Pediatric Pulmonology Training in India: Current Status and Future Directions

Respiratory illnesses are common causes of morbidity and mortality in children. Postgraduates in Pediatrics spent significant time in learning to manage respiratory disorders. Improved survival of preterm neonates, improved diagnosis and survival of chronic respiratory problems, and advances in diagnosis and therapeutics have increased the need for specialists trained in managing these patients. Training programs in Pediatric Pulmonology are evolving over the past few decades. In India, super-specialty training in Pediatric Pulmonology has grown over the past few years. There is a need to modify the training structure used in industrialized countries due to differences in patient population, priorities, and limited available resources and expertise. Formal training courses have been started in a limited number of institutions. There is a large gap between the need for a trained workforce and the available specialists in the limited number of institutions. The Indian Academy of Pediatrics National Respiratory Chapter (IAPNRC) has initiated a fellowship program to bridge the gap. Comprehensive training involving academic and hands-on training may go a long way to improve the care of children with acute and chronic respiratory problems. For sustainable development of the super specialty, there is a need to work towards creating Pediatric Pulmonology service departments in various institutions that may be responsible for comprehensive training and research activities to answer common research questions.

Knowledge attitude and practice (KAP) of diabetes in Mathura Uttar Pradesh - An observational study

Introduction: Objective of this study is to determine the knowledge, attitude and practice regarding type 2 diabetes in diabetics as well as in Non-diabetics and also to determine the knowledge versus practice gap among diabetics. There is almost no study of this kind from Uttar Pradesh region of India. Material and method: A pretested and validated questionnaire were used for assessment of these parameters. This questionnaire was divided in to 3 parts. First part used for assessment of knowledge in all the study subjects and had 8 questions. Second part had five questions based on risk factors and complication of diabetes. Third part was used only for diabetics and again had five questions based on their health care seeking behavior. A total of 412 study subjects (206 diabetics and 206 Non-diabetics) were interviewed and their responses were noted in this questionnaire form. Results: 50% of the diabetics are in the age group category of 41-60 years. > 50% of non-diabetics are in the age group category 21-40 years. Most of the respondents were aware of symptomatology, non-communicability, need of self-monitoring of glucose at home and rapidly increasing incidence of diabetes. Almost 70 % of diabetics were aware about foot care and Very nominal number of diabetics (7.8%) was consuming sweets daily. A disheartening fact revealed that approximately 87% of diabetics do not carry sugar candy or any form of sugar before leaving home to correct any hypoglycemic episode. Conclusion: Knowledge of symptomatology of diabetes and requirement of self-monitoring of blood glucose at home was adequate among most of the study subjects and uniformly distributed among diabetics and Nondiabetics. More than 80% of diabetics were not aware about hypoglycemia symptoms and its treatment. Training of health care providers and large-scale education and awareness campaigns are the need of the hour for this region to further improve the knowledge and to improve self-care practices among all Diabetics.

Statistical reporting in indian pediatrics.

We analyzed 45 original articles from Indian Pediatrics for appropriateness of the statistical methods. Appropriate statistical tests (93%), no use of obscure test and use of exact P value were the positive findings observed. Sample size was calculated in 24% and confidence interval in 13%. There is a need to generate awareness regarding confidence interval and sample size calculations.

A comparative study of low dose weekly paclitaxel versus cisplatin with concurrent radiation in the treatment of locally advanced head and neck cancers.

PURPOSE: The purpose of this study was to compare low dose weekly paclitaxel versus cisplatin with concurrent radiation in locally advanced head and neck cancers. MATERIALS AND METHODS: From August 2005 to July 2006, a total of 100 biopsy proven, locally advanced head and neck cancers were enrolled for the study. All the patients were stratified in two groups, study group A and control group B. Study group patients received injection Paclitaxel 20 mg/m 2 , I/V 1 hr infusion weekly for 6 weeks and control group patients received injection Cisplatin 30 mg/m 2 , I/V 2 hrs infusion weekly for 6 weeks. All patients received 66-70 Gy concurrent radiation at the rate of 2 Gy/day, 5 #/week, in 6-7 weeks by cobalt theratron phoenix - 80 teletherapy units. RESULT: Complete response achieved in 73% of patients in study group and 64% of patients in control group. There was no statistically significant difference observed between the study group and the control group (chi2 = 1.167, df = 1, level of significance 0.05). On 3-10 months of follow-up 59% of patients in the study group and 42% of patients in the control group are alive and disease free. Local toxicities including mucositis, dysphasia and skin reactions were more in the study group but tolerable. CONCLUSION: Efficacy of paclitaxel in low dose weekly schedule is comparable to cisplatin in locally advanced head and neck squamous cell carcinoma. Further analysis and follow-up are needed to evaluate if this benefit will translate into prolonged survival.

Invasive aspergillosis in an immunocompetent host.

Invasive aspergillosis is an uncommon opportunistic infection usually seen in immunocompromised patients. Despite extensive therapeutic measures the outcome is usually unfavourable. We report a case of invasive aspergillosis in an immunocompetent individual.

Corneal endothelial changes following pars plana lensectomy.

The corneal endothelial status was studied in 40 eyes of patients with congenital cataract before and 3 months after surgery. Twenty eyes of patients who underwent pars plana lensectomy revealed a mean endothelial cell loss of 8% (SD +/- .76) while the remaining 20 eyes which were operated by needling aspiration had a endothelial cell loss of 10% (SD +/- .89). The difference between the two groups was not statistically significant.

Evaluation of topical povidone-iodine versus gentamycin in staphylococcus coagulase positive corneal ulcers--an experimental study.

Povidone iodine was found highly effective in controlling the infection and reducing the period of morbidity caused by experimentally produced staphylococcal coagulase positive corneal ulcers in 50 eyes of rabbits in comparison to Gentamycin sulphate. Povidone-iodine was also found to be safe, without any adverse reaction. Hence it can be considered for use in human beings for effective control of corneal infections.

The hypotensive effect of verapamil eye drops on ocular hypertension.

Verapamil eye drops (0.125%) were prepared in phosphate buffer (pH7). Ten patients with unilateral (5 cases) or bilateral (5 cases) ocular hypertension received the drug topically three times daily for two weeks. A significant reduction in the mean ocular tension was observed in 6 right eyes at the end of the first (4.5 mm Hg Schiotz) and second week (7 mm Hg Schiotz) and in 9 left eyes at the end of the second week (6.7 mm Hg Schiotz). The reduction in tension was minimal (1 mm Hg Schiotz) in the eyes with normal initial values. The systolic and diastolic blood pressured dropped by 12.8 mm Hg and 4.0 mm Hg in the first week and by 11.2 mm Hg and 5.4 mm Hg in the second week respectively. There was also a reduction in the mean pulse rate by 7 beats and 13 beats in the first and second week of therapy. These observations indicate persistent hypotensive effect of topical Verapamil on ocular hypertension and some amount of systemic absorption of the drug from eye.