Journal of Postgraduate Medicine, Education and Research

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2019 | October-December | Volume 53 | Issue 4

EDITORIAL

Dr Divyesh Kumar, Dr Bhavana Rai

Fertility in Women with BRCA1 and 2 Mutations - Do We Need to be Concerned?

[Year:2019] [Month:October-December] [Volume:53] [Number:4] [Pages:1] [Pages No:0 - 0]

PDF  |  DOI: 10.5005/jpmer-53-4-iii  |  Open Access |  How to cite  | 

Original Article

Vinita Sarbhai, Tanvisha Singla

Diagnostic Value of Outpatient Endometrial Aspiration and Transvaginal Sonography vs Inpatient Hysteroscopy in Evaluation of Abnormal Uterine Bleeding

[Year:2019] [Month:October-December] [Volume:53] [Number:4] [Pages:4] [Pages No:143 - 146]

Keywords: Hysteroscopy, Transvaginal sonography,Abnormal uterine bleeding, Endometrial aspiration

PDF  |  DOI: 10.5005/jp-journals-10028-1335  |  Open Access |  How to cite  | 

Abstract

Objective: The objective of this study was to compare the efficacy of outpatient and inpatient procedures, and to assess whether hysteroscopy offers any additional benefit when compared to a combination of endometrial biopsy and vaginal ultrasound. Materials and methods: A total of 50 patients aged >18 years who presented with abnormal uterine bleeding were included in this study. Endometrial aspiration with Pipelle cannula and transvaginal sonography on an outpatient basis and hysteroscopy under anesthesia were performed. The findings of endometrial aspiration and transvaginal sonography were correlated with hysteroscopy-guided biopsy. Results: There is good sensitivity and negative predictive value of combined EA and TVS (i.e., 84.62% and 88.89%, respectively), while low specificity and positive predictive value (i.e., 51.61% and 42.31%, respectively), which is comparable to hysteroscopy, which has diagnostic accuracy values of sensitivity (84.62%), negative predictive value (90%), positive predictive value (45.83%), and specificity (58.06%). Conclusion: The combination of TVS and pipelle sampling enhances the diagnostic yield, and hence can be used as first-line investigation as they complement each other, and can be used to triage the patients for hysteroscopy, which is the gold standard and has the added advantage of combining see and treat in skilled hands many cases.

Original Article

Ravi Gupta, Sonali Shamdasani, Aditi Mehra

Seasonal Epidemic of Swine Flu: Role of Hospital Administration in Preparedness

[Year:2019] [Month:October-December] [Volume:53] [Number:4] [Pages:5] [Pages No:147 - 151]

Keywords: Comorbidity, Demographic profile, Hospital administration, Mechanical ventilation, Outcome, Swine flu

PDF  |  DOI: 10.5005/jp-journals-10028-1333  |  Open Access |  How to cite  | 

Abstract

Aim: To analyze the trend of swine flu disease and the demographic details of the category C swine flu patients admitted in a tertiary care hospital and assess their outcome. Based on this, we want to define the role of hospital administrators in planning for management of swine flu epidemic. Materials and methods: Record based retrospective analysis of confirmed cases of swine flu infection from January, 2016 to February, 2019 was done. The trend of disease during the study period and the demographic details of the confirmed cases in category C were assessed to analyze the variables that could affect the outcome of the disease. Results: Among 466 suspected cases, 29.4% (n = 137) were positive for swine flu infection. The trend of the disease over the study period was variable. A total of 118 patients (86.1%) were of category C. Amongst category C, maximum cases and mortalities were in age-group 21–60 years (p < 0.001). The occurrence and mortality of disease (p = 0.098, p = 0.249 respectively) was almost equal among both genders. Around 43.2% category C patients required mechanical ventilation and 56.8% required oxygen therapy. The mortality was very high amongst category C patients on mechanical ventilation (94.1%). No association was observed between comorbidity and mortality. Conclusion: By knowing the trend of disease and the outcome, planning can be done to effectively manage swine flu epidemic in terms of infrastructure, manpower and other resources. Thus, the hospital administrators play pivotal role. Clinical significance: The study will help the hospital administrators to understand the variable trend of disease and demographic profile planning for management of swine flu epidemic.

RESEARCH ARTICLE

Prasoon Kumar, Rohit Kansal

Routine Chemoprophylaxis for Venous Thromboembolism in Orthopedic Patients: Is it Justified?

[Year:2019] [Month:October-December] [Volume:53] [Number:4] [Pages:6] [Pages No:152 - 157]

Keywords: Acetabulum fractures, Arthroplasty, Chemoprophylaxis, Deep vein thrombosis, Long-bone fractures, Pelvic fractures, Pulmonary embolism, Venous thromboembolism

PDF  |  DOI: 10.5005/jp-journals-10028-1334  |  Open Access |  How to cite  | 

Abstract

Introduction: Orthopedic patients require prolonged immobilization and undergo major surgical procedures which make them susceptible to venous thromboembolism (VTE). The role of chemoprophylaxis to prevent VTE is still debated, with many surgeons using it routinely, while certain centers use it sporadically. The present review assesses the evidence in literature regarding the VTE chemoprophylaxis in different subsets of orthopedic patients with specific focus on arthroplasty, pelvic trauma, and long-bone fractures. Materials and methods: A PubMed search to look for current usage of routine chemoprophylaxis in hip/knee arthroplasties and postoperative cases of pelvic-acetabular, hip, and tibia fractures yielded 2,216 hits. Based on the relevant articles, the evidence in literature was studied to determine the role of chemoprophylaxis. Results: The incidence of VTE in orthopedics patients is well documented with several studies, both Indian and Western quoting rates of up to 72%. There are no guidelines from any Indian orthopedics body or society, and most of the surgeons rely on the recommendations from the American Academy of Orthopaedic Surgeons (AAOS) and the American College of Chest Physicians (ACCP). These guidelines are based on the review of the literature and recommend routine chemoprophylaxis to prevent VTE in hip/knee arthroplasties and hip fractures. Low molecular weight heparin, apixaban, rivaroxaban, and fondaparinux are potential agents. Oral low-dose aspirin is also effective in arthroplasty patients, while its efficacy may not be at par with the other agents in trauma cases; the evidence is however still not clear. There is no similar role of routine chemoprophylaxis in fractures distal to the knee; as the thrombi formed are distal, they do not often embolize to the lungs and are rarely clinically significant. Conclusion: Patients undergoing hip and knee arthroplasties or surgeries for pelvic-acetabular and hip fractures require routine VTE chemoprophylaxis. LMWH or newer agents like apixaban or fondaparinux are effective in decreasing the incidence of clinical VTE and could be prescribed for a period as long as 6–8 weeks postoperatively.

CASE REPORT

Gaurav Vohra, Jasmine Sethi

Systemic Lupus Erythematosus Presenting with Thrombotic–Thrombocytopenic Purpura-like Syndrome and Catatonia

[Year:2019] [Month:October-December] [Volume:53] [Number:4] [Pages:2] [Pages No:158 - 159]

Keywords: Catatonia, Systemic lupus erythematosus, Thrombotic microangiopathy, Thrombotic–Thrombocytopenic purpura

PDF  |  DOI: 10.5005/jp-journals-10028-1332  |  Open Access |  How to cite  | 

Abstract

Systemic lupus erythematosus (SLE) can present with thrombotic microangiopathy (TMA), and differentiating this from thrombotic thrombocytopenic purpura can be a challenging task. Though thrombotic–thrombocytopenic purpura (TTP) is a type of TMA demonstrating a severely reduced activity of VWF, cleaving protease ADAMTS 13 can differentiate it from other causes of TMA. Association of TTP-like TMA and catatonia in lupus is not described in literature. Neuropsychiatric lupus presenting as catatonia is uncommon. Here we describe a 41-year-old female who was presented with TTP-like TMA and catatonic symptoms, which improved with plasma-exchange, benzodiazepines, and immunosuppression.

CASE REPORT

Richa Vatsa, Jyoti Meena, Sunesh Kumar, Kallol K Roy

Female Genital Tract Affected by Xanthogranulomatous Inflammation: A Series of Four Cases and Review of Literature

[Year:2019] [Month:October-December] [Volume:53] [Number:4] [Pages:3] [Pages No:160 - 162]

Keywords: Inflammation, Oophoritis, Salpingitis, Xanthogranulomatous

PDF  |  DOI: 10.5005/jp-journals-10028-1336  |  Open Access |  How to cite  | 

Abstract

Objective: Xanthogranulomatous inflammation is a form of chronic inflammation that rarely affects the female genital tract. Endomertium is most commonly involved in the genital tract; ovary and fallopian tube is rarely affected. The purpose of this case series is to make clinicians familiar about this rare condition. Case description: Here we are presenting a series of four cases, three of xanthogranulomatous oophoritis and one of xanthogranulomatous salpingitis each. One of our cases appeared as carcinoma ovary and other as metastasis of carcinoma cervix to ovary. Conclusion: Xanthogranulomatous inflammation of the female genital tract is an uncommon entity, clinical and radiological features of this entity may mimic ovarian tumor, and hence it must be considered in the differential diagnosis of ovarian mass. Histopathological examination is essential for its diagnosis. Awareness of this entity is vital to avoid an incorrect and overdiagnosis of malignancy.

LETTER TO THE EDITOR

Uttam C Saini

Total Knee Arthroplasty in a Case of Tuberculosis Knee in Healing Stage: Is it Safe?

[Year:2019] [Month:October-December] [Volume:53] [Number:4] [Pages:1] [Pages No:163 - 163]

PDF  |  DOI: 10.5005/jp-journals-10028-1338  |  Open Access |  How to cite  | 

BIOSTATISTICS SERIES

Statistics Corner: Data Cleaning-II

[Year:2019] [Month:October-December] [Volume:53] [Number:4] [Pages:4] [Pages No:164 - 167]

PDF  |  DOI: 10.5005/jp-journals-10028-1339  |  Open Access |  How to cite  | 

Abstract

Reality check Microsoft Excel is one of the most routinely used spreadsheets to enter and clean data by researchers. However, the lack of professional training in Excel hinder its efficient usage. Majority of investigators are aware of basic data entry and cleaning mechanisms in Excel. However, there are numerous advanced easy-to-use functions that increase the efficiency and accuracy of data entry. The present article will be discussing four vital functions to enter and clean data efficiently. These functions are the following: • Data form • Data validation • Go to special • Protecting specific columns, worksheet, and workbook

Symposium

Rakesh Kapoor

Fertility-sparing Radiation and Chemotherapy

[Year:2019] [Month:October-December] [Volume:53] [Number:4] [Pages:5] [Pages No:168 - 172]

Keywords: Brachytherapy, Chemotherapy, Fertility preservation, Radiation therapy

PDF  |  DOI: 10.5005/jp-journals-10028-1340  |  Open Access |  How to cite  | 

Symposium

Gaurav Prakash, Arihant Jain, Chandan K Das

Impact on Fertility in Patients with Hematological Malignancies and Bone Marrow Transplant

[Year:2019] [Month:October-December] [Volume:53] [Number:4] [Pages:3] [Pages No:173 - 175]

Keywords: Chemotherapy, Fertility, Hematology, Preservation,Bone marrow transplant, Cancer

PDF  |  DOI: 10.5005/jp-journals-10028-1337  |  Open Access |  How to cite  | 

Abstract

With the rapidly improving outcome of patients suffering from hematologic disorders and cancers, there exists a rapidly widening gap of unmet need regarding fertility preservation in this group. Hematologic cancers make for a large proportion of all cancers in young patients and there are issues peculiar to hematologic neoplasms which are not observed by the patients suffering from solid tumors. The biggest challenge is seen with the patients undergoing hematologic stem cell transplants because it involves use of high doses of cytotoxic chemotherapy with or without radiation. In majority of these cases, the damage to gonadal function is irreversible. Each hematologic disorder in young patients poses a unique challenge regarding fertility preservation. In this review, we address some important aspects related to fertility in patients suffering from a few selected hematologic disorders.

Symposium

Aditya P Sharma, Ravimohan S Mavuduru

Oncofertility and Fertility Preservation in Males: Current Perspective

[Year:2019] [Month:October-December] [Volume:53] [Number:4] [Pages:3] [Pages No:176 - 178]

Keywords: Cancer, Male infertility, Oncofertility

PDF  |  DOI: 10.5005/jp-journals-10028-1341  |  Open Access |  How to cite  | 

Symposium

Shalini Gainder, Japleen Kaur

Fertility Preservation in Females: Emerging Era of Ice Age

[Year:2019] [Month:October-December] [Volume:53] [Number:4] [Pages:3] [Pages No:179 - 181]

Keywords: Embryo, Fertility preservation, Gonadotoxic, Non-Hodgkins, Oncofertility, Oocyte,Cryofreezing

PDF  |  DOI: 10.5005/jp-journals-10028-1343  |  Open Access |  How to cite  | 

Abstract

Fertility preservation in malignancy and certain benign conditions is gaining momentum, with advancement in the techniques for the same. It has become more relevant with improving treatment of cancers and increasing life expectancy. Reproductive potential is an important aspect of a woman\'s life. It is the responsibility of the care provider to be aware of the options of fertility preservation. The various techniques available for the purpose of fertility preservation in females range from oocyte/embryo/ovarian tissue cryopreservation to fertility-preserving surgeries, and the choice of procedure depends on numerous patient and treatment factors. Healthcare provider must be able to assess eligibility of the patient for preservation of fertility potential, carefully balancing the risk and benefit of the same, in relation to the cancer treatment. There are other ethical and legal concerns, which must be discussed in detail with the woman. Therefore, counseling is an integral part of the process.

Clinicopathological Conference Report

Prof Uma Nahar, Ridhi Sood, Prof Ajay Bahl, Prof Manphool Singh, Prof Krishnan Lal Gupta

Primary Amyloidosis Presenting as Restrictive Cardiomyopathy

[Year:2019] [Month:October-December] [Volume:53] [Number:4] [Pages:7] [Pages No:182 - 188]

PDF  |  DOI: 10.5005/jp-journals-10028-1342  |  Open Access |  How to cite  | 

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