Sanjay Gandhi Post Graduate Institute Of Medical Sciences Research Articles

An Outbreak of Ralstonia mannitolilytica Septicaemia at a Tertiary Care Hospital: An Observational Cross-sectional Study

Introduction: Ralstonia spp. is an emerging non fermenting Gram negative bacillus implicated in cases of bloodstream infections in immunocompromised individuals. It is commonly found as an environmental contaminant in hospital settings. Several sporadic outbreaks have been reported from different parts of the world due to Ralstonia spp. This study reports a similar outbreak at a tertiary care hospital in Northern India. Aim: To determine the source of Ralstonia septicaemia in affected patients at a tertiary care centre. Materials and Methods: The present observational crosssectional study was conducted at the Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India from February 2020 until the end of March 2020 (two months). A total of 2,650 blood cultures were received during the study period; of these, 53 (2%) patients were found to have Ralstonia mannitolilytica infection over a two month period. All patients from various wards whose blood cultures showed growth of Ralstonia species were included in this study. The organism was identified using both biochemical tests and Matrix-Assisted Laser Desorption Ionisation-Time of Flight Mass Spectrometry (MALDI-TOF MS). Antibiotic sensitivity testing was conducted using the Kirby-Bauer disk diffusion assay. Environmental surveillance was conducted to detect the source of origin. Patients’ age, sex, duration of hospital stay, co-morbidities, and other clinical parameters were recorded. Statistical analysis was performed using Microsoft Excel. Results: There were 52 cases of septicaemia due to Ralstonia mannitolilytica, and one Ralstonia isolate was obtained from intraoperative pus. Most of the Ralstonia isolates obtained were Multidrug-Resistant (MDR), showing resistance to imipenem, meropenem, amikacin, aztreonam, and sensitivity to first-line drugs such as ceftazidime, piperacillin-tazobactam, cefoperazone-sulbactam, levofloxacin, and trimethoprimsulfamethoxazole, resulting in successful treatment. Out of 53 cases, one patient succumbed to death due to surgical complications. Environmental sampling did not yield any organisms resembling Ralstonia spp. Conclusion: The environmental source of the Ralstonia bacteraemia outbreak could not be identified in this study. All patients except one were successfully treated with antibiotics. Clinicians and microbiologists should remain vigilant in case any such case arises to prevent further outbreaks.

Seroprevalence of Human Parvovirus B19 in Haematological and Extra-haematological Disorders: A Retrospective Observational Study

Introduction: Human parvovirus B19 (B19V) has an affinity for multiple organs and causes a myriad of clinical diseases depending on the host’s immunological and haematological status. The seroprevalence of human parvovirus B19 has mostly been studied in haematological disorders, but there is still a lack of data on B19V seroprevalence in extra-haematological disorders. Aim: To study the seroprevalence of B19V in haematological and extra-haematological disorders. Materials and Methods: This retrospective observational study was conducted at the Microbiology Laboratory of Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India. Data was collected from September 2017 to September 2020, and data analysis was done from October 2020 to January 2021. A total of 702 serum samples from patients suspected of B19V infection were received over a threeyear duration for parvovirus B19 antibody testing. Of these, 674 serum samples were included in the study as per the inclusion and exclusion criteria. The prevalence of B19V antibodies in different clinical disorders was investigated by collecting patient details like age, gender, underlying clinical disorder, and B19Vspecific Immunoglobulin M (IgM) and IgG antibodies detected by quantitative enzyme immunoassay on all serum samples suspected of B19V infection using Statistical Package for Social Sciences (SPSS) version 25.0 software. The Chi-square test was used to analyse statistically significant variables. Results: B19V-specific IgM and IgG antibodies were detected in 35.7% (241/674) of the serum samples received over a three-year duration. The positivity rate was 94 (13.9%) for IgG, 108 (16%) for IgM, and 39 (5.8%) for both IgG and IgM. The positivity in adults aged 18 years and over (39.6% or 160/404) was statistically significantly higher compared to children aged 17 years and younger (30% or 81/270) (p=0.0109). Among the 241 B19V-positive patients, 126 (52.3%) had haematological disorders, and 115 (47.7%) had extra-haematological disorders. The total positivity of IgG plus IgM antibodies was highest in musculoskeletal and connective tissue disorders (33 (54.1%) and haematological disorders 126 (48.3%). Conclusion: The B19V seroprevalence was relatively low in the present study compared to most serological studies conducted in other regions. The present study provides information on the seroprevalence of B19V in both haematological and extrahaematological disorders simultaneously.

A Study to assess the impact of an ongoing capacity building program for nursing staff on augmentation of Knowledge, Attitude and Practice (KAP) of the trainees at Program Study Centre (PSC), Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow

Introduction: The Government of India had notified Department of Hospital Administration (DoHA), Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) as Program Study Center (PSC) to provide comprehensive training to selected candidates for Bridge Program on Certificate in Community Health Nursing. To fulfill a commitment, to assess the effectiveness of the assigned program, the PSC: DoHA, SGPGIMS endeavored to create a reliable, valid, and accurate assessment of program decisions and outcomes.Aim: The aim of the study was to assess the impact of an ongoing capacity building program for nursing staff on augmentation of Knowledge, Attitude, and Practice (KAP) of the trainees at PSC, SGPGIMS, Lucknow.Objectives:To ascertain the preintervention status of KAP among trainees of an ongoing capacity building program, through appropriately designed toolTo ascertain the postintervention status of KAP among trainees of an ongoing capacity building program, through appropriately designed toolTo recommend evidence-based modifiers, as feed-forward for the subsequent phases of the program, based on the analysis of the data thus obtained.Methodology: Interventional study.Results: Preintervention score: Knowledge – 68.5%, Attitude – 75.2%, Practice – 44.65%. Postintervention score: Knowledge – 86.846%, Attitude – 82.4%, and Practice – 51.15%. Increase: Knowledge – 18.346%, Attitude – 7.2%, and Practice-6.5%.Conclusion: The training program was successful in achieving a significant improvement in trainees' knowledge and awareness regarding delivery of comprehensive primary care services which was reflected as improvement and change in their attitude. The performance was better in the postinterventional phase as compared to preintervention. Therefore, it is of utmost importance to sustain the present and provide occasions for further improvement in the knowledge and skills to health-care providers as a measure for continuous quality improvement.

Posterior Cloaca: Multicenter Experience of a Very Rare and Unusual Anorectal and Genitourinary Malformation.

Posterior cloacal malformations (PCMs) are distinguished from classical cloacal malformations by the posterior location of the common opening in the perineum. We aim to describe our experience of management of these rare and complex malformations. This study was a retrospective chart review of all patients with PCM who underwent treatment at Kalawati Saran Children's Hospital (KSCH), New Delhi, and Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, between 2013 and 2021. Individual anatomical variations and their impact on the clinical presentation, management, and final outcome (cosmesis and function) were recorded and analyzed. During the study period, four girls with a median age of 2 (range: 0-5) years presented to us with PCM. Three patients were referred to KSCH as ambiguous genitalia whereas one patient was born at SGPGIMS with an antenatal diagnosis of "urorectal septal defect." On examination, three patients had the urogenital sinus (UGS) opening immediately anterior to the normally located anal opening (2 orifices), whereas one had a single orifice at the normal location of the anus with the UGS opening in the anterior rectal wall. Associated anomalies included: (a) hydrocolpos (n = 3), which was managed by a tube vaginostomy; (b) urethral duplication with dorsal atretic urethra (n = 3); (c) uterine didelphys (n = 1); (d) bilateral grade 5 vesicoureteric reflux (n = 1); and (e) vaginal calculus (n = 1). Total urogenital mobilization (anterior sagittal approach) with feminizing genitoplasty was performed for patients with UGS and normal anus (n = 3). In the patient with a single opening at the normal location of the anus, posterior sagittal ano-recto-urethro-vaginoplasty was performed. At a median follow-up of 24 months, three patients are continent for urine and stool, whereas one patient is yet to be toilet trained. PCMs are unusual complex malformations that necessitate meticulous clinical examination, detailed diagnostic workup, and multistaged surgical management. Management should be tailored as per each individual patient's anatomy and clinical presentation for an optimal outcome.

Telemedicine: History and Success Story of Remote Surgical Education in India.

Initiation of telemedicine in medical education in India was at par with developed countries but acceptance and progress have been slow. However, the recent coronavirus disease-19 (COVID-19) pandemic leading to disruption of Halstedian model of surgical teaching has changed the traditional dynamics of perception of this mode of education. Sanjay Gandhi PostGraduate Institute of Medical Sciences (SGPGIMS), has been a pioneer and introduced the telemedicine system into surgical education as early as in year 2001. In this article, we reviewed the literature on tele-education in surgical field in Indian scenario, with particular emphasis on tele-education activities at the SGPGIMS, with respect to current thinking and future prospects on surgical training.

MO690HIGHER EXPRESSION OF TOLL LIKE RECEPTOR AND CELL ADHESION MOLECULES ARE ASSOCIATED WITH RECURRENT/RELAPSE PERITONITIS AND MORTALITY IN PATIENT ON CAPD

Abstract Background and Aims CAPD is an established modality of treatment for patients with end stage renal disease (ESRD). Peritonitis is a leading cause of technique failure and death in patients on CAPD. Studies on expressions of host genetic factors like TLRs, CAMs, Pro and Anti-inflammatory cytokines and their link to peritonitis and other co-morbidity and functional status are lacking throughout the world. Hence the present study was done to determine the expressions of TLR2 and TLR4, CAMs and inflammatory cytokines in patients on CAPD. Method A total of 110 ESRD patients categorized into 3 groups: 1- CAPD patients (n=45), group 2- CAPD with peritonitis patients (n=35), and group 3- CAPD patients with recurrent/relapsing peritonitis. (n=30) from department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow were included in the study. Blood sample was collected for analysis of cytokines and Cell adhesion molecules level and RNA extraction. Dialysate (only from patients undergoing PD with or without peritonitis)- whole drained bag; 50-100 ml for microscopy and culture for bacterial and fungal pathogens using automated BACTEC culture system in patients with peritonitis and supernatant was collected for cytokine ELISA. Statistical analysis: One-way ANOVA (Two tailed) and non-parametric student t-test used for statistical analysis of differences between the group. Results mRNA expression of TLR 2 and TLR 4 expression was higher in peritonitis and recurrent/relapsing peritonitis group as compared to CAPD patient without peritonitis group. mRNA expression of TNF-alpha, IL-1B and IFN-gamma was higher in peritonitis group of patients compared to all other group of patients. mRNA expression of IL-10 and IL-4 was also highest in Peritonitis group. Level of IL-1β and TNF-alpha was observed to be elevated in peritonitis and recurrent/relapse peritonitis patients compared to CAPD in sera and dialysate. IL-12 level in Sera was also elevated in peritonitis patients but its level in dialysate was highest in CAPD without peritonitis as compared to peritonitis and recurrent/relapse. IL-10 and IL-4 was observed to be elevated in peritonitis group followed by CAPD with recurrent/relapse peritonitis in sera whereas in dialysate level of IL-4 was higher in both peritonitis group and Recurrent groups of patients but IL-10 level was highest in peritonitis group but less in recurrent/relapse. mRNA Expression levels of adhesion molecule ICAM-1 and LFA-1 were observed to be higher in Peritonitis and Recurrent groups as compared to the CAPD without peritonitis; whereas, in sera the level of ICAM-1 was higher in peritonitis patients. However, in dialysate its level was observed to be almost similar. Level of LFA-1 was observed to be higher in peritonitis group in dialysate but in sera its level was higher in Recurrent group with peritonitis. Conclusion It is likely that CAMs are also involved in the pathogenesis of CAPD peritonitis, its morbidity and mortality. TLRs activation by bacterial molecules leads to the induction of chemokines and cytokines through the activation of NF-ķB pathway and may be responsible for atherosclerosis, morbidity, and mortality in ESRD patients. Elevated level of ICAM-1, IL-1beta, TNF-a and IFN-G may be responsible for chronic inflammation in PD patients.

Tele-education for hepatology residents in Bangladesh during the Covid-19 pandemic.

Tele-education for hepatology residents in Bangladesh during the Covid-19 pandemic.

Smartphone-Based Application for Tele-follow-up of Patients with Endocrine Disorders in Context of a LMIC: A Compliance, Satisfaction, Clinical Safety and Outcome Assessment.

Remote video consultations are increasingly used in clinical practice, and a lot of data are emerging on its feasibility and acceptability. This study aims to bring out qualitative and quantitative data which will enhance our understanding of strengths and limitations of this media in the setting of a low- and middle-income country (LMIC). This was a prospective study conducted from January 2017 to May 2018, at the Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India. A total of 107 patients were selected who chose remote follow-up care through social media (WhatsApp). Data were analyzed on feasibility, clinical safety, satisfaction and economic burden. A total of 107 postoperative patients were followed up using a social media tool. A total of 396 tele-sessions were held. The average number of tele-consultations per patient was 3.7 (range 2-6). Reasons for tele-follow-up included: confirmation of histology report (n = 92), medication dosage adjustments (n = 148), wound evaluation (n = 102), reporting of serum TSH and serum calcium levels (n = 296) and medical fitness certificate (n = 13). Wound evaluation through tele-follow-up was on par with the outpatient department (OPD) follow-up as no patient had to report to OPD for wound infection. Satisfaction level was excellent in 55% of patients and very good in 25%. 20% of the patients reported an average satisfaction level. If all of these 107 patients would have come to our OPD follow-up, they would have traveled 613.2 miles (908km) per patient on an average, apart from losing work hours. Average cost and workdays saved per visit were $78 and 5.4days, respectively. Video consultation using social media tools is clinically safe and cost effective. Economic benefits far outweigh the risk of missing an adverse event, especially in the setting of low- and middle-income countries.

Neurology at Sanjay Gandhi PGI: Beginning, progress and hope

High quality publications, patient care and educational standard have made Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India a favored destination for the patients and medical students, for getting treatment and education, respectively. The current article traces the history and milestone of the Department of Neurology, SGPGIMS, Lucknow and summarizes its achievements and facilities. The uniqueness of the department lies in being sensitive to the expectation of the patients, students and its faculty's own aspirations in research, keeping the patient as the center of focus.

Optimal Utilization of Government Assisted Financing for Poor Patients: Facilitation by a Hospital

ABSTRACT Introduction Sole objective of healthcare financing is that rich and poor should be treated equally as poverty is not a disability and wealth is not an advantage. Approximately, 78% of Indian population spends for healthcare from out of pocket expenditure, remaining by salary, agriculture, business, etc. Only 3% population is covered by health insurance. Prime minister (PM) fund is one of the methods to offset the treatment cost from poor. Objective Present paper is aimed to highlight the contribution of PM fund for patients getting treatment at Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) hospital and efforts made by hospital for its optimal utilization. Materials and methods Retrospective studies were carried out in 2010 and July 2013 for contribution received form PM fund for indoor poor patients treatment during last 5 years, number of patient availed/not availed financial assistance, reasons for not availing, on the line of problem solving process. Efforts made by SGPGIMS for its optimal utilization were also highlighted. Result During financial year 2007-2008 to 2009-2010, total 1246 patients received the fund of worth USD 1.30 million (₹ 78792750.00) and only USD 1.09 million (₹ 65569869.00) was utilized by 1110 (89%) patients. One hundred and thirtysix (10.91%) patients did not utilize. Hospital administration made efforts for optimal utilization by minimizing the barriers, consequently it improved the utilization by 8.20%. During financial year 2010-11 to 2011-12, USD 1.85 million (₹ 111081789.00) was received for 1450 patients, out of which 730 patients have already utilized and 682 are still using the fund (total 1412/97.40%) and 38 patients (2.60%) did not use it. Conclusion Simple efforts made by hospital improved the utilization of PM fund by 8.20% and poor were really benefited. Hospitals should also fulfill the social responsibility by facilitating the patients. How to cite this article Chandra H, Bhardwaj ND, Mansoor F, Mandal R, Srivastava DC, Harsvardhan R. Optimal Utilization of Government Assisted Financing for Poor Patients: Facilitation by a Hospital. Int J Res Foundation Hosp Healthc Adm 2015;3(1):25-28.

Use of information technology and services by medical students: a case study

Purpose – The purpose of this paper is to examine users’ attitude toward the implementation of information technology (IT) on the library of Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS). The paper also aims to explore the hindrances and recommendations for IT-enabled services and find out the present status of automation in the library of SGPGIMS. Design/methodology/approach – A well-structured questionnaire was designed to collect the data for the present study. A thorough survey of the literature was done to examine the findings of the earlier relevant studies. Findings – The results of the survey provide the important information regarding the state-of-the-art of the users of mentioned library. It also finds the barriers due to which overall implication of IT is being delayed. The findings of the study bequeath measures to eradicate the barriers and get the fully automated medical library. Originality/value – The study will have important implications on policymakers, librarians and other higher authorities of SGPGIMS to improve the IT status of their library. It evaluates the users need and points out the measures which can improve the IT status of these libraries.

Information Seeking Behaviour of Health Professionals of Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow

The paper deals with information seeking behaviour of health professionals. The Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, is a very renowned institution in the field of Medical Sciences. The paper highlighted the topics such as formal and informal sources of information, purpose of seeking information, preferences to database, methods for keeping themselves updated, etc., which are questioned from the health professionals of SGPGIMS, Lucknow. The information seeking habits, satisfaction gained by them in seeking information, preferred information services, etc., are inquired from the medicos. The paper discovers the important information seeking practices by health professionals in the SGPGIMS, Lucknow.

Evolution of Endocrine Surgery in India

Evolution of Endocrine Surgery in India

Surgical management of Pott′s disease of the spine in pediatric patients: A single surgeon′s experience of 8 years in a tertiary care center

Study Design:A retrospective, case study of 64 pediatric patients who underwent spinal surgery for Pott's spine and have minimum 6 months follow-up.Objective:The aim of this study was to evaluate the surgical management and outcome of 64 pediatric Pott's spine cases operated by single surgeon over last 8 years, with a minimum follow-up of 6 months. The prognostic significance and the outcome of the demographic factors, location of the disease, and its surgical approach were also evaluated in these patients.Materials and Methods:The data collected retrospectively from the institute's record case sheets of the 64 pediatric patients with Pott's disease of the spine, operated between 2002 and 2010 in the Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, were analyzed. The study population consisted of 40 male and 24 female pediatric patients. Clinical findings included back pain, paraparesis, kyphosis, fever, sensory disturbance, and bowel and bladder dysfunction.Results:The most common region of Pott's disease was the thoracic region [21/64 (33%)] followed by craniovertebral junction (CVJ) [17/64 (27%)]. At presentation, all of the patients had neurological features of spinal cord compression. All patients were treated with antituberculous chemotherapy which was continued after the surgical intervention also. Transthoracic surgical approach [18/64 (28%)] was the most frequently required surgery followed by transoral decompression with posterior fusion [12/64 (19%)] depending on the site of disease and compression of neuraxis. Initially, more than two-third of the patients were in poor grade of Kumar and Kalra scoring as well as modified Kumar and Kalra scoring, which were reduced to about one fifth after the surgical intervention, and the outcome was good as the condition of 46 patients (72%) improved significantly.Conclusion:Currently, treatment of spinal tubercular infections requires a multidisciplinary team that includes infectious diseases experts, neuroradiologists, and spine surgeons. The key to successful management is early detection and timely and judicious surgical intervention, the decision of which needs to be taken in view of clinicoradiological compression of the spinal cord and nerve roots, age of the patient and responsiveness of ATT.

Polymorphism in cytochrome P450 2E1 and interaction with other genetic risk factors and susceptibility to alcoholic liver cirrhosis

The association of polymorphism in cytochrome P450 2E1 (CYP2E1), the major microsomal ethanol metabolizing enzyme and its interaction with genes, involved in detoxification of reactive oxygen species, such as glutathione-S-transferases M1 (GSTM1) and alcohol intake, gamma-aminobutyric acid receptor γ2 (GABRG2) was studied with the risk to alcoholic cirrhosis in a case–control study. A total of 160 alcoholic cirrhotic and 125 non-alcoholic cirrhotic cases, visiting the OPD facility of Gastroenterology Department of Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, India and 250 non-alcoholic and 100 alcoholic controls having no evidence of liver disease were included in the study. PCR-based RFLP methodology was followed for genotyping studies. Our data revealed that the variant genotypes of CYP2E1*5B exhibited significant association with the alcoholic liver cirrhosis when compared to non-alcoholic controls (OR: 4.3; 95%CI: 1.5–12.4; p: 0.003) or non-alcoholic cirrhosis patients (OR: 5.4; 95%CI: 1.2–24.5; p: 0.01) or alcoholic controls (OR: 4.3; 95%CI: 0.95–19.62; p: 0.04). Haplotype approach revealed that haplotype T–A–T was found to be associated with more than 5-fold increase in risk for alcoholic cirrhosis. Likewise, combination of variant genotype of CYP2E1*5B with null genotype of GSTM1, a phase II detoxification enzyme, resulted in several fold increase in risk in alcoholic cirrhotic patients when compared with non-alcoholic controls or non-alcoholic cirrhotic patients. Further, the combination of variant genotype of CYP2E1*5B with GABRG2, significantly increased the risk upto 6.5-fold in alcoholic cirrhotic patients when compared with non-alcoholic controls thereby suggesting the role of gene–gene interaction in alcoholic cirrhosis.

Polymorphism in glutathione-S-transferases: A risk factor in alcoholic liver cirrhosis

In a case-control study, association of polymorphism in glutathione-S-transferases ( GSTM1, GSTT1, GSTP1), involved in detoxification of reactive oxygen species (ROS), was studied with alcoholic liver cirrhosis. The study included 175 alcoholic cirrhotic patients (ACPs), 140 non-alcoholic cirrhotic patients (NACPs), visiting Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, India, 255 non-alcoholic controls and 140 alcoholic controls. The data showed an increase in risk to alcoholic cirrhosis in ACPs with GSTM1 ( null) genotype when compared with non-alcoholic controls (OR: 1.7; 95% CI: 1.15–2.56) or alcoholic controls (OR: 1.7; 95% CI: 1.07–2.73). Significant increase in risk was also observed in ACPs with variant genotype of GSTP1 when compared with non-alcoholic controls (OR: 1.65; 95% CI: 1.12–2.43). A much higher risk to alcoholic liver cirrhosis was observed in patients carrying combination of null genotypes of GSTM1 and GSTT1 (OR: 2.8; 95% CI: 1.3–6.06) or variant genotype of GSTP1 and null genotype of GSTM1 (OR: 2.8; 95% CI: 1.58–4.90) or GSTT1 (OR: 2.16; 95% CI: 1.08–4.28). Likewise, greater risk for alcoholic cirrhosis was observed in patients carrying combination of GSTM1, GSTT1 ( null) and variant genotype of GSTP1 (OR: 5.8; 95% CI: 2.17–15.80). Our data further showed that interaction of GSTs with variant genotype of manganese superoxide dismutase ( MnSOD), which detoxifies free radicals, or cytochrome P450 2E1, which generates free radicals, resulted in several fold increase in risk to alcoholic liver cirrhosis in ACPs when compared with non-alcoholic controls thus demonstrating the role of gene–gene interactions in modulating the risk to alcoholic liver cirrhosis.

Telementoring in Endocrine Surgery: Preliminary Indian Experience

Telemedicine is starting to play an important role in the health field in India. In this case report we describe the successful use of telementoring to remove a parathyroid tumor in a patient with residual hyperparathyroidism after two previous unsuccessful attempts in tumor excision. A 21-yr-old patient crippled with advanced hyperparathyroidism was taken up for third-time exploration at Amrita Institute of Medical Sciences (AIMS), Kochi, with guidance from the Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, using telemedicine technology. These two centers are located 2,500 km apart, and telementoring from the more experienced endocrine surgeons at SGPGIMS resulted in successful tumor localization and removal. For this session both the institutions were provided with a dedicated 512 Kbps very small aperture terminal (VSAT) link and two-way video-audio connectivity. Even though two previous explorations were unsuccessful, with the help of telemedicine technology the same surgeon was successful in locating and removing the tumor. The video and audio quality was of good enough quality for the expert at SGPGIMS to guide the team at AIMS satisfactorily. The patient benefited since he did not have to travel to a far-off specialized center for surgery. This case report testifies to the usefulness of telemedicine in the field of surgery, especially in developing countries, which have few medical experts in certain specialized areas.

Use of telemedicine in evading cholera outbreak in Mahakumbh Mela, Prayag, UP, India: an encouraging experience.

Telemedicine (TM) services a process in which expert medical advice from afar is provided using electronic signals to transfer the medical data from one site to another. As a pilot project to assess the efficacy of TM in developing countries like India, a telemedicine center was set up at the main hospital of Mahakumbh mela--a grand religious fair, at Prayag, a city in north India. The daily reporting of the in-patient and outpatient cases at the fair revealed a surge of diarrhea cases among the pilgrims at the fair. This information was communicated to the referral center at Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), which, with the help of its microbiology department, conducted microbiological examinations of stool samples and rectal swabs of patients along with various water samples. Vibrio cholerae was isolated in 22.6% (7/31) of the samples. This information was immediately relayed to the Main Hospital at the fair online, and then to the health authorities, who took strict and prompt measures to improve hygiene. Subsequently, the number of diarrhea cases decreased considerably in a matter of a few days, and thus an epidemic disaster was averted, which could have created havoc in such a large gathering.

Completion total thyroidectomy in the management of differentiated thyroid carcinoma.

Completion thyroidectomy is the removal of any thyroid tissue that remains after a less than total thyroidectomy. This procedure has been commonly performed when the final histopathology of the excised ipsilateral thyroid lobe reveals papillary or follicular carcinoma of the thyroid. Complete thyroidectomy carries little morbidity if performed by experienced surgeons using a lateral approach. The purpose of this study is to reinforce the usefulness of a lateral approach. A retrospective analysis over a 5 year period at the Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) yielded 19 patients who underwent completion thyroidectomy. This group represents 23% of 82 patients who underwent total thyroidectomy for differentiated thyroid cancer (DTC) during that period. The residual thyroid tissue was excised through a lateral approach and could be resected safely, preserving the recurrent laryngeal nerve (RLN) and the parathyroid glands. A lateral approach dissection could be performed with ease in a virgin area. Excision of residual thyroid tissue could be performed safely even in cases with prior partial lobectomy or bilateral subtotal resection. Tumour was found in 52% of the re-operative specimens: in three out of four of those after a previous partial lobectomy, in six out of 12 of those after a total lobectomy, and in one out of three of those after a prior bilateral (although incomplete) thyroid resection. Postoperative complications included transient RLN palsy (n = 2) and transient hypoparathyroidism (n = 4). Completion thyroidectomy using a lateral approach is safe in re-operative thyroid surgery.

HLA sharing, anti-paternal cytotoxic antibodies and MLR blocking factors in women with recurrent spontaneous abortion.

To study the prevalence of HLA sharing between spouses and its correlation with presence of antipaternal cytotoxic antibody (APCA) and mixed lymphocyte reaction (MLR) blocking factors in recurrent spontaneous aborters (RSA). Study was carried out at Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGI), Lucknow, from 1988-1992. Hundred couples with 3 or more consecutive recurrent spontaneous abortions and equal number of age, parity and ethinically matched normal controls were selected for studying HLA, APCA and MLR blocking factors. Meta-analysis was performed using standard formula and significance was tested by Chi-square analysis. Significant HLA sharing was observed in couples with RSA at A and DR loci compared to normal controls (p < 0.001). Twenty-seven point eight percent of couples with RSA were positive for APCA compared to 49% of controls (p < 0.01). MLR blocking factors were detected in 26% couples with RSA compared to 78% in controls (p < 0.001). An inverse correlation between HLA sharing and APCA and MLR positivity was demonstrated. The study supports that greater HLA sharing between spouses, associated with lack of an appropriate immune response to them could be responsible for RSA.