Journal of postgraduate medicine最新文献

{"title":"1. Study designs for making most of the limited resources.","authors":"A Indrayan","doi":"10.4103/jpgm.jpgm_607_24","DOIUrl":"10.4103/jpgm.jpgm_607_24","url":null,"abstract":"<p><strong>Abstract: </strong>Medical research is costly and requires significant effort. While intracellular research hardly follows a formal design, most data-based studies require a structural approach for optimal utilization of resources. Depending on the study's objectives and available resources, as well as the aim to obtain valid and reliable results, the design may be descriptive, employing specific sampling strategies, or analytical, exploring antecedent-outcome relationships. Analytical studies often involve designs such as randomization and blinding in clinical trials, and may use prospective, retrospective, or cross-sectional designs in observational studies. This first article in the series on biostatistics methods specifies the essential features of each design and describes the contexts in which they are most appropriate.</p>","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":" ","pages":"227-231"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of mesalamine potentiating hypoprothrombinemic effect of vitamin K antagonist (VKA) therapy resulting in life-threatening bleeding.","authors":"R S Prabhu, S N Rahmathullah, J Ahammad","doi":"10.4103/jpgm.jpgm_622_24","DOIUrl":"10.4103/jpgm.jpgm_622_24","url":null,"abstract":"<p><strong>Abstract: </strong>A 76-year-old male patient, who underwent a post-aortic valve replacement with a mechanical valve in 2006, was on oral anticoagulant therapy with warfarin, maintaining a stable therapeutic level of anticoagulation until 2022. He had a new diagnosis of ulcerative colitis in 2022, following which he was started on mesalamine. He had been having a supratherapeutic level of anticoagulation, as evidenced by an international normalized ratio (INR) of 12 to 14 on multiple occasions since 2022, leading to gastrointestinal bleeding, necessitating multiple packed red cell transfusions. He presented to us in August 2024 with severe anemia due to gastrointestinal bleeding. The evaluation revealed severe depletion of vitamin K-dependent coagulation factors. In this report, we discuss the possible drug-drug interactions between mesalamine and vitamin K antagonists, which went unrecognized leading to life-threatening gastrointestinal bleeding.</p>","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":" ","pages":"249-251"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of deaths due to gender-based violence: An autopsy-based cross-sectional study from Mumbai.","authors":"H M Pathak, A Kaur, N Chaudhary, A S Paul","doi":"10.4103/jpgm.jpgm_576_23","DOIUrl":"10.4103/jpgm.jpgm_576_23","url":null,"abstract":"<p><strong>Introduction: </strong>Gender-based violence (GBV), including domestic violence, honor killings, and dowry deaths, represents one of the most extreme forms of violence against women. These deaths are often misclassified as accidents or suicides due to societal biases, leading to underreporting and obscuring the true impact of GBV on women's mortality.</p><p><strong>Aims and objectives: </strong>This study aimed to evaluate the prevalence of GBV-related deaths, with a focus on cases misreported as accidents or suicides. The objective was to determine the proportion of female deaths attributable to GBV and to highlight the challenges in reporting and investigating these cases.</p><p><strong>Materials and methods: </strong>A retrospective, cross-sectional study was conducted at a medical teaching institution in Mumbai, analyzing 5 years (May 2017-April 2022) of autopsy data involving unnatural female deaths. Autopsy records, police reports, and victim/relative statements were examined to identify potential GBV cases and discrepancies in death classification.</p><p><strong>Results: </strong>The study found a significant proportion of female deaths attributed to GBV, primarily within domestic settings. Many cases initially reported as accidents or suicides showed discrepancies in injury patterns and circumstances. The majority of GBV victims were young women aged 15-44 years, with burns being the most common cause of death.</p><p><strong>Conclusion: </strong>The study emphasizes the need for improved investigation and classification of unnatural female deaths. Domestic violence emerged as the most common factor in these deaths, with intimate partners being primary perpetrators, with most incidents occurring within the home. It also stresses on enhanced protocols to accurately identify and address GBV-related fatalities.</p>","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":" ","pages":"204-208"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left ventricular pacing in a young African patient with a metallic tricuspid valve and infected epicardial leads: A case report.","authors":"M P Singhal, A Udyavar","doi":"10.4103/jpgm.jpgm_283_24","DOIUrl":"10.4103/jpgm.jpgm_283_24","url":null,"abstract":"<p><strong>Abstract: </strong>Tricuspid valve pathology is a relatively common anomaly. In patients with mechanical tricuspid valve replacement, implantation of a permanent pacemaker can be challenging due to the risk of valve damage, failure, and lead fracture associated with right ventricular endocardial leads. Epicardial leads may be an option, but they require a surgical procedure and are not preferred in patients with prior thoracotomy. This case report aims to demonstrate the safety and feasibility of left ventricular (LV) pacing via the coronary sinus (CS) in a 30-year-old young female with a mechanical tricuspid valve and infected epicardial leads. Due to the complications and contraindications of traditional approaches, Lead implantation via the CS was utilized. This method allowed for successful pacemaker implantation, demonstrating the feasibility and safety of LV pacing in such complex cases. The use of CS-guiding catheters and specialized leads facilitated effective cannulation and stable, reliable pacing, avoiding the need for further invasive surgeries.</p>","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":" ","pages":"245-248"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatic signet-ring cell carcinoma (the rare) with urinary bladder metastasis (the rarer).","authors":"P Vaideeswar, S Kolhe","doi":"10.4103/jpgm.jpgm_553_24","DOIUrl":"10.4103/jpgm.jpgm_553_24","url":null,"abstract":"","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":" ","pages":"255-256"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fatal familial insomnia: Reporting a case of the rare nightmare.","authors":"E Hogue, D Weinberg, E Palecek","doi":"10.4103/jpgm.jpgm_582_24","DOIUrl":"10.4103/jpgm.jpgm_582_24","url":null,"abstract":"<p><strong>Abstract: </strong>Prion diseases are rare, incurable, and rapidly progressive. Pathogenic misfolded proteins accumulate in the central nervous system causing fatal neurodegeneration. Fatal familial insomnia (FFI) is an even rarer, hereditary subset of prion disease. The initial clinical course is nonspecific, leading to difficulties with diagnosis. We describe a patient with a family history of prion disease who presented with early symptoms of FFI including disordered sleep, cognitive dysfunction, and autonomic dysregulation. Notably, diagnostic studies including magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, and electroencephalography (EEG) did not show changes characteristic of prion disease. However, genetic testing showed a pathological, heterozygous mutation c.532G> A (p.Asp178Asn), confirming FFI. His clinical course progressed rapidly, and death occurred several months after the initial hospital presentation. We discuss the pathophysiology and diagnosis of FFI and the emotional care required to treat this fatal disease. General practitioners should be aware of this rare diagnosis to improve patient management.</p>","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":" ","pages":"252-254"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling Balantidium coli : A rare protozoan causing a series of cases of dysentery in Rajasthan and review of literature.","authors":"S Kataria, A Singla, C Sharma","doi":"10.4103/jpgm.jpgm_509_24","DOIUrl":"10.4103/jpgm.jpgm_509_24","url":null,"abstract":"<p><strong>Abstract: </strong>Balantidium coli is the largest, uncommon, and only ciliate parasite that infects humans and is more common in tropics and subtropical regions. It is mostly asymptomatic, but can cause diarrhea and abdominal pain and sometimes leads to perforation of the colon. It is harbored in animals, particularly among pigs in hotter environments and monkeys in the jungles. If not treated on time, it may lead to perforation of the large intestine, peritonitis, appendicle involvement, etc. It is more common in immune-compromised individuals, particularly in those living in poor hygienic conditions. Retrieval of rare parasites was possible only because of prompt stool transport and its early processing. There are only few previous reports regarding the pediatric cases of balantidiasis, and there is a little information about its clinical signs and treatment. Here, we report a case series of B. coli infection presenting as an acute diarrheal disease from Rajasthan.</p>","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":" ","pages":"242-244"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating healthcare leadership: Theories, challenges, and practical insights for the future.","authors":"P K Singh, S Singh, V Kumari, M Tiwari","doi":"10.4103/jpgm.jpgm_533_24","DOIUrl":"10.4103/jpgm.jpgm_533_24","url":null,"abstract":"<p><strong>Abstract: </strong>Effective healthcare leadership is essential to ensure high-quality patient care and foster a supportive work environment for healthcare professionals. This review aims to consolidate existing healthcare leadership literature to provide evidence-based insights that can guide leadership development, improve team performance, and enhance patient care outcomes. A systematic search of academic databases such as PubMed, Scopus, Web of Science, CINAHL, Embase, and Google Scholar was performed using keywords related to healthcare leadership. Studies were selected based on their relevance, peer-reviewed status, and focus on healthcare settings. Thematic analysis was employed to synthesize findings from the selected studies. The review explores various leadership theories, including Great Man, trait, behavioral, transactional, transformational, and contingency theories, highlighting their relevance and application in healthcare. Effective healthcare leaders must possess traits such as vision, emotional intelligence, adaptability, and ethical integrity to navigate the complexities of modern healthcare. The review categorizes different leadership styles, including authoritarian, transformational, transactional, servant, and participative, and discusses their application in specific healthcare contexts. Leaders face challenges such as balancing personal and professional responsibilities, adapting to technological advancements, managing financial constraints, and ensuring regulatory compliance. Healthcare leadership requires a dynamic and adaptable approach that integrates various leadership theories and styles to address the unique challenges of the healthcare environment. This review underscores the importance of leadership development programs and calls for further research to explore the practical implementation of leadership strategies in diverse healthcare settings. The findings provide actionable insights for healthcare leaders to tailor their leadership styles to the specific needs of their teams and organizational contexts, ultimately enhancing patient care and operational efficiency.</p>","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":" ","pages":"232-241"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A randomized, double-blind, placebo controlled study to evaluate the effect of alpha-lipoic acid on inhibition of ADP-and collagen-induced platelet aggregation ex vivo in diabetic neuropathy patients on gabapentin or pregabalin.","authors":"U Pingali, P Sravanasandya, P Mekala, S Yareeda, K Sireesha, I Khan","doi":"10.4103/jpgm.jpgm_310_24","DOIUrl":"10.4103/jpgm.jpgm_310_24","url":null,"abstract":"<p><strong>Background: </strong>Diabetic peripheral neuropathy (DPN) is a chronic microvascular complication in diabetic mellitus patients due to chronic hyperglycemia, resulting in platelet hyperactivity and dyslipidemia. Alpha-lipoic acid (ALA) is a potent antioxidant which has antiplatelet activity and lipid-modulating characteristics and plays a major role in the prevention of disease progression.</p><p><strong>Aim: </strong>To evaluate the effect of ALA on inhibition of platelet aggregation and lipid profile.</p><p><strong>Settings and design: </strong>This was a prospective, randomized, double-blind, placebo-controlled study conducted at the Department of Clinical Pharmacology and Therapeutics at a tertiary care hospital.</p><p><strong>Materials and methods: </strong>We recorded efficacy parameters including changes in inhibition of platelet aggregation, lipid profile, blood sugars, and glycated hemoglobin over 12 weeks of ALA (600 mg once daily orally) supplementation in DPN patients on gabapentin (300 mg twice daily [BD]) or pregabalin (75 mg BD) compared to placebo. We used Student's t-test paired and unpaired for within-group and between-group comparisons, respectively.</p><p><strong>Results: </strong>A total of 52 study participants (males = 22, females = 30) with a mean age 55.63 ± 7.5 years were randomized to receive either ALA or placebo. Between-group analysis at 12 weeks showed that ALA significantly inhibited both collagen-induced platelet aggregation (from 32.61 ± 8.00 to 24.88 ± 5.30; P < 0.001) and adenosine diphosphate-induced platelet aggregation (from 34.00 ± 6.97 to 25.96 ± 6.45; P < 0.001) compared to placebo. Significant reduction in total cholesterol, low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol, and triglycerides was found in the ALA group at 12 weeks compared to baseline. No serious adverse events were reported.</p><p><strong>Conclusion: </strong>ALA, an antioxidant, demonstrated a protective effect against DPN by the virtue of its inhibitory effect on platelet aggregation and lipid-modulating effects and was found to have good safety.</p>","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":" ","pages":"191-197"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142788158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in implementing an Antimicrobial Stewardship Program (ASP) in developing countries.","authors":"C A Divecha, M S Tullu, S Karande","doi":"10.4103/jpgm.jpgm_228_24","DOIUrl":"10.4103/jpgm.jpgm_228_24","url":null,"abstract":"","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":" ","pages":"185-190"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}