Current Issue Volume 52, Number 3 , July-September 2018

EDITORIAL
Sandeep Grover, Ajit Avasthi

Stress in Trainee Resident Doctors: What can be Done?

[Year:2018] [Month:July-September] [Volumn:52 ] [Number:3] [Pages:60] [Pages No:iii-vii]



Stress among doctors is a global phenomenon. Stress in medical practice can arise in the context of patient care and in the context of working environment.1 In view of the nature of work, doctors are exposed to different emotions in varied situations, like the need to save a seriously ill patient, sense of failure and frustration in the face of progression of disease of their patients, sense of powerlessness against illness and its associated losses, grief, and fear of contacting illnesses.1


ORIGINAL ARTICLE
Kruthika Nagaraj, Renuka Prithviraj, Rajappa Maheswaran

Retrospective Descriptive Analysis of a University Undergraduate Community Medicine Question Papers, Karnataka

[Year:2018] [Month:July-September] [Volumn:52 ] [Number:3] [Pages:60] [Pages No:105-109]



Introduction: Summative assessment of students is done to know whether the student is competent enough for certification. As all assessment methods have some intrinsic flaws, solutions need to be identified to reduce these flaws before implementation.

Aim: To evaluate the validity of content in the university undergraduate community medicine question papers and suggest a blueprint format to be used in designing community medicine question paper.

Materials and methods: It is a retrospective descriptive analysis. Undergraduate community medicine theory question papers (papers I and II) of the last nine years, from 2008 to 2016, of a selected university in Karnataka were analyzed for content coverage, weightage, etc. Data are expressed as frequency, percentages, median, and interquartile range.

Results: Analysis of the question papers revealed that in majority of the papers, there was good coverage of all the chapters. Majority (57.6%) of the questions assessed knowledge followed by comprehension (33.1%), application skills (9%), and only 0.3% questions assessed analysis skills. Majority of the marks were from questions of must-know topics.

Conclusion: The present study establishes the scope for improvement while designing question papers in community medicine examinations. Also, blueprint should be an integral part of assessment.

Keywords: Blueprint, Community medicine, Evaluation, Undergraduates, Validity.

How to cite this article: Nagaraj K, Prithviraj R, Maheswaran R. Retrospective Descriptive Analysis of a University Undergraduate Community Medicine Question Papers, Karnataka. J Postgrad Med Edu Res 2018;52(3):105-109.

Source of support: Nil

Conflict of interest: None


RESEARCH ARTICLE
Vinuprasad Venugopalan, ER Manas, Rishikesh V Behere, Samir K Praharaj, Haridas Kanaradi

A Study on Alexithymia, Quality of Life, and Facial Emotion Recognition Abilities in Somatoform Disorders

[Year:2018] [Month:July-September] [Volumn:52 ] [Number:3] [Pages:60] [Pages No:110-116]



Aim: To assess alexithymia and quality of life among patients of somatoform disorders (SFD) compared with healthy control subjects and to assess the association between alexithymia and facial emotion recognition ability and its influence on quality of life within diagnostic subgroups of SFD.

Materials and methods: Forty-three patients diagnosed to have SFD (International Classification of Diseases (ICD)-10) were assessed on the World Health Organization (WHO) SFD symptom checklist, Toronto Alexithymia Scale-26 (TAS-26), Tool for Recognition of Emotions in Neurological Disorders (TRENDS) and WHO Quality of Life (QOL) BREF to measure quality of life. They were compared with a control group of 47 healthy subjects.

Results: Patients with SFD had greater alexithymia scores and poorer quality of life compared with controls. A novel observation was the inverse correlation between alexithymia and facial emotion recognition deficit, specifically in the diagnostic subgroup of persistent somatoform pain disorder compared with other diagnostic subtypes.

Conclusion: Alexithymia is an important trait influencing quality of life, especially in patients with a diagnosis of persistent somatoform pain disorder and is associated with deficits in facial emotion recognition.

Clinical significance: Association between alexithymia and facial emotion recognition is predominant in patients with somatoform pain disorder. Psychological interventions focusing on improving social cognition could potentially play a role in improving the quality of life in patients with persistent somatoform pain disorder.

Keywords: Alexithymia, Case-control study, Facial emotion recognition, Quality of life, Somatoform disorder.

How to cite this article: Venugopalan V, Manas ER, Behere RV, Praharaj SK, Kanaradi H. A Study on Alexithymia, Quality of Life, and Facial Emotion Recognition Abilities in Somatoform Disorders. J Postgrad Med Edu Res 2018;52(3):110-116.

Source of support: Nil

Conflict of interest: None


RESEARCH ARTICLE
Farah N Qamar, Khadija N Humayun, Sana Saeed, Arshalooz J Rahman, Hashim Ahmed, Kashif Karim

Effectiveness of a Course on Research Methodology in a Pediatric Residency Program.

[Year:2018] [Month:July-September] [Volumn:52 ] [Number:3] [Pages:60] [Pages No:117-119]



Background: The lack of physician’s training in research and conducting interdisciplinary/translational or clinical research has been discussed for more than a decade. Little is done to make research methodology as a core curriculum for residency programs, especially in developing countries. The Department of Pediatrics at the Aga Khan University, Pakistan, started a course on child health research methods in 2010 and we report the improvement in knowledge of the residents as a result of introduction of this course.

Materials and methods: We conducted a 1-year course with fortnightly sessions to provide an overview of how to plan and conduct a research project. Major topics included identifying research questions, techniques of literature search, basic principles of epidemiology including types of study designs, measures of disease frequency and association, protocol and questionnaire development, basic biostatistics, ethical issues involved in human subject research, and data and bibliography management. For the assessment of impact, the pretest- posttest design was used.

Results: Thirty residents filled the pre- and posttest questionnaires. There was significant improvement in the knowledge of basic epidemiology and biostatistics (p = 0.02 and <0.01 respectively). Baseline knowledge of ethics was good and did not improve significantly in the posttest. There was a significant difference in the overall mean pre- and posttest scores [p = 0.014, confidence interval (CI) 1.05-1.7]

Conclusion: The research methodology course in the residency curriculum improves awareness and understanding of young postgraduate trainees in basic epidemiology.

Keywords: Pakistan, Research course, Residency training.

How to cite this article: Qamar FN, Humayun KN, Saeed S, Rahman AJ, Ahmed H, Karim K. Effectiveness of a Course on Research Methodology in a Pediatric Residency Program. J Postgrad Med Edu Res 2018;52(3):117-119.

Source of support: Nil

Conflict of interest: None


RESEARCH ARTICLE
Adarsh Kohli, Aditi Sharma, Susanta K Padhy

Profile of Deficits on Assessment Battery in Children with Specific Learning Disorders

[Year:2018] [Month:July-September] [Volumn:52 ] [Number:3] [Pages:60] [Pages No:120-127]



Learning disabilities affects the acquisition, organization, retention, understanding, or use of verbal or nonverbal information. They usually result from impairments in memory, attention, phonological processing, language processing, visuospatial processing, and so forth leading to inabilities in oral language like speaking and understanding the grammatical constructions, reading like phonetic knowledge and word recognition, written language like spellings and alphabet recognition, and also arithmetic like computation.
The aim of the current study is to show the profile in learning disabled children.
Brigance Basic Skills List and the National Institute of Mental Health and Neurosciences (NIMHANS) index of specific learning disabilities are used for the purpose. The Brigance Basic Skills List is designed to assess visuomotor skills, visual discrimination, acquisition of gross motor and fine motor skills, and acquisition of alphabets and numbers. The NIMHANS index in addition to the above also assesses the reading, writing, spellings, and arithmetic skills of the subjects and other functions like attention, memory, and perceptual motor functions of the subjects. The sample was drawn from the Child and Adolescent Psychiatric clinic of outpatient of Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. It comprised of 20 subjects within the age range of 10 to 18 years with learning disabilities in one or more areas along with difficulties. They were all belonging to middle- to upper-middle socioeconomic status and were studying in private school setup.
The results show the profile of the subjects on attention in terms of distractibility and impulsiveness, the memory profile, perceptual motor functions, basic academic skills in terms of visual and auditory discrimination, concept and sequencing of letters and numbers, and the type of errors in terms of their reading, writing, spellings, and arithmetic skills.

Keywords: Attention, Disability, Learning, Memory.

How to cite this article: Kohli A, Sharma A, Padhy SK. Profile of Deficits on Assessment Battery in Children with Specific Learning Disorders. J Postgrad Med Edu Res 2018;52(3):120-127.

Source of support: Nil

Conflict of interest: None


RESEARCH ARTICLE
Gabriel Andrade, Saud Qureshi, Saleh Khasawneh, Alladin Kawaiah, Joseph Sarra

Religious Affiliations and Ethical Opinions of Students at Xavier University School of Medicine, Aruba

[Year:2018] [Month:July-September] [Volumn:52 ] [Number:3] [Pages:60] [Pages No:128-134]



Xavier University School of Medicine, Aruba, is an offshore medical school located in the Dutch Caribbean. Most of its students come from the United States and Canada. Yet, they are immensely diverse in their religious affiliation. A study was conducted with students, asking them what their religious affiliation is. Then, they were presented with a series of hypothetical cases dealing with abortion, in vitro technology, embryonic stem cells, and euthanasia. They were asked to give their moral evaluation. The results came out showing that, as a general trend, respondents form their ethical opinions in the medical field, independently of the doctrines of their religious affiliations.

Keywords: Abortion, Euthanasia, Medical ethics, Religion.

How to cite this article: Andrade G, Qureshi S, Khasawneh S, Kawaiah A, Sarra J. Religious Affiliations and Ethical Opinions of Students at Xavier University School of Medicine, Aruba. J Postgrad Med Edu Res 2018;52(3):128-134.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Prem L Manhas, Nikita Makkar, Rakesh Sehgal, Pankaj Malhotra

Advances in Malaria at MICROCON 2016

[Year:2018] [Month:July-September] [Volumn:52 ] [Number:3] [Pages:60] [Pages No:135-142]



Malaria is one of the prevalent vector-borne diseases in India. Though it is a curable disease, failure to recognize it early and increasing resistance to present antimalarial drugs are the major obstacles in its treatment. Thus, irrespective of substantial advancement, there is a demand of supplemental diagnostic methods with high sensitivity and specificity to account for early diagnosis and treatment. Additionally, advanced antimalarial drugs and profound research in pathophysiological mechanism of antimalarial drug resistance is also indispensable. In this review, we have summed up the presentations on malaria that were presented during the 40th Annual Conference of Indian Association of Medical Microbiologists, MICROCON 2016 at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India, from November 23 to 27, 2016. Videos of the talks held in the conference are also available on website http://microcon2016.com/conference-videos/. Major talks were focused on the development of newer diagnostic techniques with high sensitivity and specificity. Further, research on the markers for drug resistance and prevention of spread of drug resistance in malaria was also discussed closely.

Keywords: Diagnostic methods, Malaria, Markers for drug resistance.

How to cite this article: Manhas PL, Makkar N, Sehgal R, Malhotra P. Advances in Malaria at MICROCON 2016. J Postgrad Med Edu Res 2018;52(3):135-142.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Morankar Rahul, Goyal Ashima, Sanjeev Singh, Jaiswal Manoj, Gauba Krishan

Multiple Accessory Cusps in Maxillary Primary Second Molars and Permanent First Molars and Its Clinical Implications

[Year:2018] [Month:July-September] [Volumn:52 ] [Number:3] [Pages:60] [Pages No:143-146]



The primary and permanent teeth in humans may show anomalies related to numbers and morphology of crown and roots. There can be a variation in morphology, location, and prevalence of accessory cusps that can often lead to dental problems. The present case report is of a 9-year-old child exhibiting multiple accessory cusps on the occlusal surface of maxillary primary second molars and maxillary permanent first molars. This article highlights the clinical implications of condition and the associated problems.

Keywords: Central cusp, Clinical implications, Dens evaginatus, Multiple accessory cusps.

How to cite this article: Rahul M, Ashima G, Singh S, Manoj J, Krishan G. Multiple Accessory Cusps in Maxillary Primary Second Molars and Permanent First Molars and Its Clinical Implications. J Postgrad Med Edu Res 2018;52(3):143-146.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Morankar Rahul, Sanjeev Singh, Gauba Krishan, Goyal Ashima

Oral Self-mutilation: The Rare Neurological Manifestation in a Case of Japanese Encephalitis

[Year:2018] [Month:July-September] [Volumn:52 ] [Number:3] [Pages:60] [Pages No:147-149]



Self-mutilation is a behavioral disturbance characterized by the deliberate destruction of or damage to body tissues. This case report describes a 7-year-old child reported with multiple ulcerations in the oral cavity due to self-biting. Intraoral examination showed ulcerations on the left and right buccal mucosa and tongue. Medical history revealed history of fever accompanied by acute onset of flaccid paralysis and encephalopathy. Magnetic resonance imaging brain was suggestive of acute viral meningoencephalitis. Japanese encephalitis (JE) infection was confirmed by immunoglobulin M (IgM) detection. The damage due to self-biting was progressive in nature and the patient’s condition did not improve on medication. Extractions of permanent teeth were carried out under local anesthesia to prevent the self-injurious behavior (SIB).

Keywords: Japanese encephalitis, Japanese encephalitis virus, Self-injurious behavior.

How to cite this article: Rahul M, Singh S, Krishan G, Ashima G. Oral Self-mutilation: The Rare Neurological Manifestation in a Case of Japanese Encephalitis. J Postgrad Med Edu Res 2018;52(3):147-149.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Muzamil Latief, Muzamil Nazir, Farhat Abbas

Poncet’s Disease in Tubercular Cervical Lymphadenitis.

[Year:2018] [Month:July-September] [Volumn:52 ] [Number:3] [Pages:60] [Pages No:150-151]



Introduction: Poncet’s disease (PD) is a type of reactive arthritis that accompanies tuberculosis (TB) infection. The joint involvement varies both in number and in severity of involvement. Treatment usually involves anti-inflammatory drugs and antituberculosis treatment (ATT).

Case report: We report a female patient who presented with fever with joint swelling and pain, who, on further evaluation, turned out to be harboring tubercular cervical lymphadenitis as confirmed by histopathology of lymph node and tuberculin skin test. Her joint X-rays, joint aspirate, and negative serological markers established diagnosis of PD. She was treated with ATT and nonsteroidal anti-inflammatory drugs (NSAIDs). Patient responded to this treatment and joint signs and symptoms subsided in 3 weeks after institution of treatment. She went on to complete ATT and is doing well on follow-up.

Conclusion: Diseases like PD, though being rare entities, still have very much clinical importance given the possibility of misdiagnosis and wrong treatment which otherwise is very much treatable with ATT and NSAIDs. Hence, clinical suspicion is very important in this disease state.

Keywords: Lymphadenitis, Poncet’s disease, Tuberculosis.

How to cite this article: Latief M, Nazir M, Abbas F. Poncet’s Disease in Tubercular Cervical Lymphadenitis. J Postgrad Med Edu Res 2018;52(3):150-151.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Leszek Sulkowski, Maciej Matyja, Artur Pasternak

Salvage Technique for Complicated Hemodialysis Patients with Central Venous Occlusion

[Year:2018] [Month:July-September] [Volumn:52 ] [Number:3] [Pages:60] [Pages No:152-154]



Background: Although safe, central venous catheters (CVCs) may cause several complications including central venous occlusions. The salvage access techniques are life-saving alternatives required for patients who have exhausted other access options.

Technique: We present a technique of placing a permanent catheter in the femoral vein facing the dilated collaterals. This is done in case of iliac vein and vena cava thrombosis following placement of multiple CVCs.

Conclusion: This technique might be an effective alternative to the translumbar approach when performed by an experienced operator in a well-equipped access center. It must not be attempted as a blind procedure.
Salvaged access can be considered when other access options have been exhausted and only translumbar or transhepatic inferior vena cava accesses are left.

Clinical significance: The CVCs remain the fastest, safe, and effective access for hemodialysis. As a last resort, lower extremity access may be considered. The presented salvage procedure is a modification of the routine CVC placement technique.

Keywords: Central venous catheter, Complications, Hemodialysis, Vascular access, Venography.

How to cite this article: Sulkowski L, Matyja M, Pasternak A. Salvage Technique for Complicated Hemodialysis Patients with Central Venous Occlusion. J Postgrad Med Edu Res 2018;52(3):152-154.

Source of support: Nil

Conflict of interest: None


CLINICOPATHOLOGICAL CONFERENCE REPORT (CPC)
Ritambhra Nada, Manoj G Madakshira, Mohd Umair, Phillip Daniel, Usha Dutta, Kunwer, Ashim Das

Acute-on-chronic Liver Failure in a Young Lady

[Year:2018] [Month:July-September] [Volumn:52 ] [Number:3] [Pages:60] [Pages No:155-163]



A 25-year-old lady presented with a history of abdominal distension for 3 months and jaundice for 1 week. The patient was apparently asymptomatic 3 months back when she had spontaneous abortion at 4 weeks of gestation.


BIOSKETCH
Ajit Avasthi, Subho Chakrabarti

Prof. N N Wig... The Living Legend of Indian Psychiatry

[Year:2018] [Month:July-September] [Volumn:52 ] [Number:3] [Pages:60] [Pages No:164-165]



Professor NN Wig is, in the true sense of the word, a living legend of Indian psychiatry. The Department of Psychiatry at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, owes its existence to him and his vision continues to guide the staff and students. He single-handedly brought the department into being in 1963 and he continues to be intimately associated with the department and the PGIMER as one of its emeritus professors.


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