Indian Journal of Medical Specialities最新文献

{"title":"Bone mineral densitometry in a 55-year-old Indian female","authors":"ArunKumar R. Pande, Sanjay Kalra","doi":"10.4103/injms.injms_45_23","DOIUrl":"https://doi.org/10.4103/injms.injms_45_23","url":null,"abstract":"Osteoporosis is a condition of the bone, which is diagnosed by performing bone mineral density (BMD) investigation. To diagnose osteoporosis on BMD, we have to focus on T-score and Z-score values on the report. T-score is the standard deviation (SD) of the BMD value of the subject from peak bone mass that is BMD of young age individual. A value T-score less than or equal to −2.5 is considered to be suggestive of osteoporosis. Z-score is the SD of the BMD value from the subject same age group. A value Z-score ≤2.0 is considered to be suggestive of low BMD. As BMD value the mass of mineral per volume of bone, those individual who are shorter their BMD varies as compared to those who are taller. Average Indians are shorter in height as compared to Caucasians. To mitigate this issue, BMD reference data were collected; the Indian Council of Medical Research conducted a community-based multicenter study to derive Indian references for peak bone mass.[1] As T-score is the SD of BMD from peak bone mass and Z-score is the SD BMD from individuals of the same age. It is impossible to have a T-score of −1.7 and Z-score of −3.3 in a particular patient. We want to highlight a BMD report of 55-year-old female whose BMD was performed by GE Lunar DPX DEXA machine for spine BMD, which came out to be 0.903 g/cm2 with T-score of −1.7 also the result shows 81% of BMD of young age. If we back calculate the mean of BMD of peak bone mass or of a young age person, it comes out to 1.115 g/cm2. The Z-score of the same patient comes out to be −3.3 and the result also shows 69% of mean or peak age-matched BMD. If we back calculate the mean of BMD of age matched, it comes to 1.309 g/cm2. BMD of age matched cannot be greater than that of peak bone of young age. Either there is a flaw in the data or the reference data are not representative. However, we still see such reports in our practice, especially in females of age 55 years and around. As the Z-score is ≤2.0, we have to check for secondary causes of osteoporosis. All investigation comes out negative. This wastes the time of treating physicians and adds to the stress and financial burden to the patient, during the time, they are undergoing such investigations. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship None. Conflicts of interest There are no conflicts of interest.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135845194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing chronic obstructive pulmonary diseases in 2023 – What is new?","authors":"Vidushi Rathi, Nitesh Gupta, M. Madan, P. Ish","doi":"10.4103/injms.injms_145_22","DOIUrl":"https://doi.org/10.4103/injms.injms_145_22","url":null,"abstract":"","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49640714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A catastrophic combination of Kikuchi–Fujimoto disease and systemic lupus erythematosus complicated with autoimmune hemolytic anemia in a pregnant woman","authors":"RaghaviAbhilesh Bembey, Ram Babu, Ajay Tanwar, Manoj Sareen, Mansi Jain, Kush Goyal","doi":"10.4103/injms.injms_33_23","DOIUrl":"https://doi.org/10.4103/injms.injms_33_23","url":null,"abstract":"Kikuchi–Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a benign, idiopathic, self-limiting, and systemic disorder involving lymph nodes (LNs) of unknown etiology. The first case was reported in Japan, with an increasing incidence globally. The disease is a challenge because of the nonspecific clinical features, and the disease is easily mistaken for other forms of lymphadenitis leading to misdiagnosis and mistreatment. It is associated with many autoimmune disorders, of which systemic lupus erythematosus (SLE) is the most common association. The diagnosis is based on the histological examination of LNs, which typically reveals necrosis surrounded by histiocytes with crescentic nucleus, immunoblasts and plasma cells, and absence of neutrophils. We report the case of a 24-year-old pregnant Indian female patient without any relevant past medical history to demonstrate the correlation between KFD and SLE complicated with autoimmune hemolytic anemia.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of out-of-pocket expenditure on noncommunicable diseases in urban slum of Mysuru City","authors":"Amogha Shree, None Choedon, MR Narayana Murthy, N Chandan","doi":"10.4103/injms.injms_38_23","DOIUrl":"https://doi.org/10.4103/injms.injms_38_23","url":null,"abstract":"Background: Noncommunicable diseases (NCDs) are the leading cause of death and disability globally, and the burden is expected to grow rapidly in developing countries. In the absence of health insurance, public provisioning, and donor funds, the management and treatment of NCDs such as hypertension and diabetes might result in very large out-of-pocket expenditures (OOPEs) for households. Objectives: The objectives were as follows: to estimate OOPE and to study the association between sociodemographic characteristics and OOPE among patients suffering from NCDs. Materials and Methods: The sample size was estimated based on a mean OOPE of 63.5 Indian rupees (INR), with a standard deviation (SD) of 110 INR, a sample size of 464 was obtained, and individuals with NCDs were interviewed. Results: Of the total 464 participants, 325 (70%) were female and 139 (30%) were male, with a mean (SD) age of 55.78 ± 13.204. Three hundred and two (65.1%) participants were having hypertension and 232 (50%) were having diabetes. The mean total OOPE was 1173.0603 (INR), with a SD of 1424.54108 (INR), and the mean direct cost incurred was 1141.03. The mean (SD) direct cost spent for medication was 895.61 ± 1100.32, for the laboratory was 148.38 ± 440.7, and for consultation was 97.04 ± 113.86. Only 34 (7.7%) participants were having health insurance. There was an association between the OOPE and sociodemographic profiles such as occupation, educational status, and economic status where the P (<0.05) was noted as P = 0.004, P = 0.024, and P < 0.001, respectively. Conclusion: Knowledge and awareness about health insurance scheme and their benefits help in reducing the OOPE.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From tradition to transformation: Revolutionizing medical education for the digital age through virtual problem-based learning","authors":"SaurabhRamBihariLal Shrivastava, PrateekSaurabh Shrivastava","doi":"10.4103/injms.injms_75_23","DOIUrl":"https://doi.org/10.4103/injms.injms_75_23","url":null,"abstract":"In the field of medical education delivery, problem-based learning (PBL) is an important teaching–learning method owing to the active engagement of students.[1] PBL plays a pivotal role in the making of a lifelong learner by cultivating the skill of self-directed learning, which in turn enables medical students to adapt to real-world professional challenges and thereby develop a mindset of continuous improvement.[1,2] Further, it also promotes interdisciplinary learning by encouraging students to establish linkage between different specialties, which in turn ensures a holistic understanding of complex medical issues.[3] Owing to the emergence of the coronavirus disease-2019 pandemic, different health-care institutions colleges resorted to virtual PBL and reported encouraging results.[4,5] VIRTUAL PROBLEM-BASED LEARNING Virtual PBL is an innovative pedagogical approach that merges the principles of PBL with the benefits of online and digital technologies.[6] In the current era, the utility and scope of virtual learning environments have significantly increased, as it gives a platform for teachers to engage students and provide them with interactive learning experiences.[6,7] Virtual PBL has the potential to expose students to authentic and real-world scenarios that essentially require active participation and collaboration.[7] This motivates medical students to work in virtual teams, and also apply their knowledge to come out with solutions to complex problems. Further, owing to the online discussions, virtual presentations, and asynchronous collaboration, students also acquire a wide range of skills, namely communication, teamwork, and self-directed learning, which are a must in the making of a competent healthcare professional.[5–7] DESIGNING AND IMPLEMENTING VIRTUAL PROBLEM-BASED LEARNING As educators, we must ensure the creation of an engaging and meaningful learning experience for medical students.[5,7] The process of design and implementation of virtual PBL in any institution depends on the successful execution of multiple steps.[8–13] The first and foremost step will be to select and formulate authentic problems (viz., relevant, realistic, and aligned with the learning objectives) that are crucial in the conduct of virtual PBL.[7,8] These problems must represent challenges prevailing in the real world, and their resolution must depend on critical thinking and problem-solving skills. The selection of such problems should be made by the facilitators after giving due consideration to the available resources and technological tools in the virtual learning environment.[7,8] The successful conduct of virtual PBL also depends on the making of virtual PBL groups and assigning specific roles and responsibilities to each member of the group.[9] It is quite essential that facilitators should acknowledge the strengths, backgrounds, and interests of the students, and then create groups of students, which will play a crucial role in the formation of a ba","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135845193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes remission: Myth or reality?","authors":"Ashok Kumar, S. Margekar, Ravin Kumar","doi":"10.4103/injms.injms_123_22","DOIUrl":"https://doi.org/10.4103/injms.injms_123_22","url":null,"abstract":"The rising prevalence of diabetes mellitus (DM) increases the burden of morbidity and mortality worldwide. DM is recognized as an independent risk factor of cardiovascular mortality. Uncontrolled diabetes leads to various long-term microvascular and macrovascular complications. Optimum control of glycemia is desirable to prevent these complications to improve quality of life and decrease mortality. The concept of remission or reversal of diabetes is evolving for many decades and various definitions and approaches to achieve remission also have evolved. Obesity-related surgeries had shown remarkable control of blood glucose levels. Recently, therapy directed toward weight loss either by medical nutrition therapy, physical activity, or anti-diabetic medications seems promising in achieving remission of diabetes.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41669969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversible brain death: A rare manifestation of snake envenomation","authors":"Ankusha Patra, Vrinda Goel, S. Narang, A. Aggarwal","doi":"10.4103/injms.injms_125_22","DOIUrl":"https://doi.org/10.4103/injms.injms_125_22","url":null,"abstract":"Snakebite is a serious public health problem and one of the priorities in WHO's list of neglected tropical diseases. It significantly increases morbidity and mortality associated with envenomation in India. A neurotoxic snakebite can present in the form of symptoms ranging from asymptomatic presentation, ptosis, and complete external and internal ophthalmoplegia to complete respiratory failure. This is a case report of a 22-year-old male, who presented with bilateral ptosis and impending respiratory failure. He soon became deeply comatose, with absent brain stem reflexes (mute plantar, fixed pupils, and the absence of the doll's eye reflex) which were suggestive of brain death. He was treated with polyvalent anti-snake venom, anticholinesterases, and supportive therapy and recovered completely with an excellent outcome.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47897844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Umbilical cord blood banking: Myth and realities","authors":"A. Nigam","doi":"10.4103/injms.injms_143_22","DOIUrl":"https://doi.org/10.4103/injms.injms_143_22","url":null,"abstract":"","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48355180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of abdominal volume index with glycemic control (glycated hemoglobin) and urine albumin levels in type 2 diabetes mellitus","authors":"Priya Bansal, Majida Muzaffar, Debasish Chaudhury, Rohit Bansal","doi":"10.4103/injms.injms_25_23","DOIUrl":"https://doi.org/10.4103/injms.injms_25_23","url":null,"abstract":"Context: Anthropometric parameters can play an important role in monitoring the progression and management of diabetes mellitus (DM). This study was planned to highlight the relationship of abdominal volume index (AVI) with glycemic control and the microvascular complication of albumin excretion. Aims: We aimed to study the association of AVI with glycemic control and urine albumin excretion in patients of type 2 DM. Settings and Design: This was a descriptive, observational, cross-sectional, hospital-based study. Subjects and Methods: The study conducted in a tertiary care health center of North India recruited thirty consecutive patients of type 2 DM attending the Medicine outpatient department. Anthropometric assessment was made, and samples for blood biochemistry including glycated hemoglobin (HbA1c) and urine albumin excretion were taken. Statistical Analysis Used: The association of AVI with degree of glycemic control and urine albumin levels was expressed as correlation coefficients (r) by using Spearman or Pearson correlation measures for qualitative and quantitative variables respectively. The ability of AVI to predict HbA1C and urine albumin–creatinine ratio was calculated by a simple linear regression technique. P <0.05 was considered statistically significant. Results: There was no statistical significance in the predictive ability of AVI and glycemic control, and microalbuminuria. Conclusions: Our study showed that AVI is not a reliable marker in diabetic patients to predict the degree of glycemic control and microalbuminuria.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of electrocardiographic repolarization parameters in patients who received ribociclib and palbociclib therapy","authors":"Cennet Yildiz, GülçinSahingöz Erdal, Dilay Karabulut, Nilgun Isiksacan, Ersan Oflar, FatmaNihan Turhan Çaglar, Osman Pirhan, HasanAli Sinoplu, Fahrettin Katkat, Deniz Tural","doi":"10.4103/injms.injms_27_23","DOIUrl":"https://doi.org/10.4103/injms.injms_27_23","url":null,"abstract":"Introduction: Ribociclib and palbociclib are the inhibitors of cyclin-dependent kinase (CDK) 4/6 activity which have been used in the treatment of metastatic hormone receptor (HR)-positive, human epidermal growth factor receptor 2-negative breast cancer. QT interval prolongation has been the main reported adverse effect in Phase III trials of ribociclib and palbociclib therapy. In the present study, we aimed to evaluate electrocardiographic (ECG) changes in patients who received palbociclib and ribociclib therapy. Materials and Methods: Sixty women with metastatic HR-positive, human epidermal growth factor-2-negative breast cancer were included in the study. Baseline ECG and echocardiographic examinations of these patients were done. Second control electrocardiogram was obtained on the 14th day of first-cycle therapy. PR interval, corrected QT (QTc) interval, QT dispersion (QTD), and QRS duration were calculated. Results: Heart rate, PR interval, QRS, QT, QTc, QTD, and corrected QTD duration did not differ before and after CDK 4/6 treatment. Two patients who received ribociclib and palbociclib treatment had basal QTc duration higher than 450 ms (458 ms and 465 ms, respectively). The 14th-day QTc intervals of these patients were found to be 318 ms and 406 ms, respectively. After CDK 4/6 treatment, only two patients had QTc interval of 469 ms and 507 ms. The mean change of QTc interval before and during the 14th day of CDK 4/6 therapy was 7.38 ± 35.049 ms. When palbociclib and ribociclib treatments were analyzed separately, the baseline and 14th day of QTc interval were 415 ± 31.5 versus 428.11 ± 24.52 and 416.13 ± 26.05 versus 420.07 ± 31.32 ms, respectively. Conclusions: Ribociclib and palbociclib treatment was associated with a small statistically insignificant increase in QTc interval. Physicians should be aware of the side effect of these treatments.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}