Journal of Postgraduate Medicine, Education and Research

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2016 | April-June | Volume 50 | Issue 2

EDITORIAL

Babita Ghai

Chronic Pain: Wake up call for all

[Year:2016] [Month:April-June] [Volume:50] [Number:2] [Pages:1] [Pages No:0 - 0]

PDF  |  DOI: 10.5005/jpmer-50-2-v  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

Alex Kountouris, Rajesh Puranik, Christopher Semsarian, Jessica J Orchard, David Samra, Johan Duflou, Patrick Groenestein, Mark Young, Peter Brukner

Prevention of Sudden Cardiac Death in Cricketers

[Year:2016] [Month:April-June] [Volume:50] [Number:2] [Pages:10] [Pages No:49 - 58]

PDF  |  DOI: 10.5005/jp-journals-10028-1193  |  Open Access |  How to cite  | 

Abstract

Aims

Sudden death in cricketers is rare, with the most common causes being cardiac, neurological (head/neck trauma, mainly from ball impact) and environmental (e.g., lightning strike and heat stroke, the former which usually involves cardiac arrest). The aim of this study was to review possible prevention of sudden cardiac death and make recommendations.

Materials and methods

A literature review of possible causes of sudden cardiac death (SCD) among cricketers was performed, along with evaluation of evidence for existing preventative measures. The method for evaluation was expert panel (cardiology and sports medicine) consensus recommendations based on the published evidence base.

Results

Potential cardiac causes of sudden death while playing cricket can be divided into the following categories: (1) atraumatic-origin preexisting arrhythmias, cardiomyopathies and valve disorders (2) traumatic-origin arrhythmia (commotio cordis) (3) acquired coronary or valvular disease (4) viral myocarditis (5) Lightning strike. Preventive measures can be divided into pre-season (e.g., cardiovascular screening), prematch (e.g., assessment of viral illness), protective equipment (e.g., chest guards) and post-event (presence of first aid response including defibrillators). Our panel agreed that there was strong evidence that (1) trained and planned emergency response particularly with a defibrillator is effective at preventing SCD and (2) ceasing play in the presence of lightning strikes prevents lightning-related death (3) players with symptoms, risk factors or history suggestive of possible cardiac disease should undertake specific individual workup. There are other potential methods to prevent SCD, with expert level recommendations made in the absence of strong evidence.

Discussion and conclusion

The most controversial aspect of prevention of SCD is electrocardiogram (ECG) screening of asymptomatic players and this paper outlines the arguments both in favor and against without fully resolving the debate. The possible increase in early diagnosis of potentially life-threatening cases needs to be balanced against the risk of false positive results which may lead to discussion of exclusion from cricket. Cardiac workup is clearly of net benefit to symptomatic individuals (e.g. history of syncope, chest pain) or any player at higher than usual baseline risk (e.g., positive family history). Basic life support including access to defibrillators should be available with trained personnel wherever they can be afforded, which has strong evidence in favor of improving survival at the time of cardiac arrest.

How to cite this article

Orchard JW, Puranik R, Semsarian C, Orchard JJ, Samra D, Duflou J, Groenestein P, Young M, Brukner P, Kountouris A. Prevention of Sudden Cardiac Death in Cricketers. J Postgrad Med Edu Res 2016;50(2):49-58.

RESEARCH ARTICLE

Smita Sinha

Risk Factors of Congenital Malformations in North India: A Case—control Study

[Year:2016] [Month:April-June] [Volume:50] [Number:2] [Pages:5] [Pages No:59 - 63]

PDF  |  DOI: 10.5005/jp-journals-10028-1194  |  Open Access |  How to cite  | 

Abstract

Background and objective

To ascertain the determinants of congenital malformations.

Materials and methods

This hospital based age-sex matched pair case control study was done at Advanced Pediatric Centre, Obstetrics and Gynecology Department (ANC clinic, Maternity ward, labor room, etc.) and Special Clinics, PGIMER, Chandigarh, India in 2008. The mothers were interviewed to collect information about risk factors.

Results

Two hundred three CMF (under five children and gestational CMF) cases and same number of controls were studied. Significant association of CMF was observed with the use of sex selection drugs by mothers (OR = 4.35), habits of fathers like taking alcohol (OR = 3), smoking (OR = 4.5) and using tobacco (OR = 2.7). Mother's age at marriage < 18 years and history of abortion were also important predictors of CMF.

Conclusion

Most of the risk factors for CMF were avoidable viz addiction, early marriage and use of sex selection drugs. People need to be educated about this.

How to cite this article

Singh A, Sinha S. Risk Factors of Congenital Malformations in North India: A Case—control Study. J Postgrad Med Edu Res 2016;50(2):59-63.

RESEARCH ARTICLE

Arunkumar Vijay, Jambu Nageswaran, Senthil Loganathan, Samuel Chittaranjan Bedford

Intraarticular vs Intravenous Tranexamic Acid in Reduction of Blood Loss in Primary Total Knee Replacement

[Year:2016] [Month:April-June] [Volume:50] [Number:2] [Pages:5] [Pages No:64 - 68]

PDF  |  DOI: 10.5005/jp-journals-10028-1195  |  Open Access |  How to cite  | 

Abstract

Aim

To study the efficacy of topical intraarticular vs intravenous tranexamic acid (TXA) in reducing blood loss following primary total knee replacement (TKR).

Materials and methods

A phase 3, single center, double blind and randomized controlled study was conducted in the Department of Orthopedics, Sri Ramachandra University, Chennai, Tamil Nadu. A prospective study of 100 patients lasted from July 2013 to July 2015.

Results

Postoperative transfusion rates were zero in both the groups (intraarticular and intravenous). The mean 48-hour drain collected is 285.6 ml in group A (intraarticular), while it is 325.8 ml in group B (intravenous); the mean drop in hemoglobin is 1.7 gm/dl in group A (intraarticular) while it is 2.4 gm/dl in group B (intravenous).

Conclusion

This study shows that topical intraarticular administration of TXA has better efficacy than intravenous TXA in controlling postoperative blood loss following primary uncomplicated TKR with no significant complications.

How to cite this article

Vijay A, Nageswaran J, Loganathan S, Bedford SC. Intraarticular vs Intravenous Tranexamic Acid in Reduction of Blood Loss in Primary Total Knee Replacement. J Postgrad Med Edu Res 2016;50(2):64-68.

RESEARCH ARTICLE

Rashmi Bagga, Payal Keswarpu, Sarif Kumar Naik, Vidya Chandrasekhar, Lovi Gupta, Soubhik Paul

Feasibility of Using Mobile Smartphone Camera as an Imaging Device for Screening of Cervical Cancer in a Low-resource Setting

[Year:2016] [Month:April-June] [Volume:50] [Number:2] [Pages:6] [Pages No:69 - 74]

PDF  |  DOI: 10.5005/jp-journals-10028-1196  |  Open Access |  How to cite  | 

Abstract

Objective

The aim of this study is to determine the feasibility of a screening method for cervical cancer using an application developed on smartphone to aid visual inspection with acetic acid.

Materials and methods

A prospective study was carried out in 230 women in the Department of Gynaecology, PGIMER, Chandigarh, India. These women were divided into two groups. Among the first group, screen positive women (n = 28) were examined by two gynecologists. In the second group (n = 202), health care workers screened women in a mobile van. The two groups were examined using the smartphone and digital colposcope. Abnormal findings were confirmed by liquid-based cytology and histopathology. The image quality of ColpPhon® was compared with colposcopic images as the gold standard. Kappa was used for comparison of ColpPhon® and colposcopic findings for final diagnosis.

Results

Among the 230 women screened, cervical intraepithelial neoplasia (CIN) was diagnosed in six cases by histopathology (CIN 2/3 in five and CIN 1 in one). These six women belonged to the group of 28 women examined in the colposcopy clinic. Both colposcope and ColpPhon® were able to identify these six women. The individual image quality parameters for ColpPhon® were slightly inferior to the colposcope. The overall image clarity had an agreement in 82% (184/225) as being either good or excellent. The diagnosis made on images acquired from each device had an agreement in 90% (208/230) of the cases.

Conclusion

This study demonstrates feasibility of incorporating a smartphone device to capture images of the cervix for improving cervical cancer screening in resource-poor countries.

How to cite this article

Bagga R, Suri V, Srinivasan R, Khandelwal N, Keswarpu P, Naik SK, Chandrasekhar V, Gupta L, Paul S. Feasibility of Using Mobile Smartphone Camera as an Imaging Device for Screening of Cervical Cancer in a Lowresource Setting. J Postgrad Med Edu Res 2016;50(2):69-74.

REVIEW ARTICLE

Nitesh Gahlot, Uttam Chand Saini

Bisphosphonates in Orthopedics: Evidence-based Review of Indications and Adverse Effects

[Year:2016] [Month:April-June] [Volume:50] [Number:2] [Pages:11] [Pages No:75 - 85]

PDF  |  DOI: 10.5005/jp-journals-10028-1197  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Aggarwal S, Gahlot N, Saini UC, Dhillon MS. Bisphosphonates in Orthopedics: Evidencebased Review of Indications and Adverse Effects. J Postgrad Med Edu Res 2016;50(2):75-85.

REVIEW ARTICLE

Anil Chauhan, Nishant Jaiswal, Manvi Singh, Kiran Kumar Thumburu, Shailender Singh Chauhan, Sunil Dhatwalia, Mananda S Bhende, Meenu Singh

Vitamin D reduces Exacerbation in Children with Asthma: A Systematic Review and Meta-analysis

[Year:2016] [Month:April-June] [Volume:50] [Number:2] [Pages:7] [Pages No:86 - 92]

PDF  |  DOI: 10.5005/jp-journals-10028-1198  |  Open Access |  How to cite  | 

Abstract

Aim

The question whether treatment with vitamin D improves asthma exacerbations in children and adults still needs to be addressed.

Background

Recent studies in children and adults found a higher prevalence of hypovitaminosis D associated with a higher severity of asthma and impaired pulmonary function. In asthmatic children, patients with vitamin D deficiency demonstrated increased airway hyperresponsiveness and corticosteroid requirements.

Results

Of 469 records/studies identified through database searching, 5 studies were included in this systematic review. The overall pooled effect showed a significant reduction in acute asthma exacerbation in the vitamin D group (odds ratio 0.45, 95% confidence interval 0.22—0.93). There were no studies that focus on the quality of life.

Conclusion

This systematic review supports the role of vitamin D in reducing the number of asthma exacerbations in children but not in adults.

Clinical significance

The present systematic review demonstrates reduction in asthma exacerbations in children. Most of the asthma children are on inhaled corticosteroid, which poses a threat for its side effects. However, vitamin D having multiple functions in body could be used as an alternative therapy in asthmatic children. In adults, more trials are needed wherein the deficient individuals are supplemented with vitamin D and further assessed for asthma exacerbations. There is no harm in supplementation of vitamin D to deficient and insufficient asthmatic individuals.

How to cite this article

Chauhan A, Singh M, Jaiswal N, Thumburu KK, Agarwal A, Chauhan SS, Dhatwalia S, Bhende MS, Singh M. Vitamin D reduces Exacerbation in Children with Asthma: A Systematic Review and Meta-analysis. J Postgrad Med Edu Res 2016;50(2):86-92.

RESEARCH ARTICLE

Chandeep Singh, Shitij Kacker, Sanjiv KS Marya

Modified Extended Trochanteric Osteotomy

[Year:2016] [Month:April-June] [Volume:50] [Number:2] [Pages:3] [Pages No:93 - 95]

PDF  |  DOI: 10.5005/jp-journals-10028-1199  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Kacker S, Singh C, Marya SKS. Modified Extended Trochanteric Osteotomy. J Postgrad Med Edu Res 2016;50(2):93-95.

CASE REPORT

Nadeesha Jeewan Nawarathna, Deepthika Chandrasekara, Nawam R Kumarasinghe, Rasika Shamalie Balasooriya, Palitha Rathnayake, Ranjith J Seneviratne

Primary Osteosarcoma of the Breast presenting as a Large Breast Abscess

[Year:2016] [Month:April-June] [Volume:50] [Number:2] [Pages:4] [Pages No:96 - 99]

PDF  |  DOI: 10.5005/jp-journals-10028-1200  |  Open Access |  How to cite  | 

Abstract

Introduction

Primary extraosseous osteogenic sarcoma is one of the rarest forms of malignant tumor of the breast. It can arise as a result of osseous metaplasia of a preexisting neoplasm or from a none-phyllodes sarcoma of a previously normal breast. Due to its rarity, the natural history and optimal treatment methods remain unclear.

Case presentation

A 60 years old patient presented to the surgical casualty with a large breast abscess. Abscess wall histology revealed an osteosarcoma of the breast. Left total mastectomy with axillary clearance was performed. Histology and subsequent immunohistochemical studies confirmed the diagnosis of osteogenic sarcoma without lymph nodal metastasis. Patient was referred to the oncologist for further management.

Conclusion

Rare types of breast tumors can be presented as breast abscess. Incision and drainage together with wall biopsy aid to exclude associated sinister pathologies. Diagnosis of primary osteosarcoma of the breast was made using histological and immunohistochemical findings once the possible primary from the bones of sternum and ribs was excluded. Treatment is as for sarcomas affecting other locations and should comprise a multidisciplinary approach.

How to cite this article

Nawarathna NJ, Chandrasekara D, Kumarasinghe NR, Balasooriya RS, Rathnayake P, Seneviratne RJ. Primary Osteosarcoma of the Breast presenting as a Large Breast Abscess. J Postgrad Med Edu Res 2016;50(2):96-99.

CASE REPORT

SR Challa, Jaahnavi Chinamilli, Rajeshwar Reddy Langati

A Rare Case of Gastric Diverticula on Posterior Wall associated with Cholelithiasis

[Year:2016] [Month:April-June] [Volume:50] [Number:2] [Pages:3] [Pages No:100 - 102]

PDF  |  DOI: 10.5005/jp-journals-10028-1201  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Challa SR, Chinamilli J, Langati RR. A Rare Case of Gastric Diverticula on Posterior Wall associated with Cholelithiasis. J Postgrad Med Edu Res 2016;50(2):100-102.

CASE REPORT

Uma Devaraj, Gnanapriya Vellaisamy, Julian Crasta

Primary Hepatoid Adenocarcinoma of the Lung

[Year:2016] [Month:April-June] [Volume:50] [Number:2] [Pages:4] [Pages No:103 - 106]

PDF  |  DOI: 10.5005/jp-journals-10028-1202  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Vellaisamy G, Rout P, Crasta J, Devaraj U. Primary Hepatoid Adenocarcinoma of the Lung. J Postgrad Med Edu Res 2016;50(2):103-106.

RESEARCH ARTICLE

Shiv Sajan Saini

Spectrum of Childhood Illness in Outpatient Clinic in a Remote AreaS of Kashmir

[Year:2016] [Month:April-June] [Volume:50] [Number:2] [Pages:1] [Pages No:107 - 107]

PDF  |  DOI: 10.5005/jpmer-50-2-107  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

Subhash Varma

Proposed Revision in the International Committee of Medical Journal Editors (ICMJE) Authorship Criteria

[Year:2016] [Month:April-June] [Volume:50] [Number:2] [Pages:2] [Pages No:108 - 109]

PDF  |  DOI: 10.5005/jpmer-50-2-108  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

Digambar Behera, Navneet Singh, Venkata Nagarjuna Maturu, Inderpaul Singh Sehgal

Clinical experience with oral topotecan in relapsed small cell lung cancer patients following irinotecan-platinum chemotherapy

[Year:2016] [Month:April-June] [Volume:50] [Number:2] [Pages:2] [Pages No:110 - 111]

PDF  |  DOI: 10.5005/jpmer-50-2-110  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

SC Varma, Nandita Kakkar, Renu Suthar, Akshay Saxena, Sadhana Lal

A 12-year-old Girl with Massive Hepatosplenomegaly

[Year:2016] [Month:April-June] [Volume:50] [Number:2] [Pages:10] [Pages No:112 - 121]

PDF  |  DOI: 10.5005/jpmer-50-2-112  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

Ramandeep Virk

NEW SCANNING TECHNOLOGY

[Year:2016] [Month:April-June] [Volume:50] [Number:2] [Pages:1] [Pages No:122 - 122]

PDF  |  DOI: 10.5005/jpmer-50-2-122  |  Open Access |  How to cite  | 

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