Journal of Postgraduate Medicine, Education and Research

Register      Login

Table of Content

2020 | April-June | Volume 54 | Issue 2

EDITORIAL

Prasoon Kumar, Ashish Behera

Final Countdown to the COVID-19 Lockdown!!

[Year:2020] [Month:April-June] [Volume:54] [Number:2] [Pages:2] [Pages No:27 - 28]

PDF  |  DOI: 10.5005/jp-journals-10028-1359  |  Open Access |  How to cite  | 

Original Article

Gautam Kumar, Nusrat Shafiq, CVN Harish, Samir Malhotra

Evaluation of Drug-related Emergency Department Admissions in a Tertiary Care Hospital

[Year:2020] [Month:April-June] [Volume:54] [Number:2] [Pages:5] [Pages No:29 - 33]

Keywords: Cross-sectional study, Drug-related admissions, Medication-related problems

PDF  |  DOI: 10.5005/jp-journals-10028-1356  |  Open Access |  How to cite  | 

Abstract

Aims: To estimate the incidence, severity, preventability, and cost of medication-related problems. To classify patients admitted with medication-related illnesses based on causative factors. Study design: Single-center, cross-sectional, observational study. Materials and methods: Patient details were collected within 24 hours of admission into emergency. The causality assessment for adverse drug reaction (ADR) was assessed using the Naranjo scale. The modified Canadian emergency department triage and the acuity scale was used for assessment of severity of the ADR and the likely outcome. Results: We screened approximately 6,050 admissions; of them, 180 (2.97%) were related to medication-related problems. About 59 (32.8%) were classified as definitely preventable, 92 (51.1%) possibly preventable, and remaining 29 (16.1%) were not preventable. A total of 103 (57.2%) were categorized as severe, 76 (42.2%) as moderate, and 1 as mild. Average number of drugs received prior to admission was 1.29 (±1.15), which increased to 6.93 (±2.34) at the time of analysis. The median (range) cost of medications was $11.70 ($0.32–253.6) per patient per day. Conclusion: Considering the high number of patients admitted with severe illness at the time of admission and the prohibitive cost of medication, we can reduce the financial burden, morbidity, and mortality with drug-related admissions with proper and timely intervention. Also, the inappropriate use of complementary and alternative medications (CAM) should be controlled in order to reduce the incidence of medication-related problems. Clinical significance: Nonadherence and ADRs constitute majority of admissions due to medication-related problems.

Original Article

Rajan Bhagat

Analysis of Time Trend of Cost of Medications

[Year:2020] [Month:April-June] [Volume:54] [Number:2] [Pages:3] [Pages No:34 - 36]

Keywords: Commonly used drugs, Drug price, Increase over time

PDF  |  DOI: 10.5005/jp-journals-10028-1357  |  Open Access |  How to cite  | 

Abstract

Background: Increase in prices of drugs has always been a topic of concern across the world. In countries like India, where people have to bear this expenditure out of pocket, rise in prices of drugs is a major issue. Objective: To find out the pattern of changes in prices of some commonly used drugs over a period of 15 years. Materials and methods: We selected some commonly used drugs used in the treatment of cardiovascular system (CVS), central nervous system (CNS), respiratory, hematological, gastrointestinal, and endocrine diseases. We also included some other drugs like antimicrobials, anti-allergics, and nonsteroidal anti-inflammatory drugs (NSAIDs). Information on the prices of drugs was extracted at four time points: years 2001, 2006, 2011, and 2016. Percentage change in prices over a period of 15 years was calculated. We followed the time course of price variation of the same dosing strengths of the highest and lowest priced brands, out of the various brands available. We categorized the drugs into three categories: more than or equal to 100% increase in price, “decrease” and “no change.” Results: Out of total 117 drugs, 28 drugs (24%) showed an increase of more than 100% over this period. Among lowest priced brands, there was a mean [standard deviation (SD)] increase of 222% (142), and among highest priced brands, there was an average increase of 244% (205). Fifty-nine (50%) drugs showed “no change” or “decrease” in price, the reason for which in 31 (52.5%) came under price control. Conclusion: Since the prices of raw materials tend to decline over time, the hike in drug prices appears unjustified.

Original Article

Divya Sharma, Suman Mor

Extent, Trend, and Pattern of Use of Health and Wellness Products by People in Chandigarh and Shimla

[Year:2020] [Month:April-June] [Volume:54] [Number:2] [Pages:3] [Pages No:37 - 39]

Keywords: Wellness, Wellness revolution,Health, Products

PDF  |  DOI: 10.5005/jp-journals-10028-1353  |  Open Access |  How to cite  | 

Abstract

The concept of wellness has evolved over the last few decades. This, in turn, has led to a great increase in the use of health and wellness products. Objective: To analyze the extent, trend, and pattern of use of health and wellness products by people in Chandigarh and Shimla. Materials and methods: This quantitative cross-sectional study was carried out in Chandigarh, UT, and Shimla, Himachal Pradesh. The data were collected from participants using structured questionnaires. Results: A total of 150 individuals were taken for the study. Among food products, traditional food products like rice, sugar, salt, and flour were used by all. In hair care products, shampoos and oil were used the most. Among skin care products, soap and face wash had high frequency of use. Hand wash had the highest frequency of use among hygiene products. Running shoes and yoga pants had highest usage among fitness products. Conclusion: The use of health and wellness products was moderate in the study areas. The maximum used products were food and beauty care products.

Original Article

Uma Debi, Lokesh Singh, Vaibhav Gulia, Vishal Sharma, Rohan S Kamat, Richa S Chauhan, Kaushal K Prasad

Role of Double-contrast Barium Enema in Crohn's Colitis

[Year:2020] [Month:April-June] [Volume:54] [Number:2] [Pages:5] [Pages No:40 - 44]

Keywords: Barium enema, Colitis, Colonoscopy, Crohn\'s

PDF  |  DOI: 10.5005/jp-journals-10028-1354  |  Open Access |  How to cite  | 

Abstract

Background: Double-contrast barium enema (DCBE) is a safe, noninvasive, inexpensive, and cost-effective imaging technique. It offers complete visualization of the colonic mucosa. Inflammatory bowel disease (IBD) including Crohn\'s disease can easily be diagnosed using the DCBE technique. Aims and objectives: To demonstrate the accuracy of DCBE in diagnosis of Crohn\'s colitis. Materials and methods: A retrospective review of DCBE examination in 57 patients of colonic Crohn\'s disease was performed. A barium suspension of medium viscosity at 100% w/v was used. Each DCBE was evaluated by two experienced gastrointestinal radiologists independently without any knowledge of the colonoscopic findings. Results: In 89% of patients, the radiological diagnosis corresponded with the clinical diagnosis of Crohn\'s disease. Five patients were misclassified as tubercular and one as ulcerative colitis. Asymmetric disease with rectal sparing and discrete ulcers were the most commonly observed radiological findings. About 19% of patients showed the features of early Crohn\'s as suggested by the finding of aphthoid ulcerations with background of the normal mucosa. The left-sided colon was more commonly involved compared with the right side with the transverse colon being the most commonly involved part. Conclusion: The double-contrast examination technique, because of its high accuracy in diagnosing Crohn\'s disease and due to its relatively specific signs, is suggested to be the preferred examination in the radiological assessment of inflammatory bowel disease.

Original Article

Deepanjan Bhattacharya, Suresh K Angurana, Renu Suthar, Venkatasesan Sundaram, Arushi Saini, Lokesh Saini, Muneer A Malik, Vimal S Munda, Vikas Gautam

Disseminated Staphylococcal Disease in Neonates Admitted to Pediatric Emergency of a Developing Economy: Clinicomicrobiological Profile, Management, and Outcome

[Year:2020] [Month:April-June] [Volume:54] [Number:2] [Pages:5] [Pages No:45 - 49]

Keywords: Neonates, Staphylococcus aureus,Abscesses, Methicillin-resistant Staphylococcus aureus

PDF  |  DOI: 10.5005/jp-journals-10028-1361  |  Open Access |  How to cite  | 

Abstract

Aim: To report clinical and microbiological profile, complications, management, and short-term outcome of neonates with disseminated staphylococcal disease. Materials and methods: This retrospective study was conducted in pediatric emergency of a tertiary-care teaching hospital in North India involving 26 outborn neonates admitted with diagnosis of disseminated staphylococcal disease over 1-year period (January–December 2018). Results: Majority of the neonates presented between day 7 and day 28 of life with mean duration of illness of 6.6 (2.4) days. The risk factor for disseminated staphylococcal disease was noted in 38.5% (n = 10) cases (intramuscular injection, venous cannula, nonpenetrative trauma, and umbilical line). Skin and subcutaneous tissue abscesses were the commonest localization (88.5%) followed by pneumonia (30.8%), meningitis (26.9%), septic arthritis (19.2%), and osteomyelitis (11.5%). Staphylococcus aureus was isolated in 53.8% cases, and methicillin-resistant Staphylococcus aureus (MRSA) accounted for 71.4% of isolates. Common complications were acute kidney injury, respiratory failure, and shock (in 26.9% each) and venous thrombosis and septic ileus (in 7.7% each). The duration of appropriate antibiotics was 16.5 (6.4) days. Incision and drainage of abscesses was done in 53.8% cases, 19.2% underwent arthrotomy, 27% needed vasoactive drugs, and 19% received invasive mechanical ventilation. The duration of hospital stay was 17.7 (8.7) days, and mortality was 15.4% (n = 4). Conclusion: Disseminated staphylococcal disease is common in neonates. The skin and soft tissue focus with hematological spread to distant organs lead to fulminant disseminated disease. High index of suspicion, early diagnosis, prompt appropriate antibiotics, and early surgical debridement are integral part of management. The MRSA contributes to significant burden.

CASE REPORT

Prasoon Kumar, Amit K Salaria, Sameer Aggarwal, Saurabh Agarwal

Uncoiling of Flexible Reamer during Closed Nailing for Shaft Femur Fracture

[Year:2020] [Month:April-June] [Volume:54] [Number:2] [Pages:3] [Pages No:50 - 52]

Keywords: Femur fracture, Flexible reamer, Incarceration, Interlocked nail, Uncoiling

PDF  |  DOI: 10.5005/jp-journals-10028-1358  |  Open Access |  How to cite  | 

Abstract

Introduction: Despite the documented pros and cons of reaming, the reamed intramedullary interlocking nail (IMILN) for closed shaft of femur fractures in adults is a worldwide standard procedure. Reaming requires a careful technique and instrumentation, despite that complications related to hardware, like breakage or incarceration, can occur. We present a peculiar case of uncoiling of the flexible reamer during closed nailing for a femoral shaft fracture in a 21-year-old male, discuss the causative factors, and highlight the precautions necessary to avoid it. Such an incident has only been reported once previously and ours is the second case ever to be reported. Case description: A 21-year-old male presented to the advanced trauma center of our institute with closed fracture of the left femur. He was posted for a reamed femoral interlocking nail, wherein, during the reaming procedure with the reamer size 9.5, it got stuck and uncoiled over the beaded guidewire. The reamer was extracted with back hammering and thereon the surgery went on smoothly. The patient did well postoperatively and had union at 4 months. Conclusion: Uncoiling of a flexible reamer is a rare complication of femoral intramedullary nailing. Sequential reaming, moderate force, and appropriate instrumentation are of paramount importance. Careful consideration must be given before using the same reamer for multiple surgeries.

CASE REPORT

Surinder Singh Rana, Ravi Sharma, Rajesh Gupta

Successful Pancreatic Endotherapy after Demonstration of Anatomical Variation in Pancreatic Duct by Endoscopic Ultrasound Pancreatography

[Year:2020] [Month:April-June] [Volume:54] [Number:2] [Pages:3] [Pages No:53 - 55]

Keywords: Intravenous, Magnetic resonance cholangiopancreatography, Pancreas,Endosonography

PDF  |  DOI: 10.5005/jp-journals-10028-1355  |  Open Access |  How to cite  | 

Abstract

Aim: We aim to describe the role of accessory pancreatic duct in pancreatic endotherapy as well as role of endoscopic ultrasound (EUS) pancreatography in the demonstration of pancreatic duct anatomy. Case description: We describe a 25-year-old male, chronic alcoholic, who presented with recurrent upper abdominal pain and investigations revealed a diagnosis of chronic calcific pancreatitis. Endoscopic retrograde pancreatography (ERP) failed as a guide wire could not be negotiated deep into pancreatic duct. EUS-guided pancreatography revealed that contrast was entering duodenum through the minor papilla via the patent accessory duct. The contrast was clearly seen exiting into the duodenum through the minor papilla orifice and successful minor papilla endotherapy could be done. Conclusion: The patent accessory duct can provide a drainage route for endoscopic interventions via the minor papilla even in patients without pancreas divisum, and EUS pancreatography can help in delineating pancreatic duct anatomy in cases where ERP fails.

CASE REPORT

Balaji Ramamourthy, Anant Basotia, Divya Jain, Joseph L Mathew, Ramandeep Singh Virk

Successful Management of Congenital Glottic Web Using Plasma Ablation and Fibrin Glue in an Infant: A Case Report

[Year:2020] [Month:April-June] [Volume:54] [Number:2] [Pages:3] [Pages No:56 - 58]

Keywords: Endoscope, Fibrin glue, Glottic web

PDF  |  DOI: 10.5005/jp-journals-10028-1370  |  Open Access |  How to cite  | 

Abstract

Congenital laryngeal webs are rare anomalies usually diagnosed in infancy, that is, children presented with respiratory difficulty or dysphonia. Diagnosis is made by laryngobronchoscopy. Various options such as endoscopic release with LASER, cold instruments with mitomycin C application, and open procedures are mentioned. We describe the usage of plasma ablation for the endoscopic release of glottic web and application of fibrin glue to prevent restenosis.

CASE REPORT

Manjuri Sharma, Manzoor A Parry, Ronica Baruah, Naushad Shah

Leukemic Infiltration of Kidney in a Case of T-cell Acute Lyphomatous Leukemia

[Year:2020] [Month:April-June] [Volume:54] [Number:2] [Pages:3] [Pages No:59 - 61]

Keywords: Leukemic infiltration,Acute kidney injury, Acute lymphomatous leukemia

PDF  |  DOI: 10.5005/jp-journals-10028-1376  |  Open Access |  How to cite  | 

Abstract

Kidney involvement in acute lymphomatous leukemia (ALL) presenting as acute kidney injury (AKI) is uncommon. We document a case report of a 19-year-old male who presented with loss of weight, weakness, and anorexia. On evaluation, he was found to have T-cell ALL with AKI. Renal biopsy was done, and immunohistochemistry (IHC) confirmed renal infiltration by the leukemic T cells. The patient was started on chemotherapy, and improvement of renal function with subsequent bone marrow showed an initial complete remission. This case illustrates the uncommon presentation of T-cell ALL as AKI.

CASE REPORT

Shivjee Prasanth, Sachin Singh, Joseph L Mathew, Ramandeep Singh Virk

Isolated Pediatric Supraglottic Stenosis Managed Using Plasma Ablation: A Case Report

[Year:2020] [Month:April-June] [Volume:54] [Number:2] [Pages:2] [Pages No:62 - 63]

Keywords: Decannulation, Dysphagia, Plasma ablation, Supraglottic stenosis

PDF  |  DOI: 10.5005/jp-journals-10028-1369  |  Open Access |  How to cite  | 

Abstract

We describe the technique of plasma ablation (PA) used for releasing supraglottic stenosis (SS). Supraglottic stenosis is associated with the history of airway manipulation or surgery causing chronic laryngeal edema and thereby stenosis. This usually manifests as decannulation failures and often associated with dysphagia and aspiration. A child presented to the emergency with distress following ingestion of green chillis and was intubated. Further developed aspiration pneumonia and fiberoptic endoscopy revealed cricopharyngeal stricture (CPS) and SS. Child was taken up for the release with PA and decannulated successfully. Supraglottic stenosis can be safely treated using PA as an alternative to LASER.

LETTER TO THE EDITOR

Health and Wellness Centers and Noncommunicable Disease Care: Opportunities and Challenges in the New Government Strategy

[Year:2020] [Month:April-June] [Volume:54] [Number:2] [Pages:2] [Pages No:64 - 65]

PDF  |  DOI: 10.5005/jp-journals-10028-1352  |  Open Access |  How to cite  | 

BIOSTATISTICS SERIES

Rakesh Kapoor

Statistics Corner: Reporting Descriptive Statistics

[Year:2020] [Month:April-June] [Volume:54] [Number:2] [Pages:3] [Pages No:66 - 68]

PDF  |  DOI: 10.5005/jp-journals-10028-1364  |  Open Access |  How to cite  | 

Abstract

Reality check Most of the studies in medical research collect raw data. However, raw data need to be processed and presented in meaningful numerical summaries to get information. Data processing can be broadly segmented into descriptive and inferential statistics. There are various descriptive measures to report data. However, the mean and standard deviation are the most popular reporting measures. Therefore, many times, investigator face dilemmas to either report mean and SD or some other appropriate descriptive measures? • Are there any guidelines to report descriptive measure? • What are the best descriptive measures to report continuous data? • What are the best descriptive measures to report ordinal data? • What are the best descriptive measures to report nominal data?

Clinicopathological Conference Report

Dr Balamurugan Thirunavukkarasu, Dr Ashish Behera, Dr Nidhi Prabhakar, Dr Divya Aggarwal, Dr Deepesh Lad, Prof Rakesh Kochar

Non-Hodgkin's Lymphoma: What Matters Tumor Type or Burden?

[Year:2020] [Month:April-June] [Volume:54] [Number:2] [Pages:8] [Pages No:69 - 76]

PDF  |  DOI: 10.5005/jp-journals-10028-1360  |  Open Access |  How to cite  | 

© Jaypee Brothers Medical Publishers (P) LTD.