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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


Dipeptidyl peptidase-4 inhibitors (DPP-4i) are one of the mainstay drugs in the management of type 2 diabetes mellitus. It has been well-documented that these class of drugs cause allergic reactions. Bullous pemphigoid (BP) is a blistering skin condition commonly associated with many drugs. Here, we report a case of probable DPP-4i-induced BP in an elderly man, which resolved on discontinuation of the drug. Although this adverse drug reaction has been documented in Western world and Japanese ethnicity, this seems to be the first case report of such occurrence in Indian ethnicity.


The primary objective of this study was to evaluate the economic burden of slow learners (students with “borderline intellectual functioning”) by estimating its direct, indirect, and intangible costs. The secondary objective was to assess the impact of variables on the economic burden.


Medical student journals (MSJs) refer to a cluster of entirely student-led periodicals that publish student-authored articles. A recent review showed that MSJs characteristically employ a student-friendly and feeble peer review process, which is largely associated with poor quality of published articles. Herein, as a graduate medical student, I call on peer medical students to make an informed decision in refraining from submitting their research work to MSJs for four primary reasons. These reasons, generally, include: 1) opaque peer-review process, 2) lack of MEDLINE┬« indexing, 3) absence of official journal impact factor scores, and 4) poor article visibility and exposure to scientific community. Furthermore, I encourage students to take advantage of the existing opportunities provided by the professional MEDLINE┬«-indexed journals in disseminating their research work. These opportunities include: 1) the absolute welcoming calls for student-authored contributions, and 2) the designated ‘student contribution corners’. Lastly, I succinctly highlight the joint duties of medical schools, undergraduate research committees, institutional review boards and mentors in publishing the student-authored research work in the professional journals, rather than the MSJs.


Solving the conundrum between a migrainous infarction (MI) and an infarct-induced migrainous attack (MA) is challenging. A 35-year-old woman with previous history of migraine with visual auras was addressed for acute aphasia followed by progressive right hemibody paresthesia and then by positive visual symptoms in her right visual field. These phenomena were followed by a migrainous headache. A perfusion CT performed during symptoms showed an extended hypoperfusion in the left temporo-occipital region corresponding to a migraine during an aura attack. An ASL sequence brain MRI undertaken 12 hours later (while the patient was only cephalalgic) showed an area of diffuse hyper-perfusion in the left hemisphere. DWI sequence showed a left middle cerebral artery territory infarction. We believe our case was most likely to have been an infarct-induced MA. To conclude, it is crucial to rule out cerebral infarction in cases where a patient experiences an atypical aura even in the context of established migraine.


Globally, around half of all under-5 deaths are attributable to undernutrition. The magnitude of child undernutrition in India is one of the highest in the world. Responsive feeding that has the potential to optimize nutrition and development depends on a “healthy mother.”


There are multiple economic, psychological, and physical consequences of high job stress, low job satisfaction and burnout in faculty of a teaching hospital in South India. Data from developing countries on these domains are sparse.