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Browsing by Author "Pai, Sanjay A"

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Book Review : Dr Spin Doctor.
(2011-04) Pai, Sanjay A
For about two decades now, the pharmaceutical industry -particularly its marketing and sales arms – has been receiving a lot of flak. The bad publicity has come from all sides – articles in learned medical journals, in general newspapers and magazines, in movies and from whistleblowers in the industry – and has reached such an extent that the public approval of the industry in the USA dropped from 80% in 1987 to a mere 9% in 2005, putting its reputation just above the oil and tobacco industries. Carl Elliot in his book, aptly subtitled “Adventures on the dark side of medicine”, drives one more nail in the coffin of the drug industry. Elliot illustrates how Big Pharma stoops low and how medical professionals join hands with them, knowingly or unknowingly.
Career preferences of medical students who joined Grant Medical College, Bombay in 1957 and 1982.
(2009-05) Pai, Sanjay A
Background. Scant data are available on the career paths of Indian medical students. I wished to determine the career destinations of students who joined Grant Medical College, Bombay in 1982 and 1957, at 25 and 50 years, respectively, after having joined the medical school. Methods. Questionnaire, telephone interview, e-mail response and personal interview were used to collect the data. I also collated emigration data for the students of the 1982 batch and sought to learn whether they were happy with their choice of career. Results. Forty-nine of 156 students of the 1982 batch and 49 of 84 students of the 1957 batch were abroad, at the 25- and 50-year stage, respectively. Most students (125 of 129) from the 1982 batch had no regrets about their choice of career. Most of those in India (94 of 106) worked entirely in the private health sector. Only 1 student from each batch was in basic research. Conclusion. At least one-fourth of students from the batch of 1982 and over half the students from the batch of 1957 were abroad. Over 90% of those in India were in the private health sector and were happy with their choice of career.
Cryptococcal prostatitis and osteomyelitis.
(2007-01-15) Joshi, Sangeeta; Gowda, Sunil; Pai, Sanjay A; Chakravarty, R D; Amarnath, S K
Cystic lymphangioma of the colon.
(2009-11) Kulkarni, Jayashree; Bhat, Naresh; Pai, Sanjay A
Drug promotional practices in Mumbai: a qualitative study.
(2007-04-17) Roy, Nobhojit; Madhiwalla, Neha; Pai, Sanjay A
We conducted a qualitative study to determine the range of promotional practices influencing drug usage in Mumbai. Open-ended interviews were conducted with 15 senior executives in drug companies, 25 chemists and 25 doctors; focus group discussions were held with 36 medical representatives. The study provided a picture of what might be described as an unholy alliance: manufacturers, chemists and doctors conspire to make profits at the expense of consumers and the public's health, even as they negotiate with each other on their respective shares of these profits. Misleading information, incentives and unethical trade practices were identified as methods to increase the prescription and sale of drugs. Medical representatives provide incomplete medical information to influence prescribing practices; they also offer incentives including conference sponsorship. Doctors may also demand incentives, as when doctors' associations threaten to boycott companies that do not comply with their demands for sponsorship. Manufacturers, chemists and medical representatives use various unethical trade practices. Of particular interest was the finding that chemists are major players in this system, providing drug information directly to patients. The study also reinforced our impression that medical representatives are the least powerful of the four groups.
An editor speaks: Setting the record straight
(Forum for Medical Ethics Society, 2018-10) Pai, Sanjay A
An opportunity to read the memoirs of one of the most famous medical editors of our times, of one of the most prestigious medical journals of all time, was not something I could pass up. Thus, it was with glee and curiosity that I took up the job of reading and reviewing the memoirs of Dr Jerome Kassirer, former editor-in-chief of the New England Journal of Medicine (NEJM).
Errors by surgical pathologists in India: results of a questionnaire survey.
(2003-07-11) Pai, Sanjay A
BACKGROUND: Data from the United Kingdom show that most surgical pathologists are aware of about one serious mistake in their reports every year. There are no corresponding data from India or the developing world. I made an attempt to determine the rate of error made by Indian pathologists. METHODS: A postal questionnaire was sent to 96 pathologists and 71 clinicians in different cities. The questions included some related to their experience with error in histopathology, as well as a few on the respondents' views on the legal and ethical aspects in the case of medical error. RESULTS: Fifty pathologists and 47 clinicians responded. Of the evaluable responses, 32 pathologists were aware of 86 errors in the past 5 years, while 30 clinicians recalled 162 errors. Most mistakes that pathologists remembered were cases related to lymphoid disease (n = 15) while for clinicians, gastrointestinal tract (n = 12) and lymphoid tissue (n = 9) were common sites of error. Benign-malignant errors were the most common type of error. CONCLUSION: The discrepancy between the rates of error between the two groups suggests that better pathologist-clinician communication is required. Medical councils and related governing bodies should consider introducing a quality control programme for anatomic pathology.
The ethics of research on stored biological samples: outcomes of a Workshop.
(2016-04) Vaz, Manjulika; Sridhar, TS; Pai, Sanjay A
Research is often conducted using laboratory samples and data. The ethical issues that arise in a study involving residual samples are considerably different from those arising in a prospective study. Some of these ethical issues concern the risks to confidentiality, individual autonomy, trust in and credibility of the researcher or the research, commercialisation and even the nomenclature involved.
Geographic eponyms: A history of geography in medicine.
(2016-05) Hussain, Maharra; Pai, Sanjay A
Geographic eponyms have commonly been used in medical terminology, with diseases and medical entities being named after the place where the condition was discovered (e.g. Bombay Blood group) or invented (Jaipur Foot) or where the disease was first detected (Rocky Mountain Spotted fever) or where a consensus meeting has been held (Banff) or for other reasons (Argentina flag, Congo red stain). In 2015, the WHO decided to adopt a politically correct method to name infectious diseases in the future. We illustrate, in verse form, some of the places that have been used in medical terminology, over the centuries. An accompanying essay explains the specific reasons for the selection of these locales in our vocabulary. Natl Med J India 2016;29:166–8
Giant cell arteritis: A clinical and pathological study.
(2010-01) Vankalakunti, Mahesha; Dharmanand, B G; Chandra, Suresh; Pai, Sanjay A
Background. Giant cell arteritis is a vasculitis affecting large- and medium-calibre vessels. It is not uncommon in the West and there are many large series in the literature. However, there are very few reports of giant cell arteritis among Indian patients. Methods. We did a retrospective study of 9 Indian patients (5 men and 4 women; age range 59–81 years [mean and median 70 years]) who had had a temporal artery biopsy for suspected giant cell arteritis at a tertiary care hospital. Results. Eight patients had biopsy-proven giant cell arteritis. The common presenting features were pyrexia of unknown origin (4), headache (6) and blurring of vision (2). The erythrocyte sedimentation rate was elevated and ranged from 25 to 120 mm at the end of the first hour (mean 96, median 105). The C-reactive protein level, which was available in 5 cases, was raised. Giant cells and inflammatory cells were seen in 7 of 8 temporal artery biopsies; a transmural lymphocytic and neutrophil infiltrate without giant cells was present in 1 case. All patients were treated with steroids and they responded well. Conclusion. Temporal arteritis is probably under-recognized in India. Pyrexia is a common presenting feature of the disease; temporal arteritis should be considered in the differential diagnosis of elderly patients with pyrexia of unknown origin.
How to catch a thief.
(2010-01) Pai, Sanjay A
Immunohistochemistry: some more benefits.
(2008-03-24) Pai, Sanjay A; Patil, Poonam U
Kikuchi-like lymphadenitis may be an early manifestation of SLE.
(2004-06-08) Pai, Sanjay A
'Living in the clouds of a vain illusion': The decline and fall of clinical autopsies
(2016-05) Pai, Sanjay A; Pandya, Sunil K
Autos is Greek for oneself and opsis refers to the act of viewing; combined into autopsy, the word refers to the act of seeing for oneself.1,2 Historically, autopsies have been crucial to our understanding of the natural history of disease and the efficacy of our attempts to treat them. They have also humbled us by showing our shortcomings and errors. Campos and Rocha have reviewed autopsies over the past 4000 years and have highlighted their pedagogical value.3 In the era preceding Roentgen, autopsies were an unparalleled means for learning pathology. Works of great masters such as Giovanni Battista Morgagni (1682–1771) and Rudolph Virchow (1821–1902) were based on meticulous autopsies; Virchow added the use of the microscope. Carl Rokitansky (1804–78), working at the Allgemeine Krankenhaus in Vienna, performed 30 000 autopsies personally and supervised many more, making his institute one of the most respected training centres in pathology in Europe.1,2 The names of two early clinicians, who used autopsies to understand disease, come to mind. Pierre Charles Alexandre Louis (1787–1872) studied enteric fevers and distinguished typhoid from other causes of fevers. He correlated the intestinal lesions termed Peyer’s patches (after Johann Conrad Peyer [1653–1712] who had described them in the 1670s) with typhoid and used medical statistics to lay the foundation of what we now term evidence-based medicine.4 The surviving volumes of autopsy notes by William Osler at McGill University, the Montreal General Hospital and Philadelphia General Hospital, stand witness to his enthusiasm and competence in extracting the last bit of information from his subjects. His genius lay in correlating autopsy findings with clinical features to build unforgettable descriptions of several diseases. The lessons learnt in the autopsy room were disseminated to his students at dissections, through papers, books and at meetings.
Medical Council of India's amended qualifications for Indian medical teachers: Well intended, yet half-hearted
(Indian Cancer Society, 2018-01) Bandewar, Sunita V. S.; Aggarwal, Amita; Kumar, Rajeev; Aggarwal, Rakesh; Sahni, Peush; Pai, Sanjay A
Medical Council of India’s Amended Qualifications for Indian Medical Teachers: Well Intended, yet Half-hearted
(Indian Academy of Pediatrics, 2018-02) Bandewar, Sunita VS; Aggarwal, Amita; Kumar, Rajeev; Aggarwal, Rakesh; Sahni, Peush; Pai, Sanjay A
Medical ethics in laboratory medicine: A review, with an oath for pathologists
(Forum for Medical Ethics Society, 2020-01) Bhagwat, Swarupa; Pai, Sanjay A
The basic tenets of medical ethics are: autonomy of the patient, beneficence, non-maleficence and justice. These are usually interpreted in the light of the practice of clinical medicine but also apply to pathology and laboratory medicine, a field in which there is often no direct patient contact. We wished to evaluate these basic tenets of medical ethics with respect to laboratory medicine and to provide insights into some of the issues that laboratory physicians, in routine practice and in academia, face on a regular basis. This was done by using the published literature related to the topic of medical ethics, with a special focus on laboratory medicine, as well as the authors’ interpretations and opinions, based on their experience. We conclude that the idea of autonomy of the patient or research participant is pertinent with respect to specimens, autopsies and in legal issues such as consent for publication in the media and social media. Beneficence is relevant with respect to laboratory values in reports, financial issues and in research and education. The concept of non-maleficence is important from the point of view of doing no harm, communication with patients and colleagues, reducing/containing error and misdiagnosis in medicine, screening for disease and in over diagnosis. Justice is applicable to issues of distribution of resources and manpower, and their equitable usage. Many of the tenets, however, need to be interpreted in the light of local laws and customs which differ across the world. We conclude with an Oath for pathologists and laboratory physicians. Key words: medical ethics, misconduct, autonomy, beneficence, non-maleficence, justice, informed consent, medical research, oaths
Multiple dermatofibromas on face treated with carbon dioxide laser.
(2007-05-15) Krupa Shankar, D S; Kushalappa, A A; Suma, K S; Pai, Sanjay A
News from here and there.
(2016-01) Pai, Sanjay A
1 December 2015, the Pan American Health Organization (PAHO) issued an epidemiological alert warning of a suspected link between Zika and Guillain–Barré syndrome or microcephaly, but with the caveat that final proof was lacking. However, the health ministries of Brazil and Mexico, where Zika cases have been seen, have stated that the link is Zika virus. Zika virus disease is a mosquito-borne viral disease caused by the Zika virus, a member of the Flavivirus genus, family Flaviviridae. The virus is named after the Zika forest in Uganda where it was first isolated in 1947 in rhesus monkeys in the course of mosquito and primate surveillance. It then spread to Southeast Asia where it caused small sporadic infections. In 2007, the first major outbreak occurred in the Yap Islands of Micronesia. In 2013, a bigger outbreak occurred in French Polynesia, where the estimated infection rates were 70% on some islands. There were also reports of Guillain–Barré syndrome among adults. The virus first appeared in the western hemisphere in February 2014, on Chile’s Easter Island. Since then, it has spread over the length and breadth of Latin America. The first confirmed Zika virus infection in Brazil was in March 2015. Over the past 5 years, Brazil (population: 204 million), had 130 to 170 cases of microcephaly each year. From January to September 2015, this figure roughly doubled, and between October and December 2015, over 2400 new cases have been reported. Zika virus is a 40 nanometre enveloped virus with an icosahedral shape. It has a non-segmented single-strand, positive sense RNA genome. The genome encodes for a polyprotein with three structural proteins and seven non-structural proteins. The virus is primarily transmitted to people through the bite of an infected Aedes species mosquito (A. aegypti/A. albopictus). The Zika virus can be transmitted from an infected pregnant woman to her foetus during pregnancy or around the time of birth. Currently, there are no reports of Zika virus transmission through breastfeeding. Sexual transmission of the virus is possible. The virus is present longer in semen than in blood. Zika virus has been detected in blood and other body fluids including urine, semen, saliva, amniotic fluids as well as cerebrospinal fluid. During the outbreak in French Polynesia, 2.8% of blood donors tested positive for Zika virus. The virus has also been found in blood donors in previous outbreaks. There have been multiple reports of transmission of the virus through blood transfusion in Brazil. Most Zika virus infections are asymptomatic. Severe infection leading to hospitalization is uncommon and case fatality is low. However, as mentioned above, there is a likely link between Zika virus infection and Guillain–Barré syndrome or microcephaly. Infection is likely to give lifelong immunity. No specific antiviral treatment is available for Zika virus infection. Infected people should get plenty of rest, sufficient fluids, and analgesics and antipyretics.
Publication and citation ethics.
(2006-03-08) Srinivasan, Sandhya; Thomas, George; Pai, Sanjay A

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