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  Most popular articles (Since March 11, 2015)

 
 
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STATISTICAL PAGES
Chi-square test and its application in hypothesis testing
Rakesh Rana, Richa Singhal
January-April 2015, 1(1):69-71
DOI:10.4103/2395-5414.157577  
In medical research, there are studies which often collect data on categorical variables that can be summarized as a series of counts. These counts are commonly arranged in a tabular format known as a contingency table. The chi-square test statistic can be used to evaluate whether there is an association between the rows and columns in a contingency table. More specifically, this statistic can be used to determine whether there is any difference between the study groups in the proportions of the risk factor of interest. Chi-square test and the logic of hypothesis testing were developed by Karl Pearson. This article describes in detail what is a chi-square test, on which type of data it is used, the assumptions associated with its application, how to manually calculate it and how to make use of an online calculator for calculating the Chi-square statistics and its associated P-value.
  28,922 2,477 6
Commonly used t-tests in medical research
RM Pandey
May-August 2015, 1(2):185-188
DOI:10.4103/2395-5414.166321  
Student's t-test is a method of testing hypotheses about the mean of a small sample drawn from a normally distributed population when the population standard deviation is unknown. In 1908 William Sealy Gosset, an Englishman publishing under the pseudonym Student, developed the t-test. This article discusses the types of T test and shows a simple way of doing a T test.
  12,808 1,061 2
ORIGINAL ARTICLES
Heart failure in India: The INDUS (INDia Ukieri Study) study
Vivek Chaturvedi, Neeraj Parakh, Sandeep Seth, Balram Bhargava, S Ramakrishnan, Ambuj Roy, Anita Saxena, Namit Gupta, Puneet Misra, Sanjay Kumar Rai, K Anand, Chandrakant S Pandav, Rakesh Sharma, Sanjay Prasad
January-April 2016, 2(1):28-35
DOI:10.4103/2395-5414.182988  
Introduction: There are few data on heart failure (HF) burden and none available on the community prevalence of HF in India. We conducted a study aimed at determining the HF prevalence in a rural community as well as tertiary hospital care setting in North India. We also reviewed the existing literature regarding the estimated and projected prevalence of HF in India. Methodology: All adults (>20 years) with chronic breathlessness in six villages under a primary health care center in Northern India were identified and evaluated with standardized questionnaire and physical examination by trained health care workers. HF was diagnosed by standardized criteria and a transthoracic echocardiogram was performed in all subjects. In the hospital study, 500 consecutive patients presenting to our tertiary referral hospital were evaluated for the diagnosis of HF. For the systematic review, all published studies addressing HF or the burden of risk factors in India were identified. Projections for the absolute HF burden were made using local data and global studies of HF incidence, morbidity, and mortality. Results: Among the surveyed rural adult population of 10,163 patients, chronic breathlessness was present in 128 (1.3%). HF was present in 9% (n = 12), of which 67% (n = 8) had preserved left ventricular (LV) systolic function and 33% (n = 4) had LV systolic dysfunction. Therefore, the prevalence of HF in this general community was 1.2/1000. All patients with HF and preserved ejection fraction had poorly controlled hypertension. In the hospital study, of 500 consecutive patients, 20.4% had HF. Rheumatic heart disease (52%) was the most common cause followed by ischemic heart disease (17%). The mean age of presentation was 39 ± 16 years. The prevalence of HF in the outpatient department patients was 22.5% below 30 years and 14.9% above 50 years, reflecting the young population of HF. For the estimates concerning HF burden in India, projections were made using both age-specific extrapolations from developing countries and data regarding development of HF in the presence of risk factors. The estimated prevalence of HF is about 1% of the total population or about 8–10 million individuals. The estimated mortality attributable to HF is about 0.1–0.16 million individuals per year. Conclusions: While our hospital data are consistent with the HF burden and etiology expected in a government tertiary hospital setting, our community-based study is the first of its kind reported from India. The community study demonstrates a surprisingly low prevalence of symptomatic HF in the surveyed villages. This could be partially explained by the rural farming-based community setting but is also likely due to under-reporting of symptoms. Our review of the projected national estimates suggests an alarming burden of HF in India despite a younger population than the developed nations. A significant proportion of this burden may be preventable with better screening and early and adequate treatment of the risk factors.
  8,422 1,149 8
LESSONS FROM HISTORY
Hippocrates and the hippocratic oath
Saurabh K Gupta
January-April 2015, 1(1):81-86
DOI:10.4103/2395-5414.157583  
For a long-time men had a philosophic view of health and disease, and this lasted till almost 2500 years back. Hippocrates, the great Greek physician, is believed to have seperated the "art of healing" and philosophy. An astute observer, Hippocrates during his practice employed principles that laid the foundation of modern medicine. The medical fraternity worldwide unanimously bestowed the title of "father of medicine" to this great man. Apart from being a physician, he was instrumental in bringing about the concept of ethics in the realm of medicine. The famous document "Hippocratic Oath" while being respected by almost all has generated a great amount of debate among historians. Nonetheless, almost all medical schools across the world have the Oath ceremony where medical graduates agree to the commandments of the Hippocratic Oath, either in its original or modified form. Although a statement of promise this Oath does not have any legal implications as might be seen by a person outside the medical community. This article outlines the contributions made by Hippocrates to the medical world with an emphasis on the Hippocratic Oath.
  8,863 428 -
REVIEW ARTICLES
Prosthetic heart valve thrombosis: Diagnosis and newer thrombolytic regimes
Shanmugam Krishnan
January-April 2016, 2(1):7-12
DOI:10.4103/2395-5414.182993  
Prosthetic heart valve thrombosis incidence is high in developing countries and contributes to significant late mortality postvalve surgery. Many guidelines advocate surgery as the first line therapy though thrombolysis is often used in many centers. In this article, we review the newer regimens of fibrin-specific thrombolytics. Newer regimens of very low-dose, slow infusion lead to equal efficacy with lower complication in majority of patients. Patients with the New York Heart Association (NYHA) Class I–II who have low thrombus burden should receive thrombolysis with low-dose slow infusion while those with high thrombus burden should be planned for surgery. Patients presenting with NYHA Class IV should be treated with classical dose thrombolysis.
  7,643 1,447 1
BEDSIDE MEDICINE
A case of right sided heart failure
Siddharthan Deepti, Saurabh Kumar Gupta
May-August 2015, 1(2):130-137
DOI:10.4103/2395-5414.166328  
A patient of dominant right sided heart failure for 7 years is presented and discussed, starting from the history and examination findings and going on to all the investigations. The clinical findings, along with the electrocardiogram, chest X-ray, echocardiogram, and cardiac computed tomography are used to arrive at a diagnosis of chronic constrictive pericarditis. The differential diagnosis at each stage of presentation are presented and discussed.
  8,057 550 -
REVIEW ARTICLES
Implications of 2017 hypertension guidelines for Indian patients
Rajiv Narang, S Srikant
January-April 2018, 4(1):3-5
DOI:10.4103/jpcs.jpcs_19_18  
The new US blood pressure guideline lowers the definition of high blood pressure to 130/80 mm Hg.The new guideline adopts a key component of the 2013 cholesterol guideline and incorporates overall cardiovascular risk. The AAFP has decided to not endorse the recent hypertension guideline because it gave undue importance to the SPRINT trial and cardiovascular risk which was not validated and would lead to overtreatment. The guidelines are discussed in this article.
  7,401 1,034 2
CURRICULUM IN CARDIOLOGY - STATISTICAL PAGES
Decoding the Bland–Altman plot: Basic review
Aakshi Kalra
January-April 2017, 3(1):36-38
DOI:10.4103/jpcs.jpcs_11_17  
The Bland–Altman plot is a method for comparing two measurements of the same variable. The concept is that X-axis is the mean of your two measurements, and the Y-axis is the difference between the two measurements. The chart can then highlight anomalies, for example, if one method always gives too high a result, then all points are above or below the zero line. It can also reveal that one method overestimates high values and underestimates low values. If the points on the Bland–Altman plot are scattered all over the place, above and below zero, then it suggests that there is no consistent bias of one approach versus the other. It is, therefore, a good first step for two measurement techniques of a variable.
  7,110 1,089 2
MISCELLANEOUS - HISTORY
Development of mechanical heart valves - an inspiring tale
P Rajashekar
September-December 2015, 1(3):289-293
DOI:10.4103/2395-5414.177309  
The historical evolution of the prosthetic heart valves from the first attempts with the Hufnagel's valve in the treatment of the aortic insufficiency to the Starr-Edwards' ball valve and later the tilting disc valves (Bjork-Shiley etc.,) and finally the bileaflet valves (St. Jude) are discussed. The Indian contribution with Chitra valve is also described.
  6,366 962 2
ORIGINAL ARTICLES
Lung transplant: The Indian experience and suggested guidelines – Part 1 selection of the donor and recipient
T Sunder, T Paul Ramesh, K Madhan Kumar, M Suresh, Sarvesh P Singh, S Seth
May-August 2018, 4(2):88-95
DOI:10.4103/jpcs.jpcs_46_18  
Background: The selection of the correct donor lung is crucial for a successful lung transplant. Since the median survival after lung transplant is 5 years and the morbidity and mortality of lung transplant is higher than other transplants, it is crucial to preselect the correct recipient. Methodology: In India, Dr. P. Venugopal at the All India Institute of Medical Sciences, New Delhi, performed the first successful heart transplant, while Dr. K. M. Cherian performed the first heart–lung transplant at Chennai. At Apollo Hopsitals, Chennai, the first heart transplant was performed by Dr. M. R. Girinath. Subsequently, the Department of Heart and Lung Transplantation at Apollo Hospitals, Chennai, have performed a large number of heart and lung transplants and its experience is summarized. Results: The Department of Heart and Lung Transplantation at Apollo Hospitals, Chennai, has done 101 lung and 62 heart transplants as part of their lung and heart lung transplant program. There were 21 heart–lung transplants and 25 double lung transplants. The results are discussed and indications, contraindications for lung and heart–lung transplant as well as recipient and donor workup are discussed in this first part of a set of three articles. Conclusions: Careful selection of a recipient and donor leads to a successful lung and heart–lung transplant program.
  6,745 330 -
CURRICULUM IN CARDIOLOGY - STATISTICS
Linear regression analysis study
Khushbu Kumari, Suniti Yadav
January-April 2018, 4(1):33-36
DOI:10.4103/jpcs.jpcs_8_18  
Linear regression is a statistical procedure for calculating the value of a dependent variable from an independent variable. Linear regression measures the association between two variables. It is a modeling technique where a dependent variable is predicted based on one or more independent variables. Linear regression analysis is the most widely used of all statistical techniques. This article explains the basic concepts and explains how we can do linear regression calculations in SPSS and excel.
  6,161 908 -
CURRICULUM IN CARDIOLOGY - BEDSIDE CASE
Case of cyanotic congenital heart disease
Shanmugam Krishnan, Preetam Krishnamurthy, S Ramakrishnan, Saurabh Gupta
May-August 2016, 2(2):114-119
DOI:10.4103/2395-5414.191526  
A adult patient presented with cyanosis since early childhood. The clinical approach to such a patient, including review of the ecg, chest xray and echocardiogram is presented. Various aspects of the bedside approach to adult cyanotic heart disease are discussed
  5,721 931 -
REVIEW ARTICLES
Deciphering the dilemma of parametric and nonparametric tests
Rakesh Kumar Rana, Richa Singhal, Pamila Dua
May-August 2016, 2(2):95-98
DOI:10.4103/2395-5414.191521  
The potential source of complexity while analyzing the data is to choose on whether the data collected could be analyzed properly by the application of parametric tests or nonparametric tests. This concern cannot be underrated as there are certain assumptions which should be fulfilled before analyzing the data by applying either of the two types of tests. This article describes in detail the difference between parametric and nonparametric tests, when to apply which and the advantages of using one over the other.
  5,361 568 -
CURRICULUM IN CARDIOLOGY - STATISTICS
Correlation analysis in biological studies
Suniti Yadav
May-August 2018, 4(2):116-121
DOI:10.4103/jpcs.jpcs_31_18  
Correlation is a statistical procedure to test the relationship between quantitative variables and categorical variables. In other words, it describes the degree of relation between two variables. It is one of the most commonly used statistical techniques. The present article is based on selected statistical textbook, review of the literature, and our own research experience study.
  5,538 290 2
REVIEW ARTICLES
Heart failure guidelines for India: Update 2017
Sandeep Seth, S Ramakrishnan, Neeraj Parekh, G Karthikeyan, Sandeep Singh, Gautam Sharma
September-December 2017, 3(3):133-138
DOI:10.4103/jpcs.jpcs_1_18  
Heart failure (HF) is a major health problem in India with a postadmission mortality of 20%–30%. Medication adherence ranges from 25% to 50%, and the tolerance of guideline-based medication is low for Indian patients. We took out guidelines on HF in 2015, and this update covers the changes which have occurred in HF management in the past 2 years. As a number of new drugs such as angiotensin receptor-neprilysin inhibitor and ivabradine have been approved for use in India, devices such as implantable cardioverter-defibrillators and cardiac resynchronization therapy are becoming more accessible and more left ventricular assist devices and transplants are being done in India, there is need for clear guidelines for the use of each which are practical for India.
  4,584 889 1
BEDSIDE MEDICINE
Adolf Kussmaul and Kussmaul's sign
Navreet Singh, Devinder Singh Chadha, Prashant Bharadwaj, Naveen Agarwal
May-August 2015, 1(2):128-129
DOI:10.4103/2395-5414.166317  
Kussmaul's has provided us with three important signs: Pulses paradoxus, Kussmaul's sign and Kussmaul Breathing. This article discusses Kussmaul's sign, its discovery, first description, pathophyiology and exceptions.
  4,949 383 -
CURRICULUM IN CARDIOLOGY - CASE DISCUSSION
Ruptured sinus of valsalva aneurysm: Clinical case presentation and management
Nitin Kumar Parashar, Dinkar Bhasin, Patil Surajkumar Marotrao, Faraz Ahmed Farooqui, Sunil Kumar Verma, Anita Saxena
May-August 2017, 3(2):109-114
DOI:10.4103/jpcs.jpcs_27_17  
A 27-year-old female presented with generalized body swelling and progressive shortness of breath for the past 4 months. On examination, she had a loud continuous murmur, elevated jugular venous pressure, and gross ascites. The examination findings, electrocardiogram, chest radiography, and echocardiogram are discussed in a step-wise manner to arrive at a diagnosis and plan of management of a patient with ruptured sinus of Valsalva aneurysm is discussed along with review of relevant literature.
  4,352 550 -
ORIGINAL ARTICLES
Epidemiology of cardiomyopathy - A clinical and genetic study of dilated cardiomyopathy: The EPOCH-D study
Soumi Das, Amitabh Biswas, Mitali Kapoor, Sandeep Seth, Balram Bhargava, Vadlamudi R Rao
January-April 2015, 1(1):30-34
DOI:10.4103/2395-5414.157562  
Background: Dilated Cardiomyopathy (DCM) is a genetic disorder where a heterogeneous group of cardiac-muscles are involved and is characterized by ventricular dilatation, impaired systolic function, reduced myocardial contractility with left ventricular ejection fraction (LVEF) less than 40%. Our study aims to report the Demographic, Clinical and Genetic profile of Indian Dilated Cardiomyopathy patients. Methodology: All patients were recruited with prior written informed consent and are of Indian origin. Results: In a total of 80 DCM patients, the prevalence was higher among males. In males, mean age of onset was comparatively less than females. In this cohort, 40% had familial inheritance. Sixty two percent of DCM patients belong to NYHA functional class II with ejection fraction (EF) ranging between 21-30% and, around one third of the patients had atrial fibrillation (AF). Genetic screening revealed a novel splice site mutation LMNA (c.639+ G>C) and a rare variant MYH7 (c.2769 C>T) in a patient and insilico analysis of both variants suggested functional changes that were considered pathogenic. We report 3% and 4% occurance of variants, each in LMNA and MYH7, where as reported frequencies of these genes are 6% LMNA and 4% MYH7. Conclusions: DCM is often familial and all possible candidate genes should be screened to identify mutations. Such type of exercise may help in the identification of mechanistic pathways. Next generation sequencing platforms may play an important role in this respect in future.
  4,301 485 -
EDITORIALS - FROM THE EDITORS DESK
Requiem for the steth? Not Yet: Are you Listening?
Sandeep Seth, Shyamal K Goswami, Balram Bhargava, Sanjay Prasad, Mark Huffman
September-December 2015, 1(3):225-226
DOI:10.4103/2395-5414.177224  
  1,288 3,460 -
REVIEW ARTICLES
Genexpert technology: A new ray of hope for the diagnosis of tuberculour pericardial effusion
Neema Negi, Bimal Kumar Das
September-December 2015, 1(3):233-240
DOI:10.4103/2395-5414.177230  
Tuberculous pericardial effusion is a well-known complication of tuberculosis (TB). However, the greatest challenge in front of clinicians is its diagnosis as the conventional methods lack the required sensitivity and specificity of detection. The emergence of drug resistance and co-infections such as human immunodeficiency virus further complicates the situation making it difficult to diagnose such cases. GeneXpert technology is a major breakthrough in the field of TB diagnosis and has opened newer avenues for many new molecular tests to be launched in the future. The World Health Organization endorsed this technology in 2010 for rapid and simultaneous detection of Mycobacterium tuberculosis (MTB) and rifampicin (RIF) resistance. GeneXpert-MTB/RIF assay was highly recommended as an initial diagnostic platform in high burden countries for early and quick detection of TB cases. Until date, very few studies have evaluated the performance of this brilliant assay in pericardial effusion cases, thus, more studies are required to address the unanswered questions left so far. Our review attempts to recapitulate the achievements, the potential impacts and the prospective use of this novel technology in early diagnosis of TB, especially focussing pericardial effusion cases.
  4,082 461 1
FELLOWS FORUM
Cyanosis in a patient with atrial septal defect
Vikas Thakran, Anunay Gupta
January-April 2015, 1(1):74-75
DOI:10.4103/2395-5414.157579  
Cyanosis in ASD has multiple causes requiring etiology directed management. Cyanosis can present in the setting of elevated pulmonary artery pressure, as in Eisenmenger syndromes having a poor prognosis. Conversely, cyanosis may present in patients having normal pulmonary artery pressure with potentially treatable conditions.
  4,100 442 1
REVIEW ARTICLES
Alpha blockers: A relook at phenoxybenzamine
Sambhunath Das, Pankaj Kumar, Usha Kiran, Balram Airan
January-April 2017, 3(1):11-17
DOI:10.4103/jpcs.jpcs_42_16  
Phenoxybenzamine (PBZ) is an alpha adrenergic antagonist, used for the management of hypertension. PBZ acts by blocking alpha-adrenergic receptors, leading to vasodilatation and low systemic vascular resistance. This helps in control of blood pressure in pheochromocytoma, improvement of systemic oxygen delivery, and optimization of the Qp/Qs in pediatric cardiac surgery such as hypoplastic left heart syndrome and improving perfusion parameters during open heart surgery. The uses have further extended to causalgia, Raynaud's phenomenon, autonomic hyperreflexia, and even for patency of radial artery conduit in coronary artery bypass grafting surgery. However, its prolonged hypotensive effect limits the regular use. In this review, we discussed the mechanism of action, pharmaco-physiology of PBZ, perioperative uses in different clinical setting and controversies for its uses; publications in different scientific journals from the previous years.
  4,207 317 -
MY APPROACH
Treatment of tuberculosis pericarditis
J Harikrishna, Alladi Mohan
May-August 2015, 1(2):179-181
DOI:10.4103/2395-5414.166337  
Tuberculosis (TB) is responsible for approximately 70% of the cases of large pericardial effusion and the most cases of constrictive pericarditis in developing countries. Early diagnosis and institution of appropriate therapy are critical to prevent mortality. Treatment of TB pericardial effusion consists of 4-drug therapy (isoniazid, rifampicin, pyrazinamide, and ethambutol) for 2 months followed by 2 drugs (isoniazid and rifampicin) for 4 months. Systematic reviews and meta-analyses suggest that although overall corticosteroids are associated with a beneficial effect on the variables analyzed, the wide confidence interval and a small number of events make it impossible to draw firm conclusions. Pericardiectomy is the definitive treatment for constrictive pericarditis, but is unwarranted either in very early constriction where it could be transitory.
  4,077 342 -
CURRICULUM IN CARDIOLOGY - HISTORY OF MEDICINE
Department of Cardiology, All India Institute of Medical Sciences
Sivasubramanian Ramakrishnan, Sudha Bhushan
January-April 2016, 2(1):52-54
DOI:10.4103/2395-5414.182989  
Cardiology developed in India in the 1950's and 1960's with the setting up of the Departments of Cardiology in Vellore, in AIIMS, and in many other colleges all over India. History teaches us many lessons and meeting some of the stalwarts who made this history inspires us to greater heights. In February 2016, AIIMS organized an alumni event in which many of the old faculty and students got together. We bring together some photographs and videos. We also invite everyone to send more photographs and thoughts to the journal for further compilation.
  4,161 228 -
FROM THE FUNDING AGENCIES
Health Ministry's Screening Committee (Indian Council of Medical Research)
Sandeep Seth
May-August 2015, 1(2):216-217
DOI:10.4103/2395-5414.166344  
The Health Ministry's Screening Committee (Indian Council of Medical Research) takes decisions on the international research proposals in the field of health research, requiring foreign collaboration and assistance from foreign funding agencies.
  3,940 349 1