gastrointestinal bleeding. She was under a therapy with non-steroidal anti-inflammatory drugs (NSAID) and P-gp-modulating drugs and renal function was impaired. We conclude that NSAID and P-gp-modulating drugs should be avoided in dabigatran-treated patients. If renal function deteriorates the dabigatran-dosage should be reduced or the therapy should be stopped. There is an urgent need to increase knowledge about drug interactions with dabigatran.
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COMMENTARIES
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P Enright
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M Baidya, V Gopichandran
April-June 2014, 60(2):222-222		   2,270 24 -
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April-June 2014, 60(2):223-224		   2,248 23 -
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April-June 2014, 60(2):220-221		   2,200 21 -
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