Avinash Supe

King Edward Memorial Hospital | KEM Hospital · Surgical Gastroenterology

Successful and effective management of gastric cancer involves a multidisciplinary approach. Accurate and appropriate staging of gastric cancer is mandatory to define the optimum treatment strategy. Safe surgery achieving R0 re-section is considered potentially curative. Surgery remains the cornerstone of multimodal therapy. There is a well-defined...

Pancreatic cystic neoplasms present a complex diagnostic scenario encompassing low-and high-grade malignancies. Their prevalence varies widely, notably increasing with age, reaching 75% in individuals older than 80 years. Accurate diagnosis is crucial, as errors occur in approximately one-third of resected cysts discovered incidentally. Various ima...

Acute calculous cholecystitis is one of the most common surgical entities seen in practice and laparoscopic cholecystectomy is the gold standard surgical procedure for its treatment. According to the Tokyo guidelines , Grade 3 cases present with organ dysfunction and hence Percutaneous cholecystostomy (PCT) has been recommended as a bridge to surge...

Successful and effective management of gastric cancer involves a multidisciplinary approach. Accurate and appropriate staging of gastric cancer is mandatory to define the optimum treatment strategy. Safe surgery achieving R0 resection is considered potentially curative. Surgery remains the cornerstone of multimodal therapy. There is a well-defined...

The Foundation for Advancement of International Medical Education and Research (FAIMER), a member of Intealth, offers longitudinal faculty development programs (LFDPs) in health professions education (HPE) and leadership through its International FAIMER Institute (IFI) in the United States and FAIMER Regional Institutes (FRIs) globally. FAIMER fost...

Introduction: Health professions education is fast transforming due to the implementation of competency-based curriculum, the far-reaching effects of the COVID pandemic, and the wider use of newer methods and technology. Objective: To review the research priority in health professional education. Methods: An opinion from health professional educato...

pandalai oration

The new competency-based curriculum recognized the importance of leadership skills in physicians and has outlined competencies that would lead to attaining this goal. To prepare the Indian medical graduates as effective healthcare leader, there is no universal approach; it is desirable that the institutes organize the leadership competencies into a...

Review of book Humanities in Medical Education by Mahajan R and Singh T

A primary pancreatic-isolated hydatid cyst, that too in tail of pancreas with no lesion in liver, is a rare presentation of this disease. We report a case of 30-year-old lady presenting with only abdominal pain and on imaging found to be a cystic lesion in tail of pancreas without any liver lesion. Contrast-enhanced computed tomography scan is help...

In view of the coronavirus pandemic, there is a thrust on online teaching and assessment. This module released by the National Medical Commission serves as a guide to faculty to conduct training and assessment online under these circumstances. The module can be accessed from the NMC website: https://www.nmc.org.in/wp-content/uploads/2020/11/Modul...

Health profession educators need to assume various leadership roles throughout their professional life. These leadership roles may vary according to the future scenario of classrooms, clinical units, departments, medical colleges, or universities. In the existing undergraduate and postgraduate curricula, there is very little sensitization about pla...

Newer surgical interventions have been planned and conducted over last few decades, but many of these novel surgical interventions have not been properly assessed before they were introduced clinically. Indian Council for Medical Research, Ethical Guidelines 2017, have specifically mentioned regarding surgical interventions and have emphasized prop...

Background: Through Corporate Social Responsibility (CSR), a company achieves a balance of economic, environmental and social objectives and is also mandated by Indian law. CSR can help in strengthening healthcare in public hospitals catering to the needy population. Aims: This study documents the various CSR activities going on in a large tertiary...

This article was migrated. The article was not marked as recommended. Student portfolios are a collection of evidence, prepared by the student and evaluated by the faculty member to demonstrate mastery, comprehension, application, and synthesis of a given set of concepts. The purpose of this study was to investigate the effect of portfolio on stude...

Background: Globally, cities get flooded due to heavy rains. As the incidence of leptospirosis increases after such flooding in Mumbai, community chemoprophylaxis to selected individuals was a consensus recommendation by experts. Methods: We surveyed a total of 1 499 293 houses in severely affected areas of Mumbai (where there was waterlogging o...

Antimicrobial therapy is a mainstay of the management for patients with acute cholangitis and/or cholecystitis. Tokyo Guidelines 2018 (TG 18) provides recommendations for the appropriate for use of antimicrobials for community-acquired and healthcare-associated infections. The listed agents are for empirical therapy) provided before the infecting i...

Management bundles that define items or procedures strongly recommended in clinical practice have been used in many guidelines in recent years. Application of these bundles facilitates the adaptation of guidelines and helps improve the prognosis of target diseases. In Tokyo Guidelines 2013 (TG13), we proposed management bundles for acute cholangiti...

In some cases, laparoscopic cholecystectomy (LC) may be difficult to perform in patients with acute cholecystitis (AC) with severe inflammation and fibrosis. The Tokyo Guidelines 2018 (TG18) expand the indications for LC under difficult conditions for each level of severity of AC. As a result of expanding the indications for LC to treat AC, it is a...

Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines...

Background: Bile duct injury (BDI) during laparoscopic cholecystectomy remains a serious iatrogenic surgical complication. BDI most often occurs as a result of misidentification of the anatomy; however, clinical evidence on its precise mechanism and surgeons' perceptions is scarce. Methods: Surgeons from Japan, Korea, Taiwan, and the U.S., etc....

The Tokyo guidelines 2013 (TG13) include new topics in the biliary drainage section. From these topics, we describe the indications and new techniques of biliary drainage for acute cholangitis with videos. Recently, many novel studies and case series have been published across the world, thus TG13 need to be updated regarding the indications and se...

Discussion forums provide the ability for asynchronous discussion to occur over a period of time. The ability to learn asynchronously gives flexibility in learning and is one of the primary benefits of online learning. The combination of the asynchronous and interactive nature of the online learning environment encourages participants to engage in...

Authorship should be considered if one has made substantial contributions to the conception, acquisition, analysis, or interpretation of data, drafted or revised the work, approved the final manuscript, and willingness to take responsibility (ICMJE criteria).Authorship is attractive as it helps in professional growth and leads to respect from the p...

For a doctor to provide medical care with competence, he must not only have knowledge but must also be able to translate that knowledge into action. It is his competence in clinical skills that will enable him to practice safely and effectively in the real world. To ensure acquisition of clinical skills, medical teachers must adopt teaching methods...

The cross-cultural exchanges between the people of India and their colonial rulers provides a fascinating insight into how these encounters shaped medicine and medical education in India. This article traces the history of how Indian medicine was transformed in the backdrop of colonialism and hegemony. It goes on to show how six decades after indep...

It will improve the relevance of entrance tests and reduce financial malpractice India’s medical education system is one of the largest in the world. Many of its graduates emigrate, and the quality of the education of these doctors has global impact. The number of medical schools in India has increased in the past 35 years, especially in the priva...

Book for faculty students

Objectives: To assess the effectiveness of learning stress coping skills in improving academic performance and reducing anxiety levels amongst undergraduate students of dentistry. Methods: 43 students received a pre-validated module on stress coping skills. The module consisted of 13 units, a total duration of 24 hours consisting of topics related...

Background Despite choledochal cysts being common in children, an increasing number of patients present with ongoing symptoms in adult life. The aim of this study was to review the management of adult patients with choledochal cysts in a tertiary referral centre. Methods: The records of 31 patients with choledochal cysts presented to us between 201...

AIM: Indeterminate pancreatic head mass in chronic calcific pancreatitis is a management dilemma often faced by surgeons. The aim of this study was to identify factors that could assist in distinguishing between malignant and inflammatory pancreatic head lesions arising in background of chronic pancreatitis and to analyse the clinical, biochemical...

Development of a subcapsular liver hematoma after laparoscopic cholecystectomy is an infrequent complication and rarely reported. Fourteen cases have been published with different etiologies including use of NSAID's like Ketorolac during & after surgery, hemangiomas or small iatrogenic lesions aggravated by administration of ketorolac, coagulation...

Introduction Laparoscopic surgery in recurrent appendicitis, late presentations of acute appendicitis and interval appendicectomy can be challenging for the surgeons. These situations result in dense adhesions between appendix and adjacent structures like colon, and distort the anatomy. Submucosal dissection of appendix (Submucosal appendicectomy)...

Introduction: Abdominal tuberculosis is extremely common in our country. It has a varied presentation. However, at times the presentation may be nonspecific, posing a diagnostic dilemma to the clinicians. Aim of study: The present study assesses the efficacy of diagnostic laparoscopy in establishing the diagnosis of abdominal tuberculosis. Material...

Background: The etiology of corrosive esophageal strictures is different from that reported in Western literature, with acid ingestion being a major cause. This study evaluated functional and morphological changes in the colon used as neoesophagus. Methods: Functional changes in the neoesophagus were evaluated by symptom score of dysphagia and m...

Obesity is on rise with increasing globalization and changing life styles over last two decades. Morbid obesity (BMI > 40 kg/ m) is associated with metabolic syndrome (diabetes mellitus (T2DM), hypertension, dyslipidemia, and ovarian polycystic syndrome) that leads to an increased risk of cardiovascular diseases and related morbidity and mortality....

Background: Teachers' belief in their ability to teach influences how much of the new knowledge and skills gained during faculty development (FD) programs are actually implemented at the workplace. Aim: To study the effect of a longitudinal FD program on the self-efficacy beliefs (SEB) of teachers of health professions using quasi-experimental m...

Since the publication of the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07), diagnostic criteria and severity assessment criteria for acute cholangitis have been presented and extensively used as the primary standard all over the world. However, it has been found that there are crucial limitations in these criteri...

This paper describes typical diseases and morbidities classified in the category of miscellaneous etiology of cholangitis and cholecystitis. The paper also comments on the evidence presented in the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG 07) published in 2007 and the evidence reported subsequently, as well as...

In 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) were first published in the Journal of Hepato-Biliary-Pancreatic Surgery. The fundamental policy of TG07 was to achieve the objectives of TG07 through the development of consensus among specialists in this field throughout the world. Considering such a si...

Background: Laparoscopic cholecystectomy is now accepted as a surgical procedure for acute cholecystitis when it is performed by an expert surgeon. There are several lines of strong evidence, such as randomized controlled trials (RCTs) and meta-analyses, supporting the introduction of laparoscopic cholecystectomy for patients with acute cholecysti...

Percutaneous transhepatic gallbladder drainage (PTGBD) is considered a safe alternative to early cholecystectomy, especially in surgically high-risk patients with acute cholecystitis. Although randomized prospective controlled trials are lacking, data from most retrospective studies demonstrate that PTGBD is the most common gallbladder drainage met...

Since its publication in 2007, the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG07) have been widely adopted. The validation of TG07 conducted in terms of clinical practice has shown that the diagnostic criteria for acute cholecystitis are highly reliable but that the definition of definite diagnosis is ambiguous. D...

This booklet is intended for use by surgical trainees to provide basic surgical skills through photo-guided instruction through exercises in use of a scalpel, surgical scissors, knot tying, suturing, tissue forceps and vascular clamps. This booklet contains many commonly performed surgical activities. Though this book is entirely self explanatory,...

The medical humanities have been introduced in medical curricula over the past 30 years in the western world. Having medical humanities in a medical school curriculum can nurture positive attitudes in the regular work of a clinician and contribute equally to personality development. Though substantial evidence in favour of a medical humanities curr...

Structured training on box trainers in laparoscopic skills in the initial years of residency has been used and found to be effective. Although there are studies that confirm immediate improvement after training, there is a lack of well-designed trials addressing the crucial issue of retention of these skills over time. The purpose of this study is...

In spite of the existence of a dual system of postgraduation, one under the Medical Council of India (MCI) and the other on a parallel track under the National Board of Examinations, postgraduate medical education in India is beset with several problems. For example, the curriculum has not been revised comprehensively for several decades. The diplo...

A primary pancreatic-isolated hydatid cyst, that too in tail of pancreas with no lesion in liver, is a rare presentation of this disease. We report a case of 30-year-old lady presenting with only abdominal pain and on imaging found to be a cystic lesion in tail of pancreas without any liver lesion. Contrast-enhanced computed tomography scan is help...

Communicating bad news to patients and families is an essential skill for physicians but can be difficult for interns. Very little is known about skills in this area for interns in developing countries. Two focus groups, consisting of a total of 12 interns, were conducted in the Seth G.S. Medical College and KEM Hospital in Mumbai, India. The groun...

Abstract Poster sessions in congresses are usually designed to present a huge number of posters, and presenters generally have little time to interact with the audience. Working with smaller groups in training programs provides opportunities to design poster presentations that enable participants to present their work and to create opportunities fo...

India has a large burden of individuals harboring asymptomatic gallstones. Based on Markov model decision and cost analysis, selective and concomitant cholecystectomy is recommended for special indications like hemolytic disorders and stones in endemic areas. Expectant management should be adopted in all others. The evolution of laparoscopy should...

Angiomatous malformation is the most common vascular abnormality, accounting for 30-40% cases of obscure GI bleeding from small bowel. Surgical resection is the treatment of choice in severe or recurrent hemorrhage requiring multiple blood transfusions. However, the diffuse nature of the lesions poses a challenge to localize them accurately preoper...

Using CA 19-9 and CEA (elevated > 2 times of normal) as predictors in determining operability and survival in pancreatic tumors. Levels of CA 19-9 and CEA were measured (pre and post operatively) in 49 patients of pancreatic malignancy. CECT was performed for diagnosis and staging. An experienced surgeon determined the operability. The levels of tu...

Laparoscopic surgery provides patients with less painful surgery but is more demanding for the surgeon. The increased technological complexity and sometimes poorly adapted equipment have led to increased complaints of surgeon fatigue and discomfort during laparoscopic surgery. Ergonomic integration and suitable laparoscopic operating room environme...

A century after the publication of Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching (the Flexner Report), the quality of medical education in much of Asia is threatened by weak regulation, inadequate public funding, and explosive growth of private medical schools. Competition for...

The term integration in education means coordination in the teaching learning activities to ensure harmonious functioning of the ucational processes.The medical curriculum is vast and students are expected to learn many subjects at the same time. The teachers arealso involved in a number of activities apart from teaching like research , administrat...

Over the past 2 decades, laparoscopic techniques have evolved from diagnostic laparoscopy to more complex procedures. Minimally invasive techniques are routinely used for bariatric, colonic and advanced gastrointestinal surgical procedures. These new techniques require highly developed psychomotor skills and place an extra demand upon surgeons to a...

Gallstone disease is the most common cause of acute pancreatitis. Cholecystectomy is mandatory to avoid recurrence of pancreatitis. Our objective was to evaluate the results of laparoscopic cholecystectomy (LC) in patients with gall-stone induced pancreatitis. All patients presenting to us within the time frame from February 2004 to June 2008 with...

Splenectomy has been the conventional surgical treatment for patients with Immune Thrombocytopenic Purpura (ITP). To define response to surgical therapy, pre operative factors influencing outcome and tolerability of surgery in adult patients undergoing splenectomy for ITP. We analyzed prospectively maintained data of 33 patients who were diagnosed...

Gastrointestinal stromal tumours (GIST) are soft tissue tumours arising from the mesenchyma in the gastrointestinal tract. These are rare tumours. However, over the past few years with the better understanding of the pathogenesis of GIST and better imaging facilities, the diagnosis is made more frequently. The characteristic diagnostic feature of G...

In mass disaster situations, demands frequently exceed the capacity of personnel and facilities. In the last few years, there has been an increased incidence of civil disasters; the spectrum of possible catastrophes has also dramatically increased as a result of an increasingly technologically sophisticated society. During the last 15 years, varied...

Social networking is being increasingly used as a tool of choice for communications and collaborations in business and higher education. Learning and practice become inseparable when professionals work in communities of practice that create interpersonal bonds and promote collective learning. Individual learning that arises from the critical recons...

Single, best response, multiple choice questions (MCQs) with 4 options (3 distractors and 1 correct answer) or 5 options (4 distractors) have been widely used as an assessment tool in medical education in India and globally. Writing plausible distractors is time consuming and the most difficult part of preparing MCQs. If the number of options can b...