Profile of pulmonary embolism in service personnel posted at high altitude area

Background We evaluated the clinical presentation and risk factors of pulmonary embolism (PE) in soldiers posted at high altitude areas (HAA). Methods We conducted a retrospective analysis of all cases of PE presented to us between March 2011 and Aug 2014. The patients were serving at an altitude between 10,000 and 22,000 ft above sea level and PE was diagnosed using the pulmonary CT angiography. Screening for the deep vein thrombosis (DVT) and procoagulant conditions was done at presentation and after six months of treatment. The patients were managed as per the American College of Cardiology (ACC) guidelines and descriptive statistics were used to present the data. Results The patients (53 males) had a mean age of 33 ± 4.2 year and were serving at a mean altitude of 12,176 ± 448 feet (ranged between 10,000 and 20,500) at the onset of symptoms. Dyspnea (79%) and tachycardia (68%) were the commonest symptom and sign, respectively. D dimer was positive in 96.2% of the cases while nonspecific T inversion in the ECG was seen in 54.7% of the patients. Procoagulant work up revealed a hereditary thrombophilic condition in 9 out of 53 patients. A total of 44 cases were idiopathic and DVT of lower limb veins was seen in 2 patients. There was no mortality in our case series. Conclusion PE is a common complication of HAA and hereditary thrombophilia contributes in a minority of the patients. Further studies are needed to ascertain the risk factors of PE at HAA.

Publication trends of research articles from infectious diseases specialty in a medical journal from India.

Background: Details about research productivity in the infectious diseases specialty from India are lacking. Objective: To analyse publishing trends and research productivity of articles related to infectious diseases in the Journal of the Association of Physicians of India (JAPI). Materials and Methods : We carried out bibliometric analysis of articles related to infectious diseases specialty from JAPI published between 2000 and 2011. Data were derived from the journal's website and the articles were analysed for type (original article, case reports, etc.), microorganism (bacterial, viral, etc.) place of the research and timelines for publication. Results : Out of 2977 articles published in JAPI over last 12 years, 256 articles belong to infectious diseases subspecialty. Infectious diseases contributed 11-18% of the published articles per year in JAPI during the last decade. Original articles (31%), case reports (38%) and correspondence (22%) constitute the majority of article types, while remaining 9% was made up by images. Bacterial (22%), protozoal and helminthic (20%), HIV (15%) and mycobacterial (16%) diseases lead the type of microorganisms represented in the research articles. Mumbai (16%), Delhi (9%) and Kolkata (7%) are the top three places contributing to the articles, followed by Chandigarh and Chennai. Original articles and case reports took approximately 14 months for publication, as compared to 6 months for an image (P < 0.0001). Conclusion : Infectious diseases specialty contributes about 15% of articles per annum in JAPI. HIV and tuberculosis together account for 30% of published litearture with fair representation from other organisms. Mumbai and Delhi are the leading contributors towards research productivity in this specialty.

Two interesting cases highlighting an oblivious specialty of psychoneuroendocrinology.

Psychoneuroendocrinology deals with the overlap disorders pertaining to three different specialties. Awareness about the somatic manifestations of psychiatric diseases and vice versa is a must for all the clinicians. The knowledge of this interlinked specialty is essential because of the obscure presentation of certain disorders. Our first case was treated as depressive disorder, whereas the diagnosis was hypogonadism with empty sella. Our second patient was managed as schizophrenia and the evaluation revealed bilateral basal ganglia calcification and a diagnosis of Fahr's disease. We report these cases for their unusual presentation and to highlight the importance of this emerging specialty.

Publication trends of a biomedical journal from India.

Background: The details about the research productivity of the biomedical journals published from India is lacking. We analyzed the publishing trends and the research productivity of the Journal of the Association of Physicians of India (JAPI). Materials and Methods: This was a bibliometric analysis of a biomedical journal. The data was obtained from the website of JAPI about the publications between 2000 and 2011. The articles were analyzed for the type (original article, case reports, correspondence, pictorial image, reviews, editorials, philately and miscellaneous), subspecialty (endocrinology, cardiology, etc), and place of the research work (Mumbai, Delhi, etc). Descriptive statistics giving data in numbers and percentages were used. Results: JAPI published 2977 articles over last 12 years (12 volumes and 134 issues). Case reports (29.5%), original articles (22.6%), and correspondence (20.5%) constitute 3/4 of the published articles. JAPI showed a gradual declining trend of published articles per issue (29.5 in 2000 to 17 in 2011). The data about 1798 research articles was analyzed further. Most of the articles belong to the Endocrinology, neurology, and infectious diseases. Mumbai is the leader over past 12 years in contributing toward the articles followed by other three metros. Conclusion: JAPI showed a declining trend in the number of published articles over last decade. Metro cities contributed the maximum research articles and the subspecialty coverage skewed in favor of Endocrinology.

Obesity and thyrotropinemia.

Objective. To study the relation between body mass index (BMI) and TSH in euthyroid and subclinical hypothyroid obese children and compared serum TSH level among obese and overweight children. Methods. Fifty consecutive children (aged 2-18 yr) presenting for obesity were studied. All cases with TSH > 10, low T3/T4, organic and syndromic obesity were excluded. Patients were divided into Group 1: Overweight (n=20) (BMI between 85th to 95th centile) and Group 2: Obesity (n=30) (BMI > 95th centile). Fisher’s exact test, Mann-Whitney U test and Pearson’s correlation were used for statistical analysis. P value < 0.05 was considered significant. Results. Elevated TSH level (between 4.5 – 10 mIU/L) with normal T3, T4 was seen in 4/20 overweight and 9/30 of obese children (P=0.5219). The mean TSH was comparable in both the groups (3.22 ± 3.1 mIU/L vs. 3.63 ± 2.2 mIU/L, P=0.3491). Overall TSH showed no correlation with BMI (r= 0.0014, P=0.9924). Conclusion. The preliminary data did not show any relation between severity of obesity and TSH level. Further large scale data from population are required to confirm these findings.