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   2015| April-June  | Volume 61 | Issue 2  
    Online since March 13, 2015
 
 
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ORIGINAL ARTICLES
Medical students and interns' knowledge about and attitude towards homosexuality
G Banwari, K Mistry, A Soni, N Parikh, H Gandhi
April-June 2015, 61(2):95-100
DOI:10.4103/0022-3859.153103  PMID:25766341
Background and Rationale: Medical professionals' attitude towards homosexuals affects health care offered to such patients with a different sexual orientation. There is absence of literature that explores the attitudes of Indian medical students or physicians towards homosexuality. Aim: This study aimed to evaluate Indian medical students and interns' knowledge about homosexuality and attitude towards homosexuals. Materials and Methods: After IEC approval and written informed consent, a cross-sectional study was conducted on a purposive sample of undergraduate medical students and interns studying in one Indian medical college. The response rate was 80.5%. Only completely and validly filled responses (N = 244) were analyzed. The participants filled the Sex Education and Knowledge about Homosexuality Questionnaire (SEKHQ) and the Attitudes towards Homosexuals Questionnaire (AHQ). SEKHQ consisted of 32 statements with response chosen from 'true', 'false', or 'don't know'. AHQ consisted of 20 statements scorable on a 5-point Likert scale. Multiple linear regression was used to find the predictors of knowledge and attitude. Results: Medical students and interns had inadequate knowledge about homosexuality, although they endorsed a neutral stance insofar as their attitude towards homosexuals is concerned. Females had more positive attitudes towards homosexuals. Knowledge emerged as the most significant predictor of attitude; those having higher knowledge had more positive attitudes. Conclusion: Enhancing knowledge of medical students by incorporation of homosexuality related health issues in the curriculum could help reduce prejudice towards the sexual minority and thus impact their future clinical practice.
  23 15,655 31
Surgical checklist application and its impact on patient safety in pediatric surgery
SN Oak, NM Dave, MB Garasia, SV Parelkar
April-June 2015, 61(2):92-94
DOI:10.4103/0022-3859.150450  PMID:25766340
Background: Surgical care is an essential component of health care of children worldwide. Incidences of congenital anomalies, trauma, cancers and acquired diseases continue to rise and along with that the impact of surgical intervention on public health system also increases. It then becomes essential that the surgical teams make the procedures safe and error proof. The World Health Organization (WHO) has instituted the surgical checklist as a global initiative to improve surgical safety. Aims: To assess the acceptance, application and adherence to the WHO Safe Surgery Checklist in Pediatric Surgery Practice at a university teaching hospital. Materials and Methods: In a prospective study, spanning 2 years, the checklist was implemented for all patients who underwent operative procedures under general anesthesia. The checklist identified three phases of an operation, each corresponding to a specific period in the normal flow of work: Before the induction of anesthesia ("sign in"), before the skin incision ("time out") and before the patient leaves the operating room ("sign out"). In each phase, an anesthesiologist,-"checklist coordinator," confirmed that the anesthesia, surgery and nursing teams have completed the listed tasks before proceeding with the operation and exit. The checklist was used for 3000 consecutive patients. Results: No major perioperative errors were noted. In 54 (1.8%) patients, children had the same names and identical surgical procedure posted on the same operation list. The patient identification tag was missing in four (0.1%) patients. Mention of the side of procedures was missing in 108 (3.6%) cases. In 0.1% (3) of patients there was mix up of the mention of side of operation in the case papers and consent forms. In 78 (2.6%) patients, the consent form was not signed by parents/guardians or the side of the procedure was not quoted. Antibiotic orders were missing in five (0.2%) patients. In 12 (0.4%) cases, immobilization of the patients was suboptimal, which led to displacement of diathermy grounding pad. In 54 (1.8%) patients, the checklist was not used at all. In 76 (2.5%) patients the checklist was found to be incompletely filled. Conclusions: Our study supports the use of the checklist as an essential safety tool and reinforcement of the same. The checklist may act as a valuable prompt to focus the team, to ensure that even the simple things have been cared for.
   12 12,965 32
CASE SERIES
Hospital-acquired pneumonia due to Leclercia adecarboxylata in a neurosurgical centre
MR Prakash, R Ravikumar, N Patra, B Indiradevi
April-June 2015, 61(2):123-125
DOI:10.4103/0022-3859.153108  PMID:25766348
Leclercia adecarboxylata , a gram-negative bacillus of the Enterobacteriaceae family, is an uncommonly identified human pathogen. The organism has been reported worldwide and isolated from various environmental sources. Most human infections are polymicrobial and commonly occur in immunocompromised hosts, although nosocomial infections in immunocompetent hosts have been documented. We describe three case reports of L. adecarboxylata isolation from cases of hospital acquired pneumonia admitted to a tertiary care center for neurosurgical care.
   6 5,550 32
NARRATIVE REVIEW
Heart failure: Novel therapeutic approaches
C Patel, S Deoghare
April-June 2015, 61(2):101-108
DOI:10.4103/0022-3859.153104  PMID:25766342
Heart failure (HF) is a complex clinical syndrome that can result from any structural or functional cardiac disorders that impairs the ability of the ventricle to fill with or eject blood. Despite effective medical interventions, mortality and morbidity remain substantial. There have been significant advances in the therapy of HF in recent decades, such as the introduction of beta-blockers and antagonists of the renin-angiotensin system but still there is a major unmet need for better therapies for HF. In the present era, pathophysiology of HF has been explored. Various novel pathways, molecular sites have been identified, which contribute to the progression of the disease. By targeting these sites, newer pharmacological agents have been developed, which can play a promising role in the treatment of HF. This article focuses on recent advancements in pharmacotherapy of HF, which include agents targeting myocardial contractility, cytokines and inflammation, fibrosis and remodeling, myocardial metabolism, oxidative stress, and other newly defined pathways.
   5 7,884 30
ORIGINAL ARTICLES
Refining a socio-economic status scale for use in community-based health research in India
P Dudeja, P Bahuguna, A Singh, N Bhatnagar
April-June 2015, 61(2):77-83
DOI:10.4103/0022-3859.150442  PMID:25766337
Objective: Socio economic status is an important determinant of health and disease in population. Various scales for measuring the same exist in modern Indian society each with it's own limitations. Present study was done to abridge the existing and latest available Aggarwal Scale. Study Design: Cross Sectional Study Material and methods: All relevant information pertaining to Aggarwal et al scale was collected for 197 households and analyzed in SPSS 16. Data reduction was done using Factor Analysis (FA) under which Principal Components Analysis (PCA) was used. Results: Four components were selected based on criteria Eigen value of more than one and elbowing in scree plot. All the 22 items of Aggarwal et al were divided among these 4 components. Based on factor loadings four reduced scales were constructed. Percentage agreement of reduced scales with original scale increased as we increased the number of items in the scale. Analysis narrowed down the 22 items of Aggarwal et al scale to six items e.g. locality, education of husband/ wife, occupation of husband/ wife, family possessions, caste and monthly per capita income. These 6 items together accounted for 49% of the variation and can be taken as a surrogate measure of SES of the family. Conclusion: We have presented reduced versions of Aggarwal et al scale along with degree of agreement with the original scale. Authors propose the use of these scales to measure SES to overcome the time constraint in practicing research.
   5 12,966 38
Treatment results in advanced stage Hodgkin's lymphoma: A retrospective study
H Jain, M Sengar, R Nair, H Menon, S Laskar, T Shet, S Gujral, E Sridhar
April-June 2015, 61(2):88-91
DOI:10.4103/0022-3859.150446  PMID:25766339
Background: Hodgkin's lymphoma displays distinct epidemiological attributes in Asian population thus making it relevant to study whether there are any differences in treatment outcomes too when treated with current standard of care. Aim: To evaluate the treatment outcomes of de-novo advanced stage HL in adults. Materials and Methods: This retrospective study included de-novo advanced stage HL patients (≥15 years) registered at our center from January 2004 to December 2007. Treatment outcomes were measured in terms of response rates, overall survival (OS) and progression-free survival (PFS). Overall and PFS were calculated with Kaplan-Meier methodology and Cox-proportional hazards model was used for multivariate analysis to identify prognostic factors. Results: There were 125 patients (males 77%) who received minimum one cycle of chemotherapy with median age of 32 years (Range 15-65 years). Stage IV disease was seen in (46 patients) 37%; 75% (94 patients) patients had B symptoms. International prognostic score (IPS) ≤4 was seen in 95/112 (85%) patients. ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) chemotherapy was given to 94%. Radiation to residual/bulky sites was given to 36% (45 patients). Response data was available for 112 patients; complete response in 76%; partial response in 10 % and progressive disease in 3 patients. Nineteen deaths (progressive disease-7, toxicity-8, unrelated cause-4) were observed. At median follow-up of 28 months, estimated 5-year OS and PFS were 60% and 58%, respectively. On multivariate analysis, IPS and response to treatment were significant factors for both OS and PFS. Conclusions: The treatment outcomes in this study are comparable with the published literature with limited follow-up data.
   4 6,831 32
CASE REPORTS
Systemic lupus erythematosus presenting as acute lupus pneumonitis in a young female
B Chattopadhyay, A Chatterjee, A Maiti, NB Debnath
April-June 2015, 61(2):129-130
DOI:10.4103/0022-3859.150902  PMID:25766350
Acute lupus pneumonitis is a rare initial presentation of systemic lupus erythematosus (SLE). We report a 19-year-old female presenting with fever and recurrent hemoptysis with radiological evidence of parenchymal lung involvement with mild pleural effusion. Subsequent development of malar and discoid rash with anti-nuclear antibodies (ANA) and anti-dsDNA positivity clinched the diagnosis. Her clinical signs and symptoms resolved with a course of intravenous pulse methyl-prednisolone along with radiological resolution.
   3 7,804 32
Mycobacterium abscessus: Causing fatal endocarditis after cardiac catheterization
S Mahajan, V Mishra, J Sorabjee
April-June 2015, 61(2):131-133
DOI:10.4103/0022-3859.150898  PMID:25766351
Mycobacterium abscessus is an unusual cause of infection in immunocompetent patients. The intrinsic and acquired resistance of this organism to multiple antibiotics is a major issue in planning treatment regimens. We report a case of M. abscessus endocarditis of the native aortic valve in an immunocompetent patient following coronary angiography with a fatal outcome. The case highlights an unfortunate intervention - related nosocomial infection and the difficulties in chemotherapeutic options for this organism, particularly in the presence of renal failure.
   3 5,762 37
CASE SERIES
Painful legs and moving toes syndrome responsive to pregabalin
FH Rossi, W Liu, E Geigel, S Castaneda, EM Rossi, K Schnacky
April-June 2015, 61(2):116-119
DOI:10.4103/0022-3859.153106  PMID:25766346
Report three cases of painful legs and moving toes (PLMT) syndrome responsive to pregabalin along with a review of its literature. Three patients with PLMT syndrome improved with pregabalin. The first and third patient reported improvement in pain scores, quality of life, and quality of sleep sustained over time. The second and third patient had near complete remission of toe movements, but pregabalin was discontinued in the second patient due to aggravation of leg edema. PLMT is a rare and debilitating disorder characterized by lower limb pain and involuntary toes or feet movements. Its pathophysiology remains unknown and its therapy refractory to most drugs, except for pregabalin, as shown in this case series. PLMT is a rare and incapacitating syndrome due to the lack of an effective pain therapy. We report three patients with PLMT who favorable responded to pregabalin. We propose pregabalin be considered in the management of PLMT.
   3 8,366 33
Muckle-Wells syndrome in an Indian family associated with NLRP3 mutation
MC Abdulla, J Alungal, PN Hawkins, S Mohammed
April-June 2015, 61(2):120-122
DOI:10.4103/0022-3859.153107  PMID:25766347
Muckle - Wells syndrome (MWS) is a rare autosomal dominant disease that belongs to a group of hereditary periodic fever syndromes. It is part of the wider spectrum of the cryopyrin-associated periodic syndrome (CAPS) which has only rarely been described in non-Caucasian individuals. It is characterized by recurrent self-limiting episodes of fever, urticaria, arthralgia, myalgia and conjunctivitis from childhood. Progressive sensorineural hearing loss and amyloidosis are two late complications. MWS is caused by gain of function mutations in the NLRP3 gene, which encodes cryopyrin, a protein involved in regulating the production of proinflammatory cytokines. We report two patients with MWS in an Indian family associated with the p.D303N mutation in the NLRP3 gene. These findings promote awareness of these hereditary periodic fever syndromes as a cause for recurrent fevers from childhood in the Indian population.
   3 8,020 27
LETTERS
Nasal conidiobolomycosis: A successful treatment option for localized disease
LM Cherian, L Varghese, BS Panchatcharam, HV Parmar, GM Varghese
April-June 2015, 61(2):143-144
DOI:10.4103/0022-3859.153112  PMID:25766357		   3 4,882 35
CASE SERIES
Hemophagocytic lymphohistiocytosis secondary to infections: A tropical experience!
P Kodan, M Chakrapani, M Shetty, R Pavan, P Bhat
April-June 2015, 61(2):112-115
DOI:10.4103/0022-3859.150904  PMID:25766345
Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal hyper inflammatory condition, if not recognized and treated in time. A high index of suspicion can help identify the condition early. This condition can occur in the primary or secondary form. Secondary HLH or hemophagocytic syndrome (HPS) secondary to infections is an important clinical entity especially in tropical world. In this article, we share our experience with this entity and make an attempt to explore literature about ravenous macrophages which occurs secondary to infections. It is a series of six cases of HLH secondary to infectious disease in our center in a coastal city in South India over last one year with follow up.
   2 9,684 29
CASE SNIPPETS
Development of chronic myelogenous leukemia in a case of chronic lymphocytic leukemia with Tp53 gene deletion
A Gupta, M Parihar, AK Yadav, A Chakrapani
April-June 2015, 61(2):137-138
DOI:10.4103/0022-3859.150907  PMID:25766353		   2 4,712 25
LETTERS
The peculiar case of a blue man
A Biswas
April-June 2015, 61(2):140-141
DOI:10.4103/0022-3859.153110  PMID:25766355		   2 5,126 34
ADVERSE DRUG REACTION REPORT
A case of probable bemiparin-induced HIT type II managed with low-dose fondaparinux
T Koufakis, K Tsapakidis, A Margaritis, I Gabranis
April-June 2015, 61(2):109-109
DOI:10.4103/0022-3859.150451  PMID:25766343		   1 4,780 50
Iatrogenic nocturnal eneuresis- an overlooked side effect of anti histamines?
D Italiano, F Italiano, C Genovese, RS Calabro
April-June 2015, 61(2):110-111
DOI:10.4103/0022-3859.153105  PMID:25766344
Nocturnal enuresis is a common disorder in childhood, but its pathophysiological mechanisms have not been fully elucidated. Iatrogenic nocturnal enuresis has been described following treatment with several psychotropic medications. Herein, we describe a 6-year-old child who experienced nocturnal enuresis during treatment with the antihistamine cetirizine. Drug rechallenge was positive. Several neurotransmitters are implicated in the pathogenesis of nocturnal enuresis, including noradrenaline, serotonin and dopamine. Antihistamine treatment may provoke functional imbalance of these pathways resulting in incontinence.
   1 5,886 35
CASE REPORTS
A case of intestinal MALToma with co-existent tuberculosis and Peutz-Jeghers polyp
AP Srinivasan, BO Parijatham, H Ganapathy
April-June 2015, 61(2):134-136
DOI:10.4103/0022-3859.150900  PMID:25766352
A 22-year-old male patient underwent a segmental resection of the ileum due to clinical symptoms of bowel obstruction and radiological evidence of ileal wall thickening and enlarged mesenteric nodes. Histopathological examination of the resected specimen revealed an extranodal marginal zone B-cell lymphoma(MALToma) of the intestine and tuberculous lesions along with a solitary Peutz-Jeghers polyp. The case is presented for its rarity and to stress upon the clinical and radiological challenges that arise when lymphomas and tuberculous lesions co-exist at the same site.
   1 4,773 26
Primary renal primitive neuroectodermal tumor: A rare presentation
V Goel, V Talwar, C Dodagoudar, S Singh, A Sharma, N Patnaik
April-June 2015, 61(2):126-128
DOI:10.4103/0022-3859.150897  PMID:25766349
Primitive Neuroectodermal Tumor of the kidney is a rare entity. Very few cases of primary renal PNET have been reported to date. Most literature about rPNET is isolated case reports. We report a case of rPNET in a 39-year-old male with a pre-operative diagnosis of renal cell carcinoma with renal vein thrombosis. The patient underwent radical nephrectomy with thrombolectomy, and histopathological examination revealed a highly aggressive tumor composed of monotonous sheets of round cells. Tumor cells were positive for CD 99 and FLI-1, hence confirming the diagnosis of Primitive Neuroectodermal Tumor. Post-surgery, patient was given VAC/IE-based adjuvant chemotherapy. In view of highly aggressive nature of this tumor, prompt diagnosis and imparting effective chemotherapy regimen to the patient is required, and it is important to differentiate PNET from other small round-cell tumors because of different therapeutic approach.
   1 5,513 28
CASE SNIPPETS
Nodular granular muscle degeneration of the appendix and obesity
A Handra-Luca
April-June 2015, 61(2):138-139
DOI:10.4103/0022-3859.153109  PMID:25766354		   1 4,728 26
LETTERS
A novel option for treatment of primary axillary hyperhidrosis: Fractionated microneedle radiofrequency
F Fatemi Naeini, M Pourazizi, B Abtahi-Naeini, MA Nilforoushzadeh, J Najafian
April-June 2015, 61(2):141-143
DOI:10.4103/0022-3859.153111  PMID:25766356		   1 5,870 23
Longitudinal extensive transverse myelitis due to tuberculosis: A report of four cases
S Ekinci, F Akyildiz, S Sari, S Akpancar
April-June 2015, 61(2):145-146
DOI:10.4103/0022-3859.153116  PMID:25766360		   1 4,860 23
ORIGINAL ARTICLES
An audit of histopathology reports of carcinoma endometrium: Experience from a tertiary referral center
KK Deodhar, B Rekhi, S Menon, B Ganesh
April-June 2015, 61(2):84-87
DOI:10.4103/0022-3859.150444  PMID:25766338
Background: The aim was to see, compliance to minimum data information in carcinoma endometrium reports, in a team of 13 pathologists, and also to analyze these parameters e.g. tumor size, type, grade, depth of myometrial invasion, lymph node yield, pTNM stage etc. Materials and Methods: During the period of 2008-2010, from the files of Pathology department of our hospital, reports of 114 cases of carcinoma endometrium, who were operated in house, were analyzed. Results: The median age was 58.04 years and median tumor size was 4 cm. Endometrioid adenocarcinoma was the most common type (82.5%), followed by malignant mixed Mullerian tumor (MMMT) (6.1%) and Serous carcinoma (3.5%). Grade 2 was the commonest tumor grade (42.1%). Less than half of myometrial invasion was seen in 50% of the cases and more than half of the myometrial invasion was seen in 46.5% of cases. (Information was not available in four cases). Parametrial involvement was seen in 5.3% cases. The pTNM stage was not mentioned in 71.9% reports. The median lymph node yield was 15. Conclusion: The compliance to adhere to and to provide minimum data information in carcinoma endometrium reports is generally good. Lymph node yield is reasonable. Mentioning of pTNM staging is to be done more meticulously. Use of proformas/checklists is recommended.
   1 5,490 33
BOOK REVIEW
Celldom appreciated: A journey through the wonders of the realms of the cell
B Desai
April-June 2015, 61(2):150-150		   - 3,715 24
EDITORIAL
Improving peri-operative patient care: The surgical safety checklist
P Ranganathan, NJ Gogtay
April-June 2015, 61(2):73-74
DOI:10.4103/0022-3859.153101  PMID:25766335		   - 6,592 31
GUEST EDITORIAL
Managing advanced stage Hodgkin lymphoma
TK Saikia
April-June 2015, 61(2):75-76
DOI:10.4103/0022-3859.153102  PMID:25766336		   - 4,968 27
LETTERS
Authors' reply
SK Sahu, S Giri, N Gupta
April-June 2015, 61(2):146-146		   - 3,412 23
Relatives' experiences in acute care settings: Barriers and remedial measures
S Senthilkumaran, F Benita, R Manikam, P Thirumalaikolundusubramanian
April-June 2015, 61(2):146-147
DOI:10.4103/0022-3859.153122  PMID:25766361		   - 4,562 27
Authors' reply
A Bhalla, V Suri, P Kaur, S Kaur
April-June 2015, 61(2):147-148		   - 3,394 30
Establishing correlation between genetics and nonresponse
SK Raina
April-June 2015, 61(2):148-148
DOI:10.4103/0022-3859.153130  PMID:25766362		   - 4,523 28
Authors' reply
S Gupta, RK Goel, BK Agrawal, I Chattopadhyaya, PK Sehajpal
April-June 2015, 61(2):149-149		   - 3,372 24
Comment on the article "Outcome of surgically treated octogenarians with breast cancer"
AK Belli, G Memis, O Dere, O Nazli
April-June 2015, 61(2):144-144
DOI:10.4103/0022-3859.153113  PMID:25766358		   - 4,185 26
Offender: Virus or parasite or both
P Chhabra
April-June 2015, 61(2):145-145
DOI:10.4103/0022-3859.153114  PMID:25766359		   - 4,451 24
Authors' reply
N Dominguez-Pinilla, M Baro-Fernandez, LI Gonzalez-Granado
April-June 2015, 61(2):145-145		   - 3,402 23
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