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HOW TO MANAGE ALLERGIC RHINITIS?
A REVIEW FOR COMMUNITY PHYSICIANS

Posted in ENT

Allergic rhinitis (AR) is an inflammatory disease of the nasal mucosa. The typical symptoms are rhinorrhea, sneezing, nasal congestion, nasal pruritus which could extend to eyes, and also redness and lacrimation in many patients. In this article Dr. Manuj Jain (ENT Surgeon), guides on "How to manage Allergic Rhinitis".

Table of Contents

Definition
Epidemiology
Pathophysiology

Genetics

How to Manage Allergic Rhinitis?

Treatment Options
Avoidance
Antihistamines
Steroids
Decongestants
Cromones
Miscellaneous
Immunotherapy

Conclusion
About the Author

Dr. Manuj Jain

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REFERENCES

Definition

Allergic rhinitis (AR) is an inflammatory disease of the nasal mucosa. The typical symptoms are rhinorrhea, sneezing, nasal congestion, nasal pruritus which could extend to eyes, and also redness and lacrimation in many patients. AR can lead to many other consequent diseases including Obstructive Sleep Apnea Syndrome (OSAS) syndrome, rhinosinusitis, asthma, conjunctivitis, and otitis media, and could affect the social life, school outcomes, work production. (1)

Epidemiology

The burden of allergic rhinitis is enormous, constituting about 55% of all allergies. About 20-30% of Indian population suffers from at least one allergic disease. Reported incidence of allergic rhinitis in India also ranges between 20% and 30 % (2), (3).

While many patients downplay rhinitis symptoms as an inconvenience rather than a disease, the economic burden is quite significant. The disease has a direct impact in the form of hospital admission and stay and an indirect impact in the form of work leaves. It is estimated that productivity decreases by US$600 per affected employee per year, which is a greater loss than asthma, diabetes, and coronary heart disease. (4)

Pathophysiology

AR is an immunoglobulin E−mediated inflammatory reaction in the nasal mucosa caused by inhaled allergens, such as pollen, mold, or animal dander. The allergic response occurs in 2 phases—early and late.

The early (or acute) phase of an allergic reaction, which develops within minutes of exposure and causes AR symptoms include sneezing, nasal pruritus (itching), upper airway obstruction (congestion or blockage), rhinorrhea (clear nasal discharge), and itchy or watery eyes.

The late response is associated with chronic inflammation and includes the same symptoms seen in the early-phase response, with nasal congestion becoming the primary symptom due to mucosal edema. These symptoms begin 6 to 12 hours after allergen exposure, peaking at 12 to 24 hours.

There are 2 symptom patterns of AR, seasonal (also known as hay fever, or intermittent) and perennial (or persistent). Seasonal allergic rhinitis (SAR) symptoms are usually easily identifiable and directly associated with seasonal allergen exposure, such as tree, grass, and weed pollens, or fungi.

Perennial allergic rhinitis (PAR) symptoms occur for up to 75% of the year, are present for >4 days per week and for >4 weeks, and are less easy to identify because they overlap with symptoms seen in sinusitis, respiratory infections, and other types of rhinitis. Symptoms are often caused by nonseasonal allergens, such as dust mites, animal dander, or mold. (5)

Genetics

Monozygotic twins show a concordance of 45-60% in the development of allergic rhinitis, and dizygotic twins have a concordance rate of about 25%. These data point to a genetic link. (6)

How to Manage Allergic Rhinitis?

Treatment Options

According to ARIA guidelines, the standard care in the treatment of AR includes antihistamines, nasal decongestants or/and corticosteroids, cromones, antileucotrienics (if asthma coexists), and specific immunotherapy (7)

There are many options for the treatment of AR, both nonpharmacologic and pharmacologic. A number of medications are also available over the counter (OTC) without a prescription, and product selection should be based on patient factors, including their symptoms and medical history. The goal of treatment is to reduce or eliminate current symptoms while preventing future attacks and long-term complications. Appropriate treatment selection should allow for minimal adverse effects and enable the patient to maintain a normal lifestyle.

Three approaches of AR management include allergen avoidance, pharmacotherapy, and immunotherapy. Nonpharmacologic interventions, such as allergen avoidance, can reduce or eliminate AR symptoms and the amount of pharmacotherapy needed for symptom control. Allergen avoidance is a practical option when allergens have been identified, either by the patient or by allergy testing. Patients can take steps to reduce exposure to triggers based on the specific allergen, whether it is pollen, mold, or animal dander. Allergen avoidance should be part of an overall treatment strategy that includes pharmacotherapy. (5)

Avoidance

Precautions can be taken against dust mites. Carpet removal, removal of soft toys from the bedroom, using allergen-impermeable bedding covers for the mattress and pillow, vacuuming with a high-efficiency particulate air (HEPA) filter, and washing bedclothes and bed sheets in hot water (60℃) are helpful. Any single method alone is unlikely to provide benefit, and patient should be encouraged to use multiple interventions. For those with animal allergies, ideally, removal of the pet from the home would be best along with careful vacuuming of all carpets, upholstered furniture, and mattresses.

Environmental moisture control can improve mold levels. Using pesticides and meticulous control of food debris can decrease cockroach environmental allergens. However, it may take over 6 months to remove residual cockroach allergen. (8)

Antihistamines

Histamine activates the H1 receptor on a distinct set of neurons to produce the sensation of itching. This leads to sneezing, nose rubbing, and the "allergic salute". The newer second-generation agents have both anti-allergic and anti-inflammatory properties.

The first generation H1 antihistamines such as diphenhydramine, chlorpheniramine, brompheniramine and hydroxyzine are also referred to as the sedating antihistamines. These agents are effective at controlling rhinorrhea, sneezing and pruritus associated with allergic rhinitis. Unfortunately, these agents cross the blood-brain barrier thus producing undesirable side effects such as central nervous system depression, sedation leading to impaired performance at home, work and school and cardiotoxicity.

The second-generation antihistamines developed in the early 1980's, have improved H1 receptor selectivity, absent or decreased sedation, faster onset and longer duration of action and fewer adverse effects. Their half-lives are longer (12-24 hours) compared to the first generation (4-12 hours).14 Of the second generation H1-antagonists, fexofenadine has no sedating effects even at higher than recommended doses. Loratadine and desloratadine are non-sedating at recommended doses but may cause sedation at higher doses. Cetirizine, and its purified enantiomer levocetirizine, have more sedation potential than other second generation H1-antagonists (9) (10).

Topical H1-antihistamines (azelastine, olopatadine) provided faster onset of action (less than 15 minutes) and similar to greater efficacy compared to oral preparations in regard to rhinitis and conjunctivitis.
Some patients may complain of a bitter taste, and intranasal H1-antagonists are less effective than intranasal steroids. In a direct comparison trial between azelastine nasal spray versus oral cetirizine, azelastine was found to have a significant improvement in nasal symptom scores for the specific symptoms of sneezing and nasal congestion over cetirizine (11).

Steroids

In addition to oral H1-antihistamines, intranasal corticosteroids are a mainstay of treatment. They are the most effective medications for controlling all rhinitis symptoms. Their onset of action is from 3-12 hours. They are generally safe, and there is little evidence to support suppression of the hypothalamic-pituitary-adrenal axis with prolonged use. Side effects are generally mild (crusting, dryness, and minor epistaxis). They can be minimized by proper nasal spray technique. Septal perforation has only been described anecdotally.
Systemic corticosteroids should be considered a last resort treatment option, but they may be necessary for severe or intractable symptoms. Steroids should never be injected into the turbinates. Recommendations on short courses oral steroids differ from 5-7 days1 to no more than 3 weeks.2

Decongestants

Decongestants are also available in oral and topical formulations. They are effective in relieving congestion. However, studies of H1-antihistamine in combination with oral decongestants failed to show improved benefit compared to either alone. Side effects include insomnia, anorexia, irritability, and rarely elevated blood pressure. Oral decongestants should be avoided in children less the 1-year of age, adults over 60 years of age, and any patient with a cardiac condition. The main side effect of topical decongestants is the development of rhinitis medicamentosa. Maximum duration for use of oral decongestant nasal drops is 5-7days.

Cromones

Intranasal formulations of cromolyn and nedocromil have been used to treat allergic rhinitis but are less effective than topical corticosteroids. Although the exact mechanism is unknown, they work mainly by inhibiting mast cell activation. There may even be an inhibitory effect on neural signals involved in rhinitis.2 Overall, they are safe with minimal to no side effects.1,2

Miscellaneous

The anticholinergic ipratropium bromide is available in a nasal form and blocks the parasympathetic signaling that leads to watery rhinorrhea, and it has been shown effective in controlling this particular symptom. There are little to no side effects. Guidelines state it does not decrease sneezing or nasal obstruction, but one study in children showed improvement in rhinorrhea, congestion, and sneezing although to a lesser degree than intranasal steroids.

Leukotriene receptor antagonists have been shown to be effective controlling allergic rhinitis, and they are comparably effective with oral antihistamines. After 2 weeks of therapy, montelukast progressively decreased symptoms scores, but still to a lesser degree than intranasal fluticasone (12).For patients whose symptoms are not controlled with intranasal corticosteroids, adding montelukast did not offer any further benefit (13).

The anti-IgE antibody omalizumab may be efficacious, but it has not been shown to be superior to current allergic rhinitis treatments. Additionally, its high cost limits it use as a standard treatment.
Taken as a whole, intranasal corticosteroids seem to be the most effective in controlling nasal symptoms. The next most effective are oral and intranasal antihistamines.

Immunotherapy

Subcutaneous immunotherapy (SCIT) has been shown to be effective in treating allergic rhinitis in patients with identifiable IgE mediated symptom triggers. It has some advantages over the above-mentioned treatments. Effects can be sustained for years, and it may prevent the development of new allergen sensitivities or even asthma. It is effective for not only control of allergic rhinitis but also of allergic conjunctivitis and allergen induced asthma. In regard to specific inhaled allergens, evidence supports immunotherapy for pollens, animal dander, and dust mite. Large local reactions at the injection site are the most common adverse reaction. The risk of severe systemic reactions during subcutaneous immunotherapy is rare but present in less than 1% of those receiving standard immunotherapy. It is advised that patients receive immunotherapy injections in a setting with staff and equipment that can handle anaphylaxis, and that patients be observed for 30 minutes after each injection. Other disadvantages include injection discomfort, the frequency of shot visits, and the total cost. However, immunotherapy is the only treatment that can modify the disease. When the direct costs of symptomatically managed allergic rhinitis are compared to the cost of immunotherapy, the values are virtually the same. When indirect costs are factored in, immunotherapy may be much more economical.

Subcutaneously is the most common way to deliver immunotherapy, but sublingual immunotherapy (SLIT) is also used. SLIT has been reported to cause oral itching and gastrointestinal side effects, but in most studies, these rates seem to be the same as those observed in the placebo arm. There is a lack of standardization in SLIT with timothy grass pollen extracts being the only commercially available therapy (Grazax by ALK-Abelló Hørsholm. Denmark), and there are no SLIT therapies approved for the US by Food and Drug Administration. Advantages of SLIT include an extremely low risk of anaphylaxis and the ability to begin therapy at the maintenance dose without a build-up phase. SLIT is not as well established as SCIT, and further investigation is required to determine the optimal dose and patient selection (15, 16)

Conclusion

Allergic rhinitis is a predominant disease of the modern world with extensive use of fossil fuels for daily travel, unchecked and fast-growing construction, lack of green belt, and most of all lack of immunity in the growing children due to the eating habits and lack of exposure to the outer world in their formative years being some of the reasons.

AR requires thorough examination and proper categorization following which customized approach to tackle each patient must be made rather than casual prescription of OTC drugs both on part of the patient as well as the treating physician.

Care must be taken to diagnose patients of AR early and start them on a proper treatment plan so that they do not land into complications like Bronchial Asthma and skin disorders.

About the Author

Dr. Manuj Jain

Dr. Manuj Jain is a tireless dynamic ENT surgeon with an active practice at both Delhi and Gurgaon, born and raised in Delhi. Dr. Jain has a deep connection to his hometown. Trained under the most prominent ENT surgeons in our country. He is known for his holistic approach towards his patients in his professional practice and keeps himself updated with the latest trends and developments in the field of ENT through journals, attending & conducting workshops and CME’s.

Graduated from KIMSDU, Karad and holds the postgraduate degree from NBE from the prestigious Balabhai NANAVATI HOSPITAL, MUMBAI/ MAX NANAVATI SUPERSECIALITY HOSPITAL, MUMBAI. Went on to train in ADVANCED ENT in MUMBAI, HISSAR, DELHI & JAIPUR. Completed his fellowship in minimal access endoscopic surgery and anterior skull base surgery from JAIN ENT HOSPITAL, JAIPUR under the guidance of the most prominent ENT surgeon of the modern era- Dr. SATISH JAIN.

His areas of interest include endoscopic surgeries for Ear, Nose and Throat along with treatment of Allergic cough/ Nasobronchial Allergies/Asthma, Snoring disorders, Facial aesthetic surgery (RHINOPLASTY), and vertigo/imbalance disorders. Believes in professional conduct with his patients yet having an interactive relationship with the patients in helping them provide the best possible treatment and care to his patients.

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May 17, 2022May 17, 2022

ENT,Surgery

10 mn read

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Spinal claudication vs Vascular claudication

Posted in Neurosurgery Bullets

In this post we compare the major differences between Spinal Claudication vs Vascular Claudication.

Table of Contents

Claudication Definition
Spinal Claudication vs Vascular Claudication

Claudication Definition

The word claudication originates from a Latin word "claudicare" which means, 'to limp' [1]. Claudication is a pain, cramp or sense of fatigue in a muscle group of the lower extremity related to walking or any sustained exercise of lower limbs [2]. It is relieved by taking rest. Claudication occurs elsewhere in the body, but it is the symptoms and nature of pain in the legs that have a major clinical significance.

Spinal Claudication vs Vascular Claudication

The table below enumerates the differences [3]:

No.	Characteristic	Spinal or Neurogenic Claudication	Vascular Claudication
1	Mechanism	Ileofemoral Arterial Insufficiency	Lumbosacral Nerve Root entrapment
2	Cause	Ischemic	Mechanical compression which leads to Ischemia of cauda equina
3	Pain	Cramping	Radicular
4	Pain Location	Exercised muscles	Lumbosacral (sciatic)
5	Pain relieved by	Rest (any posture)	Rest (Flexion posture or sitting)
6	Postural changes	Yes	No
7	Walking upright	Cause symptoms	Causes Symptoms
8	Standing stationary	Symptoms not relieved	Relieves symptoms
9	Sitting	Relieves symptoms	Relieves symptoms
10	Stair climbing	Up easier (back flexed)	Down easier (less work for muscles)
11	Bicycle (back flexed)	Relieves symptoms	Causes symptoms
12	Motor Deficit	Rare	Variable, exacerbated by walking
13	Pulses	Decreased	Normal
14	Arterial Bruit	May be present	Absent
15	Diagnostic Investigation	Angiography	MRI Lumbosacral spine

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References

https://en.wiktionary.org/wiki/claudicare
Smith RB III. Claudication. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 13. Available from: https://www.ncbi.nlm.nih.gov/books/NBK235/
Binder, D. K., Schmidt, M. H., & Weinstein, P. R. (2002). Lumbar Spinal Stenosis. Semin Neurol, 22(02), 157–166. DOI: 10.1055/s-2002-36539. https://pubmed.ncbi.nlm.nih.gov/12524561/

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Dr Sandeep

May 3, 2022May 4, 2022

DNB Final Exam,FRCS Preparation,MCh Preparation,MRCS Exam,MRCS Preparation,NEET,NEET PG,NEET SS Surgery,Neurosurgery,Neurosurgery Bullets,PG Preparation,PLAB,Resident Doctors,Surgery,Surgery Neet SS,Surgery Residency,Vascular Surgery

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NMC (MCI) Approved Indexing Guidelines for Journals

3 mn read

NMC (MCI) Approved Journals Indexing Guidelines for Research Publication-2022

Posted in Surgery Residency

Publishing your research article in journals following NMC (MCI) Approved Indexing guidelines has become important for Faculty appointment and promotions in medical colleges in India. In this article we will give you the latest available information until 2021/2022 regarding what to check before submitting your research article to a journal and NMC/MCI guidelines for Indexed journals.

The National Medical Council (NMC), previously called Medical Council of India (MCI) is the ultimate authority in the formulation of regulations and laws regarding the education system at medical schools across the country. It has recommended minimum qualifications that are mandatory to be a candidate for appointment or promotions of faculty members in teaching post. The two primary requirements for promotion are duration of the service as well as the number of publications. This document, dubbed the "Minimum Qualifications for Teachers in Medical Institutions Regulations, 1998" was published with the requirements for publications in the year 2009. Since that time, it has been subject to periodic amendments. The most recent NMC/MCI modification was made through the Gazette Notification No. MCI-12(2)/ 2019-Med.Misc./189334 on February 12, 2020 regarding guidelines on Indexed journals for research article publication.

This table below summarizes NMC/MCI amendments regarding publishing requirements for faculty promotion over the years (scroll to right side to see the full table).

Year of amendment notification	2009	2010	2015	2017	2019 (circular dated February 2020)
Circular date	No.MCI-12(2) / 2009 -Med. Misc. / 56925	No.MCI- 12(2)/2010-Med. Misc. /33038	No.MCI-12(1)/2015- TEQ/ 131880	No.MCI- 12(1)/2017-Med. Misc./115698	No.MCI-12(2)/2019- Med.Misc./189334
Number of publica tions (assistant to associate professor)	At least two	At least two	At least two	At least two	At least one
Nationality of journal	Journals by the National Associations/ Societies	National journal accepted/published	National/international journal	National/interna tional journal	Removed both words
Indexing agencies	Choice of index ing services not specified	Choice of indexing services not specified	Scopus PubMed Medline Embase Excerpta Medica Index medicus Index Copernicus	Scopus PubMed Medline Embase Excerpta Medica Index medicus Index Copernicus	Directory of Open access journals (DoAJ) PubMed Central Citation index Sciences citation index Expanded Embase Medline Scopus
E-journals	Not included	Excluded	Excluded	Excluded	DOAJ included

NMC/MCI guidelines for Indexed journals

NMC/MCI guidelines on Type of article and level of Authorship

The table below gives information on which type of articles and level of authorship are considered valid to be considered for Faculty promotion depending on the article publication date:

Date/Year of Publication	Before 24/07/2009	24/07/2009- 02/11/2010	03/11/2010- 02/09/2015	03/09/2015- 07/06/2017	08/06/2017- 12/02/2020 (with 02 Yrs Transitory period)
Manuscript/ Article type	Original research paper	Original research paper	Original research articles Original research papers	Original research articles Original research papers	Original articles Systematic reviews Meta-analysis Case series
Authorship Level	First author	First author, second author	First author, second author	First author, corresponding author	First three authors or the corresponding author

NMC/MCI guidelines for Manuscript type and Authorship

You can use this tool to assess the validity of your publication as per the latest requirements by the NMC.

What are BCMET & BCBMR Certificates?

If the faculty submits the articles for consideration as per the latest NMC (MCI) Approved Journals Indexing Guidelines for Research Publication dated 12 Feb 2020, he/she is also required to submit the following 2 certificates (both the certificates are mandatory):

The National Medical Commission (NMC) has published the details of its Online Research Method Course and Medical Education Technology course for Postgraduate Faculty and Students 2021 via its website.

The course is titled "Basic Course in Bio-medical Research" is an online course designed for postgraduate Medical Students as well as Medical Teachers. It is a National Medical Commission (NMC) authorized course in partnership with the ICMR National Institute of Epidemiology as well as SWAYAM NPTEL. The NMC has made available on its official website its Information Bulletin as well as the registration form for the course.

To enhance the research abilities that post-graduate (MD/MS) students as well as medical educators in order to enhance the research abilities of medical teachers and students, medical teachers and students, the National Medical Commission (NMC) has recommended a common research methodology course for all students across the nation. The course online, "Basic Course in Bio-medical Research" will be provided by the ICMR-National Institute for Epidemiology (ICMR-NIE), Chennai. The course will cover the fundamentals of research methodological research. This course is available by the SWAYAM program of the Ministry of Education through SWAYAM NPTEL.

Modifications were introduced in "Minimum Qualifications for Teachers in Medical Institutions Regulations" on 12.02.2020 making it necessary that medical instructors be able to pass the Basic Course in Biomedical Research at a designated Institution(s) to be promoted to different teaching titles.

The course will be available on the website https://swayam.gov.in and ICMR-NIE (http://nie.gov.in/niecer/bcbr/index.htm). Candidates must sign up for the course as soon as enrollment is open for the cycle.

Details of the course are available on NMC official website at the following URLs:

References:

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February 7, 2022April 27, 2022

Indian Healthcare News,Resident Doctors,Surgery,Surgery Residency

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Sticky

Surgical Training in India: Problems and Solutions

Posted in Surgery Residency

The origin of this post comes from my participation in a recent Panel discussion about improving Surgical Training in India. The session was titled "HOW WE CAN IMPROVE SURGICAL TRAINING IN THE INDIAN SUBCONTINENT" organized by Learning General Surgery Group. In the group we have recently been seeing an uprise of frustration among surgical residents about not getting enough operative opportunities, and surprisingly the problem is countrywide. On one side there are clear prescribed guidelines on the kind of surgeries a resident is supposed to do during his training and the role of resident in each surgery is clearly prescribed in the course brochures of MS and DNB General surgery by the governing agencies like NBE, NMC and respective Medical Universities. But the same is not being put into practice which is causing the rising frustration in the community of surgical trainees in India. Most residents will agree with my views and most faculty will not and may think that they also did the same, why create all the fuss. But if the system has to be improved, an open-minded approach towards discussion and deliberation is necessary.

The Problems with the Surgical Training in India

In this section, before talking about the solutions, let's start by clearly defining the problem statement while keeping in mind the perspectives of both the surgical residents and faculty. Below I have enumerated the problems which I could identify as most pressing:

1. Surgical Residents are increasingly being used for Clerical works

Everyone is aware of the systemic deficiencies our hospitals have (especially government institutes). Many jobs which are clearly a nursing job are not done by nurses due to their indifferent attitude, strong unions, lack of clear guidelines from hospital administration, nursing administration and medical administration. Many nursing jobs are imposed on residents as nobody else does them.

Similarly, due to the absence of efficient IT systems, collection of lab and radiological investigation reports are also considered to be the responsibility of surgical residents or interns.

2. No Facility for Intermediate surgical training

Most Indian surgical institutes do not have any facilities (functioning) for intermediate surgical training like Wet Labs, Skill Labs and facilities for Cadaveric anatomic dissection and cadaveric surgery sessions. So, the current surgical teaching process in practice is "read-observe-operate", rather than "read-observe-practice-operate". We are currently missing upon this big opportunity where the residents can practice and master a specific surgery with procedure simulations over animal models before operating on real patients, for example- Bowel anastomosis simulation, vascular anastomosis simulations, lap simulations etc.)

https://youtu.be/mOIduDqWNVk

3. More number of Senior Residents and Assistant Professors above the trainee residents

The number of posts of senior residents and Assistant professors have increased and since they are also in their learning stage, a major share of surgeries (especially laparoscopic surgeries) is taken up by them and the trainee residents are left with a very limited number and variety of procedures.

4.. Number of Residents is increasing

In the last 4-5 years there has been a big increase in PG seats by atleast 70-80 percent since 2014. This has led to distribution of operative cases between the increasing number of residents, hence reduced the overall operative exposure.

5. Increasing number of litigations making senior faculty uncomfortable in giving operative free hand

Since there has been an increase in litigations over patient outcomes over the past few decades, the faculty are getting uncomfortable in giving operative free hand especially in private medical colleges and private hospitals running DNB courses.

6. Culture of Teaching during surgeries is gradually dwindling

The culture of teaching is gradually dwindling in medical institutes and the usual excuse given is that the residents are not up to the mark and have not come prepared (while they are day and night busy with clerical work, emergency duties and ward duties).

7. Paying patients expect only their consulting surgeons to be operating on them

Paying patients in private medical colleges and Private hospitals running DNB courses come with expectation that only their consulting or star surgeon to be operating on them (they usually come with an expectation that all surgical steps including opening and closure will be done by him).

8. No mechanism for quality audits for surgical teaching programs

The procedures which a resident is supposed to assist and do independently during his residency program are clearly outlined in the course prospectus of MS/MCh and DNB/DrNB surgical courses. But the guidelines are seldom put into practice and there is no mechanism to ensure if these training guidelines are being followed or not. In short, there is no quality feedback mechanism both for the institute and also for the surgical residents to decide which institute to choose during counselling.

Proposed Solutions for improving Surgical Training in India

Mandatory provision for cadaveric training and simulation training facilities in each institute running a surgical residency course.
Anatomical dissection hall to be allowed for PGs and Super specialty residents also who want to revise their anatomy before particular surgery.
Attending forensic autopsy can also be one avenue to be explored where residents can get the feel of anatomy and real tissue.
The quality feedback mechanism can be introduced by any of the following means:
- Transparent Quality audits by governing agencies (NBE, NMC or Concerning Medical University)
- A system for anonymous rating by surgical residents based on which ranking of institutes can be populated, so that institutes offering better training and exposure get higher ranking doctors. In the current scenario, the doctors choose their institutes based on hearsay and face value of the institute rather than the real value. There is no method for objective ranking of the institutes.
Residents should take learning seriously and show more involvement in overall patient care so that faculty becomes more interested in teaching. Similarly, faculty should also take teaching as a responsibility.
Private medical colleges and DNB institutes should be mandated to arrange for postings in Government colleges for hands on exposure.
Clear distribution of cases by complexity between 1st, 2nd, 3rd year residents, senior residents and assistant professors while keeping in mind course guidelines for surgical training (course brochures).

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Dr Sandeep

February 27, 2022April 21, 2022

Resident Doctors,Surgery,Surgery Residency

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Which is the latest edition of Bailey and Love?

Posted in Surgery

Update : New 28th edition is expected to arrive this year (2022).

The latest edition of Bailey and Love as of May 2020 is 27th Edition. The publishing date for 27th edition is 16 November 2018. Previous edition release dates are as follows:

26th - 18 Feb 2013
25th - 27 Jun 2008
24th - 26 Mar 2004
23rd - 25 Apr 2000

As per this trend it seems that they publish a new edition of bailey and love every 4-5 years. So I guess there is a long wait for Bailey and Love 28th edition to get published. You could expect the 28th edition of Bailey and Love surgery to come by 2022-2023.

Here is the link to the International Student's Edition of Bailey and Love - 27th Edition that you can buy at a discounted price in India.

It is considered to be the Best book for surgery for MBBS. The 27th edition is less bulky and excludes some unimportant things (tables, epidemiological facts etc ) and is more colourful and attractive. Language is very easy to understand. If you are a surgery aspirant, this is the best book for surgery. Not at all like other famous bigger books with small font and endless literature which is not actionable and is low yield. But surgery steps are not given for most of surgeries, so you will have to refer to some operative surgery books for surgical steps. As for those facing problems in exam preparation due to difficulty in recalling after reading Bailey, my advice would be to make your own bullet notes as you read the chapters.

Here is a Youtube video with the interview by the authors of Bailey and Love with their comments and updates about Bailey and Love 27th Edition.

Studying surgery with Bailey & Love: an overview for trainees, students & surgical consultants

Here is another video by Prof. P. Ronan O’Connell, one of the editors of Bailey and Love. In this video he gives his views regarding his future plans for Bailey and Love and what it takes to come up with a new edition.