Revised Guidelines on Management of Antenatal Hydronephrosis.

Widespread antenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. The present guidelines update the recommendations published in 2000. Antenatal hydronephrosis (ANH) is transient and resolves by the third trimester in almost one-half cases. The presence of oligohydramnios and additional renal or extrarenal anomalies suggests significant pathology. All patients with ANH should undergo postnatal ultrasonography; the intensity of subsequent evaluation depends on anteroposterior diameter (APD) of the renal pelvis and/or Society for Fetal Urology (SFU) grading. Patients with postnatal APD exceeding 10 mm and/or SFU grade 3-4 should be screened for upper or lower urinary tract obstruction and vesicoureteric reflux. Infants with vesicoureteric reflux should receive antibiotic prophylaxis through the first year of life, and their parents counseled regarding the risk of urinary tract infections. The management of patients with pelviureteric junction or vesicoureteric junction obstruction depends on clinical features and results of sequential ultrasonography and radionuclide renography. Surgery is considered in patients with increasing renal pelvic APD and/or an obstructed renogram with differential renal function <35-40% or its subsequent decline. Further studies are necessary to clarify the role of prenatal intervention, frequency of follow up investigations and indications for surgery in these patients.

Doctors and Padma awards.

Background. The announcement of the annual Padma awards in January always generates a great deal of interest as well as controversy and, some believe that many good candidates are excluded and many less deserving ones included. We analysed the recipients in the field of medicine to determine whether or not a pattern emerged regarding who were bestowed these honours. We were not able to objectively evaluate whether or not the honours were ‘deserved’. Methods. We obtained and then analysed the list of awardees from newspapers and the official website of the Ministry of Home Affairs. Between 2000 and 2010, a total of 1166 awards were announced, of which 157 (13.4%) were in the field of medicine. We excluded foreigners and those from ‘alternative’ fields (20), and evaluated the remaining 137 in detail. Results. Sixty-two (45.3%) recipients were from Delhi, 18 (13.1%) from Maharashtra and 17 (12.4%) from Tamil Nadu. Of the 137 awardees, 31 (22.6%) were cardiologists or cardiac surgeons. Many large states of the country, such as West Bengal, Gujarat, Rajasthan, Madhya Pradesh, Punjab and Haryana, did not have a single awardee. Conclusion. The over-representation of Delhi and cardiology in the Padma awards for medicine suggests that their distribution is not entirely fair.