Hirabai Cowasji Jehangir Medical Research Institute




Teaching Programs

HCJMRI is involved in teaching for PhD students (affiliated to the Savitribai Phule Pune University), Pediatric Endocrine Fellows and National and International interns

 

PhD Program:

The HCJMRI has been recognized for PhD studies since 2008 and around 20 studnets have been/ are being mentored/ co-mentored at the center. Following are the list of students and their topics of work:

  1. Dr. Neha Sanwalka: Studies in Bone Mass Accrual and Strategies to Promote Calcium Absorption in Children and Adolescents.

Guide:  Dr. A. Khadilkar, Dr. Chiplonkar- AWARDED DEGREE

 

  1. Dr. Smita Joshi: Prevalence and type distribution of high-risk HPV in HIV infected women and its correlation with cervical abnormalities in Pune, India

Guide: Dr U. Divate AWARDED DEGREE

 

  1. Dr. Veena H. Ekbote: Studies in Calcium status in childhood

   with special reference to growth hormone deficient children.

Guide:  Dr. V. Khadilkar, Dr. Chiplonkar, Dr. A. Khadilkar- AWARDED DEGREE

 

  1. Dr. Neha Kajale: Studies in nutritional quality of lactation supplements

and their relationship with metabolic syndrome, bone health of young women and infant growth

 Guides: Dr. A. Khadilkar , Dr.Chiplonkar- AWARDED DEGREE

 

  1. Ms. Deepa Pandit: Studies in relationship of nutritional status with metabolic syndrome in children and risk of sub-clinical atherosclerosis.

Guide:  Dr. Chiplonkar, Dr. V. Khadilkar - AWARDED DEGREE

 

  1. Ms Nidhi Kadam (UGC-JRF): Studies in nutritional aspects of bone health in premenarchal girls and postmenopausal women

Guides:  Dr. Chiplonkar, Dr. A. Khadilkar - AWARDED DEGREE

 

  1. Ms. Lavanya Parthasarthy (UGC-JRF): Studies in oxidative stress related to Type 1 diabetes mellitus and  efficacy of supplementing antioxidants in children with Type1 diabetes mellitus.

Guides:  Dr. Chiplonkar, Dr. V. Khadilkar , Dr A Khadilkar - AWARDED DEGREE

 

  1. Dr. Vivek Patwardhan: Studies in metabolic interaction of vitamin D with cholesterol and statins in adult Indian men

Guides:  Dr. A. Khadilkar, Dr. Chiplonkar. - AWARDED DEGREE

 

  1. Ms. Rubina Mandlik (UGC-JRF) - Assessment of Health and Nutritional Status and Strategies for Prevention of Infections in Rural Indian School Girls

Guides: Dr A Khadilkar, Dr. V. Khadilkar – AWARDED DEGREE

 

  1. Dr. Jayant Palaskar: Studies in mandibular bone density in Indian adults with special reference to edentulous patients

 Guides, Dr. V. Khadilkar , Dr A Khadilkar- ON-GOING

 

  1. Ms Smruti Vispute (UGC-JRF): Studies in influence of ecoregional and lifestyle variations on growth and body composition of Indian children and adolescents.

 Guides: Dr A Khadilkar, Dr. V. Khadilkar- ON-GOING

 

  1. Ms. Sonal Palande (UGC-JRF): Studies in Inter relations of Physical Activity, Nutrient Intake and Muscle Function in Rural Indian Children

 Guides, Dr. V. Khadilkar , Dr A Khadilkar- ON-GOING

 

  1. Ms. Rashmi Lote-Oke: Studies in determinants of Vitamin D status and its vegetarian sources in children and adolescents in India

 Guides, Dr. V. Khadilkar , Dr A Khadilkar- ON-GOING

 

  1. Ms. Mugdha Deshpande: A Study Assessing the Patterns and Determinants of Gestational Weight Gain in Pregnant Women and the Impact of Gestational Weight Gain on Maternal and Neonatal Outcomes.

Guides: Dr A Khadilkar, Dr. V. Khadilkar- ON-GOING

 

  1. Ms. Gauri Khot: Studies in Sarcopenia & its Functional Indices among Urban & Rural Indian Women.

Guides: Dr. A Khadilkar, Dr. V. Khadilkar- ON-GOING

 

  1. Ms. Vaishali Tamahane- A study of the gut microbiome in children with type 1 diabetes.

 Guides: Dr. V. Khadilkar , Dr. A Khadilkar- ON-GOING

 

  1. Ms. Swapna Deshpande- An urban picture of overweight, gestational weight gain and pregnancy outcomes among slum dwellers in Pune, India.

Guides: Dr. Tarja Kinnunen (Tampere University), Dr. A Khadilkar

 

Other Projects which have been Co-mentored:

  1. Dr. Sonal Deshmukh- Modification of TW3 RUS for bone age assessment for Indian children using digital image processing- AWARDED DEGREE
  2. Dr. Pinal Patel. Evaluating and Monitoring the Effect of Lifestyle on the Stress Level and Nutritional Health Status of Young Women in Gujarat State- AWARDED DEGREE
  3. Dr. Prerna Patel- Monitoring and Evaluating the Nutritional health status of school going children in Gujarat- AWARDED DEGREE
  4. Devising a non-invasive tool for the assessment of blood sugar in children with diabetes- AWARDED DEGREE

 

Clinical Research fellowship in Pediatric Endocrinology, Growth and Diabetes

Preamble:

The need for a training program in Pediatric Endocrinology:

 

Knowledge in the field of pediatrics is now very vast. With the increase in knowledge and concomitant increase in investigative modalities and therapeutic avenues, specialization has become necessary to maintain excellence in health care. Specialist in specific areas of need have now become necessary to fulfill, the need of increased demand of subspecialty training. 

 

Pediatrics has lagged behind in the development of specialties. Pediatric specialists so far have either been trained abroad or have been trained by mentors in the corresponding adult specialty. As a result the country now has in place only a handful of pediatric specialists in teaching institutions, who can now function as the mentors. Among the pediatric specialties, pediatric endocrinology is one of the youngest in India. There are scarcely 12 to 14 pediatricians in the whole country who are trained pediatric endocrinologists. 

 

Pediatric endocrinology encompasses areas such as growth and puberty, the very child development and pediatrics.  Even the appreciation of the normal in these aspects of pediatrics is inadequately taught in general pediatric training.  Proper management of disorders such as diabetes mellitus, growth retardation, metabolic bone disease, disorders of sexual differentiation, and other hormonal abnormalities requires specialized training and exposure than is available in a typical pediatrics training program. Relatively newer problems such as childhood obesity, type 1 and 2 diabetes have now become commonplace in routine pediatric practice.  To ensure good care of children with these and other disorders in India, there is an urgent need to augment the numbers of trained manpower in the field.

 

Aims and objectives of the program:

 

1.    Early recognition of pediatric endocrine and growth disorders, improvement in the care of children and adolescents with pediatric endocrine disorders

2.    To train postgraduates in pediatrics with sufficient knowledge and skill to recognize and manage growth and pediatric endocrine disorders at peripheral centers in India. 

3.    To provide an alternative to similar super specialty training programme abroad which are often beyond the reach of a typical pediatric post-graduate in India. 

4.    To provide a viable alternative to much longer DNB of DM courses in endocrinology which are only available as super specialty of adult medicine. The course will aim at emphasizing a similar curriculum in a concise manner in the stipulated one-year period.

Proposed eligibility and selection of trainee:

 

Eligibility: Pediatrician holding MD or DNB degree in pediatrics

Number of candidates: One per year. 

Selection: Interview (Final decision at the discretion of HCJMRI Management)

Training period: 6 months to 1 year

 

Terms and conditions:

1.    The faculty shall include individuals with sufficient post MD or DNB experience in pediatric endocrinology/overseas training/long standing experience in pediatric endocrinology as a teacher

2.    The course duration is of 12 months where the candidate will work in HCJMRI and Jehangir Hospital Pediatric endocrine unit

3.    The candidates work will involve substantial research responsibilities.

4.    There would be an examination at the end of fellowship.  It is mandatory to pass this examination to acquire fellowship certificate.

 

Faculty:
Dr. Vaman Khadilkar MD, MRCP Consultant Pediatric Endocrinologist

Dr. Anuradha Khadilkar MD, DCH Deputy Director HCJMRI

 

Course design:

 

Postings:

 

The trainee will spend a year in clinical pediatric and adolescent endocrinology / diabetes and pediatric endocrine research the laboratory training.  He/she will complete at least one paper acceptable for publication in a peer reviewed journal, and participate in the teaching programs in the department (case presentations, seminar, journal club, radiology/nuclear medicine meetings and pathology/mortality/research project presentation/combined endocrinology surgery meeting).

 

He/she will be responsible for caring for all inpatient pediatric endocrinology and diabetes admissions, as well as pediatric endocrinology interdepartmental consultations and emergencies. Diabetes education of patients as well as nurses will also be his/her responsibility.

 

The candidate is expected to attend Pediatric Endocrine clinic at Jehangir Hospital .

 

Books and study materials: 

 

Textbooks in Endocrinology (the minimum):

1.    Handbook of Clinical Pediatric Endocrinology – CGD Brook, R. S. Brown, Blackwell Publishing, 2008

2.    Pediatric Endocrine Disorders – Orient Longman, Editors: Meena Desai, Vijayalaxmi Bhatia, PSN Menon 

3.    Handbook of Endocrine investigations in children – IA Hughes, Wright publications.

Journals:.

1.    Journal of Endocrinology and Metabolism Journal of the American Endocrine Society

2.    Journal of Pediatric Endocrinology and Metabolism- Journal of the European Pediatric Endocrine Society

 

 

 

Curriculum: 

 

1. Principles of hormone measurement

 

Principles of RIA/IRMA/ELISA. Definition of sensitivity, specificity, inter and intraassay CV.  When to accept or reject an assay -preliminary knowledge.  Practically perform at least 2 immunoassays and observe 2 ELISAs and 2 spectrophotometric assays. 

 

2.    Principles of hormone action

 

Categories (and examples) of hormones, type of receptors, second messengers -broad categories with some examples, particularly relevant to disease.

 

3.    Genetics in pediatric endocrinology

 

Definition of and familiarity with Southern, Northern and Western blots, RFLP, PCR, FISH, karyotyping.

 

Awareness of genetics forms of pediatric endocrine diseases, for example,   hypopituitarism /growth hormone deficiency, childhood thyroid disease, genes in sexual differentiation.

 

4.    Fetal-neonatal

Adult consequences of fetal disease

o    neonatal hypoglycemia and IDM 

o    neonatal hypo and hyper calcemia and magnesemia 

o    neonatal thyrotoxicosis and hypothyroidism

 

5.    Growth : short and tall stature

 

Normal growth – patterns, control of (including details of hormonal control of growth), measurement, bone age and growth charts

Short staturecauses, diagnosis and management

Tall staturedifferential diagnosis, treatment, Marfan, SotosDysmorphic syndromes – Details of Turner, Noonan, Prader Willi, Klinefelter.

Others – Briefly (Down, Russell Silver, Laurence Moon Beidel)

 

6.    Skeletal dysplasias

Achondroplasia, spondyloepiphyseal dysplasia (SED), SEMD, Morquio, hypochondroplasia, metaphysial dysplasia - clinical and radiological features

 

7.    Disorders of Growth Hormone (GH) production and action and treatment of GH deficiency.

Etiology of GHD including genetic causes, cranial irradiation (GHD) and tumours, clinical features.  (Detailed knowledge of problems in GH testing).  Detailed knowledge of indications for monitoring of GH therapy.  Clinical features and diagnosis of Laron dwarfism and gigantism, of tall stature, differential clinical features and diagnosis of gigantism.

 

8.    Puberty

Initiation of normal puberty, physical changes in normal puberty

Delayed puberty, definition, CDGP, hypo and hyper hypogonadotropic hypogonadism.  Kallman, Klinefelter and Turner syndromes in detail, diagnosis and management primary and secondary amenorhoea. Precocious puberty -definition, true puberty, peripheral puberty, precocious thelarche and pubarche, diagnosis and management. 

Gynecomastia-causes and treatment.

 

9.    Periphebertal hyperandrogenism

PCOD – pathogenesis, differential diagnosis and management

 

10.    Thyroid

Physiology.

Genetic causes of congenital hypothyroidism

Interpretation of thyroid function tests

Congenital hypothyroidism-newborn screening, etiology, treatment, outcome studies.

Goitre in childhood, thyroiditis

Iodine deficiency disorders- daily requirement, typical syndromes of iodine deficiency

Graves disease-etiology, clinical features, treatment including permanent ablation. Neonatal graves – details of clinical features and treatment                     -Thyroid hormone resistance – preliminary knowledge, types and important clinical features

 

11.    Adrenal

Steroidogenic pathways – names of intermediary, metabolites and enzymes

CAH -21 hydroxylase deficiency – genetics, clinical features, management, long term outcome; prenatal diagnosis and therapy – basic knowledge. 

11 βOH, 3β HSD, 17OH, 17  βHSD – presentation and management

Cushing syndrome-clinical features, peculiarities of different etiologies of Cushings and differences from adults; interpretation of the various screening and definitive tests, imaging, IPSS. Treatment medical, surgical, radiotherapy and outcome.  Non Cushing adenoma, carcinoma, incidentaloma 

 

Hypertension with hypokalemia, and differential diagnosis.

 

Addisons disease – etiology, clinical features and treatment, polyglandular autoimmune syndromes.  

Phaeochromocytoma-clinical features, diagnosis (biochemistry, precautions and interpretation), imaging and treatment.

 

12.    Sexual differentiation, Cryptorclindism, Micropenis, Hypospadias Normal embryology and hormonal influences.

Genes involved – basic knowledge of current status.

Details of clinical features, diagnosis and treatment

13.    Pituitary:

Hypopituitarism

Diabetis insipidus and SIADH, cerebral salt wasting-basic knowledge of osmoregulation., differentiation of central/nephrogenic/primary polydipsia and treatment

Craniopharyngionia-detail knowledge of presentation imaging and management

 

14.    Diabetes mellitus and lipids

Classification, differences between type 1, type 2 and FCPD.

MODY – basic knowledge of differentiating clinical features and management

Type 1-pathogenesis – (basic knowledge) and pathophysiology

Details of clinical features, management, long term follow-up-detail, including

complication screening, DKA/hypoglycemia.

Lipids –only basic knowledge relevant to clinically management.

 

15.    Hypoglycemia

Neonatal hypoglycemia and IDM - details of causes, but only superficial

Knowledge for disorders of fuel metabolism.  Persistent hyperinsulinemic hypoglycemia of infancy – details of pathogenesis, clinical features management and outcome.

 

16.    Obesity

Control of appetite and satiety

Definition – clinically relevant knowledge

Management – strategies and some knowledge of outcome

 

17.    Metabolic Bone Disease, Calcium, Phosphorus and Magnesium metabolism

Hypocalcemia, especially neonatal hypocalcemia etiology, diagnosis and management.

Hypercalcemia, etiology, diagnosis and management.

Calcium sensing receptor disorders and William syndrome

Rickets – complete details of etiology, clinical features, diagnosis and

management.

Bone turnover studies, bone physiology – clinically relevant areas only

Osteogenesis Imperfecta, glucocorticoid induced osteoporosis

Fibrous dysplasia and metabolic bone disease of prematurity-full details of

pathogenesis and management.

Pediatric DEXA (bone densitometry): interpretation and use.

 

Suggested names and designation of potential examiners:

1.    Dr. Raghupati, Pediatric Endocrinologist, Sagar Apollo Hospital, Bangalore

2.    Dr. Archana Arya Dayal, Sir Ganga Ram Hospital, New Delhi

3.    Dr. Sudha Rao, BJ Wadia Hospital for Children, Mumbai

4.    Dr. Shaila Bhattacharya, Pediatric Endocrinologist, Manipal Hospital, Bangalore

5.    Dr. Anurag Bajpai, Pediatric Endocrinologist, Consultant Pediatric and adolescent Endocrinologist, Regency Hospital Limited, A2 Sarvodaya Nagar,
Kanpur UP 208 005

6.    Dr. Ahila Ayavoo, G Kuppuswamy Naidu Memorial Hospital No 6327, Nethaji Road, Papanaickenpalayam, Coimbatore - 641037,

 

Fellows trained in HCJMRI:

  1. Dr. Nikhil Lohiya
  2. Dr. Nikhil Shah
  3. Dr. Madhura Karguppikar
  4. Dr. Chirantap Oza


Address:

Lower Ground Floor,
Block V, Jehangir Hospital,
32 Sassoon Road,
Pune 411 001.


Phone: 020 -66811741 / 26057004


Email Id: hcjmri.jehangirpune@gmail.com





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