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   2021| July-September  | Volume 67 | Issue 3  
    Online since August 20, 2021

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Child sexual abuse in India: A wake-up call
S Tyagi, S Karande
July-September 2021, 67(3):125-129
DOI:10.4103/jpgm.JPGM_264_21  PMID:34380802
  11,615 25 2
Supraclavicular lymphadenopathy secondary to COVID-19 BNT162b2 vaccine
B Roca, M Rambla, M Manuel Roca
July-September 2021, 67(3):180-181
DOI:10.4103/jpgm.JPGM_254_21  PMID:34414929
  4,802 19 3
Association of atopic dermatitis with an increased risk of systemic lupus erythematosus: A systematic review and meta-analysis
B Ponvilawan, N Charoenngam, W Wongtrakul, P Ungprasert
July-September 2021, 67(3):139-145
DOI:10.4103/jpgm.JPGM_1270_20  PMID:34427279
Context: Previous studies on the association between atopic dermatitis (AD) and systemic lupus erythematosus (SLE) have yielded inconsistent results. Aims: To investigate the relationship between atopic dermatitis and systemic lupus erythematosus. Settings and Design: Systematic review and meta-analysis. Materials and Methods: A systematic review was conducted on EMBASE and MEDLINE databases from inception to March 2020 using a search strategy that consisted of terms related to AD and SLE. Eligible study must be either cohort or case-control study. For cohort studies, they must include patients with AD and comparators without AD, then follow them for incident SLE. For case-control studies, they must include cases with SLE and controls without SLE and examine their prior history of AD. Statistical Analysis Used: Meta-analysis of the studies was performed using a random-effect, generic inverse variance method to combine effect estimate and standard error. Funnel plot was used to assess publication bias. Results: A total of 21,486 articles were retrieved. After two rounds of review by three investigators, six case-control studies were qualified for the meta-analysis. The case-control study meta-analysis found a significantly increased odds of SLE among patients with AD with the pooled odds ratio of 1.46 (95% CI, 1.05–2.04). Conclusions: A significant association between AD and increased odds of SLE was observed by this systematic review and meta-analysis.
  4,579 19 3
Subcutaneous sarcoidosis: A case series of 19 patients
AE Lopez-Sundh, T Maestre-Orozco, MC Gonzalez-Vela, M Fernandez-Ayala
July-September 2021, 67(3):154-157
DOI:10.4103/jpgm.JPGM_1072_20  PMID:34341224
Subcutaneous sarcoidosis is a rare variant of this disease, whose relationship with systemic disease is still controversial. Our objective was to describe the clinical characteristics of a series of patients with subcutaneous sarcoidosis and to investigate the relationship between these skin lesions and the disease's activity, severity, and prognosis. Nineteen patients with biopsy-confirmed subcutaneous sarcoidosis between 2009 and 2019 were selected. Mean age at diagnosis was 53 years. Lung involvement was detected in 10 patients (52.6%), mainly in stages I and II. Only two patients (10.5%) had additional systemic signs and five patients (26%) suffered from other autoimmune diseases simultaneously. Six patients (31.6%) had elevated angiotensin-converting enzyme levels (mean level 174.5 U/L). Eight patients (42%) received treatment, mainly systemic corticosteroids, and all patients except for one had a favorable clinical outcome. Subcutaneous sarcoidosis is frequently associated with a mild form of systemic disease, and the prognosis seems favorable regardless of treatment. Sarcoid nodules could be an early finding of systemic disease, allowing for less invasive procedures for histological confirmation.
  4,310 20 6
Coexistent urothelial papilloma and ureteric calculus in an 8-year-old child: A rare co-occurrence
MA Agnihotri, PA Sathe
July-September 2021, 67(3):182-183
DOI:10.4103/jpgm.JPGM_300_20  PMID:33380592
  3,784 19 -
DRESS syndrome induced by imatinib
S Kaur, S Singh, R Singh, P Singla
July-September 2021, 67(3):158-163
DOI:10.4103/jpgm.JPGM_746_20  PMID:34427280
Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) is a severe, potentially life-threatening drug-induced hypersensitivity reaction characterized by cutaneous eruptions, fever, diffuse lymphadenopathy, along with eosinophilia and elevated liver enzymes. The severity and potential organ damage associated with DRESS mandates withdrawing the offending drug and provide a suitable replacement. We report a 55-year-old man who developed prolonged fever, generalized maculopapular rash and facial edema after 3 weeks of starting imatinib for chronic myeloid leukemia (CML). A diagnosis of DRESS was confirmed by eosinophilia and skin biopsy findings, along with a consistent RegiSCAR score. Imatinib was stopped and he was initiated on low-dose steroids, which led to complete resolution of rash and eosinophilia. A rechallenge with imatinib was positive, and he was switched to dasatinib for further therapy, following which he attained an optimal molecular response. DRESS following imatinib has only been reported in eight patients so far. In this report we summarize the current evidence for managing DRESS and its impact on the treatment of CML.
  3,670 24 -
A literature review of consent declines and consent withdrawals in randomized controlled trials conducted during the COVID-19 pandemic
NJ Gogtay, HJ Sheth, MR Maurya, MN Belhekar, UM Thatte
July-September 2021, 67(3):134-138
DOI:10.4103/jpgm.JPGM_77_21  PMID:34414930
Objectives: We evaluated the extent of consent declines and consent withdrawals during the COVID-19 pandemic as seen in published randomized controlled trials (RCTs) and compared it with non-COVID-19 RCTs published at the same time and two historical controls. Methods: PubMed/Medline only was searched using key-word “COVID-19” and “RCTs” separately, and filtered for COVID-19 RCTs and non-COVID-19 RCTs respectively, published during a nine-month period (1 Feb - 1 Nov 2020). Exclusions were study protocols, observational studies, interim analysis of RCT data and RCTs with missing data. Primary outcome measures were the proportion of consent declines and consent withdrawals as percentage of total participants screened and randomized respectively in COVID-19 RCTs. We compared consent declines and consent withdrawals of COVID-19 RCTs with non-COVID-19 RCTs and two earlier studies on the same topic that served as historical controls (non-pandemic setting). Results: The search yielded a total of 111 COVID-19 RCTs and 49 non-COVID-19 RCTs. Of these, 39 (35.13%) COVID-19 RCTs and 11 (22.45%) non-COVID-19 RCTs were finally analysed. A total of 770/17759 (4.3%) consent declines and 100/7607 (1.31%) consent withdrawals were seen in 39 COVID-19 RCTs. A significant difference was observed in consent declines between COVID-19 vs non-COVID-19 RCTs [4.3% vs 11.9%, p < 0.0001] and between COVID-19 RCTs vs two historical controls [(4.3% vs 8.6%, p < 0.0001) and (4.3% vs 21.1%, p < 0.0001), respectively]. Conclusion: RCTs conducted during the COVID-19 pandemic appear to have significantly lower consent declines relative to non-COVID-19 RCTs during pandemic and RCTs conducted in non-pandemic settings.
  3,422 19 1
Severe myocardial bridge presenting as paroxysmal atrioventricular block
CC Lin, CH Lai, WS Lin, CS Lin
July-September 2021, 67(3):171-173
DOI:10.4103/jpgm.JPGM_1027_20  PMID:33835057
Chest pain complicated with electrocardiographic changes is not an uncommon scenario in emergency departments, which should be examined cautiously. We describe a 51-years-old man with a myocardial bridge of coronary artery presenting with simultaneous Mobitz type I atrioventricular block on electrocardiography. Echocardiography excluded valvular abnormality and systolic/diastolic dysfunction. Coronary angiography confirmed the diagnosis of a myocardial bridge at the middle segment of the left anterior descending artery, involving the most dominant septal perforator branch with marked systolic compression. The patient underwent coronary artery bypass grafting surgery and was followed up uneventfully at the outpatient department with medical treatment of diltiazem and clopidogrel. The present case is being reported to highlight that clinicians should be alert to such a congenital abnormality as a potential cause of repeated myocardial infarction and conduction abnormality.
  3,406 24 4
Minimally invasive techniques as a first line approach in the management of emphysematous pyelonephritis - A single centre experience
VA Gite, V Shaw, M Agrawal, P Sankapal, M Maheshwari
July-September 2021, 67(3):146-153
DOI:10.4103/jpgm.JPGM_1315_20  PMID:34380801
Context: Emphysematous pyelonephritis (EPN) is a dangerous necrotizing infection of the kidney involving the diabetics with a high case fatality rate. Recent medical literature has shown shifting of treatment strategy from conventional radical approach to minimally invasive approach. Aims: The aim of our study was to assess the role of minimally invasive stepwise decompression techniques in the management of EPN and preservation of the renal unit. Settings and Design: This was a retrospective observational study conducted from June 2017 to April 2020 at a tertiary care centre. Material and Methods: We reviewed the hospital online records of 18 patients diagnosed with EPN for patient demographics, clinical profiles, co-morbidities, laboratory and, radiological investigations, surgical interventions performed and the outcomes. The severity of EPN was graded as per the Huang classification. Patients underwent surgical interventions as per the treatment protocol and response was assessed. Statistical Analysis Used: Descriptive statistics was applied. Results: Diabetes mellitus was present in 15 (83.3%) patients along with urinary tract obstruction in 8 (44.4%) patients. Flank pain (77.7%) was the most common presenting clinical feature while Escherichia coli (55.5%) were the most common causative organism. Most patients (50%) had Type- II EPN, all of which were managed successfully by minimally invasive procedures. In total seventeen patients (94.4%) responded well while one patient (5.5%) underwent nephrectomy with no mortality. Conclusions: Renal salvage in EPN requires multidisciplinary approach including the initial medical management followed by properly selected stepwise decompressive surgical techniques. Conservative management and decompression techniques have shown to improve patient's outcome, reducing the traditional morbidity associated with nephrectomy.
  3,312 19 3
Indocyanine green enhanced near-infrared fluorescence imaging for perfusion assessment of colonic conduit for esophageal replacement: Utility of a novel technique
R Gupta, V Madaan, S Kumar, D Govil
July-September 2021, 67(3):168-170
DOI:10.4103/jpgm.JPGM_1227_20  PMID:34414927
Esophagectomy, followed by esophageal replacement using gastric/colonic conduits, is a complex surgical procedure with significant perioperative morbidity. The most significant and potentially life-threatening complication associated with esophageal replacement is conduit ischaemia, resulting in anastomotic leak and conduit necrosis. Ensuring adequate perfusion of the conduit remains the key to preventing conduit ischaemia. Indocyanine green (ICG) enhanced near-infrared fluorescence imaging is a novel technique which has been used for assessing bowel perfusion. While numerous studies have focused on ICG fluorescence imaging for assessment of gastric conduit perfusion after esophagectomy, data regarding its use for colonic conduits is limited to case reports. ICG fluorescence imaging can help in resolving intraoperative issues by predicting the adequacy of colonic conduit perfusion, thereby preventing postoperative morbidity. To the best of our knowledge, this is the first report in Indian literature describing the utility of ICG fluorescence imaging for assessment of perfusion of colonic interposition.
  2,921 17 1
Scleredema adultorum of Buschke associated with hypothyroidism and liver cirrhosis
S Muralidharan, K Arun, V Ruckmani, B Devi
July-September 2021, 67(3):174-176
DOI:10.4103/jpgm.JPGM_1214_20  PMID:34380804
Scleredema adultorum of Buschke is a rare disorder of the connective tissue, involving the skin. Here, we present a 61-year-old male, who is a known case of compensated liver cirrhosis with a past history of being treated for autoimmune thyrotoxicosis, who presented with complaints of alopecia, skin tightening, dry skin, pruritus, and woody indurated plaques on the skin of the upper back, shoulder, and arms. Skin biopsy of the arm revealed the characteristic features of scleredema. He was extensively evaluated for known literature-cited causes of scleredema, and the work up revealed a negative result. He was also found to be hypothyroid on presentation. Hence, we present a case of scleredema occurring in a patient with hypothyroidism and chronic liver disease, which to our knowledge is being described for the first time in literature.
  2,858 17 -
Unusual presentation of an insulinoma in an elderly male patient
M Adarsh, M Salman, M Shiva Kumar, M Shetty
July-September 2021, 67(3):164-167
DOI:10.4103/jpgm.JPGM_1165_20  PMID:34414928
Insulinoma is a rare neuroendocrine tumor originating from hypersecreting beta-cells of islets of Langerhans in the pancreas. We report a case of 72-year-old male, with chronic alcohol abuse, presenting with atypical features like refractory recurrent secondary generalized seizures and behavioral disturbances with increased irritability, initially mistreated as alcohol withdrawal. Detailed history, particularly the relationship of the symptoms with food intake, made us think of other causes of seizures. Fasting biochemical investigations and localizing studies helped clinch the diagnosis. The tumor was localized with the help of endoscopic ultrasonography and whole-body Ga68-DOTANOC PET-CT. The patient was treated conservatively with diazoxide and is doing well on follow-up. The present case report emphasizes the importance of detailed clinical history, more so in atypically presenting cases of refractory seizures. Insulinoma can be medically managed despite surgery being the gold standard curative treatment.
  2,839 17 -
Is there still a role of nephrectomy in management of emphysematous pyelonephritis in today's era?
HN Shah
July-September 2021, 67(3):130-131
DOI:10.4103/jpgm.JPGM_337_21  PMID:34427277
  2,825 18 2
Spontaneous pneumothoraces complicating acute miliary tuberculosis in a child having recent coronavirus disease 2019
S Karande, S Mahalawat, M Muranjan
July-September 2021, 67(3):177-179
DOI:10.4103/jpgm.JPGM_338_21  PMID:34380803
  2,738 17 -
Spontaneous breast hematoma following thrombolytic therapy
N Moorthy, JH Venkatappa, A Palakshachar, R Ramalingam
July-September 2021, 67(3):188-188
DOI:10.4103/jpgm.JPGM_954_20  PMID:34045423
  2,694 22 -
Isolated aquagenic acrokeratoderma of dorsal hands
P Pande, K Poonia, J Kaur
July-September 2021, 67(3):184-185
DOI:10.4103/jpgm.JPGM_779_20  PMID:33707399
  2,489 20 -
Bridge that disconnects?
Y Lokhandwala, A Vyas
July-September 2021, 67(3):132-133
DOI:10.4103/jpgm.JPGM_333_21  PMID:34427278
  2,364 17 -
Post-traumatic hepatic artery pseudoaneurysm with recurrent hemoperitoneum and repeated laparotomies treated by endovascular coil embolization
S Mohakud, PK Sasmal, D Das, P Kumar
July-September 2021, 67(3):186-187
DOI:10.4103/jpgm.JPGM_6_21  PMID:34427281
  2,244 19 -
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