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   2008| April-June  | Volume 54 | Issue 2  
    Online since May 14, 2008

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Watson's water hammer pulse
JC Suvarna
April-June 2008, 54(2):163-165
DOI:10.4103/0022-3859.40791  PMID:18480541
  79,345 504 4
Fournier's gangrene: Evaluation of 68 patients and analysis of prognostic variables
HR Unalp, E Kamer, H Derici, K Atahan, U Balci, C Demirdoven, O Nazli, MA Onal
April-June 2008, 54(2):102-105
DOI:10.4103/0022-3859.40775  PMID:18480525
Context: Fournier's gangrene (FG) is a rapidly progressing acute gangrenous infection of the anorectal and urogenital area. Aims: The objectives of this study were to investigate patients with FG and to determine risk factors that affect mortality. Settings and Design: Retrospective clinical study. Materials and Methods: Clinical presentations and outcomes of surgical treatments were evaluated in 68 patients with FG. Statistical Analysis Used: Chi-square, Student's t -test, and logistic regression test. Results: Mean age of patients was 54 and female-to-male ratio was 9:59. Among the predisposing factors, diabetes mellitus (DM) was the most common ( n =24, 35.3%), and sepsis on admission was detected in 31 (45.6%) and 15 (22.1%) patients, respectively. Seven (10.3%) patients died. Using logistic regression test, Fournier's Gangrene Severity Index (FGSI) >9, DM and sepsis on admission were found as prognostic factors. Conclusions: FG has a high mortality rate, especially in patients with DM and sepsis. An FGSI value >9 indicates high mortality rate.
  68,654 378 44
Family burden, quality of life and disability in obsessive compulsive disorder: An Indian perspective
GP Gururaj, S Bada Math, JYC Reddy, CR Chandrashekar
April-June 2008, 54(2):91-97
DOI:10.4103/0022-3859.40773  PMID:18480523
Background: Obsessive compulsive disorder (OCD) is a psychiatric disorder that often tends to run a chronic course. The lifetime prevalence of OCD is around 1-3%, which is twice as prevalent as schizophrenia and bipolar disorder. Aim: To asses the family burden, quality of life (QoL) and disability in patients suffering from at least moderately ill OCD and then to compare them with schizophrenia patients of comparable severity. Settings and Design: We recruited 70 consecutive subjects (OCD=35, schizophrenia=35) who met study criteria between March 2005 and March 2006 from the psychiatric services of the National Institute of Mental Health and Neuro Sciences, Bangalore, India. Materials and Methods: The severity of illness was rated using the Clinical Global Impression-Severity (CGI-S). Instruments used in the current study were the Family Burden Schedule, the World Health Organization (WHO) QoL (Bref) and the WHO - Disability Assessment Schedule (DAS). Statistical Analysis: The Fisher's exact test/chi-square test was used to compare categorical variables and the independent sample t test was used to analyze continuous variables. Analysis of covariance (ANCOVA) was used to compare the groups after controlling for potential confounding variables. Pearson's correlation was used for correlation analysis. Results: Overall family burden, financial burden and disruption of family routines were significantly higher in schizophrenia patients compared to OCD although the groups did not differ with respect to other domains of family burden. On the WHO QoL, OCD patients were comparable to schizophrenia patients with respect to the psychological and social domains. On the WHO - DAS, both the groups were similar in all the domains except getting around. Conclusion: Severe OCD is associated with significant disability, poor QoL and high family burden, often comparable to schizophrenia. Therefore, there is an urgent need to increase the sensitivity among healthcare professionals to recognize and treat OCD.
  23,810 489 50
Present status of understanding on the genetic etiology of polycystic ovary syndrome
S Dasgupta, B Mohan Reddy
April-June 2008, 54(2):115-125
DOI:10.4103/0022-3859.40778  PMID:18480528
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age with a prevalence of approximately 7-10% worldwide. PCOS reflects multiple potential aetiologies and variable clinical manifestations. This syndrome is characterized by serious health implications such as diabetes, coronary heart diseases and cancer and also leads to infertility. PCOS can be viewed as a heterogeneous androgen excess disorder with varying degrees of reproductive and metabolic abnormalities determined by the interaction of multiple genetic and environmental factors. In this paper, we have attempted a comprehensive review of primarily molecular genetic studies done so far on PCOS. We have also covered the studies focusing on the environmental factors and impact of ethnicity on the presentation of this syndrome. A large number of studies have been attempted to understand the aetiological mechanisms behind PCOS both at the clinical and molecular genetic levels. In the Indian context, majority of the PCOS studies have been confined to the clinical dimensions. However, a concrete genetic mechanism behind the manifestation of PCOS is yet to be ascertained. Understanding of this complex disorder requires comprehensive studies incorporating relatively larger homogenous samples for genetic analysis and taking into account the ethnicity and the environmental conditions of the population/cohort under study. Research focused on these aspects may provide better understanding on the genetic etiology and the interaction between genes and environment, which may help develop new treatment methods and possible prevention of the syndrome.
  22,400 1,012 31
Current challenges in managing specific learning disability in Indian children
S Karande
April-June 2008, 54(2):75-77
DOI:10.4103/0022-3859.40765  PMID:18480515
  16,001 388 5
Patient-controlled epidural analgesia with fentanyl and bupivacaine provides better analgesia than intravenous morphine patient-controlled analgesia for early thoracotomy pain
BK Behera, GD Puri, B Ghai
April-June 2008, 54(2):86-90
DOI:10.4103/0022-3859.40772  PMID:18480522
Background: Intravenous patient-controlled analgesia (IVPCA) and patient-controlled epidural analgesia (PCEA) were studied in terms of analgesic efficacy, respiratory function and side effects after thoracic surgery for 24h. PCEA using fentanyl and bupivacaine as compared to IVPCA using morphine provides better pain relief both at rest and during coughing and is associated with fewer side effects. Aims: To compare IVPCA and PCEA in terms of analgesic efficacy, respiratory function and side effects after thoracic surgery. Settings and Design: Tertiary care teaching hospital. Prospective, randomized and open study. Materials and Methods: Thirty ASA-I or II patients undergoing thoracotomy were assigned randomly to receive either IVPCA using morphine or PCEA using fentanyl and bupivacaine combination postoperatively. No background infusion was administered in either group. Postoperative evaluation included pain intensity both at rest and during coughing, degree of sedation, arterial blood gas, forced vital capacity (FVC), peak expiratory flow rate (PEFR), presence of side effects such as nausea/vomiting and pruritis at 0, 2, 8, 12 and 24h. The primary outcome of the study was the percentage of patients with analgesia failure defined as VAS>30 despite three consecutive PCA boluses requiring rescue analgesia with intravenous fentanyl. Statistical Analysis: Data were analyzed using t -test, χ2 test and Mann-Whitney test. Results: Significantly less number of patients required rescue analgesia in PCEA group ( P<0.05). Pain relief was better both at rest and during coughing ( P<0.05) in PCEA group as compared to IVPCA. Patients in the PCEA group were less sedated and had fewer incidences of side effects, i.e. nausea/vomiting and pruritis. Postoperative FVC and PEFR were reduced significantly compared to baseline only in IVPCA group ( P<0.05). Conclusion: After thoracic surgery, PCEA using fentanyl and bupivacaine as compared to IVPCA using morphine provides better pain relief both at rest and during coughing and associated with fewer side effects.
  14,697 609 22
Tissue microarray: A simple technology that has revolutionized research in pathology
S Avninder, K Ylaya, SM Hewitt
April-June 2008, 54(2):158-162
DOI:10.4103/0022-3859.40790  PMID:18480540
Tissue microarray (TMA) technology is a high-throughput research tool, which has greatly facilitated and accelerated tissue analyses by in-situ technologies. TMAs are amenable to every research method that can be applied on the standard whole sections at enhanced speed. It plays a central role in target verification of results from cDNA arrays, expression profiling of tumors and tissues, and is proving to be a powerful platform for proteomic research. In this review article, primarily meant for students of pathology and oncology, we briefly discuss its basic methodology, applications and merits and limitations.
  14,575 603 36
Prevention of avascular necrosis in displaced talar neck fractures by hyperbaric oxygenation therapy: A dual case report
O Mei-Dan, I Hetsroni, G Mann, Y Melamed, M Nyska
April-June 2008, 54(2):140-143
DOI:10.4103/0022-3859.40782  PMID:18480532
Talar neck fractures are a rare injury that account for less then 2% of all foot fractures. Displaced fractures are associated with an exceedingly high rate of avascular necrosis (AVN). The incidence of AVN following Hawkins Type 3 fractures of the talar neck may approach 100%, particularly if diagnosis and reduction are delayed. Severe cases may present as pain and disability of the ankle and the subtalar joints due to a talar dome collapse, resulting in degenerative changes that usually require hind foot arthrodesis. We present two cases of traumatic displaced talar neck fractures which were treated surgically more than 2 weeks following injury due to a delay in diagnosis. Both patients underwent hyperbaric oxygen therapy (HBOT) after the operation and neither resulted in AVN of the talus in a three-year follow-up. We suggest that this favorable result may be due to the beneficial effects of HBOT.
  14,671 283 3
Hypereosinophilic syndrome with isolated Loeffler's endocarditis: Complete resolution with corticosteroids
T Sen, CK Ponde, ZF Udwadia
April-June 2008, 54(2):135-137
DOI:10.4103/0022-3859.40780  PMID:18480530
Hypereosinophilic syndrome (HES) is classically defined as prolonged, unexplained peripheral eosinophilia in a patient presenting with evidence of end-organ damage. The heart is involved in two forms; endomyocardial fibrosis (Davies disease) and eosinophilic endocarditis (Loffler's endocarditis). It was first reported in 1968 by Hard and Anderson. Chusid and co-workers formulated a definition with strict criteria for the diagnosis of HES as 1) peripheral blood eosinophilia more than 1500 cells/cu mm for at least six months duration 2)signs, symptoms of end-organ (heart, lungs, gastrointestinal tract, skin, bone-marrow, brain) involvement with eosinophil tissue infiltration/injury 3) exclusion of known secondary causes of eosinophilia. We report a case of hypereosinophilic syndrome with Loffler's endocarditis, in the absence of endomyocardial fibrosis. The patient presented with a eosinophilic vegetation over the posterior leaflet of the mitral valve. There was complete resolution of the vegetation after two months of corticosteroid therapy.
  11,226 402 18
Upper airway obstruction due to goiter: An overlooked problem!
SJ Bonnema
April-June 2008, 54(2):82-83
DOI:10.4103/0022-3859.40769  PMID:18480519
  10,727 213 4
The role of computerized tomography in the evaluation of gastrointestinal bleeding following negative or failed endoscopy: A review of current status
H Stunell, O Buckley, ID Lyburn, G McGann, M Farrell, WC Torreggiani
April-June 2008, 54(2):126-134
DOI:10.4103/0022-3859.40779  PMID:18480529
Gastrointestinal bleeding remains an important cause for emergency hospital admission with a significant related morbidity and mortality. Bleeding may relate to the upper or lower gastrointestinal tracts and clinical history and examination may guide investigations to the more likely source of bleeding. The now widespread availability of endoscopic equipment has made a huge impact on the rapid identification of the bleeding source. However, there remains a large group of patients with negative or failed endoscopy, in whom additional techniques are required to identify the source of bleeding. In the past, catheter angiography and radionuclide red cell labeling techniques were the preferred 'next step' modalities used to aid in identifying a bleeding source within the gastrointestinal tract. However, these techniques are time-consuming and of limited sensitivity and specificity. In addition, catheter angiography is a relatively invasive procedure. In recent years, computerized tomography (CT) has undergone major technological advances in its speed, resolution, multiplanar techniques and angiographic abilities. It has allowed excellent visualization of the both the small and large bowel allowing precise anatomical visualization of many causes of gastrointestinal tract (GIT) bleeding. In addition, recent advances in multiphasic imaging now allow direct visualization of bleeding into the bowel. In many centers CT has therefore become the 'next step' technique in identifying a bleeding source within the GIT following negative or failed endoscopy in the acute setting. In this review article, we review the current literature and discuss the current status of CT as a modality in investigating the patient with GIT bleeding.
  9,360 545 24
Fournier's gangrene in Mansoura Egypt: A review of 74 cases
WM Ghnnam
April-June 2008, 54(2):106-109
DOI:10.4103/0022-3859.40776  PMID:18480526
Background: Fournier's gangrene (FG), caused by synergistic aerobic and anaerobic organisms, is a life-threatening disorder in which infection of the perineum and scrotum (can affect penis alone) spreads along fascial planes, leading to soft-tissue necrosis. Despite antibiotics and aggressive debridement, the mortality rate of FG remains high. Materials and Methods: We analyzed 74 patients admitted to our institution's emergency surgical unit presenting with FG between January 2002 and January 2007, considering the anatomical site of infective gangrene, predisposing factors, etiological agents, and outcomes. Results: All the 74 patients included in this study were males; their mean age was 5110.8 years (21-72 years). The mean duration from the onset of symptoms to admission to the hospital was 3.742.09 days (1-8 days). The mean hospitalization time was 9.2 6.6 days (1-31). Forty patients (54.05%) had FG secondary to anorectal conditions. No etiologic factors for FG were found in 27 patients (36.5%). Diabetes mellitus as a predisposing factor was found in 38 patients (51.35%). There was no definite predisposing factor in 24 patients (32.43%). The microbiological finding was polymicrobial in 48 patients (64.8%) and monomicrobial in 26 patients (35.1%). The most frequent bacterial organisms were Escherichia coli (75.6%). Simple sigmoid loop colostomy was done in one patient (1.4%). Unilateral orchidectomy was done in one case (1.4%). The overall mortality rate was 16 patients (21.6%). Conclusion: FG is a rapidly progressive, fulminant infection. Even with aggressive surgical and medical treatment, mortality of the disease is high. In the present cases, such a high ratio of 21.6% means that this disease is still serious and fatal in Egypt.
  9,163 290 32
PCEA vs. PCA for post-thoracotomy pain: Is this any longer the question?
CL Burlacu
April-June 2008, 54(2):80-81
DOI:10.4103/0022-3859.40767  PMID:18480517
  8,791 296 2
My experiments with research as a medical student
TS Panchabhai
April-June 2008, 54(2):166-167
DOI:10.4103/0022-3859.40792  PMID:18480542
  8,337 595 -
Primary cavernous hemangioma of thyroid gland
R Datta, MD Venkatesh, A Nilakantan, B Joseph
April-June 2008, 54(2):147-148
DOI:10.4103/0022-3859.40784  PMID:18480534
  8,108 222 7
Cronkhite-Canada syndrome with adenomatous polyposis
Y Radha Krishna, UC Ghoshal, N Kumari, R Pandey, G Choudhuri
April-June 2008, 54(2):144-146
DOI:10.4103/0022-3859.40783  PMID:18480533
  7,805 299 4
Pulmonary function profile in patients with benign goiters without symptoms of respiratory compromise and the early effect of thyroidectomy
PV Pradeep, P Tiwari, A Mishra, G Agarwal, A Agarwal, AK Verma, SK Mishra
April-June 2008, 54(2):98-101
DOI:10.4103/0022-3859.40774  PMID:18480524
Background: A large number of patients in our country develop goiters which seem to be apparently asymptomatic. Conventional radiography does not address the abnormal air flow dynamics. Flow volume loop studies have shown characteristic dampening of both inspiratory and expiratory curves. Pulmonary function tests (PFT) can provide a simple noninvasive method of assessing airway compromise. Aim: To address the effect of longstanding asymptomatic, benign goiter by performing PFT on the preoperative airway dynamics and the early postoperative changes at six weeks. Setting and Design: Tertiary care center, Prospective study. Materials and Methods: Sixty-four patients with benign goiters were included after they satisfied the necessary exclusion and inclusion criteria. Pulmonary function tests were performed in the pre and postoperative period. Statistical Analysis Used: SPSS ver. 10 software, Pearson's Bivariate correlation and students T test. Results: The preoperative PFT showed significant reduction in the Vital capacity (VC), Forced Vital Capacity (FVC), Forced expiratory volume in one second (FEV1), mid expiratory flow (MEF 25) and MEF 50 in the females and VC, FVC and FEV1 in males. Postoperatively significant improvement was observed in the tidal volume (VT) and FEV1 in the females and airway resistance in males. Conclusions: Pulmonary function tests can demonstrate the unmanifested abnormal airflow dynamics in benign asymptomatic goiters, which would have otherwise taken years to manifest. This abnormality improved after thyroidectomy, especially the forced expiratory maneuvers. The duration and weight of the goiter correlated well with reduction in FEV1 and its subsequent improvement after surgery in females.
  7,707 171 8
Clopidogrel-induced hepatotoxicity
A Wiper, M Schmitt, DH Roberts
April-June 2008, 54(2):152-152
DOI:10.4103/0022-3859.40787  PMID:18480537
  7,255 337 10
Characterization of adult onset growth hormone deficiency syndrome in patients with hypothalamopituitary diseases: Asian Indian data
TR Bandgar, M Prashanth, SR Joshi, PS Menon, NS Shah
April-June 2008, 54(2):110-114
DOI:10.4103/0022-3859.40777  PMID:18480527
Background: Hardly any data is available on Adult onset growth hormone deficiency (AOGHD) in Patients with hypothalamopituitary diseases in India. Aims: To characterize Asian Indian AOGHD syndrome in hypothalamopituitary diseases. Settings and Design: Cross-sectional analysis of data from a tertiary care hospital. Materials and Methods: Thirty patients with AOGHD were compared with 30 age-, sex-, body mass index-matched controls with respect to endocrine evaluation, biochemistry, body composition (BC), bone mineral density (BMD), cardiovascular risk profile and quality of life (QoL). Statistical Analysis Used: Comparisons were performed using two-tailed Student's test (SPSS Software version 10.0). Results: Most of the patients had abnormal BC with central obesity [Truncal FM (%): males {33.94.4 (patient) vs. 29.316.2 (control); P -0.027}; females {39.875.93 (patient) vs. 35.763.16 (control); P - 0.025}] and poor QoL. Patients aged over 45 years did not show low bone mass or lipid abnormalities as compared to controls. Low BMD and abnormal lipid profile {Triglycerides [mg/dl]:170.5572.5 (patient) vs101.2431.0 (control); P -0.038}; {very low density lipoprotein cholesterol [mg/dl]: 33.5414.9 (patient) vs. 20.256.18 (control); P - 0.05} was seen in female patients less than 45 years of age. Conclusions: Male and female (more than 45 years) AOGHD patients have increased cardiovascular risk factors and poor QoL while BMD is unaffected. Females less than 45 years of age have the major characteristics of AOGHD and would be the group to benefit maximally with recombinant human Growth Hormone treatment, which is similar to that in the western literature.
  7,365 167 1
Nimesulide-induced hepatitis and toxic epidermal necrolysis
S Chatterjee, J Pal, N Biswas
April-June 2008, 54(2):150-151
DOI:10.4103/0022-3859.40786  PMID:18480536
  7,104 333 9
Hemoglobin electrophoresis: An important investigation in the evaluation of patients with massive hematuria
II Ulasi, CK Ijoma
April-June 2008, 54(2):168-169
DOI:10.4103/0022-3859.40793  PMID:18480543
  6,409 177 2
Providing a setup and opportunities for better training of postdoctoral research fellows in an academic environment
Muhammad N Ghayur
April-June 2008, 54(2):156-157
DOI:10.4103/0022-3859.40789  PMID:18480539
Thousands of young researchers come from different parts of the world every year to take up postdoctoral (postdoc) research fellowship positions in the developed countries. In the US alone, there were 48,601 postdocs in the year 2005 working in different labs in the fields of science, health and engineering. Many pursue this option for lack of other alternatives. Expectedly, these individuals face a lot of difficulties in making this transition from being a student to becoming an employee of an institution. Many institutions are prepared to make this transition and period of stay easy for their fellows while others are not equipped at all. The presence of a postdoc office (established by an institution) or an association (formed by the fellows) can be of immense help to postdocs. Additionally, the availability of institutional professional development and leadership programs can also help to nurture and polish postdoc fellows into future faculty members and valuable members of the community at large. To name a few, these professional development programs can focus on communication and presentation skills, medical education, teaching and learning, bioethics and mentorship. There is an urgent need to address some or all of these issues so that better training environment and opportunities are available to this group of postdoc fellows.
  6,166 184 3
Chilaiditi's sign possibly associated with malposition of chest tube placement
MS Gulati, J Wafula, S Aggarwal
April-June 2008, 54(2):138-139
DOI:10.4103/0022-3859.40781  PMID:18480531
Although diaphragmatic paralysis is a rare recognized complication of chest tube malposition, Chilaiditi's sign occurring as a result of this complication has never been reported in literature to the best of our knowledge. We describe one such case, which had an interesting clinical sequence of events and radiographic findings and suggest that the medial end of the chest tube should be positioned at least 2 cm from the mediastinum on the frontal chest radiograph to avoid these complications.
  5,402 241 3
Stavudine-induced pancreatitis followed by lopinavir-ritonavir-induced pancreatitis
H Anand, G Parthasarathi, M Ramesh
April-June 2008, 54(2):153-155
DOI:10.4103/0022-3859.40788  PMID:18480538
  5,297 196 4
Fournier's gangrene, still an enigma
N Eke
April-June 2008, 54(2):83-84
DOI:10.4103/0022-3859.40770  PMID:18480520
  4,929 341 4
Massive gastric distension from excessive food ingestion
T Kajiya, K Shiki, T Asano, K Omori, Y Natsume, S Sakurai, C Tei
April-June 2008, 54(2):149-149
DOI:10.4103/0022-3859.40785  PMID:18480535
  4,784 226 1
Statement on publishing clinical trials in Indian biomedical journals
K Satyanarayana, A Sharma, P Parikh, VK Vijayan, DK Sahu, BK Nayak, RK Gulati, MN Parikh, PS Prati, SB Bavdekar, U Sreehari, P Sahni
April-June 2008, 54(2):78-79
DOI:10.4103/0022-3859.40766  PMID:18480516
  4,685 274 8
Acute interstitial nephritis in association with polymyositis
J Das, P George, B Pawar, N Calton
April-June 2008, 54(2):170-171
DOI:10.4103/0022-3859.40795  PMID:18480545
  4,640 134 3
Neurobiological underpinnings of obsessive compulsive disorder and schizophrenia: Explanations for disability and severity
J Sareen
April-June 2008, 54(2):81-82
DOI:10.4103/0022-3859.40768  PMID:18480518
  4,492 219 -
Non-traumatic herniation of the liver in an asthmatic patient
S Gupta, R Kulshreshtha, SK Chhabra
April-June 2008, 54(2):169-170
DOI:10.4103/0022-3859.40794  PMID:18480544
  4,477 103 3
Are there any regional differences in the clinical presentation of adult growth hormone deficient patients?
HL Fideleff
April-June 2008, 54(2):84-85
DOI:10.4103/0022-3859.40771  PMID:18480521
  3,276 113 1
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2004 - Journal of Postgraduate Medicine
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