PAHO provides guidance to countries in response to increased chikungunya cases

Cristina Mitchell

15 Feb 2023

USA: Long-term achievement of lower LDL-C levels, down to <20 mg/dL, is associated with a reduced risk of cardiovascular (CV) outcomes and no safety concerns in patients with atherosclerotic cardiovascular disease, according to an analysis of FOURIER-OLE. The study appeared in the journal Circulation on Feb 13 2023.

LDL-C (low-density lipoprotein cholesterol) is a well-known risk factor for atherosclerotic cardiovascular disease. However, there is no information on the optimal achieved LDL-C level concerning safety and efficacy in the long term.

FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk) comprised 27 564 patients with stable atherosclerotic cardiovascular disease. They were randomized to evolocumab or placebo and followed for a median of 2.2 years. In FOURIER-OLE, the open-label extension, 6635 patients transitioned to open-label evolocumab irrespective of initial treatment allocation in the parent trial and were followed for an additional five years.

Prakriti Gaba from Brigham and Women's Hospital and Harvard Medical School in Boston, MA, and colleagues examined the relationship between achieved LDL-C levels, defined as an average of the first two measured LDL-C levels, in FOURIER-OLE (in 6559 patients) and the incidence of subsequent CV and safety outcomes. Sensitivity analyses were also performed to evaluate cardiovascular and safety effects in the whole FOURIER-OLE and FOURIER patient population.

The study led to the following findings:

· In FOURIER-OLE, 40%, 24%, 16%, 12%, and 7% patients achieved LDL-cholesterol levels of 20 to <40, <20, 40 to <55, ≥70, and 55 to <70 mg/dL, respectively.

· The team observed a monotonic relationship between lower achieved LDL-C levels—down to very low levels <20 mg/dL—and a lower risk of the primary efficacy endpoint (composite of myocardial infarction, cardiovascular death, stroke, or hospitalization for unstable angina or coronary revascularization) and the key secondary efficacy endpoint (composite of myocardial infarction, cardiovascular death, or stroke) that persisted after multivariable adjustment.

· No statistically significant associations were found between lower achieved levels of LDL-C and increased risk of the safety outcomes (new or recurrent cancer, serious adverse events, hemorrhagic stroke, cataract-related adverse events, neurocognitive adverse events, new-onset diabetes, muscle-related events, or noncardiovascular death) in the primary analyses.

· Similar findings were seen in the whole FOURIER-OLE and FOURIER cohort up to a maximum follow-up of 8.6 years.

To conclude, long-term achievement of lower LDL-cholesterol levels down to <20 mg/dL was linked with a lower risk of CV outcomes and no notable safety concerns in patients with cardiovascular disease.

Reference:

Gaba P, O'Donoghue ML, Park JG, Wiviott SD, Atar D, Kuder JF, Im K, Murphy SA, De Ferrari GM, Gaciong ZA, Toth K, Gouni-Berthold I, Lopez-Miranda J, Schiele F, Mach F, Flores-Arredondo JH, López JAG, Elliott-Davey M, Wang B, Monsalvo ML, Abbasi S, Giugliano RP, Sabatine MS. Association Between Achieved Low-Density Lipoprotein Cholesterol Levels and Long-Term Cardiovascular and Safety Outcomes: An Analysis of FOURIER-OLE. Circulation. 2023 Feb 13. doi: 10.1161/CIRCULATIONAHA.122.063399. Epub ahead of print. PMID: 36779348.

The neighborhood’s afflictions date to the early 1970s, when industry left and the drug trade took hold. With each new wave of drugs, the situation grows grimmer. Now, with the arrival of xylazine, a veterinary tranquilizer, new complications are burdening an already overtaxed system.

“It’s all hands on deck,” said Dave Malloy, a longtime Philadelphia social worker who does mobile outreach in Kensington and around the city.

Dealers are using xylazine, which is uncontrolled by the federal government and cheap, to cut fentanyl, a synthetic opioid up to 50 times stronger than heroin. The street name for xylazine is “tranq,” and fentanyl cut with xylazine is “tranq dope.” Mixed with the narcotic, xylazine amplifies and extends the high of fentanyl or heroin.

But it also has dire health effects: It leaves users with unhealing necrotic ulcers, because xylazine restricts blood flow through skin tissue. Also, since xylazine is a sedative rather than a narcotic, overdoses of tranq dope do not respond as well to the usual antidote — naloxone — which reverses the effects of only the latter.

Xylazine has been spreading across the country for at least a decade, according to the Drug Enforcement Administration, starting in the Northeast and then moving south and west. Plus, it has proven to be easy for offshore bad actors to manufacture, sell, and ship in large quantities, eventually getting it into the U.S., where it often circulates by express delivery.

First detected in Philadelphia in 2006, xylazine was found in 90% of street opioid samples in the city by 2021. That year, 44% of all unintentional fentanyl-related overdose deaths involved xylazine, city statistics show. Since testing procedures during postmortems vary widely from state to state, no comprehensive data for xylazine-positive overdose deaths nationally exists, according to the DEA.

Here in Kensington, the results are on display. Emaciated users walk the streets with necrotic wounds on their legs, arms, and hands, sometimes reaching the bone.

Efforts to treat these ulcers are complicated by the narrowing of blood vessels that xylazine causes as well as dehydration and the unhygienic living conditions that many users experience while living homeless, said Silvana Mazzella, associate executive officer of the public health nonprofit Prevention Point Philadelphia, a group that provides services known as harm reduction.

Stephanie Klipp, a nurse who does wound care and is active in harm reduction efforts in Kensington, said she has seen people “literally living with what’s left of their limbs — with what obviously should be amputated.”

Fatal overdoses are rising because of xylazine’s resistance to naloxone. When breathing is suppressed by a sedative, the treatment is CPR and transfer to a hospital to be put on a ventilator. “We have to keep people alive long enough to treat them, and that looks different every day here,” Klipp said.

If a patient reaches the hospital, the focus becomes managing acute withdrawal from tranq dope, which is dicey. Little to no research exists on how xylazine acts in humans.

Melanie Beddis lived with her addiction on and off the streets in Kensington for about five years. She remembers the cycle of detoxing from heroin cold turkey. It was awful, but usually, after about three days of aches, chills, and vomiting, she could “hold down food and possibly sleep.” Tranq dope upped that ante, said Beddis, now director of programs for Savage Sisters Recovery, which offers housing, outreach, and harm reduction in Kensington.

She recalled that when she tried to kick this mix in jail, she couldn’t eat or sleep for about three weeks.

There is no clear formula for what works to aid detoxing from opiates mixed with xylazine.

“We do need a recipe that’s effective,” said Dr. Jeanmarie Perrone, founding director of the Penn Medicine Center for Addiction Medicine and Policy.

Perrone said she treats opioid withdrawal first, and then, if a patient is still uncomfortable, she often uses clonidine, a blood pressure medication that also lessens anxiety. Other doctors have tried gabapentin, an anticonvulsant medication sometimes used for anxiety.

Methadone, a medication for opioid use disorder, which blunts the effects of opioids and can be used for pain management, seems to help people in tranq dope withdrawal, too.

In the hospital, after stabilizing a patient, caring for xylazine wounds may take priority. This can range from cleaning, or debridement, to antibiotic treatment — sometimes intravenously for periods as long as weeks — to amputation.

Philadelphia recently announced it is launching mobile wound care as part of its spending plan for opioid settlement funds, hopeful that this will help the xylazine problem.

The best wound care that specialists on the street can do is clean and bandage ulcers, provide supplies, advise people not to inject into wounds, and recommend treatment in medical settings, said Klipp. But many people are lost in the cycle of addiction and don’t follow through.

While heroin has a six- to eight-hour window before the user needs another hit, tranq dope wanes in just three or four, Malloy estimated. “It’s the main driver why people don’t get the proper medical care,” he said. “They can’t sit long enough in the ER.”

Also, while the resulting ulcers are typically severely painful, doctors are reluctant to give users strong pain meds. “A lot of docs see that as med-seeking rather than what people are going through,” Beddis said.

In the meantime, Jerry Daley, executive director of the local chapter of a grant program run by the Office of National Drug Control Policy, said health officials and law enforcement need to start cracking down on the xylazine supply chain and driving home the message that rogue companies that make xylazine are “literally profiting off of people’s life and limb.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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This story can be republished for free (details).

The post Choosing to prioritize pleasure and play is a form of taking your power back and realigning with your inner child first appeared on Toronto Caribbean Newspaper.

PAHO launches campaign to raise awareness of childhood cancer in Latin America and the Caribbean

Cristina Mitchell

14 Feb 2023

The Covid-19 pandemic primed the evolution of healthcare business models by channelizing novel digital concepts and strategies. Indian Immunologicals Limited (IIL) the Hyderabad-based subsidiary of the National Dairy Development Board (NDDB) has been at the forefront of business process innovation. Propelling the digital ecosystem, IIL, through its division Human Biologicals Institute, launched its first set of virtual medical representatives, a pioneering alternative to facilitate physician's interface in form of eMOz i.e. A virtual realm where e-reps can connect with doctors and foster digital relationships.

Traditional sales models in the pharma industry have been primarily indexed on engagement between sales representatives and physicians which has led to volume-based formulae, more sales representatives equal more visits to doctors, assuming incremental business. However, long have the industry embraced the challenge that the average time spent by physicians with a sales rep has seen a drastic downturn owing to various intersecting factors. The COVID-19 pandemic caused further restrictions that significantly curtailed reps' access to physicians.eMOZ is a cutting-edge and promising tool for information sharing. eMOz has inbuilt capabilities to provide constant updates on the specific needs of the physicians, thus fostering meaningful, tangible, and enduring gains. eMOz will enable complete stakeholder management on a virtual platform by providing detailed access to products and services. This will reduce several entry barriers while enhancing cost efficiency. eMOz will eventually be acquiring AI avatars of sales representatives to interact and assist physicians in one of its kind experiences. eMOz will provide credible solutions digitally for better patient care by offering greater convenience to physicians and saving their precious time.Speaking on the launch of eMOz, Dr K. Anand Kumar, Managing Director of IIL said "This generation of healthcare professionals are quite open for digital channels of communication, and we envision providing an engaging digital experience to our customers while focussing foremost on covering untapped markets".On the ground level, unveiling eMOz has witnessed significant interest from doctors. Dr Santosh Kumar Mishra, Senior Obstetric & Gynaecologist from Sanjita Maternity Care & Hospital, Bhubaneswar (Odisha) who interacted through eMOz and placed an order as well, said "There has been a huge emergence of various digital channels in our life post-pandemic, experiencing something like eMOz from Indian Immunologicals Limited is unique & interesting. It is more convenient than some of the usual drop-in interactions."While in-person rep visits still hold value, eMOz avatars will accentuate digital value perception among all stakeholders", Vice President, Human Health business, Shakul Srivastava said.

Researchers at Columbia University’s Irving Medical Center have developed a method to create three-dimensional bioengineered skin grafts. To date, bioengineered skin is typically created in flat sheets. However, these are difficult to fit to complex anatomy, such as the hand, and so these researchers have designed a more sophisticated technique that combines laser scanning, 3D printing, and cell culture to create seamless three dimensional skin grafts. For instance, the researchers have already created a skin “glove” that could be useful in replacing skin on the hands by simply slipping it over the hand (just like a glove).

Replacing skin that has been damaged is a challenge. Traditional skin grafts require skin to be harvested elsewhere before application to the damaged area, which obviously isn’t ideal. Researchers have been developing bioengineered skin by combining human cells with biomaterials, but so far these constructs tended to be simple sheets which are not easy to cut and firmly affix to our undulating anatomy.

To address this, the Columbia researchers have developed a technique that can create three dimensional constructs that more closely resemble clothing that can simply be pulled on over damaged tissue. Aside from ease of application, the method requires the constructs to be designed for each situation, enabling personalized constructs that are perfectly tailored for each patient.  

“Three-dimensional skin constructs that can be transplanted as ‘biological clothing’ would have many advantages,” said Hasan Erbil Abaci, a researcher involved in the study. “They would dramatically minimize the need for suturing, reduce the length of surgeries, and improve aesthetic outcomes.”

The approach involves laser scanning the area of the body onto which the graft will be applied – for instance, a burn injury that has damaged most of the skin on the hand. In this case, the patient’s hand would be scanned and then the researchers can use computer-aided design to create a template for a hollow glove-like construct. The next step involves 3D printing a biomaterial substrate in the required shape and then seeding it with connective tissue proteins, such as collagen, and skin fibroblasts that can secrete connective tissue components. The researchers then seed keratinocytes on the outside of the graft to form an epidermis layer.

After a culture period, the graft can be slipped onto the injured hand just like a glove. “We hypothesized that a 3D fully enclosed shape would more closely mimic our natural skin and be stronger mechanically, and that’s what we found,” said Abaci. “Simply remaining faithful to the continuous geometry of human skin significantly improves the composition, structure, and strength of the graft.”

Study in journal Science Advances: Engineering edgeless human skin with enhanced biomechanical properties

Via: Columbia University Irving Medical Center

DM Medical Gastroenterology or Doctorate of Medicine in Medical
Gastroenterology also known as DM in Medical Gastroenterology is a super
specialty level course for doctors in India that is done by them after
completion of their postgraduate medical degree course. The duration of this
super specialty course is 3 years, and it deals with the diagnosis and treatment of human digestive system-related diseases and problems.

The course is a full-time course pursued at various recognized medical
colleges across the country. Some of the top medical colleges offering this
course include All India Institute of Medical Sciences, New Delhi, Jawaharlal
Institute of Postgraduate Medical Education & Research, Puducherry
(JIPMER), Postgraduate Institute of Medical Education & Research,
Chandigarh and more.

Admission to this course is done through the NEET-SS Entrance exam
conducted by the National Board of Examinations, followed by counselling based
on the scores of the exam that is conducted by DGHS/MCC/State Authorities.

The fee for pursuing DM (Medical Gastroenterology) varies from college
to college and may range from Rs. 10000 to Rs. 20 lakhs per year.

After completion of their respective course, doctors can either join the
job market or can pursue certificate courses and Fellowship programmes
recognized by NMC and NBE. Candidates can take reputed jobs at positions as
Senior residents, Consultants, etc. with an approximate salary range of Rs.6 lakhs to Rs. 60 lakhs per year depending upon their expertise.

What is DM in Medical Gastroenterology?

Doctorate of Medicine in Medical Gastroenterology, also known as DM (Medical
Gastroenterology) or DM in (Medical Gastroenterology) is a three-year super
speciality programme that candidates can pursue after completing the post-graduate
degree.

Medical Gastroenterology is the branch of medical science dealing with the diagnosis and treatment of human digestive system-related diseases and
problems.

Gastroenterology is the study of the normal function and diseases of the
oesophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder,
bile ducts and liver.

The postgraduate students must gain ample knowledge and experience in
the diagnosis, and treatment of patients with acute, serious, and life-threatening
medical and surgical diseases.

PG education intends to create specialists who can contribute to
high-quality health care and advances in science through research and training.

The required training done by a postgraduate specialist in the field of Medical
Gastroenterology would help the specialist to recognize the health needs of the
community. The student should be competent to handle medical problems
effectively and should be aware of the recent advances in their speciality.

The candidate is also expected to know the principles of research
methodology and modes of the consulting library. The candidate should regularly
attend conferences, workshops and CMEs to upgrade her/ his knowledge.

Course Highlights

Here are some of the course highlights of DM in Medical Gastroenterology

Name of Course

DM in Medical
Gastroenterology

Level

Doctorate

Duration of Course

Three years

Course Mode

Full Time

Minimum Academic
Requirement

Candidates must have a postgraduate medical Degree in MD/DNB
(General Medicine) obtained from any college/university
recognized by the Medical Council of India (Now NMC)/NBE, this feeder
qualification mentioned here is as of 2022. For any further changes to the
prerequisite requirement please refer to the NBE website

Admission Process /
Entrance Process / Entrance Modalities

Entrance Exam
(NEET-SS)

INI CET for various
AIIMS, PGIMER Chandigarh, JIPMER Puducherry, NIMHANS Bengaluru

Counselling by
DGHS/MCC/State Authorities

Course Fees

Rs.10,000 to
Rs. 20 lakhs per year

Average Salary

Rs.6 lakhs to Rs. 60
lakhs per year

Eligibility Criteria

The eligibility criteria for DM in Medical Gastroenterology are defined
as the set of rules or minimum prerequisites that aspirants must meet in order
to be eligible for admission, which include:

Name of DM course

Course Type

Prior Eligibility Requirement

Medical
Gastroenterology

DM

MD/DNB (General Medicine)

Note:

· The feeder qualification for DM in Medical
Gastroenterology is defined by the NBE and is subject to
changes by the NBE.

· The feeder qualification mentioned here is as of
2022.

· For any changes, please refer to the NBE website.

· The candidate must have obtained permanent
registration of any State Medical Council to be eligible for admission.

· The medical college's recognition cut-off dates for
the Postgraduate Degree courses shall be as prescribed by the Medical Council
of India (now NMC).

Admission Process

• The admission process
  contains a few steps to be followed in order by the candidates for
  admission to DM in Medical Gastroenterology. Candidates can view the
  complete admission process for DM in Medical Gastroenterology mentioned
  below:

• The NEET-SS or National
  Eligibility Entrance Test for Super speciality courses is a national-level
  master's level examination conducted by the NBE for admission to
  DM/MCh/DrNB Courses.

• Qualifying
  Criteria-Candidates placed at the 50th percentile or above shall be
  declared as qualified in the NEET-SS in their respective speciality.

• The following Medical
  institutions are not covered under centralized admissions for DM/ MCh
  courses through NEET-SS:

1. AIIMS,
   New Delhi and other AIIMS
2. PGIMER,
   Chandigarh
3. JIPMER,
   Puducherry
4. NIMHANS,
   Bengaluru

• Candidates from all eligible
  feeder speciality subjects shall be required to appear in the question
  paper of the respective group if they are willing to opt for a super
  speciality course in any of the super speciality courses covered in that
  group.

• A candidate can opt for
  appearing in the question papers of as many groups for which his/her
  Postgraduate speciality qualification is an eligible feeder qualification.

• By appearing in the question
  paper of a group and on qualifying for the examination, a candidate shall be
  eligible to exercise his/her choices in the counselling only for those super speciality subjects covered in the said group for which his/ her broad
  speciality is an eligible feeder qualification.

Fees Structure

The fee structure for DM in Medical Gastroenterology varies from college
to college. The fee is generally less for Government Institutes and more for
private institutes. The average fee structure for DM in Medical
Gastroenterology is around Rs. 10,000 to Rs. 20 lakhs per year.

Colleges offering DM in Medical Gastroenterology

There are various medical colleges across India that offer courses for
pursuing DM in (Medical Gastroenterology).

As per National Medical Commission (NMC) website, the following medical
colleges are offering DM in (Medical Gastroenterology) courses for the academic
year 2022-23.

Sl.No.

Course Name

State

Name and Address of
Medical College / Medical Institution

Management of College

1

DM - Medical Gastroenterology

Andhra Pradesh

Andhra Medical College, Visakhapatnam

Govt.

2

DM - Medical Gastroenterology

Andhra Pradesh

Guntur Medical College, Guntur

Govt.

3

DM - Medical Gastroenterology

Andhra Pradesh

Kurnool Medical College, Kurnool

Govt.

4

DM - Medical Gastroenterology

Andhra Pradesh

Narayana Medical College, Nellore

Trust

5

DM - Medical Gastroenterology

Assam

Gauhati Medical College, Guwahati

Govt.

6

DM - Medical Gastroenterology

Bihar

All India Institute of Medical Sciences, Patna

Govt.

7

DM - Medical Gastroenterology

Bihar

Indira Gandhi Institute of Medical
Sciences,Sheikhpura, Patna

Govt.

8

DM - Medical Gastroenterology

Chandigarh

Postgraduate Institute of Medical Education &
Research, Chandigarh

Govt.

9

DM - Medical Gastroenterology

Delhi

All India Institute of Medical Sciences, New
Delhi

Govt.

10

DM - Medical Gastroenterology

Delhi

G.B. Pant Institute of Postgraduate Medical
Education and Research, New Delhi

Govt.

11

DM - Medical Gastroenterology

Gujarat

Smt. N.H.L.Municipal Medical College, Ahmedabad

Govt.

12

DM - Medical Gastroenterology

Haryana

Maharishi Markandeshwar Institute Of Medical
Sciences & Research, Mullana, Ambala

Trust

13

DM - Medical Gastroenterology

Himachal Pradesh

Indira Gandhi Medical College, Shimla

Govt.

14

DM - Medical Gastroenterology

Jammu & Kashmir

Sher-I-Kashmir Instt. Of Medical Sciences,
Srinagar

Govt.

15

DM - Medical Gastroenterology

Karnataka

Jawaharlal Nehru Medical College, Belgaum

Trust

16

DM - Medical Gastroenterology

Karnataka

JSS Medical College, Mysore

Trust

17

DM - Medical Gastroenterology

Karnataka

M S Ramaiah Medical College, Bangalore

Trust

18

DM - Medical Gastroenterology

Karnataka

St. Johns Medical College, Bangalore

Trust

19

DM - Medical Gastroenterology

Karnataka

Kasturba Medical College, Manipal

Trust

20

DM - Medical Gastroenterology

Karnataka

Vydehi Institute Of Medical Sciences &
Research Centre, Bangalore

Trust

21

DM - Medical Gastroenterology

Kerala

Government Medical College, Kozhikode, Calicut

Govt.

22

DM - Medical Gastroenterology

Kerala

Medical College, Thiruvananthapuram

Govt.

23

DM - Medical Gastroenterology

Kerala

Government Medical College, Kottayam

Govt.

24

DM - Medical Gastroenterology

Kerala

Amrita School of Medicine, Elamkara, Kochi

Trust

25

DM - Medical Gastroenterology

Madhya Pradesh

Sri Aurobindo Medical College and Post Graduate
Institute, Indore

Trust

26

DM - Medical Gastroenterology

Maharashtra

Lokmanya Tilak Municipal Medical College, Sion,
Mumbai

Govt.

27

DM - Medical Gastroenterology

Maharashtra

Topiwala National Medical College, Mumbai

Govt.

28

DM - Medical Gastroenterology

Maharashtra

Seth GS Medical College, and KEM Hospital, Mumbai

Govt.

29

DM - Medical Gastroenterology

Maharashtra

Jawaharlal Nehru Medical College, Sawangi
(Meghe), Wardha

Trust

30

DM - Medical Gastroenterology

Maharashtra

Bharati Vidyapeeth University Medical College,
Pune

Trust

31

DM - Medical Gastroenterology

Maharashtra

Government Medical College, Nagpur

Govt.

32

DM - Medical Gastroenterology

Maharashtra

Tata Memorial Centre, Mumbai

Govt.

33

DM - Medical Gastroenterology

Orissa

All India Institute of Medical Sciences,
Bhubaneswar

Govt.

34

DM - Medical Gastroenterology

Orissa

Kalinga Institute of Medical Sciences,
Bhubaneswar

Trust

35

DM - Medical Gastroenterology

Orissa

Instt. Of Medical Sciences & SUM Hospital,
Bhubaneswar

Trust

36

DM - Medical Gastroenterology

Orissa

SCB Medical College, Cuttack

Govt.

37

DM - Medical Gastroenterology

Pondicherry

Jawaharlal Institute of Postgraduate Medical
Education & Research, Puducherry

Govt.

38

DM - Medical Gastroenterology

Punjab

Dayanand Medical College & Hospital, Ludhiana

Trust

39

DM - Medical Gastroenterology

Rajasthan

SMS Medical College, Jaipur

Govt.

40

DM - Medical Gastroenterology

Rajasthan

Jawaharlal Nehru Medical College, Ajmer

Govt.

41

DM - Medical Gastroenterology

Rajasthan

Mahatma Gandhi Medical College and Hospital,
Sitapur, Jaipur

Trust

42

DM - Medical Gastroenterology

Rajasthan

National Institute of Medical Science &
Research, Jaipur

Trust

43

DM - Medical Gastroenterology

Rajasthan

Mahatma Gandhi Medical College and Hospital,
Sitapur, Jaipur

Trust

44

DM - Medical Gastroenterology

Rajasthan

Dr SN Medical College, Jodhpur

Govt.

45

DM - Medical Gastroenterology

Tamil Nadu

Kilpauk Medical College, Chennai

Govt.

46

DM - Medical Gastroenterology

Tamil Nadu

Christian Medical College, Vellore

Trust

47

DM - Medical Gastroenterology

Tamil Nadu

Sri Ramachandra Medical College & Research
Institute, Chennai

Trust

48

DM - Medical Gastroenterology

Tamil Nadu

Madras Medical College, Chennai

Govt.

49

DM - Medical Gastroenterology

Tamil Nadu

Chettinad Hospital & Research Institute,
Kanchipuram

Trust

50

DM - Medical Gastroenterology

Tamil Nadu

Stanley Medical College, Chennai

Govt.

51

DM - Medical Gastroenterology

Tamil Nadu

Govt. Mohan Kumaramangalam Medical College,
Salem- 30

Govt.

52

DM - Medical Gastroenterology

Tamil Nadu

Thoothukudi Medical College, Thoothukudi

Govt.

53

DM - Medical Gastroenterology

Tamil Nadu

Tirunelveli Medical College,Tirunelveli

Govt.

54

DM - Medical Gastroenterology

Tamil Nadu

Madurai Medical College, Madurai

Govt.

55

DM - Medical Gastroenterology

Tamil Nadu

Coimbatore Medical College, Coimbatore

Govt.

56

DM - Medical Gastroenterology

Tamil Nadu

Meenakshi Medical College and Research Institute,
Enathur

Trust

57

DM - Medical Gastroenterology

Tamil Nadu

PSG Institute of Medical Sciences, Coimbatore

Trust

58

DM - Medical Gastroenterology

Telangana

Gandhi Medical College, Secunderabad

Govt.

59

DM - Medical Gastroenterology

Telangana

Osmania Medical College, Hyderabad

Govt.

60

DM - Medical Gastroenterology

Uttarakhand

All India Institute of Medical Sciences,
Rishikesh

Govt.

61

DM - Medical Gastroenterology

Uttar Pradesh

Sanjay Gandhi Postgraduate Institute of Medical
Sciences, Lucknow

Govt.

62

DM - Medical Gastroenterology

Uttar Pradesh

Institute of Medical Sciences, BHU, Varanasi

Govt.

63

DM - Medical Gastroenterology

Uttar Pradesh

King George Medical University, Lucknow

Govt.

64

DM - Medical Gastroenterology

Uttar Pradesh

Moti Lal Nehru Medical College, Allahabad

Govt.

65

DM - Medical Gastroenterology

West Bengal

Institute of Postgraduate Medical Education &
Research, Kolkata

Govt.

66

DM - Medical Gastroenterology

West Bengal

Govt. Medical College, Kolkata

Govt.

67

DM - Medical Gastroenterology

West Bengal

RG Kar Medical College, Kolkata

Govt.

Syllabus

DM in Medical Gastroenterology is a three years specialization course
that provides training in the stream of Medical Gastroenterology.

NMC till date as of (12/02/2023) has not defined a Competency-based
curriculum for DM Medical Gastroenterology. The syllabus of AIIMS below
provides a basic outline of what a DM Medical Gastroenterology
candidate has to undergo while training:

At this level of training, the insistence on a syllabus may not be
appropriate. Trainees should acquire an overall knowledge of Gastroenterology
by reading standard textbooks, monographs and peer-reviewed journals dealing
with Gastroenterology, Hepatology, Pancreatology and related Basic Sciences and
Epidemiology. A core syllabus is given below, but it does not purport to be either
comprehensive or restrictive. Furthermore, it is likely to change from time to
time.

Recommended Core Syllabus:

Basic Sciences

1. Immune system of the gastrointestinal tract (GIT) and its importance
in various GI disorders

2. Molecular biology in relation to GIT

3. Genetic diseases of the GIT and the liver

4. Gene therapy

5. GI tumours and tumour biology

6. Gastrointestinal hormones in health and diseases

7. Embryology of the gut, liver, pancreas and congenital anomalies

Miscellaneous

1. Upper and lower gastrointestinal bleeding

2. Gastrointestinal tuberculosis

3. HIV and the GIT, hepatobiliary and pancreatic systems

4. GIT and liver in systemic diseases

5. Cutaneous manifestations of GI diseases

6. Vascular diseases of the GIT

7. Gastrointestinal side effects of drugs especially NSAIDs

8. Gastro-intestinal symptoms physiology and interpretation

Nausea, vomiting

Pain abdomen

Diarrhoea

Constipation

Dysphagia

Jaundice

Esophagus

1. Basic anatomy, histology and physiology

2. Congenital anomalies

3. Motility of the oesophagus and motor disorders

4. Mechanism of deglutition and dysphasia

5. Approach to a patient with dysphasia

6. Gastro-esophageal reflux disease

7. Tumors of the oesophagus

8. Esophageal webs, membranes and diverticulum

9. Management of benign and malignant oesophagal strictures

10. Esophagus and systemic diseases

11. Infectious diseases of the oesophagus

12. Foreign bodies in the oesophagus and stomach

13. Esophageal perforation

14. Drug-induced esophagitis

Stomach

1. Anatomy, histology, functions

2. Physiology of acid and bicarbonate secretion in health and diseases

3. Defence mechanisms against acid and pepsin

4. Gastroduodenal motor function in health and diseases.

5. Gastritis (nonspecific and specific)

6. Helicobacter pylori infection

7. Peptic ulcer

8. Dyspepsia

9. Stress and stomach

10. Gastric hypersecretory states including Zollinger-Ellison syndrome

11. Ulcer complications and their management

12. Surgery for peptic ulcer

13. Post-gastrectomy complication

14. Bezoars

15. Tumors of the stomach

16. Diverticuli and hernia of the stomach

Small Intestine

1. Anatomy, blood supply, histology

2. Motility of the small intestine

3. Congenital anomalies

4. Normal absorption of the nutrients

5. Intestinal electrolyte absorption and secretion

6. Malabsorption syndromes

Pathophysiology, manifestations and approach

7. Celiac sprue

8. Infection-related diseases

a. Intestinal microflora in health and diseases

b. Tropical sprue

c. Whipple’s disease. Infectious diarrhoea and food poisoning

e. Parasitic diseases

9. Small intestinal ulcers

10. Short bowel syndrome and intestinal transplantation.

11. Eosinophilic gastroenteritis

12. Food allergies

13. Intestinal obstruction and pseudo-obstruction

14. Short bowel syndrome

15. Acute appendicitis

16. Malrotation of the gut

17. Bezoars

18. Management of diarrhoea

19. GI lymphomas

20. Small intestinal tumours

21. Small intestinal transplantation

Colon

1. Basic anatomy blood supply, histology and functions

2. Motility of the colon and disorders of motility

3. Congenital anomalies

4. Megacolon

5. Constipation

6. Colonic pseudo-obstruction

7. Fecal incontinence

8. Antibiotic-associated diarrhoea

9. Inflammatory bowel disease

a. Ulcerative colitis

b. Crohn’s disease

c. Indeterminate colitis

d. Ileostomies and its management

10. Diverticular disease of the colon

11. Radiation entero-colitis

12. Colonic polyps and polyposis syndromes

13. Malignant diseases of the colon

14. Other inflammatory diseases of the colon including

a. Solitary rectal ulcer syndrome

b. Diversion colitis

c. Collagenous and microscopic colitis

d. Non-specific ulcerations of the colon

e. Malakoplakia

f. Pneumatoses cystoids intestinalis

15. Hemorrhoids

16. Diseases of the anorectum

Pancreas

1. Anatomy, physiology, blood supply, developmental anomalies

2. Physiology of the pancreatic secretion

3. Pancreatic function tests

4. Acute pancreatitis

5. Recurrent acute pancreatitis

6. Chronic pancreatitis

7. Malignancies of the pancreas(Exocrine and endocrine)

8. Cystic fibrosis and other childhood disorders of the pancreas

9. Hereditary pancreatitis

10. Pancreatic transplantation

Biliary Tree

1. Anatomy, Physiology

2. Physiology of bile formation and excretion

3. Enterohepatic circulation

4. Bilirubin metabolism.

5. Approach to patients with jaundice

6. Gallstones, their complications, and management

7. Acute acalculous cholecystitis

8. Miscellaneous disorders of the gallbladder

9. Acute cholangitis

10. Benign biliary structure

11. Benign and malignant neoplasms of the biliary system.

12. Endoscopic management of biliary obstruction.

13. Motility and dysmotility of the biliary system and sphincter of Oddi
dysfunction

14. Congenital diseases of the biliary systems Liver

1. Anatomy, physiology, blood supply

2. Functions of the liver

3. Microcirculation of liver

4. Liver function tests

5. Portal hypertension

i. Extrahepatic portosplenic vein obstruction

ii. Non-cirrhotic portal fibrosis

iii. Cirrhosis

6. Acute viral hepatitis

7. Chronic hepatitis

8. Fulminant hepatic failure

9. Subacute hepatic failure

10. Cirrhosis of the liver

11. Ascites

12. Hepatorenal syndrome

13. Autoimmune liver disease

14. Metabolic liver disease

15. Sclerosing cholangitis- primary and secondary

16. Primary biliary cirrhosis

17. Hepatic venous outflow tract obstruction

18. Fibrocystic diseases of the liver

19. Wilson’s disease

20. Hemochromatosis

21. Liver in porphyria

22. Hepatic tumours

23. Infections of the liver

24. Liver in pregnancy

25. Liver in congestive heart failure

26. Liver biopsy

27. Liver transplantation and artificial liver support

Peritorium and Retroperitoneum

1. Ascites

2. Chronic peritonitis

3. Budd-Chiari syndrome

4. Malignant ascites

5. Diseases of the retroperitoneum Nutrition

1. Normal nutritional requirements

2. Assessment of nutritional status

3. Protein-energy malnutrition

4. Manifestations and management of nutritional deficiency and excess

5. Nutritional support in various GI disorders (malabsorption, acute and
chronic pancreatitis, inflammatory bowel disease)

Vascular Diseases of the GI Tract

GI Radiology

Reading and interpreting the common x-ray films including

X-ray films of the abdomen Barium studies, ultrasound
examination CT scans, MR scans and
angiography and ERCP films

GI Pathology

Reading and interpreting histological slides of common gastrointestinal
and liver diseases.

Endoscopic Training

Endoscopic training is an integral part of training in the super speciality
of gastroenterology. A trainee is supposed to have knowledge of instruments and
their application.

i. Endoscopes

ii. Accessories

iii. Sterilization of endoscopes and accessories

iv. Electrosurgical instrument

v. Keeping of endoscopes and accessories

Career Options

After completing a DM in Medical Gastroenterology, candidates will get
employment opportunities in Government as well as in the Private sector.

In the Government sector, candidates have various options to choose from
which include Registrar, Senior Resident, Demonstrator, Tutor, etc.

While in the Private sector, the options include Resident Doctor,
Consultant, Visiting Consultant (Medical Gastroenterology), Junior Consultant,
Senior Consultant (Medical Gastroenterology), and Medical Gastroenterology Specialist.

Courses After DM in Medical Gastroenterology Course

DM in Medical Gastroenterology is a specialization course that can be
pursued after finishing a Postgraduate medical course. After pursuing
specialization in DM in Medical Gastroenterology, a candidate could also pursue
certificate courses and Fellowship programmes recognized by NMC and NBE, where DM
in Medical Gastroenterology is a feeder qualification.

Frequently Asked Questions (FAQs) –DM in Medical Gastroenterology Course

• Question: What is the full form of DM?

            Answer: The full form
of DM is a Doctorate of Medicine.

• Question: What is a DM in Medical Gastroenterology?

            Answer: DM Medical
Gastroenterology or Doctorate of Medicine in Medical Gastroenterology also
known as DM in Medical Gastroenterology is a super specialty level course             for
doctors in India that is done by them after completion of their postgraduate
medical degree course.

•  Question: What is the duration of a DM in Medical Gastroenterology?

            Answer: DM in Medical
Gastroenterology is a super-speciality programme of three years.

• Question: What is the eligibility of a DM in Medical Gastroenterology?

            Answer: The
candidate must have a postgraduate medical Degree in MD/DNB (General Medicine)
obtained from any college/university recognized by the Medical Council of              India
(Now NMC)/NBE, this feeder qualification mentioned here is as of 2022. For any further
changes to the prerequisite requirement please refer to the NBE website.

• Question: What is the scope of a DM in Medical Gastroenterology?

            Answer: DM in Medical
Gastroenterology offers candidates various employment opportunities and career
prospects.

• Question: What is the average salary for a DM in Medical
  Gastroenterology candidate?

            Answer: The DM in Medical
Gastroenterology candidate's average salary is between Rs. 6 lakhs to Rs. 60
lakhs per year depending on the experience.

• Question: Can you teach after completing DM Course?

           Answer: Yes, the candidate
can teach in a medical college/hospital after completing the DM course.