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   2022| October-December  | Volume 68 | Issue 4  
    Online since November 4, 2022

 
 
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CASE REPORTS
Giant cell arteritis with stroke and systemic diffuse vasculitis
C Lu, S Zhou, C Yang, J Ye
October-December 2022, 68(4):233-235
DOI:10.4103/jpgm.jpgm_800_21  PMID:36178126
Giant cell arteritis (GCA) is a systemic vasculitis, which mainly affects the aorta and its branches, while the abdominal aorta, the iliac artery and the limbs involvement are rare. The common clinical manifestations include headache, fever, jaw claudication, and visual impairment. Cerebrovascular accidents are relatively rare. Here, we present a GCA patient with stroke and systemic diffuse vasculitis involving the abdominal aorta, iliac artery, and femoral artery simultaneously.
  2,576 39 -
ORIGINAL ARTICLES
Assessment of the quality of randomized controlled trials in surgery using Jadad score: Where do we stand?
S Mohsina, B Gurushankari, R Niranjan, S Sureshkumar, GS Sreenath, V Kate
October-December 2022, 68(4):207-212
DOI:10.4103/jpgm.JPGM_104_21  PMID:35417999
Introduction: Quality assessment of randomized controlled trials (RCTs) is important to prevent clinical application of erroneous results. Materials and Methods: This was an assessment of published RCTs in surgical subspecialties during 2011–2018 based on MEDLINE and EMBASE search. The primary objective of the present study was to quantitatively and qualitatively analyze the RCTs published from India based on year of publication, geographical distribution, and subspecialty using the modified Jadad score (high quality if score is ≥3; or ≥2 if blinded design was not feasible). Its secondary objective was to identify factors affecting the quality of RCTs. Results: Among 1304 trials identified, 162 were analyzed. Of these 96 (59%) had a score of ≥3; and 104 (64.2%) were of high quality (score ≥2). Year-wise there was no significant quantitative (P = 0.329) or qualitative (P = 0.255) variation. Geographic regions had similar quantity (P = 0.206) and quality (P = 0.068). The RCTs among subspecialties too were comparable in quantity and quality. Higher impact factor of journal (P = 0.013) and assessment by Institute Review Board (IRB) (P = 0.004) were significantly associated with a better study quality. Type of institution, number of authors, centricity, assistance by a statistician, and source of funding did not affect the quality of RCTs. Conclusions: The quantity and quality of surgical RCTs were stable and comparable over the years and across geographical regions and subspecialties. Higher impact factor of journal and review by IRB were significantly associated with a better study quality.
  2,472 41 -
EDITORIAL
COVID-19: A nephrologists' perspective
TE Jamale, SB Thakare
October-December 2022, 68(4):187-193
DOI:10.4103/jpgm.jpgm_470_22  
  2,292 20 -
EDITORIAL COMMENTARIES
Surgical trials in India, where do we stand?
M Khajanchi
October-December 2022, 68(4):197-198
DOI:10.4103/jpgm.jpgm_367_22  PMID:36255017
  2,111 26 -
CASE SNIPPETS
Hypersensitivity pneumonitis associated with mushroom cultivation
H Satoh, H Yamada
October-December 2022, 68(4):243-244
DOI:10.4103/jpgm.jpgm_888_21  PMID:35775567
  1,732 44 -
EDITORIAL COMMENTARIES
Understanding respiratory disease 'due to' or 'with' COVID-19 to assess appropriate treatment
GA Marraro, C Spada
October-December 2022, 68(4):194-196
DOI:10.4103/jpgm.jpgm_496_22  
  1,665 18 -
ORIGINAL ARTICLES
Performance of prognostic scores in prediction of 30-day postoperative mortality in COVID-19 patients after emergency surgery: A retrospective cohort study
ST Karna, R Gouroumourty, Z Ahmad, S Trivedi, P Thaware, P Singh
October-December 2022, 68(4):199-206
DOI:10.4103/jpgm.jpgm_1197_21  PMID:36255012
Background: Risk assessment with prognostic scoring, though important, is scarcely studied in emergency surgical patients with COVID-19 infection. Methods and Material: We conducted a retrospective cohort study on adult emergency surgical patients with COVID-19 infection in our institute from 1 May 2020 to 31 October 2021 to find the 30-day postoperative mortality and predictive accuracy of prognostic scores. We assessed the demographic data, prognostic risk scores (American Society of Anesthesiologists-Physical Classification (ASA-PS), Sequential Organ Failure Assessment (SOFA), Quick SOFA (qSOFA), Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) scores), surgical and anesthetic factors. We assessed the postoperative morbidity using the Clavien-Dindo scale and recorded the 30-day mortality. Correlation of prognostic scores and mortality was evaluated using Univariate Cox proportional hazards regression, receiver operating characteristic curve (ROC), Youden's index and Hosmer- Lemeshow goodness of fit model. Results: Emergency surgery was performed in 67 COVID-19 patients with postoperative complication and 30-day mortality rate of 33% and 19%, respectively. A positive qSOFA and ASAPS IIIE/IVE had a 9.03- and 12.7-times higher risk of mortality compared to a negative qSOFA and ASA-PS IE/IIE (P < 0.001), respectively. Every unit increase of SOFA, POSSUM and P-POSSUM scores was associated with a 50%, 18% and 17% higher risk of mortality, respectively. SOFA, POSSUM and P-POSSUM AUCROC curves showed good discrimination between survivors and non-survivors (AUC 0.8829, 0.85 and 0.86, respectively). Conclusions: SOFA score has a higher sensitivity to predict 30-day postoperative mortality as compared to POSSUM and P-POSSUM. However, in absence of a control group of non-COVID-19 patients, actual risk attributable to COVID-19 infection could not be determined.
  1,584 33 -
Parental-perceived health-related quality of life of school students with borderline intellectual functioning: A cross-sectional questionnaire-based study in Mumbai, Maharashtra, India
S Karande, NJ Gogtay, T More, S Pandit, Praveenkumar
October-December 2022, 68(4):213-220
DOI:10.4103/jpgm.jpgm_310_22  PMID:35975344
Background and Objectives: Students with borderline intellectual functioning (“slow learners”) underperform in all school subjects. The primary objective of this study was to evaluate the parental-perceived health-related quality of life (HRQoL) of these students. Its secondary objective was to analyze the impact of sociodemographic variables on their HRQoL. Settings and Design: Cross-sectional single-arm questionnaire-based study was conducted in the learning disability clinic in a public medical college in Mumbai. Subjects and Methods: One hundred parents of slow learners aged 8 to 16 years were recruited by non-probability sampling. Their HRQoL scores were measured using the English DISABKIDS chronic generic module parent (proxy) long-version (“DCGM-37-P”) instrument. Statistical Analysis: Multiple regression analysis was carried out for determining the “independent” impact that sociodemographic variables had on a poor facet and total score outcomes. Results: Clinically significant deficits were detected in 4 facets, namely: small deficit in “social inclusion”; medium deficits in “independence”, “emotion”, and “social exclusion”; and large deficit in “total score”. Multivariate analysis revealed that: (i) being an only child predicted a poor “emotion” and “social exclusion” facet score outcomes (P = 0.039 and P = 0.024, respectively); (ii) being a female predicted a poor “social inclusion” facet score outcome (P = 0.022); and, (iii) studying in a single-gender school predicted a poor “limitation” facet score outcome (P = 0.020). Conclusions: Parents of slow learners perceive their psychosocial and total HRQoL to be significantly compromised. There is a need to evaluate the HRQoL of slow learners so that optimum rehabilitation can be facilitated.
  1,489 45 -
CASE SNIPPETS
Primary non-Hodgkin's lymphoma of the larynx
NK Nerurkar, A Sarkar
October-December 2022, 68(4):249-250
DOI:10.4103/jpgm.jpgm_290_22  PMID:36255015
  1,315 28 -
Bilateral asymmetrical choroidal vitiligo
GJ Manayath, S Verghese, P Chandrakanth, HV Gosalia
October-December 2022, 68(4):245-246
DOI:10.4103/jpgm.jpgm_25_22  PMID:36255014
  1,104 33 -
VIEW POINT
Commercial screening tests: Beneficial or a hypnosis to advertisements?
S Singhal, K Deokar, M Verma
October-December 2022, 68(4):231-232
DOI:10.4103/jpgm.jpgm_300_22  PMID:36255016
  1,104 30 -
CASE REPORTS
Chronic diarrhea - The poetic masquerade
S Bhattacharjee, I Siyad, BV Maramattom
October-December 2022, 68(4):239-242
DOI:10.4103/jpgm.jpgm_1169_21  
Chronic diarrhea, by definition, is the passage of loose/liquid stools, with increased frequency (more than three times/day), or an output of over 200 g/day, lasting for a duration of four or more weeks. The clinical approach to identify the cause of chronic diarrhea generally depends on the local socioeconomic status. In high-income countries, systemic causes such as irritable bowel syndrome (IBS), inflammatory bowel disease, malabsorption syndromes (lactose intolerance/coeliac disease) are primarily considered. In mid- to low-income countries, infective causes like chronic bacterial, mycobacterial, fungal infections, HIV, bowel cancer are considered before systemic causes/malabsorption syndromes. Amyloidosis, more accurately, reactive amyloidosis is one of the rarer causes of chronic/persistent diarrhea. Inflammatory colitis secondary to POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) as a cause for chronic diarrhea has been reported only in a handful of cases and is often missed. We present such a case of chronic diarrhea in a middle-aged man, who was eventually diagnosed to have POEMS syndrome.
  988 18 -
ORIGINAL ARTICLES
The development of QERM scoring system for comprehensive assessment of the Quality of Empirical Research in Medicine - Part 1
Research Quality Improvement Group*
October-December 2022, 68(4):221-230
DOI:10.4103/jpgm.jpgm_460_22  
Purpose: Whereas a large number of features are mentioned to connote the quality of medical research, no tool is available to comprehensively measure it objectively across different types of studies. Also, all the available tools are for reporting, and none includes quality of the inputs and the process of research. The present paper is aimed to initiate a discussion on the need to develop such a comprehensive scoring system (in the first place), to show that it is feasible, and to describe the process of developing a credible system. Method: An expert group comprising researchers, reviewers, and editors of medical journals extensively reviewed the literature on the quality of medical research and held detailed discussions to parse quality at all stages of medical research into specific domains and items that can be assigned scores on the pattern of quality-of-life score. Results: Besides identifying the domains of the quality of medical research, a comprehensive tool for scoring emerged that can be possibly used to objectively measure the quality of empirical research comprising surveys, trials, and observational studies. Thus, this can be used as a tool to assess Quality of Empirical Research in Medicine (QERM). The expert group confirmed its face and content validity. The tool can be used by the researchers for self-assessment and improvement before submission of a paper for publication, and the reviewers and editors can use this for assessing the submissions. Published papers can also be rated such as those included in a meta-analysis. Conclusion: It is feasible to devise a comprehensive scoring system comprising domains and items for assessing the quality of medical research end-to-end from choosing a problem to publication. The proposed scoring system needs to be reviewed by the researchers and needs to be validated.
  952 19 -
CASE REPORTS
Unusual magnetic resonance imaging findings of cystic bone lesions in congenital generalized lipodystrophy
TF T de Oliveira, MR C Natal, AA Teixeira, BB Machado
October-December 2022, 68(4):236-238
DOI:10.4103/jpgm.jpgm_1031_21  
Cystic bone lesions are the hallmark of skeletal abnormalities in patients with congenital generalized lipodystrophy (CGL). However, their pathophysiology is still unclear and theories about their origin remain largely speculative. This article reports on a patient with CGL and cystic bone lesions, some of them with unusual magnetic resonance imaging (MRI) findings that include elevated signal intensity on T1-weighted images and fluid–fluid levels, the latter evolving to a more “classic” cystic appearance on follow-up. Even though similar findings were first described almost 30 years ago, little attention was given to them back then; furthermore, other than the present report, no other study has performed sequential exams to follow their evolution in serial MRI. The authors conduct a review of the literature, hypothesizing that these remarkable findings may reflect an intermediate stage in the process of cystification of the abnormal bone marrow, incapable to perform adipose conversion, lending factual support to the modern theories about this issue.
  880 18 -
CASE SNIPPETS
Emphysematous osteomyelitis of the spine with emphysematous pyelonephritis: A rare coexistence
A Singh, N Kaur, M Gupta, S D'cruz
October-December 2022, 68(4):247-248
DOI:10.4103/jpgm.jpgm_234_22  
  609 20 -
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