The Tribune, Chandigarh, India

	From the Director’s Desk Our motto: Quality healthcare at affordable cost The Postgraduate Institute of Medical Education and Research (PGIMER) will be holding its 29th Convocation on Friday, the 18th July, 2008. We are fortunate to have the Honorable Minister of External Affairs, Mr Pranab Mukherjee, as our chief guest. We are also encouraged by the presence of the President of the institute, the Honorable Union Minister of Health and Family Welfare, Dr Anbumani Ramadoss. The PGIMER was born in 1962, thanks to the foresight of the late Sardar Partap Singh Kairon. The hospital now named as Nehru Hospital was inaugurated by the first Prime Minister of India, Pt Jawaharlal Nehru, who considered these institutions as temples of learning. Since its inception, the institute has been fortunate to be served by the hardwork and dedicated efforts of several medical icons such as Dr Tulsi Das, Dr S.S. Anand, Dr P.N. Chuttani, Dr B.K. Aikat and many others. Today, the hospital has 1487 beds that include 113 intensive care beds. The hospital caters to more than 1.3 million outdoor, half a lakh indoor, and half a lakh emergency patients every year. Patients come from as far as UP, Bihar, Jharkhand, Chhattisgarh, the Northeast and neighboring countries. Last year, one third (32/125) of the kidney transplant patients were from the Northeastern states of India. A hallmark of this institute is its easy accessibility to people from the underprivileged sections of society and those with modest economic resources. Active measures are being adopted to provide free treatment to the poorest sections of society. These efforts are aided by philanthropic organisations such as the Red Cross, Sewa Bharati, Lifeline, Rotary Club, Cancer Sahayta and also with contributions from individual philanthropists. The huge rush of patients reflects the confidence of the people in the quality of healthcare being delivered. It has been a constant endeavor of my colleagues to ensure the best possible environment, facilities and care. The heavy rush and limited resources sometimes hinder us to provide prompt and comfortable services. We have tried to make things easier for patients by putting up more signage and help desks. A package system of payment for procedures has been introduced in certain departments, which makes the process of payments easier. The first day’s emergency treatment is now being provided free of cost. Soon, the entire hospital information system would get computerised, making information access simple. The PGI website (http://pgimer.nic.in) has a lot of information for the public. We are now linked to rural and sub-district hospitals in neighbouring states via satellite through a telemedicine network. Experts in the PGI provide consultations to doctors working in remote areas through this initiative. The PGI is also linked to medical colleges in surrounding states. Teaching activities in the hospital are transmitted to these colleges and interactive sessions are regularly held with them. Several new patient care facilities have been introduced in several departments. The Advanced Eye Centre, Burn Unit, Hepatology ICU, upgraded pulmonary ICU, Stem Cell Lab, Mycology Centre and Bone Marrow Transplant facilities are recent additions. The Advanced Cardiac Centre, Advanced Trauma Centre, PET scan and Gamma Knife facility are soon going to be operational. All these will help to provide state of the art care to our patients and strengthen basic research activities. The PGI is fortunate to have around 300 members on its faculty, which is responsible for patient care, training programmes, conducting research and shaping national healthcare policies. We have identified research areas that require attention. Projects that are in the pipeline include strengthening and initiating medical oncology services, liver transplant facility; promotion of cadaver organ donation; stem cell and tissue engineering research; clinical research unit and bioinformatics. The staff of the PGI will continue to strive to retain its pre-eminent position in medical care, research and teaching in the eyes of the people, aspiring postgraduates and medical fraternity around the world. I would like to welcome the Honorable Minister of External Affairs and the Honorable Minister of Health and Family Welfare on the occasion of our Convocation. Their gracious presence and their words of advice to our students and faculty will go a long way in boosting our morale and strengthening our commitment to continually improve. I would also like to express my deepest gratitude to the people for reposing their faith in us and promise that we will continue to perform beyond the call of duty to justify their faith. This newspaper supplement containing articles by eminent doctors at the PGI is a part of our humble efforts to educate the public. Jai Hind! *Prof K.K. Talwar, Director, PGIMER*
	Kids need not fear the dentist How does one reduce anxiety in children visiting a dentist? Behaviour management is a major step in successful dental treatment of children of all age groups. The simple techniques used by the paediatric dentist include tell-show-do (where the instruments to be used are first shown and described to the child), modeling (where the child is made to stand near another child showing a positive behaviour) during any dental procedure and systematic desensitisation (where the least anxiety provoking instruments and treatment procedures are introduced first reserving the highest anxiety provoking ones for later visits). These techniques, however, may not succeed in very young children, less than three years of age, who have not yet developed the ability to comprehend complicated instructions or in slightly older but highly apprehensive children mainly during their first dental visits. Such children can be successfully managed using pharmacological means, which include procedures such as general anesthesia and conscious sedation. General anesthesia, though a sure way of getting the work done is an expensive and extensive procedure and has added risks associated with it. Moreover, it may not be the best choice in a good number of cases, which require only minor procedures. Conscious sedation is a minimally depressed level of consciousness where the child’s protective reflexes remain intact and can be carried out using a variety of drugs in low doses. It is less risky, easily monitored, readily acceptable and successful in majority of the cases and can be safely carried out in the dental operatory. What is ‘conscious sedation’? At the Oral Health Sciences Centre, PGI, “conscious sedation” is being regularly carried out using the drug midazolam via oral route. This is a short-acting drug akin to the popular sedative diazepam (Valium®). For this the child needs to remain fasting for at least 6-8 hours depending on age, prior to drug administration. To prevent the risk of dehydration in such young children, intake of clear fluids such as water and apple juice is permitted for up to three hours prior to the procedure. The drug is usually administered orally mixed in honey/strawberry syrup to mask its bitter taste and make it readily acceptable. A waiting period of about 10-15 minutes is given for the drug to take effect i.e. to reduce the child’s anxiety and make him accept the planned dental treatment. A trained anesthetist is present throughout the procedure for continuous monitoring of the vital signs of the child. How does ‘conscious sedation’ benefit the child and the doctor? The sedative effects of the drug last for about an hour, sufficient for carrying out routine simple dental procedures like fillings, extractions and root canal treatment in primary teeth, after which the child can be safely discharged. A long-term follow up of such children has shown that anxiety towards dental treatment reduces during subsequent visits and they become more amenable to non-pharmacological behaviour management methods, which instill a positive attitude towards dental treatment in young children lasting a lifetime. *Dr Ashima Goyal, Oral Health Sciences Centre*
	Donate your body, help humanity How would donating your body help humanity? Cadaver dissection is an integral part of the curriculum of medical training. It helps a student to learn topographic localisation of tissues of the body. The surgeons also require it to update their knowledge. The anatomists in most of the medical institutions feel the shortage of cadavers for imparting training to medical students. Hence there is a strong need to popularise the message to common masses to donate their bodies after death which can be preserved by embalming and later teaching and research purposes. What is the procedure for donation? The body after death can be donated to the Department of Anatomy of any medical institution under the Act of 1949, which was enacted to provide for the collection of body to hospitals and medical and teaching institutions for therapeutic purposes or for the purposes of anatomical examination, teaching dissection surgical operations and research work only if death occurs in a state hospital or in public place, within the prescribed zone of a medical institution provided the police has declared after a lapse of 48 hours that there were no claimants for the body and it could be used for medical purposes. Voluntarily also a person can donate his/her body if he/she expresses his/her desire to his/her kin that his body after death may be donated to the Department of Anatomy of any medical institution for teaching and research purposes. A person in his life can express his will in writing and can convince his kin that after death his body may be donated. The body along with the death certificate should be sent within 3-5 hrs to the Department of Anatomy of the PGI, Chandigarh (or to any other medical institute). In case of any difficulty in sending the body, the Anatomy Department will provide vehicle for the same from tricity to the PGI, Chandigarh. If the body is brought during non-working hours, it can be kept in cold chamber in the mortuary of the PGI, which is open 24 hours all days. *Dr Daisy Sawhney, Department of Anatomy*
	The nuclear deal of medicine! What is nuclear medicine? Nuclear medicine is the branch of medical science that involves the use of radioactive isotopes in the investigation and treatment of diseases. This relatively new medical specialty has developed over the past 40 years in India, and now has extensive applications. What is the role of nuclear medicine in diagnosis of diseases? Diagnostic nuclear medicine involves the use of “isotopes” of elements like technetium, iodine, thallium, gallium and indium for imaging. These are unstable forms of matter that emit electromagnetic radiation in the form of gamma rays, which are detected by instruments called “gamma cameras”. Different isotopes are attached to chemicals specially designed to target the specific organs to be imaged, to form “radiopharmaceuticals”, which are then introduced into the body by intravenous or subcutaneous injection, orally (as solid or liquid), or inhaled as a gas or aerosol. Disease processes are identified by a change in the normal distribution pattern of the radiopharmaceutical within the body, displayed as coloured images on computer screens. Radioisotope imaging or “scintigraphy” differs from plain X-rays, ultrasound, CT or MRI. Conventional radiological techniques demonstrate structural changes in organs or tissues resulting from the disease. Scintigraphy detects pathological changes in organ function at an early molecular level. These changes can be quantified to estimate the extent of the disease process and any response to treatment. The radiation dose from these investigations is usually much lower than conventional X-ray/CT imaging techniques, and risk of allergic reactions to iodinated contrast material is avoided. The most common radioisotope investigations in clinical practice are related to kidney function, especially in children. These tests are used to quantitatively estimate kidney function and drainage, identify scars in the kidney and detect urine reflux from the bladder. Bone scans are commonly used to detect spread of cancer in the entire skeleton in a single study. This scan also detects bony infections, stress fractures and metabolic bone disease very early, when plain x-rays may be normal. The stress thallium test is routinely used to identify reversible reduction of blood flow to the heart muscle (ischemia), as compared to permanently scarred heart muscle (infarct). This test may direct treatment procedures to viable heart muscle and avoid unnecessary intervention. Orally administered radiolabeled food and liquid are used to study gastro-intestinal transit and gastroesophageal reflux, while injectable tracers help in the diagnosis of jaundice in newborn babies, biliary obstruction and leakage of bile following trauma or surgery. Intestinal bleeds and unknown sources of infection can also be located with great precision by labeling different blood cells of the body with isotopes. What is PET scan? Positron emission tomography (PET) uses radiolabeled glucose to identify cancerous masses, which are metabolically more active, and use more glucose than normal tissues. The PET scan also uses isotopes of natural constituents of the body, like oxygen, carbon and nitrogen to trace the metabolism of new drugs and pharmaceuticals vital for research purposes. The function of different parts of the brain can also be studied using special radioactive tracers taken up by specific parts of the brain. This forms an essential part of neurological and psychiatric research in addition to patient management. Fusion imaging is a new technique in which a common gantry supports a multi-slice CT scanner with a gamma camera (SPECT-CT) or PET system (PET-CT). The scintigraphic and CT images are digitally fused to provide exquisite anatomical detail with the high functional sensitivity of isotope imaging. Thus, the stage and exact location of a disease process like cancer can be identified. The department of nuclear medicine at PGIMER is equipped with three gamma cameras, including a state-of-the-art hybrid SPECT-CT system. A new PET-CT system and cyclotron will also be operational in the coming months. This will immensely benefit cancer and cardiac patients referred to the PGI from the entire region. What is the role of nuclear medicine in the treatment of diseases? Radioisotopes which emit destructive radiation in the form of beta particles are used for therapeutic purposes, the most common being treatment of thyroid disorders. Radioactive iodine when administered orally destroys functioning thyroid tissue in a controlled manner by irradiating the gland internally. This provides a permanent cure for the disease without surgery, and avoids the side effects associated with anti-thyroid drugs. Thyrotoxicosis is common in northwestern India, and PGI’s nuclear medicine department has used radioiodine therapy to cure a large number of these patients of all age groups. Higher doses of radioiodine are used to treat thyroid cancer even after it has spread to lymph nodes, lungs or bones. A new high-dose radioiodine therapy ward for this purpose is nearing completion in the department, and will greatly benefit patients of this region. Other radioisotopes like radioactive phosphorus, strontium and samarium are used to alleviate severe pain resulting from spread of cancer to the bones, by delivering a high dose of radiation locally to the involved site. *Dr Anish Bhattacharya, Department of Nuclear Medicine*
	Osteoarthritis Lifestyle changes hold the key What is osteoarthritis and what causes it? Osteoarthritis is the most common form of arthritis (joint pain and swelling) and one of the most common indications for joint replacement surgery. It is caused by abnormal wearing of the cartilage that covers the joints; and destruction or decrease of synovial fluid that lubricates those joints. As the bone surfaces become less well protected, the patient experiences pain upon weight bearing, including walking and standing. Some risk factors for primary disease include advancing age, a positive family history of osteoarthritis, previous injury to the joints, obesity with excess weight bearing, and jobs requiring repetitive lifting and standing. How does lifestyle changes help? Lifestyle modification in the osteoarthritis patient is the most important form of therapy. This safe and conservative treatment reduces uneven joint alignment and helps to prevent future progression of degenerative joint disorders. For osteoarthritis of the knee joints, it includes losing weight, switching from running or jumping exercises to swimming, and minimizing activities that aggravate the condition, such as climbing stairs, squatting, using Indian style toilet and sitting on low lying chair. Dr Aman Sharma, Dept of Internal Medicine
	Mobile Phones For mobility or morbidity? There has been a tremendous increase in the use of mobile phones during the last few years. There have been growing concerns about the safety of electromagnetic radiations emitted from mobile phones. The Department of Otolaryngology at the PGI, Chandigarh, conducted a study on 100 long-term mobile users in Chandigarh. The aim was to assess if long-term mobile phone use had any adverse effect on hearing. It was found that people using mobile phones for more than four years and longer than 60 minutes a day are at risk of developing hearing loss at higher frequencies. The hearing loss was more in the ear of use. This may lead to a frank hearing loss in later years. Presence of ear warmth or strange noises in the ear is a warning signal, which should not be ignored. *Dr Naresh Panda, Dept of Otolaryngology*