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Journal of Postgraduate Medicine Education and Research
Current Issue : Volume 51, Issue 4, October-December 2017
 
 
1.  Editorial
Stem Cell in Spinal Cord Injury: Hype or A New hope?
Vishal Kumar, Sarvdeep Singh Dhatt
[Pages No:iii]
Full Text PDF | Abstract | FREE

ABSTRACT

Spinal cord injury (SCI) occurs most commonly in young adults due to high-velocity trauma and fall from the height, leaving behind the lifelong physical, psychological and social disability. There is no effective medical or surgical treatment yet available to reverse the disability produced in sequence to injury. Cavitation and loss of neural and stromal tissue at the time of SCI result in not only sensory-motor loss but also autonomic dysfunction. Residual functional cord tissue is not capable of reconstituting the gap already created in the spinal cord; on the other hand remodeling results in glial scar formation but no neural tissue is formed. Among the treatment options available and explored in recent research, use of stem cells is capable of bridging the area of cavitation and neuronal regeneration in glial scar tissue as shown in animal and human studies.1 Hence, stem cell therapy is considered to be a promising treatment option in SCI, though in its evolutionary phase.

 
2.  Original Article
Fluorosis: Environmental Risk Factor for Periodontal Disease?
Priyanka J Dalvi, Kharidhi L Vandana, Saubhik Ghosh, Vinayak M Joshi, Kishor Bhat, Vivek H Prakash
[Pages No:157-161]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1255 | FREE

ABSTRACT

Background: Periodontitis is multifactorial in nature. The effects of fluorosis as an environmental factor are not evaluated and researched to designate it as a risk factor similar to smoking. The primary objectives of this study were to investigate whether there is any association between fluorosis and periodontal disease and to assess salivary oxidative stress in fluorosed and nonfluorosed patients with periodontitis contributing to periodontal disease.

Aim: This is a case-control study with an aim to investigate whether fluorosis acts as a risk factor for periodontal disease and to assess salivary oxidative stress in fluorosed and nonfluorosed patients with periodontitis contributing to periodontal disease.

Materials and methods: About 295 systemically healthy patients were divided into test group (n = 154 fluorosed subjects) and control group (n = 141 nonfluorosed subjects) and assessed for their periodontal status. Clinical parameters recorded were plaque index, gingival bleeding index (GBI), and Jackson’s fluorosis index to assess the degree of fluorosis, and community periodontal index was to assess the periodontal status. Biochemical analysis of saliva was done for assessment of malondialdehyde (MDA) levels, superoxide dismutase (SOD) levels, and total antioxidant (TAOC) levels.

Results: The plaque and GBI scores were found similar in fluorosed and nonfluorosed groups. Gingivitis was significantly higher in nonfluorosed than in fluorosed group; in contrast, periodontitis was significantly higher in fluorosed group than in nonfluorosed group. Gingivitis appeared to decline as the fluoride status worsened, while periodontitis showed an increasing gradient from lower fluoride score to higher fluoride score. As the degree of fluorosis increased, periodontitis also increased. The salivary antioxidant levels were found similar in both the groups.

Keywords: Community periodontal index, Dental fluorosis, Oral epidemiology, Periodontal disease, Saliva oxidative stress.

How to cite this article: Dalvi PJ, Vandana KL, Ghosh S, Joshi VM, Bhat K, Prakash VH. Fluorosis: Environmental Risk Factor for Periodontal Disease? J Postgrad Med Edu Res 2017; 51(4):157-161.

Source of support: Nil

Conflict of interest: None

 
3.  Original Article
Vitamin D Deficiency in Rheumatoid Arthritis and Vitamin D Levels that vary with Rheumatoid Arthritis Severity: An Indian Study
Muzamil Latief, Farhat Abbas, Amandeep Minhas, Waseem Dar, Manzoor Parry, Purshotam D Gupta
[Pages No:162-165]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1256 | FREE

ABSTRACT

Introduction: Rheumatoid arthritis (RA) is an autoimmune disease characterized by periods of remission and flares of symmetrical joint inflammation slowly progressing to joint and cartilage destruction leading to deformities. Evidence is accumulating suggesting vitamin D deficiency and its correlation in autoimmune diseases including RA.

Aims of study: (1) Estimation of vitamin D levels in RA patients. (2) Correlation of vitamin D levels with severity of the disease.

Materials and methods: A study population of 50 included 25 cases and 25 controls. Both males and females of 30 to 40 years of age were taken for this study. Patients of RA having any other autoimmune disease were excluded. Twenty-five healthy adults, whose ages were between 30 and 40 years, both male and female, free from any systemic illness were taken as controls. Routine systematic examination and detailed joint examination were done. Disease activity was measured in patients of RA according to Disease Activity Score (DAS-28). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor (RF), and anticyclic citrullinated peptide (CCP) among other routine blood investigations were done.

Results: In cases, the mean vitamin D level was 18.41 ng/mL with standard deviation (SD) of 7.10, while controls had mean level as 22.32 ng/mL with SD as 4.80. The difference between the two was recorded as statistically significant, i.e., p-value <0.05. While 4 (16.0%) patients had low severity, 15 (60.0%) had moderate severity, and 6 (24.0%) patients had high severity of disease as per DAS-28. Patients whose RA disease activity was high had lower vitamin D levels.

Conclusion: It is thus concluded that in RA patients the serum vitamin D levels are significantly lower than in healthy control, and vitamin D deficiency may be one of the causes contributing to worsening of RA.

Keywords: Disease activity score 28, Rheumatoid arthritis, Vitamin D.

How to cite this article: Latief M, Abbas F, Minhas A, Dar W, Parry M, Gupta PD. Vitamin D Deficiency in Rheumatoid Arthritis and Vitamin D Levels that vary with Rheumatoid Arthritis Severity: An Indian Study. J Postgrad Med Edu Res 2017;51(4):162-165.

Source of support: Nil

Conflict of interest: None

 
4.  Original Article
Immune Complex-positive Glomerulonephritis in Antineutrophil Cytoplasmic Antibody-positive Patients
Priyanka Bhagat, Shreekant Bharti, Parikshaa Gupta, Ranjana W Minz, Kusum Joshi, Seema Chhabra
[Pages No:166-169]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1257 | FREE

ABSTRACT

Antineutrophil cytoplasmic antibody (ANCA)-positive glomerulonephritis (GN) has traditionally been considered pauci-immune (PI); however, various reports have demonstrated the presence of immune reactants in a subset of these cases. The study was done to evaluate the prevalence of immune deposits in ANCApositive GN by direct immunofluorescence (DIF). Renal biopsies of 35 patients with ANCA-positive GN were retrospectively analyzed for light microscopic and DIF findings to look for the presence of immune reactants and to correlate these with the corresponding histologic features. Twenty-seven cases (77.2%) showed PI-GN while 8 (22.8%) cases showed ≥2+ positivity for one or more immune reactants in the mesangium and/or capillary loops and were categorized as ANCA-positive immune complex GN. Of these, seven were positive for perinuclear (P-ANCA) and one for cytoplasmic (C-ANCA). Immunoglobulin M (IgM) was the most frequent immunoglobulin. On light microscopy, these cases exhibited significantly increased mesangial cellularity (p = 0.033) and more number of normal glomeruli as compared with PI cases (p = 0.015).

Keywords: Antineutrophil cytoplasmic antibody, Direct immunofluorescence, Immune complex glomerulonephritis, Pauciimmune glomerulonephritis, Renal biopsy.

How to cite this article: Bhagat P, Bharti S, Gupta P, Minz RW, Joshi K, Chhabra S. Immune Complex-positive Glomerulonephritis in Antineutrophil Cytoplasmic Antibody-positive Patients. J Postgrad Med Edu Res 2017;51(4):166-169.

Source of support: Nil

Conflict of interest: None

 
5.  Research Article
Effect of Balance Training on Postural Analysis of Patients suffering from Balance Disorders: A Preliminary Report
Swapnil Bari, Somya Saxena, Kashif Sherwani, Neelesh Kumar, Mandeep S Dhillon
[Pages No:170-174]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1258 | FREE

ABSTRACT

Introduction: Postural stability assessment is an important task that has found widespread medical and therapeutic applications. Typically, balance measurement systems are used for this purpose. The quantitative score of postural balance is very important in determining improvement of the patients suffering from balance disorder. Postural stability of humans is highly dependent on the position of centre of pressure of the body. The analysis of sway of a human body can be successfully done by studying oscillations of its centre of pressure. The distribution of foot pressure over different regions namely medial-lateral and anterior- posterior, governs the balance of the posture in both directions.

Objective: The aim of this study is to assess quantitative changes in the postural stability of patients suffering from balance disorders after providing them biofeedback based balance training.

Materials and methods: We used Force Sensing Resistors (FSRs) to sense the magnitude of forces acting at various points of both the feet. The centre of pressure is determined using the positions of various force points and magnitude of the force acting on them. The higher capability of the body to remain at that position implies higher postural stability and a lower power of sway. The force sensors produce signal proportional to the magnitude of the foot pressure. This signal after being collected by the Data Acquisition Board is fed to the system for calculating the centre of pressure and drawing a real time graph. Different algorithms are used to determine its mean position and compare the stability. The repeated analysis shows the amount of change in patient’s postural behaviour, before and after the training.

Results: Until the publication of this research work, analysis of the data of 4 patients was performed. Post intervention trials resulted in higher scores of their postural performance. Hence, favourable results were obtained showing improvement in postural stability of the patients.

Conclusion: Wider variety of ataxia patients can be chosen to perform this assessment. The system is capable of determining a quantitative score of improvement of the postural stability and thus can be used to assess the postural performance of patients suffering from different postural disorders.

Keywords: Balance training, Hemiplegia, Postural balance, Pre-post study, Sway analysis.

How to cite this article: Bari S, Saxena S, Sherwani K, Kumar N, Dhillon MS. Effect of Balance Training on Postural Analysis of Patients suffering from Balance Disorders: A Preliminary Report. J Postgrad Med Edu Res 2017;51(4):170-174.

Source of support: Nil

Conflict of interest: None

 
6.  Review Article
Tendinopathy and Sports: Understanding the Problem and Options of Management-perspectives from Physiotherapy, Sports Medicine, and Orthopedics
Himmat S Dhillon, Sidak Dhillon, Vikas Bachhal, Mandeep S Dhillon
[Pages No:175-181]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1259 | FREE

ABSTRACT

Tendinopathies are perhaps the leading cause of sportsrelated overuse injuries necessitating visit to an expert. Increased general public participation in sports and growing intensity of elite level sport had further warranted more attention and research into pathophysiology and management of tendenopathies. As a result, its management has seen enormous changes in the last few decades. The newer research methodologies applied to diagnostic and therapeutic aspects have generated a plethora of literature, which has helped sports medicine experts. However, these newer modalities have also added to the confusion among many. This review aims to present current understanding of pathophysiology of tendinopathies and evidence of success or failure of several modalities in current use.

Keywords: Exercise, Management, Orthobiologics, Sports, Tendinopathy.

How to cite this article: Dhillon HS, Dhillon S, Bachhal V, Dhillon MS. Tendinopathy and Sports: Understanding the Problem and Options of Management Perspectives from Physiotherapy, Sports Medicine, and Orthopedics. J Postgrad Med Edu Res 2017;51(4):175-181.

Source of support: Nil

Conflict of interest: None

 
7.  Review Article
Comparison of Reverse Total Shoulder Arthroplasty vs Hemiarthroplasty for Acute Fractures of the Proximal Humerus: Systematic Review
Amrut U Borade, Filippo Familiari, Kyubo Choi, Jacob Joseph, Edward G McFarland
[Pages No:182-187]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1260 | FREE

ABSTRACT

The optimal treatment of proximal humerus fractures is debated; however, reverse total shoulder arthroplasty (RTSA) has become increasingly popular as the primary treatment. We systematically reviewed the PubMed, EMBASE, and Scopus databases to identify English-language clinical studies (evidence levels I through IV) comparing the results of RTSA with those of hemiarthroplasty (HA) for the treatment of acute proximal humerus fractures. We evaluated the following outcomes: Range of motion, patient-reported outcome measures (including pain relief), and complications. We identified eight published studies comparing RTSA with HA for treatment of acute proximal humerus fractures. The RTSA group (180 patients) showed significantly better postoperative pain relief, active anterior elevation, Constant-Murley scores, and American Shoulder and Elbow Surgeons (ASES) scores compared with the HA group (439 patients; all p < 0.05). There were no significant differences between the two groups for overall complications (RTSA, 11.8% vs HA, 20.8%), infections (2% for both groups), dislocations (RTSA, 0% vs HA, 2.5%), or nerve injury (RTSA, 1% vs HA, 2.8%). Scapular notching occurred in 15.8% of RTSA cases (grade I, 53%; grade II, 32%; grade III, 16%; and grade IV, 0%). In the treatment of acute proximal humerus fractures, RTSA provided better pain relief, postoperative anterior elevation, and outcome scores after surgery compared with HA and had similar complication rates.

Keywords: Complications, Outcomes, Pain, Reverse total shoulder, Shoulder hemiarthroplasty, Surgery, Systematic review.

How to cite this article: Borade AU, Familiari F, Choi K, Joseph J, McFarland EG. Comparison of Reverse Total Shoulder Arthroplasty vs Hemiarthroplasty for Acute Fractures of the Proximal Humerus: Systematic Review. J Postgrad Med Edu Res 2017;51(4):182-187.

Source of support: Nil

Conflict of interest: None

 
8.  Case Report
A Fatal Case of Pyrexia of Unknown Origin: Hemophagocytic Lymphohistiocytosis?
Palak Bhuta, Aakash Patel, Luv Yadav, Utsav Patel, Virendra Kosamia, Arti Muley
[Pages No:188-191]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1261 | FREE

ABSTRACT

Aim: To highlight the need of high suspicion of hemophagocytic lymphohistiocytosis (HLH) in pyrexia of unknown origin (PUO) and also the need of specific guidelines for the management of the disease.

Background:The HLH is a rare disease of overactive histiocytes and lymphocytes. Although seen in all age groups, it is less common in adults as compared with infants. It usually presents with fever, hepatosplenomegaly, pancytopenia, lymphadenopathy, and rash. Cutaneous involvement is seen in as many as 65% of patients.

Case report: A 25-year-old male presented with high-grade fever and cough since 4 weeks. Examination at presentation revealed only hepatosplenomegaly. During the course of the disease, he developed pancytopenia, but there was no lymphadenopathy or neurological or cutaneous manifestations. The patient was thoroughly investigated, but it remained inconclusive. He did not respond to any antibiotics, antimalarials, or antituberculars. There was an initial response to steroids, but it did not sustain. Bone marrow remained normal throughout the course of illness. Based on other features, we made a diagnosis of HLH, but the patient’s condition worsened rapidly and proved to be fatal despite all treatment.

Conclusion and clinical significance: The HLH must be suspected in a case of PUO especially in presence of pancytopenia and hepatosplenomegaly. It is important to look for other features like hyperferritinemia and hypertriglyceridemia to reach an early diagnosis as bone marrow features may present very late during the course of illness. Early diagnosis is all the more important in view of rapidly progressive fatal course of the disease.

Keywords: Hemophagocytic lymphohistiocytosis, Hepatosplenomegaly, Hyperferritinemia, Hypertriglyceridemia, Pancytopenia.

How to cite this article: Bhuta P, Patel A, Yadav L, Patel U, Kosamia V, Muley A. A Fatal Case of Pyrexia of Unknown Origin: Hemophagocytic Lymphohistiocytosis? J Postgrad Med Edu Res 2017;51(4):188-191.

Source of support: Nil

Conflict of interest: None

 
9.  Case Report
Laparoscopic Cholecystectomy in Kartagener Syndrome
Rahul Gupta, Harjeet Singh, Ganga R Verma
[Pages No:192-194]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1262 | FREE

ABSTRACT

Kartagener syndrome is a rare autosomal recessive disorder in which there is situs inversus involving abdominal or thoracic viscera or both. Anatomy of the abdominal organs in such a patient is distorted making laparoscopic surgery very difficult. A 45-year-old lady, a known case of Kartagener syndrome, presented with epigastric pain. Ultrasound of abdomen revealed situs inversus with mild hepatomegaly and multiple gallbladder calculi. Magnetic resonance pancreatocholangiography (MRCP) confirmed situs inversus totalis with cholelithiasis and mild central intrahepatic biliary dilatation. Patient was treated successfully with laparoscopic cholecystectomy.

Keywords: Bronchiectasis, Gallstones, Situs inversus.

How to cite this article: Gupta R, Singh H, Verma GR. Laparoscopic Cholecystectomy in Kartagener Syndrome. J Postgrad Med Edu Res 2017;51(4):192-194.

Source of support: Nil

Conflict of interest: None

 
10.  Clinicopathological Conference Report (CPC)
Metabolic Syndrome with Double Hit; Nonproteinuric Diabetic Nephropathy and Nonalcoholic Steatohepatitis-related Cirrhosis; Autopsy Findings
Ritambhra Nada, Vikarn Vishwajeet, Sunil Taneja, Anmol Bhatia, Ajay Duseja
[Pages No:195-206]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1263 | FREE

ABSTRACT

A 61-year-old female was admitted with chief complaints of altered sensorium since 2 days.

HISTORY

Patient was a known case of hypertension since 10 years and type II diabetes mellitus (DM) for 5 years. In March 2015, she presented with abdominal distension which was insidious in onset and gradually progressive. She was evaluated in liver clinic and was diagnosed to have decompensated nonalcoholic steatohepatitis (NASH)-related cirrhosis with ascite.s

 
11.  Staff clinical meeting
Contingency Screening using Noninvasive Prenatal Test for the Detection of Trisomy 21
Japleen Kaur, Jasvinder Kalra, Rashmi Bagga, P K Saha, Rimpi Singla, Aashima Arora
[Pages No:207-208]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1264 | FREE

ABSTRACT

Screening for aneuploidies is a vital component of routine antenatal care. Conventional screening methods include biochemical screening and ultrasonography. Interpretation of these tests and further course of management can be enigmatic. Noninvasive prenatal test (NIPT) using cell-free fetal deoxyribonucleic acid (DNA) is an emerging screening method with accuracy close to the diagnostic invasive tests. We present a case of an elderly primigravida, conceived after years of infertility, in whom the first trimester combined screen was reported as intermediate risk and NIPT helped in reaching the diagnosis of fetal Down’s syndrome.

 
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