Pub Date : 2024-07-01Epub Date: 2024-08-14DOI: 10.4103/jpgm.jpgm_361_24
A Kumar, A N Deshmukh, C K Pandey, N Chaudhary
Abstract: Neuraxial blockade procedures are essential for anesthesia and pain management but pose risks in patients with uncertain coagulation profiles. Traditional coagulation tests often fail to predict bleeding risks associated with neuraxial blockade. Thromboelastography (TEG) offers real-time insights into coagulation status, potentially improving safety outcomes. In this case series, six patients underwent neuraxial blockade guided by TEG analysis. An individualized anesthetic plan was formulated based on TEG findings to mitigate bleeding risks while ensuring pain management. Tailoring anesthetic techniques to real-time TEG data improved safety outcomes with minimized bleeding complications and satisfactory pain control. In conclusion, neuraxial blockade guided by TEG enhances safety in patients with uncertain coagulation profiles. Further studies are needed to validate benefits in broader clinical settings.
{"title":"Improving safety: Neuraxial blockade guided by thromboelastography for patients with uncertain coagulation profile.","authors":"A Kumar, A N Deshmukh, C K Pandey, N Chaudhary","doi":"10.4103/jpgm.jpgm_361_24","DOIUrl":"10.4103/jpgm.jpgm_361_24","url":null,"abstract":"<p><strong>Abstract: </strong>Neuraxial blockade procedures are essential for anesthesia and pain management but pose risks in patients with uncertain coagulation profiles. Traditional coagulation tests often fail to predict bleeding risks associated with neuraxial blockade. Thromboelastography (TEG) offers real-time insights into coagulation status, potentially improving safety outcomes. In this case series, six patients underwent neuraxial blockade guided by TEG analysis. An individualized anesthetic plan was formulated based on TEG findings to mitigate bleeding risks while ensuring pain management. Tailoring anesthetic techniques to real-time TEG data improved safety outcomes with minimized bleeding complications and satisfactory pain control. In conclusion, neuraxial blockade guided by TEG enhances safety in patients with uncertain coagulation profiles. Further studies are needed to validate benefits in broader clinical settings.</p>","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977578","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}
Pub Date : 2024-04-25DOI: 10.4103/jpgm.jpgm_926_23
D. Rajiv, S Jain, S. Karande
{"title":"Acute disseminated encephalomyelitis with coexisting neurocysticercosis in an 11-year-old boy: An unusual occurrence.","authors":"D. Rajiv, S Jain, S. Karande","doi":"10.4103/jpgm.jpgm_926_23","DOIUrl":"https://doi.org/10.4103/jpgm.jpgm_926_23","url":null,"abstract":"","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140658560","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}
Pub Date : 2024-04-25DOI: 10.4103/jpgm.jpgm_823_23
P. Nayak, N. Gogtay
{"title":"Large language models and the future of academic writing.","authors":"P. Nayak, N. Gogtay","doi":"10.4103/jpgm.jpgm_823_23","DOIUrl":"https://doi.org/10.4103/jpgm.jpgm_823_23","url":null,"abstract":"","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140656700","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}
Pub Date : 2024-04-23DOI: 10.4103/jpgm.jpgm_891_23
S. J. Chen, S S Chang, N. H. Meng
{"title":"Bicarotid trunk and severe kinking of right common carotid artery presenting with large intracranial hemorrhage.","authors":"S. J. Chen, S S Chang, N. H. Meng","doi":"10.4103/jpgm.jpgm_891_23","DOIUrl":"https://doi.org/10.4103/jpgm.jpgm_891_23","url":null,"abstract":"","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140672501","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}
Pub Date : 2024-04-18DOI: 10.4103/jpgm.jpgm_763_23
P. V. Patil
{"title":"Periosteal reaction in jugular foramen secondary to ipsilateral internal jugular vein thrombosis.","authors":"P. V. Patil","doi":"10.4103/jpgm.jpgm_763_23","DOIUrl":"https://doi.org/10.4103/jpgm.jpgm_763_23","url":null,"abstract":"","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140688413","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}
Pub Date : 2024-04-18DOI: 10.4103/jpgm.jpgm_753_23
A. Indrayan, R. K. Malhotra, M. Pawar
ABSTRACT The area under the ROC curve is frequently used for assessing the predictive efficacy of a model, and the Youden index is commonly used to provide the optimal cut-off. Both are misleading tools for predictions. A ROC curve is drawn for the sensitivity of a quantitative test against its (1 - specificity) at different values of the test. Both sensitivity and specificity are retrospective in nature as these are indicators of correct classification of already known conditions. They are not indicators of future events and are not valid for predictions. Predictivity intimately depends on the prevalence which may be ignored by sensitivity and specificity. We explain this fallacy in detail and illustrate with several examples that the actual predictivity could differ greatly from the ROC curve-based predictivity reported by many authors. The predictive efficacy of a test or a model is best assessed by the percentage correctly predicted in a prospective framework. We propose predictivity-based ROC curves as tools for providing predictivities at varying prevalence in different populations. For optimal cut-off for prediction, in place of the Youden index, we propose a P-index where the sum of positive and negative predictivities is maximum after subtracting 1. To conclude, for correctly assessing adequacy of a prediction models, predictivity-based ROC curves should be used instead of the usual sensitivity-specificity-based ROC curves and the P-index should replace the Youden index.
摘要 ROC 曲线下面积常用于评估模型的预测效果，而尤登指数则常用于提供最佳临界值。两者都是误导预测的工具。ROC 曲线是根据定量检测在不同检测值下的灵敏度和（1 - 特异性）绘制的。灵敏度和特异性都是回顾性的，因为它们是对已知情况进行正确分类的指标。它们不是未来事件的指标，不能用于预测。预测性与患病率密切相关，而患病率可能会被灵敏度和特异性所忽略。我们将详细解释这一谬误，并用几个例子说明，实际的预测性可能与许多作者报告的基于 ROC 曲线的预测性大相径庭。在前瞻性框架中，测试或模型的预测功效最好通过正确预测的百分比来评估。我们建议将基于预测率的 ROC 曲线作为工具，在不同人群中提供不同流行率的预测率。对于预测的最佳临界值，我们提出了一个 P 指数来代替尤登指数，即阳性和阴性预测值之和减去 1 后的最大值。总之，为了正确评估预测模型的适当性，应使用基于预测率的 ROC 曲线，而不是通常的基于灵敏度-特异性的 ROC 曲线，并用 P 指数取代尤登指数。
{"title":"Use of ROC curve analysis for prediction gives fallacious results: Use predictivity-based indices.","authors":"A. Indrayan, R. K. Malhotra, M. Pawar","doi":"10.4103/jpgm.jpgm_753_23","DOIUrl":"https://doi.org/10.4103/jpgm.jpgm_753_23","url":null,"abstract":"ABSTRACT\u0000The area under the ROC curve is frequently used for assessing the predictive efficacy of a model, and the Youden index is commonly used to provide the optimal cut-off. Both are misleading tools for predictions. A ROC curve is drawn for the sensitivity of a quantitative test against its (1 - specificity) at different values of the test. Both sensitivity and specificity are retrospective in nature as these are indicators of correct classification of already known conditions. They are not indicators of future events and are not valid for predictions. Predictivity intimately depends on the prevalence which may be ignored by sensitivity and specificity. We explain this fallacy in detail and illustrate with several examples that the actual predictivity could differ greatly from the ROC curve-based predictivity reported by many authors. The predictive efficacy of a test or a model is best assessed by the percentage correctly predicted in a prospective framework. We propose predictivity-based ROC curves as tools for providing predictivities at varying prevalence in different populations. For optimal cut-off for prediction, in place of the Youden index, we propose a P-index where the sum of positive and negative predictivities is maximum after subtracting 1. To conclude, for correctly assessing adequacy of a prediction models, predictivity-based ROC curves should be used instead of the usual sensitivity-specificity-based ROC curves and the P-index should replace the Youden index.","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140687906","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}
Pub Date : 2024-04-17DOI: 10.4103/jpgm.jpgm_708_23
P. R. Prakash, A. Narayan, S. Jain, N. Wig
ABSTRACT Arsenic compounds are colorless and odorless and toxicity can occur either acutely following ingestion of arsenicals with gastrointestinal disturbances or due to chronic exposure usually presenting with dermatologic lesions and peripheral neuropathy. We report a young couple who presented with signs and symptoms of painful sensorimotor peripheral neuropathy in a typical "stocking and glove" pattern. They had raised urinary arsenic levels with normal blood levels and thus, a diagnosis of chronic arsenic poisoning due to contaminated water intake was made after detecting elevated arsenic levels in their home water supply. Both patients underwent chelation therapy with dimercaprol for 14 days and reported subjective and objective improvement in symptoms with the reduction in urinary arsenic levels at the end of therapy.
{"title":"Chronic arsenic poisoning: A sinister cause of peripheral neuropathy in a young couple.","authors":"P. R. Prakash, A. Narayan, S. Jain, N. Wig","doi":"10.4103/jpgm.jpgm_708_23","DOIUrl":"https://doi.org/10.4103/jpgm.jpgm_708_23","url":null,"abstract":"ABSTRACT\u0000Arsenic compounds are colorless and odorless and toxicity can occur either acutely following ingestion of arsenicals with gastrointestinal disturbances or due to chronic exposure usually presenting with dermatologic lesions and peripheral neuropathy. We report a young couple who presented with signs and symptoms of painful sensorimotor peripheral neuropathy in a typical \"stocking and glove\" pattern. They had raised urinary arsenic levels with normal blood levels and thus, a diagnosis of chronic arsenic poisoning due to contaminated water intake was made after detecting elevated arsenic levels in their home water supply. Both patients underwent chelation therapy with dimercaprol for 14 days and reported subjective and objective improvement in symptoms with the reduction in urinary arsenic levels at the end of therapy.","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140693329","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}
Pub Date : 2024-04-17DOI: 10.4103/jpgm.jpgm_693_23
P. Vaideeswar, G. Sabnis
ABSTRACT Acute rheumatic fever and Takayasu arteritis are examples of autoimmune diseases that commonly affect the cardiovascular system. We report an infrequent co-occurrence of both these diseases in an adolescent male. It may appear that in some individuals, the rheumatic fever may act as a trigger for the development of large vessel vasculitis. This possibility should be considered in patients on follow-up if they develop fresh features of cardiovascular compromise despite appropriate medical, interventional, or surgical therapy for rheumatic heart disease.
{"title":"Acute rheumatic fever and Takayasu arteritis - A synchronous co-occurrence.","authors":"P. Vaideeswar, G. Sabnis","doi":"10.4103/jpgm.jpgm_693_23","DOIUrl":"https://doi.org/10.4103/jpgm.jpgm_693_23","url":null,"abstract":"ABSTRACT\u0000Acute rheumatic fever and Takayasu arteritis are examples of autoimmune diseases that commonly affect the cardiovascular system. We report an infrequent co-occurrence of both these diseases in an adolescent male. It may appear that in some individuals, the rheumatic fever may act as a trigger for the development of large vessel vasculitis. This possibility should be considered in patients on follow-up if they develop fresh features of cardiovascular compromise despite appropriate medical, interventional, or surgical therapy for rheumatic heart disease.","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140691764","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}
Pub Date : 2024-04-01Epub Date: 2023-12-06DOI: 10.4103/jpgm.jpgm_377_23
S Ray, K K Behera, T P Tripathy
Abstract: We report a 16-year-old boy who presented with abdominal pain and severe hyperglycemia. His random blood glucose on admission was above 300 mg/dL, without ketosis. Urine examination revealed mild ketonuria. Renal function tests were normal. Antibodies to glutamate acid decarboxylase (anti-GAD) and islet tyrosine phosphatase 2 (anti-IA2) were negative. Findings on enhanced abdominal computed tomography scan were compatible with complete dorsal pancreatic agenesis. The body and tail of the pancreas were not visualized. Additionally, ectopic and malrotated left kidney was detected. Magnetic resonance cholangiopancreatography confirmed the absence of the dorsal pancreatic duct. The patient was treated with multiple subcutaneous insulin injections and attained good glycemic control. He is currently doing well on follow-up. The present case is a rare combination of complete agenesis of the dorsal pancreas with an ectopic, malrotated kidney. Clinical awareness of this rare association will help improve patient management.
{"title":"Complete agenesis of dorsal pancreas: A rare cause of insulin-dependent diabetes mellitus.","authors":"S Ray, K K Behera, T P Tripathy","doi":"10.4103/jpgm.jpgm_377_23","DOIUrl":"10.4103/jpgm.jpgm_377_23","url":null,"abstract":"<p><strong>Abstract: </strong>We report a 16-year-old boy who presented with abdominal pain and severe hyperglycemia. His random blood glucose on admission was above 300 mg/dL, without ketosis. Urine examination revealed mild ketonuria. Renal function tests were normal. Antibodies to glutamate acid decarboxylase (anti-GAD) and islet tyrosine phosphatase 2 (anti-IA2) were negative. Findings on enhanced abdominal computed tomography scan were compatible with complete dorsal pancreatic agenesis. The body and tail of the pancreas were not visualized. Additionally, ectopic and malrotated left kidney was detected. Magnetic resonance cholangiopancreatography confirmed the absence of the dorsal pancreatic duct. The patient was treated with multiple subcutaneous insulin injections and attained good glycemic control. He is currently doing well on follow-up. The present case is a rare combination of complete agenesis of the dorsal pancreas with an ectopic, malrotated kidney. Clinical awareness of this rare association will help improve patient management.</p>","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11160984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138815552","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}
Pub Date : 2024-04-01Epub Date: 2023-11-27DOI: 10.4103/jpgm.jpgm_569_23
S Gajbhiye
{"title":"Status of oral anticoagulant use in a tertiary center in south India.","authors":"S Gajbhiye","doi":"10.4103/jpgm.jpgm_569_23","DOIUrl":"10.4103/jpgm.jpgm_569_23","url":null,"abstract":"","PeriodicalId":94105,"journal":{"name":"Journal of postgraduate medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11160980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138465260","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}
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