Journal of Postgraduate Medicine, Education and Research

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2022 | April-June | Volume 56 | Issue 2

EDITORIAL

Amit Kapila, Aastha Takkar

Neurological Disorders, Corticosteroids, and Fracture Risk: Hiding in the Hindsight!

[Year:2022] [Month:April-June] [Volume:56] [Number:2] [Pages:2] [Pages No:61 - 62]

   DOI: 10.5005/jp-journals-10028-1570  |  Open Access |  How to cite  | 

Original Article

Siddhant Khare, Abhinav Singh, Palak Singhai, Rajender Kumar, Debajyoti Chatterjee, Santosh Irrinki

Management of Skin Malignancies: Lessons Learnt at a Tertiary Care Center in Northern India

[Year:2022] [Month:April-June] [Volume:56] [Number:2] [Pages:7] [Pages No:63 - 69]

Keywords: BCC, DMFSP, Melanoma, Merkel cell carcinoma, SCC, Skin cancer

   DOI: 10.5005/jp-journals-10028-1567  |  Open Access |  How to cite  | 

Abstract

Introduction: The prognosis of skin cancers in India is worse when compared to the Western countries. It may be because of overall rarity and low experience at individual centers, presentation with advanced disease, inadequate first treatment and a higher incidence of poor prognostic disease subtypes. Aims and objectives: To analyze the clinicopathological characteristics, recurrence patterns and the completeness of first treatment in the patients with skin cancers. Materials and methods: It was a retrospective analysis of all patients operated for skin cancers. Mean and SD was computed for normal data; for skewed data, median and IQR were used. Kaplan-Meier analysis was used to assess the survival. Results: There were 18 cases of skin malignancies of which 8 (44.4%) patients had MM 5 (27.8%) had SCC 2 (11.1%) each had BCC and DMFSP and 1 (5.6%) had MCC. Pain was the most common presenting symptom (55.6%). The median follow-up was 12.25 months (Range 2–21.5 months). Ten (55.6%) patients had received a primary treatment elsewhere, not in accordance with the standard treatment guidelines. The median delay between the primary treatment and definitive surgery was 8 months (Range 2.5–48 months) which led to an increase in surgical morbidity in at least 4 (40%) of these patients. Median disease-free survival in the study was 12 months. Conclusion: Skin cancers have poor outcomes in Indian patients when compared to the Western countries. Awareness programs for early diagnosis, a high index of suspicion and early referral to a center experienced in handling these malignancies may help in improving outcomes.

Original Article

Tegshjargal Badamjav, Ganchimeg Dondov, Batchimeg Batbaatar, Batkhishig Munkhjargal, Ulziisaikhan Banzragch, Pilmaa Yondonjamts, Tulgaa Lonjid, Erkhembulgan Purevdorj, Batbold Batsaikhan

A Cross-sectional Study of Knowledge, Attitudes, and Practices toward COVID-19 in Mongolia

[Year:2022] [Month:April-June] [Volume:56] [Number:2] [Pages:5] [Pages No:70 - 74]

Keywords: Attitude, COVID-19, Knowledge, Mongolia, Practice

   DOI: 10.5005/jp-journals-10028-1569  |  Open Access |  How to cite  | 

Abstract

Background: Currently, 6.3 million people have been infected with severe acute respiratory syndrome (SARS)—CoV-2 and the pandemic has spread to 216 countries. To date of 6th June 2020, 383,262 deaths were confirmed. Objective: We aimed to evaluate the knowledge, attitudes, and practices (KAP) toward COVID-19 among the population. Materials and methods: This cross-sectional study was conducted in 614 residents of Ulaanbaatar city by online survey. The Ethics Committee of Institute of Medical Sciences, Mongolian National University of Medical Sciences, Mongolia, approved our study protocol, procedures, information sheet, and consent statement (№2020/D-11). The questionnaire consists of 45 questions, including general information, KAP. The KAP were evaluated by 20, 14, and 9 scores, respectively. Results: The mean scores of participants were determined and ranked into levels of good, average, and poor. Appropriate statistical methods were performed. The mean age of participants were 32.14 ± 10.82 (12–86) years and 70% were women. The mean score of knowledge questionnaire was 13.73 ± 2.7 (13.7 ± 2.3 in male, 13.8 ± 2.6 in female, p = 0.221) which refers that 72.5% (445) of participants had a mean score of knowledge. Furthermore, the mean score of attitude was 13.2 ± 2.7 (13.7 ± 2.3 in male, 13.8 ± 2.6 in female, p = 0.221) and the mean score of practice was 6.9 ± 1.6 (6.3 ± 1.7 in male, 7.1 ± 1.6 in female). Conclusion: The population has a relatively good level of KAP toward COVID-19.

Original Article

Rajendra P Anne, Suresh K Angurana, Praveen Kumar, Venkatasesan Sundaram

Short-term Outcome of Manually Ventilated Outborn Neonates Admitted in Pediatric Emergency of a Developing Economy

[Year:2022] [Month:April-June] [Volume:56] [Number:2] [Pages:6] [Pages No:75 - 80]

Keywords: Manual ventilation, Neonates, Positive pressure ventilation, Self-inflating bag

   DOI: 10.5005/jp-journals-10028-1439  |  Open Access |  How to cite  | 

Abstract

Aim and objectives: In our country, managing neonates and children in need of positive pressure ventilation (PPV) with manual ventilation are not an uncommon practice due to a lack of adequate resources. But there is a lack of data on the outcome of manually ventilated neonates. This study was conducted to determine the short-term outcome of manually ventilated outborn neonates admitted in pediatric emergency of tertiary care hospital in North India. Materials and methods: This retrospective study was conducted from April to June 2018 involving 131 outborn neonates who were manually ventilated with self-inflating bags (SIBs). Details regarding demographic variables, perinatal period, treatment received, ventilation, the reason for intubation and PPV, duration of intubation, complications related to PPV, diagnosis, and final outcome were noted. Results: The mean age at admission was 5.6 days and 76% were males. The mean gestation and birth weight were 36.4 (±4.1) weeks and 2,309 (750) g, respectively. The common diagnoses were hypoxic-ischemic encephalopathy (HIE), early-onset neonatal sepsis (EONS), late-onset neonatal sepsis (LONS), and hyaline membrane disease (HMD). The survival rate was 22.1%, 45.8% of cases died, and 32.1% left against medical advice (LAMA). On univariate analysis, complications related to PPV; and presence of shock, thrombocytopenia, disseminated intravascular coagulation (DIC), acute kidney injury (AKI), and HIE were associated with poor outcome (death + LAMA); whereas on multivariate analysis, complications related to PPV, and presence of shock and HIE were independent predictors of poor outcome (death + LAMA). Conclusion: One-fifth of manually ventilated outborn neonates survived. Complications related to PPV, and presence of shock, and HIE were an independent predictor of poor outcome (death + LAMA). Therefore, the facilities for the care of outborn neonates need to be upgraded, but in the setting where these facilities are not available, the provision of manual ventilation may save a significant number of babies.

Original Article

Vishal Kumar, Rajendra K Kanojia, Rohit Kansal, Kim Vaiphei, Mandeep S Dhillon

Vascular Endothelial Growth Factor as a Marker of Tissue Healing Response in Mangled Extremity: Preliminary Data from an Observational Study

[Year:2022] [Month:April-June] [Volume:56] [Number:2] [Pages:4] [Pages No:81 - 84]

Keywords: Amputation, Hematoxylin and eosin, Immunohistochemistry, Mangled extremity, Mangled extremity severity score, Vascular endothelial growth factor

   DOI: 10.5005/jp-journals-10028-1408  |  Open Access |  How to cite  | 

Abstract

Purpose: The postoperative complication rate in mangled extremities is substantially high, irrespective of the nature of surgery performed. We attempted to identify the role of tissue vascular endothelial growth factor (VEGF) as a marker of neovascularization in skeletal muscle postinjury and its prognostic significance if any. Materials and methods: A pilot study, including 30 patients, was conducted at an advanced trauma center in PGIMER, Chandigarh in 2016. Patients were divided into 2 groups, based on the mangled extremity severity score, each containing 15 patients. Group I patients with a score of ≥7 were planned for amputation, whereas group II patients with a score of <7 were planned for limb salvage. Intra-op, skeletal muscle biopsies were taken in group I patients from three different zones. Zone A was the mangled zone; zone C was the clinically healthy zone, and zone B was the intermediate zone. Whereas, in group II, muscle samples were taken pre- and post-debridement. All the skeletal muscle samples were subjected to hematoxylin and eosin (H&E) stain followed by immunohistochemistry (IHC) examination with VEGF antibody in an attempt to identify viable muscle in various areas of the limb. Results: On H&E stained samples, in group I patients, the percentage of viable muscle fibers increases from 6.7 to 73% from zone A to zone C, whereas it increases from 7 to 80% in group II. On IHC stained samples, the median score was 0 (showed no positive staining) in all three zones of group I with a p value >0.05; whereas in group II, the median IHC score was 0 and 1 in pre- and post-debridement samples, respectively, with a p value of 0.004. Conclusion: The higher IHC scores in zone C in group I and post-debridement samples in group II, represent increased VEGF expression in these zones postinjury. This definite increase in VEGF expression, in turn, represents higher neovascularization activity in these zones as a response of the body to repair the damage postinjury.

REVIEW ARTICLE

Susmitha R Duvvuru, Nasreen Begum, Shamsheer Khan

Urine vs Serum Ketone Bodies Measurement in the Management of Diabetic Ketoacidosis Patients

[Year:2022] [Month:April-June] [Volume:56] [Number:2] [Pages:3] [Pages No:85 - 87]

Keywords: Diabetic ketoacidosis, Diabetes mellitus, Management

   DOI: 10.5005/jp-journals-10028-1568  |  Open Access |  How to cite  | 

Abstract

Diabetic ketoacidosis is a life-threatening medical emergency. Prompt diagnosis aids in guiding adequate treatment and preventing complications. Serum and urine ketones are both widely used for diagnosis. Blood ketone measurement has more sensitivity and specificity compared to urine ketones. Hence capillary blood 3β-hydroxybutyrate (OHB) being more specific, unnecessary workups of DKA can be reduced potentially in the emergency department and it also helps in identifying the patients with euglycemic DKA in resource-limited settings.

CASE REPORT

Manoj K Sharma, Santosh K Chaturvedi, Manik Inder S Sethi, Y Paveine Paulina, Pranjali C Thakur, Happy Baglari, Priya Singh

Medically Unexplained Symptoms Attributable to Electromagnetic Hypersensitivity: Raising Awareness of the Implications

[Year:2022] [Month:April-June] [Volume:56] [Number:2] [Pages:3] [Pages No:88 - 90]

Keywords: Electromagnetic, Hypersensitivity, Mobile phone, Pain

   DOI: 10.5005/jp-journals-10028-1565  |  Open Access |  How to cite  | 

Abstract

Background: Electromagnetic hypersensitivity was observed in the context of mobile phone use. It was reported to be the reason for psychological and physical problems. There is a need to document electromagnetic hypersensitivity and its effects. Materials and methods: A clinical interview was conducted with the case. Results: The case reported the presence of pain in the facial region attributable to using mobile phone. Conclusion: There is a need for sensitization programs to raise public awareness of the effects of electromagnetic hypersensitivity.

CASE REPORT

Surinder S Rana, Rajesh Gupta, Suhang Verma, Ravi Sharma

Impending Rupture of Lesser Sac Biloma into the Stomach

[Year:2022] [Month:April-June] [Volume:56] [Number:2] [Pages:3] [Pages No:91 - 93]

Keywords: Biloma, Cholecystectomy, Endoscopy, Endosonography, Stents

   DOI: 10.5005/jp-journals-10028-1431  |  Open Access |  How to cite  | 

Abstract

Biliary injury with bile leak is a well-recognized complication following cholecystectomy. This results in an accumulation of bile within the peritoneal cavity and may manifest with biliary ascites and peritonitis or as a localized collection called biloma. Bilomas are usually intrahepatic or are located in a subhepatic or subphrenic location with the less sac being a rare location for biloma. We present a rare case of a large biloma located in the less sac compressing the stomach. The patient was successfully managed endoscopically by the placement of multiple transmural plastic stents after cannulating and dilating the transmural tract of its impending rupture into the stomach.

CASE REPORT

Anvesh Reddy, Sachin Singh, Ketan Kumar, Kamal K Singhal, Kushaljit S Sodhi, Pankaj C Vaidya, Joseph LL Mathew, Meenu Singh

A Child with Recurrent Pneumonia: Approach to Diagnosis and Management

[Year:2022] [Month:April-June] [Volume:56] [Number:2] [Pages:7] [Pages No:94 - 100]

Keywords: Chronic granulomatous disease, Clinical approach, Recurrent pneumonia

   DOI: 10.5005/jp-journals-10028-1563  |  Open Access |  How to cite  | 

Abstract

In children, recurrent pneumonia is defined as the occurrence of more than one episode of pneumonia within a single year, or greater than three episodes within any duration; with radiographically documented clearing between episodes. Although childhood pneumonia is one of the most common clinical problems in children; when a child presents with recurrent pneumonia, there are additional diagnostic considerations because most cases are associated with an underlying illness. A meticulous clinical approach and judicious choice of laboratory investigations tailored to the differential diagnoses can clinch the diagnosis and guide management. We describe the case of a 11-year-old girl, presenting with a history of recurrent pneumonia, and the clinical approach toward an unusual diagnosis.

LETTER TO EDITOR

Amrit Mishra, Abhijit Vinodrao Boratne

Addressing the Unspoken Concerns Surrounding the Pediatric Population during the COVID-19 Pandemic

[Year:2022] [Month:April-June] [Volume:56] [Number:2] [Pages:1] [Pages No:101 - 101]

   DOI: 10.5005/jp-journals-10028-1566  |  Open Access |  How to cite  | 

BIOSTATISTICS SERIES

Kamal Kishore, Vidushi Jaswal

Statistics Corner: Data Management in Rcmdr

[Year:2022] [Month:April-June] [Volume:56] [Number:2] [Pages:4] [Pages No:102 - 105]

Keywords: Data export, Data import, Data management, Rcmdr

   DOI: 10.5005/jp-journals-10028-1571  |  Open Access |  How to cite  | 

Abstract

Data collection, analysis, and interpretation are integral components of health research—the majority of literature focus on the same. However, quality analysis requires quality data. Unfortunately, routine academic teaching, training, and research emphasize study designs and instruments to collect good data before entry. Many applied researchers who don't analyze data believe that a computer quickly analyses the data–a fact. Thus, many applied researchers demand immediate analysis results from statistical collaborators. However, data cleaning consumes a significant chunk of time in any analysis as the same is riddled with errors and inconsistencies despite taking adequate precautions. Data scientists know that data cleaning is a laborious and time-consuming process. The data analysis tools are always shiny and new; the data cleaning process is ancient and unchanging. There are general and software-specific guidelines to be followed as different software have different interfaces and capabilities. The researcher needs to understand the general and particular approaches to exploit the vast potential of Rcmdr. And to utilize the enormous potential of Rcmdr, we need to know the data entry, cleaning, and export options of the same. Statistical software is like a fancy gadget whose output quality depends on input quality–data entry. Therefore, in this article, researchers will be learning: • How to enter data in Rcmdr? • How to clean and code data in Rcmdr? • How and what data formats Rcmdr can import? • How and what data formats Rcmdr can export?

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