Sudden death in cricketers is rare, with the most common causes being cardiac, neurological (head/neck trauma, mainly from ball impact) and environmental (e.g., lightning strike and heat stroke, the former which usually involves cardiac arrest). The aim of this study was to review possible prevention of sudden cardiac death and make recommendations.

A literature review of possible causes of sudden cardiac death (SCD) among cricketers was performed, along with evaluation of evidence for existing preventative measures. The method for evaluation was expert panel (cardiology and sports medicine) consensus recommendations based on the published evidence base.

Potential cardiac causes of sudden death while playing cricket can be divided into the following categories: (1) atraumatic-origin preexisting arrhythmias, cardiomyopathies and valve disorders (2) traumatic-origin arrhythmia (commotio cordis) (3) acquired coronary or valvular disease (4) viral myocarditis (5) Lightning strike. Preventive measures can be divided into pre-season (e.g., cardiovascular screening), prematch (e.g., assessment of viral illness), protective equipment (e.g., chest guards) and post-event (presence of first aid response including defibrillators). Our panel agreed that there was strong evidence that (1) trained and planned emergency response particularly with a defibrillator is effective at preventing SCD and (2) ceasing play in the presence of lightning strikes prevents lightning-related death (3) players with symptoms, risk factors or history suggestive of possible cardiac disease should undertake specific individual workup. There are other potential methods to prevent SCD, with expert level recommendations made in the absence of strong evidence.

The most controversial aspect of prevention of SCD is electrocardiogram (ECG) screening of asymptomatic players and this paper outlines the arguments both in favor and against without fully resolving the debate. The possible increase in early diagnosis of potentially life-threatening cases needs to be balanced against the risk of false positive results which may lead to discussion of exclusion from cricket. Cardiac workup is clearly of net benefit to symptomatic individuals (e.g. history of syncope, chest pain) or any player at higher than usual baseline risk (e.g., positive family history). Basic life support including access to defibrillators should be available with trained personnel wherever they can be afforded, which has strong evidence in favor of improving survival at the time of cardiac arrest.

Orchard JW, Puranik R, Semsarian C, Orchard JJ, Samra D, Duflou J, Groenestein P, Young M, Brukner P, Kountouris A. Prevention of Sudden Cardiac Death in Cricketers. J Postgrad Med Edu Res 2016;50(2):49-58.

To ascertain the determinants of congenital malformations.

This hospital based age-sex matched pair case control study was done at Advanced Pediatric Centre, Obstetrics and Gynecology Department (ANC clinic, Maternity ward, labor room, etc.) and Special Clinics, PGIMER, Chandigarh, India in 2008. The mothers were interviewed to collect information about risk factors.

Two hundred three CMF (under five children and gestational CMF) cases and same number of controls were studied. Significant association of CMF was observed with the use of sex selection drugs by mothers (OR = 4.35), habits of fathers like taking alcohol (OR = 3), smoking (OR = 4.5) and using tobacco (OR = 2.7). Mother's age at marriage < 18 years and history of abortion were also important predictors of CMF.

Most of the risk factors for CMF were avoidable viz addiction, early marriage and use of sex selection drugs. People need to be educated about this.

Singh A, Sinha S. Risk Factors of Congenital Malformations in North India: A Case—control Study. J Postgrad Med Edu Res 2016;50(2):59-63.

To study the efficacy of topical intraarticular vs intravenous tranexamic acid (TXA) in reducing blood loss following primary total knee replacement (TKR).

A phase 3, single center, double blind and randomized controlled study was conducted in the Department of Orthopedics, Sri Ramachandra University, Chennai, Tamil Nadu. A prospective study of 100 patients lasted from July 2013 to July 2015.

Postoperative transfusion rates were zero in both the groups (intraarticular and intravenous). The mean 48-hour drain collected is 285.6 ml in group A (intraarticular), while it is 325.8 ml in group B (intravenous); the mean drop in hemoglobin is 1.7 gm/dl in group A (intraarticular) while it is 2.4 gm/dl in group B (intravenous).

This study shows that topical intraarticular administration of TXA has better efficacy than intravenous TXA in controlling postoperative blood loss following primary uncomplicated TKR with no significant complications.

Vijay A, Nageswaran J, Loganathan S, Bedford SC. Intraarticular vs Intravenous Tranexamic Acid in Reduction of Blood Loss in Primary Total Knee Replacement. J Postgrad Med Edu Res 2016;50(2):64-68.

The aim of this study is to determine the feasibility of a screening method for cervical cancer using an application developed on smartphone to aid visual inspection with acetic acid.

A prospective study was carried out in 230 women in the Department of Gynaecology, PGIMER, Chandigarh, India. These women were divided into two groups. Among the first group, screen positive women (n = 28) were examined by two gynecologists. In the second group (n = 202), health care workers screened women in a mobile van. The two groups were examined using the smartphone and digital colposcope. Abnormal findings were confirmed by liquid-based cytology and histopathology. The image quality of ColpPhon® was compared with colposcopic images as the gold standard. Kappa was used for comparison of ColpPhon® and colposcopic findings for final diagnosis.

Among the 230 women screened, cervical intraepithelial neoplasia (CIN) was diagnosed in six cases by histopathology (CIN 2/3 in five and CIN 1 in one). These six women belonged to the group of 28 women examined in the colposcopy clinic. Both colposcope and ColpPhon® were able to identify these six women. The individual image quality parameters for ColpPhon® were slightly inferior to the colposcope. The overall image clarity had an agreement in 82% (184/225) as being either good or excellent. The diagnosis made on images acquired from each device had an agreement in 90% (208/230) of the cases.

This study demonstrates feasibility of incorporating a smartphone device to capture images of the cervix for improving cervical cancer screening in resource-poor countries.

Bagga R, Suri V, Srinivasan R, Khandelwal N, Keswarpu P, Naik SK, Chandrasekhar V, Gupta L, Paul S. Feasibility of Using Mobile Smartphone Camera as an Imaging Device for Screening of Cervical Cancer in a Lowresource Setting. J Postgrad Med Edu Res 2016;50(2):69-74.

Aggarwal S, Gahlot N, Saini UC, Dhillon MS. Bisphosphonates in Orthopedics: Evidencebased Review of Indications and Adverse Effects. J Postgrad Med Edu Res 2016;50(2):75-85.

The question whether treatment with vitamin D improves asthma exacerbations in children and adults still needs to be addressed.

Recent studies in children and adults found a higher prevalence of hypovitaminosis D associated with a higher severity of asthma and impaired pulmonary function. In asthmatic children, patients with vitamin D deficiency demonstrated increased airway hyperresponsiveness and corticosteroid requirements.

Of 469 records/studies identified through database searching, 5 studies were included in this systematic review. The overall pooled effect showed a significant reduction in acute asthma exacerbation in the vitamin D group (odds ratio 0.45, 95% confidence interval 0.22—0.93). There were no studies that focus on the quality of life.

This systematic review supports the role of vitamin D in reducing the number of asthma exacerbations in children but not in adults.

The present systematic review demonstrates reduction in asthma exacerbations in children. Most of the asthma children are on inhaled corticosteroid, which poses a threat for its side effects. However, vitamin D having multiple functions in body could be used as an alternative therapy in asthmatic children. In adults, more trials are needed wherein the deficient individuals are supplemented with vitamin D and further assessed for asthma exacerbations. There is no harm in supplementation of vitamin D to deficient and insufficient asthmatic individuals.

Chauhan A, Singh M, Jaiswal N, Thumburu KK, Agarwal A, Chauhan SS, Dhatwalia S, Bhende MS, Singh M. Vitamin D reduces Exacerbation in Children with Asthma: A Systematic Review and Meta-analysis. J Postgrad Med Edu Res 2016;50(2):86-92.

Kacker S, Singh C, Marya SKS. Modified Extended Trochanteric Osteotomy. J Postgrad Med Edu Res 2016;50(2):93-95.

Primary extraosseous osteogenic sarcoma is one of the rarest forms of malignant tumor of the breast. It can arise as a result of osseous metaplasia of a preexisting neoplasm or from a none-phyllodes sarcoma of a previously normal breast. Due to its rarity, the natural history and optimal treatment methods remain unclear.

A 60 years old patient presented to the surgical casualty with a large breast abscess. Abscess wall histology revealed an osteosarcoma of the breast. Left total mastectomy with axillary clearance was performed. Histology and subsequent immunohistochemical studies confirmed the diagnosis of osteogenic sarcoma without lymph nodal metastasis. Patient was referred to the oncologist for further management.

Rare types of breast tumors can be presented as breast abscess. Incision and drainage together with wall biopsy aid to exclude associated sinister pathologies. Diagnosis of primary osteosarcoma of the breast was made using histological and immunohistochemical findings once the possible primary from the bones of sternum and ribs was excluded. Treatment is as for sarcomas affecting other locations and should comprise a multidisciplinary approach.

Nawarathna NJ, Chandrasekara D, Kumarasinghe NR, Balasooriya RS, Rathnayake P, Seneviratne RJ. Primary Osteosarcoma of the Breast presenting as a Large Breast Abscess. J Postgrad Med Edu Res 2016;50(2):96-99.

Challa SR, Chinamilli J, Langati RR. A Rare Case of Gastric Diverticula on Posterior Wall associated with Cholelithiasis. J Postgrad Med Edu Res 2016;50(2):100-102.

Vellaisamy G, Rout P, Crasta J, Devaraj U. Primary Hepatoid Adenocarcinoma of the Lung. J Postgrad Med Edu Res 2016;50(2):103-106.