Journal of Postgraduate Medicine, Education and Research

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2017 | January-March | Volume 51 | Issue 1

EDITORIAL

Parikshaa Gupta, Ranjana W Minz

Beyond HLA-B27: Changing Paradigms in the Genetics of Ankylosing Spondylitis

[Year:2017] [Month:January-March] [Volume:51] [Number:1] [Pages:1] [Pages No:0 - 0]

PDF  |  DOI: 10.5005/jpmer-51-1-v  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

S Arumugam, Tvisha Ketan Parikh

Are Indian Habits of Cross-legged Sitting and Squatting associated with Anterior Knee Pain?

[Year:2017] [Month:January-March] [Volume:51] [Number:1] [Pages:6] [Pages No:1 - 6]

PDF  |  DOI: 10.5005/JPMER-51-1-1  |  Open Access |  How to cite  | 

Abstract

Aim

To evaluate the association between anterior knee pain (AKP) and traditional Indian habits of cross-legged sitting and squatting which involve deep knee flexion.

Materials and methods

A case control study was carried out in 225 patients and 225 age and sex matched controls at a tertiary care university hospital in South India over 3 years. Males and females between 18 and 55 years were evaluated using a clinical proforma of history and musculoskeletal examination. The details of deep knee flexion habits with quantification of duration were noted and participants were categorized into those who sat and did not sit cross legged, and squatters and nonsquatters. Odds ratios and chi-square tests were calculated for both these categorical variables. A subgroup analysis and stratified analysis were also performed.

Results

The Odds ratios for cross-legged sitting and squatting were not significant at 0.88 and 0.92 respectively. Sixty-nine point three percentage of the AKP cases and 72% of the controls sat cross legged (p = 0.534) and 67.6% of the AKP cases and 69.3% of controls habitually squatted (p = 0.685). Stratified analysis revealed a protective effect of cross legged sitting in AKP cases with quadriceps muscle tightness.

Conclusion

This study did not find an association between AKP and Indian habits of deep knee flexion. More than 65% of all the participants regularly engaged in these habits. Laboratory biomechanical analysis of these positions is suggested in future to understand their effect on knee joint.

Clinical significance

These positions are integral to daily habits of many Indians. The advice to AKP patients to avoid them due to their probable AKP association is not supported by the current study. Clinicians can consider the impact on the patient's quality of life before advising against these positions.

How to cite this article

Parikh TK, Arumugam S. Are Indian Habits of Cross-legged Sitting and Squatting associated with Anterior Knee Pain? J Postgrad Med Edu Res 2017;51(1):1-6.

RESEARCH ARTICLE

Dhaval Ranjitbhai Lekhadia, Rohan Rai, Niveditha Hegde, Abhinay Sorake

Assessment of Vertical Skeletal Patterns using a New Cephalometric Parameter: The Dhaval—Rohan Angle

[Year:2017] [Month:January-March] [Volume:51] [Number:1] [Pages:5] [Pages No:7 - 11]

PDF  |  DOI: 10.5005/JPMER-51-1-7  |  Open Access |  How to cite  | 

Abstract

Introduction

The aim of this study was to establish a new cephalometric parameter, named the Dhaval—Rohan angle (DR), to assess the vertical skeletal patterns on a lateral cephalogram with accuracy and reproducibility.

Materials and methods

One hundred and twenty pretreatment lateral cephalograms of the patients visiting the department of orthodontics and dentofacial orthopedics for treatment were obtained and divided into three groups. i.e., horizontal growth pattern, average growth pattern, and vertical growth pattern cases based on the routinely used cephalometric parameters; FMA, SN-GoGn, Y-axis angle and Jarabak ratio. This angle uses three skeletal landmarks, the point C (center of the condyle), point M (midpoint of premaxilla), and point G (center of the largest circle that is tangent to the internal inferior, anterior, and posterior surfaces of the mandibular symphysis).

Results

The one-way analysis of variance (ANOVA) test showed that the three groups studied were not the same for DR angle and the post hoc Tukey test found the groups to be significantly different. According to the Student's t-test, there was no statistically significant difference in mean values of DR angle between males and females.

Conclusion

Cephalometric evaluation of young adults shows that the DR angle below 28.5° indicates a horizontal growth pattern, between 28.5 and 32.5° indicate an average growth pattern and above 32.5° indicate a vertical growth pattern.

How to cite this article

Lekhadia DR, Rai R, Hegde N, Hegde G, Sorake A, Kumar A. Assessment of Vertical Skeletal Patterns using a New Cephalometric Parameter: The Dhaval—Rohan Angle. J Postgrad Med Edu Res 2017;51(1):7-11.

RESEARCH ARTICLE

Daisy Sahni, Anjali Aggarwal, Tulika Gupta, Harjeet Kaur, Kunal Chawla, Suresh K Goyal

Congenital Renal Anomalies in Indian Population

[Year:2017] [Month:January-March] [Volume:51] [Number:1] [Pages:5] [Pages No:12 - 16]

PDF  |  DOI: 10.5005/JPMER-51-1-12  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Gupta T, Goyal SK, Aggarwal A, Chawla K, Kaur H, Sahni D. Congenital Renal Anomalies in Indian Population. J Postgrad Med Edu Res 2017;51(1):12-16.

RESEARCH ARTICLE

Balaji Saibaba, Nirmal R Gopinathan, Prateek Behera, Siva S Santhanam

Prospective Role of Uniplanar Compressible External Fixation Devices in the Management of Pathological Diaphyseal Fractures Secondary to Osteomyelitis in Children

[Year:2017] [Month:January-March] [Volume:51] [Number:1] [Pages:5] [Pages No:17 - 21]

PDF  |  DOI: 10.5005/JPMER-51-1-17  |  Open Access |  How to cite  | 

Abstract

Introduction

Management of pathological diaphyseal fractures secondary to osteomyelitis in children still remains a nightmare for the treating orthopedic surgeon owing to the highly unpredictable clinical course and lack of certainty in achieving successful results. This study highlights the potential role of rail fixator in the management of pathological femur fracture secondary to osteomyelitis in children.

Materials and methods

A total of five children (8—13 years age group) with pathological diaphyseal fractures of femur (four cases) and tibia (one case), operated between January 2014 and December 2014, were included in the study. Chronic osteomyelitis was the underlying etiology in all the cases. The surgical management consisted of thorough debridement, lavage, freshening of fractured bone ends, opening of the bone ends, reduction and external stabilization using pediatric monorail fixator. All patients received postoperative antibiotics, based on intraoperative culture and sensitivity reports, for 6 weeks (intravenously for the initial 3 weeks, orally for the remaining 3 weeks). Weight bearing and knee range of motion were started in the early postoperative period as soon as the children were pain free.

Results

Staphylococcus aureus was the causative organism in all the cases. Out of five cases, four fractures united: Three femurs (between 9 and 12 weeks) and one tibia (11 weeks). There was one case of delayed union of femur (18 weeks). Septic pin tract loosening was seen in one case (femur) requiring prolonged antibiotic usage. Minimal limb length discrepancy (1—1.5 cm) was observed in all the cases.

Conclusion

Compression fixation achieved by monorail fixator can be considered as a viable option for the management of pediatric diaphyseal fractures secondary to active bony infection. It has the advantage of promoting bony union, aiding in early weight bearing, establishing successful joint mobilization, providing an option for future restoration of limb length, and improved patient comfort.

How to cite this article

Saibaba B, Gopinathan NR, Dhillon MS, Behera P, Santhanam SS. Prospective Role of Uniplanar Compressible External Fixation Devices in the Management of Pathological Diaphyseal Fractures Secondary to Osteomyelitis in Children. J Postgrad Med Edu Res 2017;51(1):17-21.

RESEARCH ARTICLE

Georgy J Eralil

Role of Structured Feedback of Direct Observation of Procedural Skills in improving Clinical Skill of Interns

[Year:2017] [Month:January-March] [Volume:51] [Number:1] [Pages:6] [Pages No:22 - 27]

PDF  |  DOI: 10.5005/JPMER-51-1-22  |  Open Access |  How to cite  | 

Abstract

Objectives

To assess clinical skills of interns in selected procedures using direct observation of procedural skills (DOPS)

To assess the change in procedural skills among students who received a structured feedback on DOPS.

Materials and methods

The study was interventional and conducted between December 2015 and February 2016 at the Department of Obstetrics and Gynaecology of Sree Narayana Institute of Medical Sciences, Ernakulam, Kerala, India. In the study, investigator observed the trainee performing a practical procedure within the workplace and recorded a rating for each competency on the assessment form. Feedback was given expanding on the reasons for any ratings of development required and makes practical suggestions for any remedial steps. The intern is reassessed for the same procedure at a later stage and the impact on skills is scored. Then the structured feedback is provided, and later on again the score on skills obtained by DOPS are compared between pre- and post-values by Wilcoxon-signed rank test.

Results

The average of pre- and post-feedback values were compared by Wilcoxon signed rank test. The p-value calculated was <0.001, which is significant. None of the interns were competent to perform the procedure before feedback; 80% of them needed more practice and 20% needed supervision. After feedback, 53.3% achieved competency and 46.7% achieved competency needing supervision; 93.3% of interns regarded feedback as superior quality, while 6.7% regarded as satisfactory.

Conclusion

Direct observation of procedural skills can be used to assess clinical skills of interns in selected procedures and it brings changes in procedural skills among students who received a structured feedback on DOPS.

How to cite this article

Eralil GJ. Role of Structured Feedback of Direct Observation of Procedural Skills in improving Clinical Skill of Interns. J Postgrad Med Edu Res 2017;51(1):22-27.

CASE REPORT

Nagarajan Doraisamy, Malarvizhi Chandrasekhar, Jim Jebakumar, Sukhdev DB Singh

Tuberculous Compound Palmar Ganglion

[Year:2017] [Month:January-March] [Volume:51] [Number:1] [Pages:2] [Pages No:28 - 29]

PDF  |  DOI: 10.5005/JPMER-51-1-28  |  Open Access |  How to cite  | 

Abstract

Introduction

Compound palmar ganglion of tuberculous etiology is an infrequent condition, which has an obvious clinical picture, but still overlooked and should be diagnosed earlier before the involvement of underlying bones and nerves.

Case Report

We present the case of a 56-year-old male presenting with progressive swelling of the palm and forearm. He was diagnosed to have chronic flexor tenosynovitis without involvement of the underlying bones and was treated by complete excision and antitubercular therapy (ATT).

Conclusion

Tuberculous palmar ganglion is a condition that can be managed by excision and chemotherapy. However, it presents as a challenge to rural surgeons where the patients present late. Hence, early identification and treatment are the main goals of this article.

How to cite this article

Doraisamy N, Chandrasekhar M, Jebakumar J, Singh SDB. Tuberculous Compound Palmar Ganglion. J Postgrad Med Edu Res 2017;51(1):28-29.

CASE REPORT

Rahul Peswani, Adarsh Trivedi

Posttraumatic Late-onset Extradural Hematoma in Dorsal Spine: A Rare Presentation

[Year:2017] [Month:January-March] [Volume:51] [Number:1] [Pages:3] [Pages No:30 - 32]

PDF  |  DOI: 10.5005/JPMER-51-1-30  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Peswani R, Trivedi A. Posttraumatic Late-onset Extradural Hematoma in Dorsal Spine: A Rare Presentation. J Postgrad Med Edu Res 2017;51(1):30-32.

CASE REPORT

Gnanapriya Vellaisamy, Julian Crasta, Gayatri Ravikumar

Basaloid Squamous Carcinoma arising at Splenic Flexure of Colon

[Year:2017] [Month:January-March] [Volume:51] [Number:1] [Pages:4] [Pages No:33 - 36]

PDF  |  DOI: 10.5005/JPMER-51-1-33  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Vellaisamy G, Ravikumar G, Crasta J, Rout P. Basaloid Squamous Carcinoma arising at Splenic Flexure of Colon. J Postgrad Med Edu Res 2017;51(1):33-36.

CASE REPORT

Lokesh K Penubarthi, Alok Rathi

Cysticercosis of Lateral Pterygoid Muscle

[Year:2017] [Month:January-March] [Volume:51] [Number:1] [Pages:3] [Pages No:37 - 39]

PDF  |  DOI: 10.5005/JPMER-51-1-37  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Virk RS, Rathi A, Penubarthi LK, Gupta AK, Bansal S. Cysticercosis of Lateral Pterygoid Muscle. J Postgrad Med Edu Res 2017;51(1):37-39.

RESEARCH ARTICLE

Manish Modi, Aditya Choudhary, Manoj Goyal, Bishan D Radotra, Rakesh K Vasishta, Balan L Gaspar

Calf Muscles Hypertrophy in Sarcoglycanopathy

[Year:2017] [Month:January-March] [Volume:51] [Number:1] [Pages:2] [Pages No:40 - 41]

PDF  |  DOI: 10.5005/JPMER-51-1-40  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Choudhary A, Goyal M, Modi M, Radotra BD, Vasishta RK, Gaspar BL. Calf Muscles Hypertrophy in Sarcoglycanopathy. J Postgrad Med Edu Res 2017;51(1):40-41.

RESEARCH ARTICLE

Kirti Gupta, Sadhna Lal, Aravind Sekar

A Three-month-old Female Child with Acute-on-chronic Liver Disease: How Far We reached after Autopsy?

[Year:2017] [Month:January-March] [Volume:51] [Number:1] [Pages:8] [Pages No:42 - 49]

PDF  |  DOI: 10.5005/JPMER-51-1-42  |  Open Access |  How to cite  | 

Book Review

Sandeep Patel, K Puneeth

Fractures of the Calcaneus

[Year:2017] [Month:January-March] [Volume:51] [Number:1] [Pages:2] [Pages No:50 - 51]

PDF  |  DOI: 10.5005/jpmer-51-1-50  |  Open Access |  How to cite  | 

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