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ARTICLES - REVIEW ARTICLE
Diuretic strategies in medical disorders
Vijoy Kumar Jha, KV Padmaprakash, Rajesh Pandey
April-June 2018, 16(2):60-67
DOI:10.4103/cmi.cmi_15_18  
Diuretics are often the cornerstone of treatment for volume overload in the emergency setting. The pharmacokinetic and pharmacodynamic properties of diuretics differ in various clinical scenarios. The choice of a diuretic, its maximum dosage, and spacing of doses are important clinical issues which every medical practitioner needs to be aware of. In this review, we discuss the pharmacokinetic and pharmacodynamic properties of diuretics, their therapeutic implications, and best strategies for use in various clinical conditions.
  2 2,485 56
TOPIC IN FOCUS - REVIEW ARTICLES
Risk assessment of intrauterine growth restriction
Reeta Vijayaselvi, Anne George Cherian
October-December 2017, 15(4):262-266
DOI:10.4103/cmi.cmi_76_17  
Intrauterine growth restriction is a condition where the estimated fetal weight is less than the 10th percentile on ultrasound and the fetus has not attained its biologically determined growth potential because of a pathologic process. This review deals with the definitions of fetal growth restriction, the etiology associated with it, the types of fetal growth restriction and discusses how to differentiate between them. The various screening mechanisms available, the approach to a patient who is at risk for fetal growth restriction and whether they will benefit from any of the prophylactic measures available are also discussed.
  2 7,359 165
MEDICINE AND LAW
Is a university competent to confer a “Recognized” medical degree or diploma in India
D Samuel Abraham
October-December 2017, 15(4):295-298
DOI:10.4103/cmi.cmi_75_17  
There have been several legal enactments in the Indian legal system that were put into force with the intention of standardizing and regulating medical education and the conferring of medical qualifications. There is a common misunderstanding that a medical degree or diploma is recognized or is legally valid if it is provided by a university. However, from a legal standpoint, while Indian Universities may provide medical education courses, they are not fully competent and cannot independently confer a degree/diploma on their own, unless they have obtained sanction from the Medical Council of India and Central government. No medical professional can suffix the name of the Diploma/Degree/Certificate after their name in the business card or seal if they are not approved by both MCI and Central Government. The issue of a Medical Degree or Medical Diploma by a University without the approval of the Central Government and the Medical Council of India (MCI) will be incomplete and invalid legally.
  1 1,836 30
TOPIC IN FOCUS - INVITED REVIEWS
Subclinical hypothyroidism
K Felix Jebasingh, Dukhabandhu Naik, Nihal Thomas
April-June 2018, 16(2):39-41
DOI:10.4103/cmi.cmi_18_18  
Subclinical hypothyroidism (SCH) is defined as an elevated serum thyroid-stimulating hormone level with a normal total and free thyroxine (T4) level. There is a certain degree of debate regarding the risks associated with this condition and whether treatment is beneficial. Individuals with SCH are either asymptomatic or present with milder symptoms than those with overt hypothyroidism. Although SCH does not cause significant clinical abnormalities, there are certain long-term consequences which have been documented. The diagnosis is based purely on biochemical investigations. Treatment of this condition is not indicated in all cases since thyroid function tests tend to normalize in 6%–35% of patients. However, there are specific clinical indications for treatment and oral levothyroxine is the treatment of choice in such situations.
  1 3,423 52
TOPIC IN FOCUS - REVIEW ARTICLES
Management of autism spectrum disorder: A case-based overview
Samuel Philip Oommen, Suman Bhattacharyya, Beena Koshy, Reeba Roshan, Lincy Samuel, R Preethi
January-March 2017, 15(1):17-27
DOI:10.4103/0973-4651.200302  
The management of autism spectrum disorder requires a multidisciplinary team (MDT) comprising parents, therapists, psychologists, special educators, and medical specialists. Therapy is aimed at helping the child acquire functional skills in daily living, to minimize the core features of autism, and eliminate behaviors that are unhelpful or disruptive. The child must be adequately assessed by every member of the MDT to formulate an intervention plan which is then brought together to tailor a specific treatment plan for each child. The involvement of the parents or caretakers in the entire process is critical. The plan should address multiple areas such as communication, social skills, behavior, daily living, motor skills, and learning early and intensive treatment has been shown to be much more effective than treatment that is delayed. The child's progress should be monitored and documented, and only then can the intervention model's effectiveness be gauged.
  1 7,291 105
Clinical features and diagnosis of autism spectrum disorder in children
Susan Mary Zachariah, Samuel Philip Oommen, Beena Koshy
January-March 2017, 15(1):6-16
DOI:10.4103/0973-4651.200297  
Autism spectrum disorder (ASD) is a neurodevelopmental disorder of behavior that presents in childhood. It is a clinically heterogeneous disorder of behavior, characterized by two features - (1) impairment in social communication and interaction and (2) repetitive patterns of behavior. The diagnosis is essentially clinical and is based primarily on history-taking and observation of the child over a period. There are several standardized screening tools and scales available to help make a diagnosis. Children with autism often present with speech delay and this has to be distinguished from other conditions. ASD is often associated with comorbid conditions which have to be identified to tailor the treatment program for each child. It is important that the parents or caretakers of the child are involved in the process of assessment and diagnosis and that their misconceptions and fears are addressed.
  1 11,323 101
TOPIC IN FOCUS: REVIEW ARTICLES
Polycystic ovarian syndrome: Treatment options for infertility
Sumi Thomas, S Sudharshini
October-December 2016, 14(4):87-93
DOI:10.4103/0973-4651.194459  
Polycystic ovarian syndrome (PCOS) is a common cause of infertility and is characterized by clinical features of irregular menstrual cycles, hirsutism, and anovulatory infertility. The diagnosis is made based on the presence of two of three features (oligo/anovulation, hyperandrogenism, and polycystic ovaries on transvaginal ultrasound) according to the Rotterdam diagnostic criteria. Lifestyle modifications to reduce weight and the use of ovulation induction medications form the cornerstone of treatment of anovulatory infertility secondary to PCOS. Clomiphene citrate is the most effective as an agent for ovulation induction. The other therapeutic options include laparoscopic ovarian drilling, ovulation induction with gonadotropins, and in vitro fertilization.
  1 4,789 70
Unexplained infertility: An approach to diagnosis and management
Mohan S Kamath, Mogili Krishna Deepti
October-December 2016, 14(4):94-100
DOI:10.4103/0973-4651.194461  
The cause of infertility is said to be unexplained when there is normal ovulatory function, semen analysis is normal, and tubal patency is established by hysterosalpingography or laparoscopy. Some of the factors that may contribute to the etiology of unexplained infertility are inability to identify the subtle reproductive abnormalities, endocrine/genetic/immunological disorders, minimal/mild endometriosis, and compromised ovarian and natural fecundability that may be less than normal. Prognostic factors in unexplained infertility include maternal age, duration of infertility, and previous obstetric history. The management options depend on various factors such as age of woman, duration of infertility, couples' preferences, and the health-care setting. The options available for treatment include expectant management, clomiphene citrate, super ovulation with intrauterine insemination, and in vitro fertilization/intracytoplasmic sperm injection.
  1 4,779 98
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