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   2018| May-June  | Volume 31 | Issue 3  
    Online since April 9, 2019

 
 
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SHORT REPORT
Pregnancy with massive splenomegaly: A case series
Seema Singhal, Kallol Kumar Roy, Sunesh Kumar, Jyoti Meena, Juhi Bharti, Bhawani Shekhar
May-June 2018, 31(3):146-148
DOI:10.4103/0970-258X.255756  PMID:31044760
Background. Pregnancy with massive splenomegaly is a rare entity and is associated with increased risk to both mother and foetus. There is paucity of studies in the literature to guide clinicians for the management of this condition. Methods. We reviewed the course of pregnancy, maternal and foetal outcomes of 5 pregnant women with massive splenomegaly who were managed in our unit during 2015–16. Results. All 5 women had anaemia and thrombocytopenia, and had different causes for splenomegaly. One patient had chronic malaria, 2 had portal hypertension with cirrhosis and the remaining 2 had non-cirrhotic portal hypertension. Life-threatening complications were present in 2 patients; one of them had severe pre-eclampsia complicated by pulmonary oedema, cardiac arrest and the other patient developed spontaneous bacterial peritonitis. Intrauterine growth restriction and meconium-stained liquor were the most common perinatal complications. Two patients had vaginal delivery and 3 required emergency caesarean section. Postpartum haemorrhage was present in 2, and the hospital stay was prolonged in all the patients. All mothers and babies were discharged in a satisfactory condition. Conclusion. Pregnancy with massive splenomegaly poses a challenge because of diverse aetiology and potentially adverse outcomes. Multidisciplinary care in a tertiary centre can help optimize the outcome.
  5,727 371 1
MEDICAL EDUCATION
Publication misconduct: Perceptions of participants of a faculty development programme
Suman P Singh, Shashi K Dhir, Monika Sharma, Tejinder Singh
May-June 2018, 31(3):169-171
DOI:10.4103/0970-258X.255762  PMID:31044767
Background. Publication misconduct is a commonly reported finding among researchers from various backgrounds including those from the medical sciences. The reasons for such events are diverse and people address them differently. Methods. The opinions and experiences of 72 medical educators enrolled in an online discussion forum for faculty development were analysed to ascertain possible reasons and ways to address publication misconduct. Results. Of the 50 educators who participated in the discussion, 46 had one or more experiences of publication misconduct to share. Twelve participants felt that almost all kinds of publication misconduct, i.e. fabrication and falsification of data, plagiarism and authorship issues were a universal phenomenon. In the experience of majority of the participants, publication misconduct was common and often no action was taken. Lack of knowledge and awareness among teachers and students, personal gains, pressure for professional advancement and lack of monitoring and control were identified as the reasons for such misconduct. Several solutions were offered by the participants to address the problem, the most common was to have a formal training programme along with stringent monitoring and control mechanisms at the institutional level. Conclusion. Publication misconduct occurs and people indulge in it for a variety of reasons. Institutional-level policies may be able to address some of these.
  4,007 313 -
CLINICAL CASE REPORT
Tuberculosis of the cervix: An uncommon cause of vaginal discharge in a post-menopausal woman
Rajesh Kumari, Vandana Vaishya, Gaurav Khanna, Mukul Chauhan, Jai Bhagwan Sharma, Alka Kriplani
May-June 2018, 31(3):149-150
DOI:10.4103/0970-258X.255757  PMID:31044761
Discharge per vaginum is a common symptom of a variety of gynaecological diseases. Among post-menopausal women, atrophic vaginitis, cervicitis and cervical carcinoma are common causes of this symptom. We present a 64-year-old woman who had foul-smelling discharge per vaginum for the past 1 year. Per speculum examination revealed an unhealthy-looking cervix and white discharge. On bi-manual examination, the cervix was flush with the vagina. There was no obvious growth felt, the exact uterine size could not be ascertained and the finger was stained with thick discharge. A biopsy of the cervix showed epithelioid cell granulomas and a diagnosis of tuberculosis was made. The patient responded to antitubercular therapy. Tuberculosis of the cervix may be a rare cause of foul- smelling discharge per vaginum in post-menopausal women but there should be a high index of suspicion of this condition, especially in areas where tuberculosis is common. We report this post-menopausal woman owing to the rarity of tuberculosis of the cervix mimicking a gynaecological malignancy.
  2,681 275 1
REVIEW ARTICLE
Management of tuberculosis of the central nervous system: Our experience
PN Tandon
May-June 2018, 31(3):151-155
DOI:10.4103/0970-258X.255758  PMID:31044762
  2,431 386 1
CORRESPONDENCE
Padma Awards in the field of medicine: A shift in the right direction—from super-specialists to public health practitioners
Soumya Swaroop Sahoo, Binod Kumar Patro
May-June 2018, 31(3):188-190
DOI:10.4103/0970-258X.255772  PMID:31044774
  2,527 142 1
EDITORIALS
Antimicrobial Resistance: Threat, consequences and options
Rajesh Bhatia
May-June 2018, 31(3):133-135
DOI:10.4103/0970-258X.255752  PMID:31044757
  2,001 283 3
MEDICINE AND SOCIETY
Using non-communicable disease clinics for tobacco cessation: A promising perspective
Garima Bhatt, Sonu Goel
May-June 2018, 31(3):172-175
DOI:10.4103/0970-258X.255763  PMID:31044768
Globally, non-communicable diseases (NCDs) are responsible for 38 million (68%) of the world’s 56 million deaths, of which 28 million occur in low- and middle-income countries. Tobacco use is a major preventable and modifiable behavioural risk factor for NCDs. It takes annually a toll of over 7 million people and by 2030, it is anticipated to kill over 8 million people every year. Internationally, WHO has advocated the Framework Convention on Tobacco Control and MPOWER policy to combat the tobacco epidemic. As part of its global commitment towards tobacco control, the Government of India has enacted a comprehensive law, namely Cigarette and Other Tobacco Products Act, in 2003, for governing tobacco control in the country followed by launching of the National Tobacco Control Programme for its effective implementation along with strengthening of tobacco cessation facilities at national and sub-national levels. As per the National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke, there is a provision of screening of risk factors for NCDs (including tobacco) besides providing treatment and behavioural advice for NCDs. However, presently, tobacco cessation services for NCD patients are under-utilized, probably due to lack of a skilled and dedicated workforce. Delivery of effective patient-centric, disease-specific, culturally sensitive tobacco cessation services at an NCD clinic might efficiently reduce complications of NCDs among patients using tobacco and might further reduce morbidity and mortality attributable to NCDs in India.
  1,695 307 2
ORIGINAL ARTICLES
Salt-sensitive phenotypes: A community-based exploratory study from northeastern India
Prasanta K Borah, Meenakshi Sharma, Hem C Kalita, M.A.Q. Pasha, Suman K Paine, Dilip Hazarika, Chandra K Bhattacharjee, Jagadish Mahanta
May-June 2018, 31(3):140-145
DOI:10.4103/0970-258X.255754  PMID:31044759
Background. Salt sensitivity is known to increase the risk of cardiovascular diseases in both normotensive and hypertensive subjects. The population in the northeastern region of India consumes excess dietary salt but their saltsensitive phenotype is not known. Methods. We did a community-based exploratory study using volunteers in the northeastern region of India to determine salt-sensitive (SS) and salt-resistant (SR) phenotypes. A total of 374 (206 normotensive and 168 hypertensive) subjects who gave informed consent were stabilized for salt with 7 days of a low-salt (2.9 g/day) diet followed by 7 days of a high-salt (15.2 g/day) diet. SS was defined as an increase of mean arterial blood pressure ≥9 mmHg after a high-salt diet. Results. We noted an increase in systolic blood pressure of 9.3 mmHg in normotensive subjects and 10.7 mmHg in hypertensive subjects, with a modest effect on diastolic blood pressure (6.9 mmHg in normotensive and 8.2 mmHg in hypertensive subjects) after a high-salt diet. Salt-sensitive phenotype was present in 40.8% of normotensive and 47.6% of hypertensive subjects. Resistance to introduction of high salt was observed in 43.7% of normotensive and 33.9% of hypertensive subjects. Consumption of extra salt (adjusted OR 1.99, 95% CI 1.25–3.18) was independently associated with salt sensitivity. Conclusion. Salt sensitivity was found in a large proportion of normotensive and hypertensive subjects. Restriction of salt intake could be an effective intervention to control hypertension among salt-sensitive subjects.
  1,695 303 2
MEDICAL EDUCATION
The need to focus on medical education in rural districts of India
Kishor Parashramji Brahmapurkar, Sanjay P Zodpey, Yogesh D Sabde, Vaishali K Brahmapurkar
May-June 2018, 31(3):164-168
DOI:10.4103/0970-258X.255761  PMID:31044766
Background. Globally, India has the highest number of medical colleges followed by Brazil and China. The density of physicians in rural India was 3 per 10 000 population against 13 per 10 000 in urban areas. Worldwide, studies show that medical schools play an important role in overcoming the shortage of physicians locally. Hence, we studied the distribution of medical colleges in India and reviewed the shortage of established and new medical colleges in rural districts with the year 2000 as baseline. Methods. We used the database of the Medical Council of India as on 27 April 2017; and Census 2011 data, based on the percentage of rural/urban population, for the classification of districts (rural/urban). All the 640 districts were included with 1210.9 million population. Results. Of the 480 rural districts in India, only 132 (27.5%) had a medical college. Jharkhand, Jammu and Kashmir and Arunachal Pradesh had no medical colleges in rural districts. Madhya Pradesh, Uttar Pradesh, Bihar, Assam, Punjab, Uttarakhand, Haryana and Rajasthan had <30% of rural districts with a medical college. Of the 286 new medical colleges established since 2000 in India, 130 (45.5%) were in rural districts with uneven distribution with lower percentage of new medical colleges in states with predominance of rural population. Conclusion. There is an overall shortage of medical colleges in rural districts of India. Paradoxically, the trend of uneven rural–urban distribution continues among the newly opened medical colleges as well.
  1,706 246 2
ORIGINAL ARTICLES
Thyroid dysfunction in patients on antiretroviral therapy: A perspective from southern India
Savitha A Sebastian, S Sumithra, Jithu Kurian, Vivek Mathew, Jyothi M Idiculla
May-June 2018, 31(3):136-139
DOI:10.4103/0970-258X.255753  PMID:31044758
Background. Thyroid dysfunction in patients with human retroviral infection has been reported but the prevalence of thyroid function abnormalities in patients on highly active antiretroviral therapy (HAART) has not been studied. We aimed to assess the prevalence of thyroid dysfunction and autoimmunity (antithyroid peroxidase auto-antibodies [TPO-Ab]) in patients on first-line HAART, identify risk factors for thyroid dysfunction and determine any association of thyroid dysfunction with HAART. Methods. We screened and enrolled consecutive patients from the outpatient department if they were (i) diagnosed with HIV infection (enzyme-linked immunosorbent assay); (ii) aged more than 18 years; (iii) on HAART for 1 year or more; and (iv) clinically stable with no evidence of any acute illness in the past 2 months. We excluded patients who were on drugs that affect thyroid function. Thyroid function tests and CD4 counts were done. Results. A total of 159 patients on firstline HAART were included in the study. Their mean (SD) age was 43.3 (10) years and duration of HAART was 44.4 (33.54) months. The mean CD4 count was 502.8 (274.45). Forty-seven patients (29.6%) had thyroid dysfunction. TPO-Ab positivity was noted in 6 patients. No association was seen between thyroid dysfunction and any type of regimen or drug. There was a significant negative correlation between CD4 counts and thyroid-stimulating harmone (TSH) suggesting that thyroid dysfunction may be more prevalent when immunity is low. Conclusions. There is a high prevalence of thyroid dysfunction, predominantly subclinical hypothyroidism, in patients on HAART. Thyroid autoimmunity is low in this subset of patients. Lower immunity is associated with higher TSH levels. Larger longitudinal studies are required to determine the course of hypothyroidism in patients on HAART.
  1,625 304 1
SELECTED SUMMARIES
Contemporary hormonal contraceptives and breast cancer risk: What do we learn?
Ilavarasi Vanidassane, Ajay Gogia, Lalit Kumar
May-June 2018, 31(3):156-157
DOI:10.4103/0970-258X.255759  PMID:31044763
  1,616 250 1
EDITORIALS
The 2017 American College of Cardiology/ American Heart Association Clinical Practice Guideline for Blood Pressure: Implications for India
Anubha Agarwal, Mark D Huffman, K Srinath Reddy, Dorairaj Prabhakaran
May-June 2018, 31(3):129-132
DOI:10.4103/0970-258X.255751  PMID:31044756
  1,274 309 1
SPEAKING FOR MYSELF
Low-Cost Pharma
Anil C Anand
May-June 2018, 31(3):176-179
DOI:10.4103/0970-258X.255764  PMID:31044769
  1,283 154 -
CORRESPONDENCE
Breakfast-eating habits of school-going adolescents in Kochi, Kerala, India
Ann John Kurien, Anjali Rejiv, Anusree Premarajan, BA Renjini, PS Rakesh
May-June 2018, 31(3):188-188
DOI:10.4103/0970-258X.255771  PMID:31044773
  1,130 204 -
CLINICO-PATHOLOGICAL CONFERENCE
A 45-year-old woman with episodic anxiety, hypertension and diabetes mellitus

May-June 2018, 31(3):160-163
DOI:10.4103/0970-258X.255755  PMID:31044765
  992 184 -
BOOK REVIEWS
Western Medicine and Colonial Society Hospitals of Calcutta,c. 1757–1860
Mridula Ramanna
May-June 2018, 31(3):187-187
DOI:10.4103/0970-258X.255770  
  863 110 -
OBITUARIES
Badri Nath Tandon (1 August 1931– 5 March 2018)
Anil Chandra Anand
May-June 2018, 31(3):180-181
DOI:10.4103/0970-258X.255765  PMID:31044770
  805 108 -
SELECTED SUMMARIES
Blood pressure reduction in barbershops
Roopali Khanna, Aditya Kapoor
May-June 2018, 31(3):158-159
DOI:10.4103/0970-258X.255760  PMID:31044764
  722 140 -
OBITUARIES
Vallath Balakrishnan (1935–2018)
VA Narayanan
May-June 2018, 31(3):182-182
DOI:10.4103/0970-258X.255766  PMID:31044771
  719 126 -
LETTER FROM MUMBAI
Letter from Mumbai
Sunil K Pandya
May-June 2018, 31(3):183-184
DOI:10.4103/0970-258X.255767  PMID:31044772
  594 95 -
NEWS FROM HERE AND THERE
News From Here and there

May-June 2018, 31(3):191-192
DOI:10.4103/0970-258X.255773  
  493 163 -
BOOK REVIEWS
Quicksand. What It Means to be a Human Being
Sunil K Pandya
May-June 2018, 31(3):185-186
DOI:10.4103/0970-258X.255769  
  508 63 -
Emergency Laparoscopy
V Lekha
May-June 2018, 31(3):185-185
DOI:10.4103/0970-258X.255768  
  398 60 -