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Journal: Journal of postgraduate medicine


Remitting Seronegative Symmetrical Synovitis with Pitting Edema (RS3PE) is a rare clinical entity that is easily missed due to lack of knowledge. It was formerly considered as a subset of rheumatoid arthritis (RA), but is now regarded as a distinct disease/syndrome. The diagnosis of RS3PE is not easy, as it is always hindered by the lack of definite diagnostic criteria and presence of other much common rheumatological disorders that mimic it. We report a series of seven cases that attended our clinic in the last year, which highlight the salient features of the disease. The disease was found to have a heterogeneous presentation. Immunogenetic, clinical, laboratory, radiological, and possible etiological factors and associations with the neoplasm are described, as also other peculiar presentations. Finally, a comparison with other common rheumatological disorders is made to alert the clinician about this rare, but easily treatable disease.

Concepts: Medicine, Cancer, Diagnosis, The Canon of Medicine, Rheumatoid arthritis, Rheumatology, Remitting seronegative symmetrical synovitis with pitting edema, Tenosynovitis


Medical professionals' attitude towards homosexuals affects health care offered to such patients with a different sexual orientation. There is absence of literature that explores the attitudes of Indian medical students or physicians towards homosexuality.

Concepts: Health care, Health care provider, Medicine, Physician, Illness, Sexual orientation, Health science, Homosexuality


Ketogenic diet (KD) is a high-fat, adequate-protein, and low-carbohydrate diet that leads to nutritional ketosis, long known for antiepileptic effects and has been used therapeutically to treat refractory epilepsy. This review attempts to summarize the evidence and clinical application of KD in diabetes, obesity, and other endocrine disorders. KD is usually animal protein based. An empiric vegetarian Indian variant of KD has been provided keeping in mind the Indian food habits. KD has beneficial effects on cardiac ischemic preconditioning, improves oxygenation in patients with respiratory failure, improves glycemic control in diabetics, is associated with significant weight loss, and has a beneficial impact on polycystic ovarian syndrome. Multivitamin supplementations are recommended with KD. Recently, ketones are being proposed as super-metabolic fuel; and KD is currently regarded as apt dietary therapy for “diabesity.”

Concepts: Nutrition, Diabetes mellitus, Obesity, Carbohydrate, Diabetic diet, Ketogenic diet, Low-carbohydrate diet, Ketosis


Pulmonary arterial hypertension (PAH) is a life-threatening disease of varied etiologies. Although PAH has no curative treatment, a greater understanding of pathophysiology, technological advances resulting in early diagnosis, and the availability of several newer drugs have improved the outlook for patients with PAH. Sildenafil is one of the therapeutic agents used extensively in the treatment of PAH in children, as an off-label drug. In 2012, the United States Food and Drug Administration (USFDA) issued a warning regarding the of use high-dose sildenafil in children with PAH. This has led to a peculiar situation where there is a paucity of approved therapies for the management of PAH in children and the use of the most extensively used drug being discouraged by the regulator. This article provides a review of the use of sildenafil in the treatment of PAH in children.

Concepts: Medicine, Myocardial infarction, Coronary artery disease, United States, Blood pressure, Pulmonary artery, Medical error, Federal Food, Drug, and Cosmetic Act


There is a paucity of studies on the progression and outcome of Systemic Inflammatory Response Syndrome (SIRS) with its determinants.


The present study was carried out for comparative evaluation of case-based learning (CBL) aided with WhatsApp and didactic lectures (DL) while teaching a pathology topic to second-year medical students. In addition, the acceptability of WhatsApp as an aid to CBL was assessed.


Alexithymia is one’s incapacity to identify, comprehend, and describe emotions. There is almost no literature data about the levels of alexithymia among patients with relapse remitting type of multiple sclerosis.


Medical trainees (i.e., students and residents) provide relevantly insightful perspectives pertaining to their ‘medical education’ at both undergraduate (i.e., medical school) and graduate (i.e., residency training) levels. Therefore, promoting related trainee-authored publications about such matters is critically important. However, unfortunately, not many medical trainees are able to voice their important education-related research findings in peer-reviewed journals. ‘Journal-level’ proposals to increase trainees' scientific scholarship are always warranted. Herein, medical journals are called to play an innovative pivotal role in further promoting the desired trend of trainee-authored publications. To that end, periodically throughout the year, mainstream (general or education-focused) medical journals are encouraged to facilitate supplements entirely dedicated to trainee-authored research contributions in the field of ‘medical education’. The grounds, dynamics, challenges and benefits of this supplement-based approach are discussed.


Left atrial appendage (LAA) tachycardia are rarely encountered in clinical practice (2.1% of focal atrial tachycardia). Out of these, the ones arising from the distal part of LAA are difficult to ablate due to higher risk of LAA perforation and thromboembolism. We hereby present a patient with LAA tachycardia mapped to the tip of LAA with the help of the CARTO system and ablated. This case highlights the inherent challenges faced in such a scenario.


We report the clinical details, imaging findings, and management of a 74-year-old male who had recurrent episodes of massive hematemesis secondary to rupture of a cavernous internal carotid artery (ICA) aneurysm. Ruptured ICA aneurysms may present with epistaxis. However, intracranial aneurysmal rupture with hematemesis as the presenting complaint has not been described previously in the literature. In this case report we describe the pathophysiology of cerebral aneurysm as a cause of hematemesis and its management.