Jawaharlal Institute of Postgraduate Medical Education & Research

www.jipmer.edu.in
Puducherry, India

The Jawaharlal Institute of Postgraduate Medical Education & Research is a medical school in India, and the oldest to teach European medicine in Asia. It is located at Pondicherry, the capital of the union territory of Puducherry, in southern India. JIPMER is an Indian central government funded institute with autonomy to run its internal administration. JIPMER is both an educational institute that imparts undergraduate and postgraduate medical training and a working hospital that provides inexpensive medical care to a large number of patients. JIPMER is an institute of national importance and a tertiary care referral hospital that is under the direct administrative control of Directorate General of Health Services , Ministry of Health and Family Welfare, Government of India.JIPMER is a residential medical institution with its own campus spread over 195 acres . It has about 200 faculty and 360 resident physicians and over 3,000 nursing, administrative and support staff. Every year it admits 145 undergraduate students and 75 postgraduate students. Wikipedia.

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Vairappan B.,Jawaharlal Institute of Postgraduate Medical Education & Research
World Journal of Hepatology | Year: 2015

This review describes the recent developments in the pathobiology of endothelial dysfunction (ED) in the context of cirrhosis with portal hypertension and defines novel strategies and potential targets for therapy. ED has prognostic implications by predicting unfavourable early hepatic events and mortality in patients with portal hypertension and advanced liver diseases. ED characterised by an impaired bioactivity of nitric oxide (NO) within the hepatic circulation and is mainly due to decreased bioavailability of NO and accelerated degradation of NO with reactive oxygen species. Furthermore, elevated inflammatory markers also inhibit NO synthesis and causes ED in cirrhotic liver. Therefore, improvement of NO availability in the hepatic circulation can be beneficial for the improvement of endothelial dysfunction and associated portal hypertension in patients with cirrhosis. Furthermore, therapeutic agents that are identified in increasing NO bioavailability through improvement of hepatic endothelial nitric oxide synthase (eNOS) activity and reduction in hepatic asymmetric dimethylarginine, an endogenous modulator of eNOS and a key mediator of elevated intrahepatic vascular tone in cirrhosis would be interesting therapeutic approaches in patients with endothelial dysfunction and portal hypertension in advanced liver diseases. © 2015 Baishideng Publishing Group Inc.


Madhugiri V.S.,Jawaharlal Institute of Postgraduate Medical Education & Research
Neurology India | Year: 2015

Context: Scientific publications are a reflection of the quality of the clinical and academic work being carried out in an institute. Training in the process of research and scientific writing are important components of the residency curriculum. Aims: The publication performance and research output of institutes training residents in neurology and neurosurgery were evaluated. Setting and Design: Internet-based study. Methods: This study was based on the data available on the websites of the Medical Council of India and the National Board of Examinations. The PubMed search interface was used to determine the publication output of institutes over the past 5 years (2010-2014). Google Scholar was used to determine the citation performance of each paper. The publication parameters were normalized to the number of faculty members in each institute as listed on the institutional web page. The normalized publication performance for an institute was computed by comparing the figures for that institute with the national average. Results: Institutes could be ranked on several criteria. There was a high degree of clustering of output from the top 5% of the institutes. About 13% of the neurology intake and 30.9% of neurosurgery intake over the past 5 years has been into the institutes that have not published a single paper during this period. Conclusions: This evaluation of the publication performance and research output of neurology and neurosurgery training institutes would serve as a baseline data for future evaluations and comparisons. The absence of any publication and research output from several training institutes is a matter of concern.


Dutta U.,Jawaharlal Institute of Postgraduate Medical Education & Research
Journal of Gastroenterology and Hepatology (Australia) | Year: 2012

Gallbladder cancer (GBC) is the leading cause of cancer related mortality in certain geographic areas. Most of the patients with GBC have advanced disease at presentation, precluding curative resection resulting in a dismal prognosis. However, recent advances in the understanding of its epidemiology and pathogenesis coupled with development of newer diagnostic tools and therapeutic options, has resulted in enhanced optimism towards the management of the disease. The leading risk factors are gallstones, advancing age, female gender, anomalous pancreaticobiliary ductal junction, certain ethnic groups and geographic populations. Advances in radiological imaging and the advent of endoscopic ultrasound have facilitated early detection and accurate staging of the tumor. A high index of suspicion in high risk groups is necessary to pick up incidental and early GBC, as surgical resection is curative. In patients with suspected GBC, an open surgical resection that is appropriate for that stage is advocated. Adjuvant combination chemotherapy and molecular targeted therapy are emerging as effective therapeutic options in those with advanced GBC. Endoscopic palliation of biliary and gastric outlet obstruction with metallic stents has improved their quality of life. Prevention remains the hitherto less explored option to reduce GBC related mortality. Prophylactic cholecystectomy in high risk groups is a cost-effective option. A multi-disciplinary systematic global approach to initiate collaborative ventures to understand epidemiology, standardize management strategies, conduct multi-centric trials with newer therapeutic agents and initiate preventive measures, would pave way for the future conquest of the disease. © 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.


Duseja A.,Jawaharlal Institute of Postgraduate Medical Education & Research
Journal of Clinical and Experimental Hepatology | Year: 2014

Hepatocellular carcinoma (HCC) is different from other malignancies because the prognosis in HCC is not only dependent upon the tumor stage but also on the liver function impairment due to accompanying cirrhosis liver. Various other staging systems used in HCC include the European systems [French staging system, Barcelona Clinic Liver Cancer (BCLC) staging system and the cancer of the liver Italian program (CLIP)] and Asian systems [Okuda staging system, Japan integrated Staging (JIS), Tokyo score and Chinese University Prognostic Index (CUPI)]. Out of all the staging systems used in HCC, Barcelona Clinic Liver Cancer (BCLC) staging system is probably the best because it takes in to account the tumor status (defined by tumor size and number, presence of vascular invasion and extrahepatic spread), liver function (defined either by the Child-Pugh's class) and general health status of the patient (defined by the ECOG classification and the presence of symptoms). Since most of the extrahepatic spread in HCC occurs to lymph nodes, lungs and bones, the assessment can be done with either PET/CT or a combination of CT (Chest and abdomen) and a bone scan. This article describes the various staging systems used in HCC, guides choosing a staging system particularly in the Indian context and the assessment of extra-hepatic spread in HCC. © 2014.


Dhiman R.K.,Jawaharlal Institute of Postgraduate Medical Education & Research
Metabolic Brain Disease | Year: 2013

There is a strong relationship between liver and gut; while the portal venous system receives blood from the gut, and its contents may affect liver functions, liver in turn, affects intestinal functions through bile secretion. There is robust evidence that the pathogenesis of hepatic encephalopathy (HE) is linked to alterations in gut microbiota and their by-products such as ammonia, indoles, oxindoles, endotoxins, etc. In the setting of intestinal barrier and immune dysfunction, these by-products are involved in the pathogenesis of complications of liver cirrhosis including HE and systemic inflammation plays an important role. Prebiotics, probiotics and synbiotics may exhibit efficacy in the treatment of HE by modulating the gut flora. They improve derangement in flora by decreasing the counts of pathogenic bacteria and thus improving the endotoxemia, HE and the liver disease. Current evidence suggest that the trials evaluating the role of probiotics in the treatment of HE are of not high quality and all trials had high risk of bias and high risk of random errors. Therefore, the use of probiotics for patients with HE cannot be currently recommended. Further RCTs are required. This review summarizes the main literature findings about the relationships between gut flora and HE, both in terms of the pathogenesis and the treatment of HE. © 2013 Springer Science+Business Media New York.


Jha V.,Jawaharlal Institute of Postgraduate Medical Education & Research
Nephrology | Year: 2010

Alternative and indigenous systems of medicine are popular amongst the poorer sections of society in the developing world. Their use in the developed world has also increased in recent times. The source and composition of these medicines vary in different parts of the world, but herbs and other botanicals are central to these systems. Largely outside the ambit of regulatory control, herbal remedies are prepared by quasi-trained herbalists and not tested for safety. Toxicity can occur when a herb with unknown toxicity is consumed, incorrect identification leads to substitution of an innocuous herb with a toxic one, preparations are contaminated with toxic non-herbal compounds or when a herb potentiates the nephrotoxic effect of a conventional therapy. Renal injury has been reported in association with several herbs. The best-known herb-induced chronic kidney disease (CKD) is aristolochic acid nephropathy. The condition is characterized by progressive interstitial nephritis, with a proportion of patients developing urothelial malignancies. The toxic compound is aristolochic acid (AA); AA-DNA adducts have been identified in the renal and urothelial tissues. Recent evidence suggests that AA also contributes to the development of Balkan endemic nephropathy. The role of herbs has been postulated in the development of CKD in other parts of the developing world, especially amongst the rural population. Public awareness and regulation of use of herbal medicines are required to eradicate this entity from the community. © 2010 Asian Pacific Society of Nephrology.


Sharma M.,Jawaharlal Institute of Postgraduate Medical Education & Research
Critical Reviews in Biotechnology | Year: 2010

Chemokines are a family of small, structurally related proteins that may participate in immune and inflammatory responses through the chemoattraction and activation of leukocytes. These chemotactic cytokines mediate their effects by binding to the seven transmembrane domain superfamily of receptor proteins. Besides their role in leukocyte trafficking, chemokines and their receptors have been found to be implicated in a number of inflammatory and infectious diseases. Chemokines also appear to have beneficial effects involving tissue repair or tumor progression, angiogenesis, hematopoiesis, and antimicrobial mechanisms. These have recently been found to be involved in coordinating the cellular communication in the central nervous system as well. Based on these findings, chemokines agonists and antagonists targeted against chemokines and their receptors have the potential to become therapeutically important in the treatment of various diseases. This review explores the role of the chemokine system in the pathophysiology of diseases and their potential as targets for therapy. © 2010 Informa UK Ltd.


Agarwal R.,Jawaharlal Institute of Postgraduate Medical Education & Research
Current Allergy and Asthma Reports | Year: 2011

A new phenotype of asthma has been described recently, namely severe asthma with fungal sensitization (SAFS). SAFS can be conceptualized as a continuum of fungal sensitization, with asthma at one end and allergic bronchopulmonary aspergillosis at the other. It is diagnosed by the presence of severe asthma, fungal sensitization, and exclusion of allergic bronchopulmonary aspergillosis. Because of the paucity of data and ambiguity in diagnostic criteria, SAFS is currently more of a diagnosis of exclusion than a specific entity. Treatment of SAFS initially should be similar to that of severe asthma, including the use of omalizumab. The potential role of itraconazole as a specific therapy in SAFS requires more evidence before it can be incorporated in routine practice. An urgent need exists for data regarding the prevalence, natural history, and clinical relevance of SAFS so that its exact characterization and importance as a specific subtype of asthma can be clearly defined. This review summarizes the current understanding of the pathogenesis, diagnosis, and management of SAFS. © Springer Science+Business Media, LLC 2011.


Rajkumar R.P.,Jawaharlal Institute of Postgraduate Medical Education & Research
Journal of Sexual Medicine | Year: 2015

Introduction: Erectile dysfunction (ED) is a common form of male sexual dysfunction. Psychological factors play an important role in the onset and persistence of ED. Disturbed childhood attachment is a biologically and psychologically plausible predisposing factor for psychogenic ED that has not been systematically studied to date. Aim: This study aims to assess the frequency and correlates of events associated with parental separation (actual or threatened) and loss in men with a diagnosis of psychogenic ED. Methods: The case records of 46 men who presented to a clinic for psychosexual disorders in the period 2012-2013, and were diagnosed with psychogenic ED using a semi-structured interview schedule, were reviewed. Results: Events causing actual or potential disturbed attachment (DA) in childhood were reported by 20 of 46 men with psychogenic ED (43.5%). This group of men (DA+) had an earlier age at onset of ED (median 25 vs. 29 years, P=0.005), were more likely to be single (15/20 vs. 5/26 (χ2=14.307, P<0.001), reported sexual performance anxiety more frequently (12/20 vs. 7/26, χ2=5.101, P=0.024), and were more likely to develop ED in the absence of a proximate stressor (4/20 vs. 15/26, P=0.015). They also showed a trend toward being more likely to report guilt over early sexual experiences as a contributory factor (5/20 vs. 1/26, P=0.072). In a binary logistic regression analysis, the presence of performance anxiety (B=2.01, P=0.023) and marital status (B=-2.85, P=0.001) were significantly associated with events causing DA. Conclusions: Disrupted childhood attachment was common in our sample of men with ED and is associated with significant differences in their clinical profile, particularly an earlier onset, a lower likelihood of being married, and higher rates of performance anxiety. This study highlights the need to consider early childhood experiences, particularly using an attachment theory framework, when examining the origins of psychogenic erectile dysfunction. © 2015 International Society for Sexual Medicine.


Agarwal R.,Jawaharlal Institute of Postgraduate Medical Education & Research
Mycopathologia | Year: 2014

Allergic bronchopulmonary aspergillosis (ABPA) is an insidious pulmonary disorder caused by hypersensitivity reactions mounted against Aspergillus fumigatus. Usually, complicating the course of patients with asthma and cystic fibrosis, the affliction has recently been described in chronic obstructive pulmonary disease and pulmonary tuberculosis-related fibrocavitary disease. Patients commonly present with poorly controlled asthma, recurrent pulmonary infiltrates and bronchiectasis. More than six decades have elapsed since the first description of this entity; however, the condition remains poorly understood. The International Society for Human and Animal Mycology has formed a working group to address the deficiencies associated with understanding of this disorder. New criteria have been laid down for diagnosis and staging of the disorder, so as to simplify the identification and management of this condition. This review summarizes the recent advances that have taken place in this condition with special emphasis on the burden and distinct character of ABPA in the Indian subcontinent. © 2014, Springer Science+Business Media Dordrecht.

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