Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 3548  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
  »  Article in PDF (2,799 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

 
  In this Article
 »  Abstract
 »  Concept and Begi...
 » Sgpgi, a New Idea
 » Neurology at Sgpgi
 » Teaching
 » Research
 »  Center of Excell...
 » Hope
 »  References
 »  Article Figures
 »  Article Tables

 Article Access Statistics
    Viewed13041    
    Printed26    
    Emailed0    
    PDF Downloaded78    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
NI FEATURE: CITADELS SCULPTING FUTURE - COMMENTARY
Year : 2016  |  Volume : 64  |  Issue : 5  |  Page : 1010-1015

Neurology at Sanjay Gandhi PGI: Beginning, progress and hope


Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Web Publication12-Sep-2016

Correspondence Address:
Usha Kant Misra
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow- 226 014, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.190247

Rights and Permissions

 » Abstract 


High quality publications, patient care and educational standard have made Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India a favored destination for the patients and medical students, for getting treatment and education, respectively. The current article traces the history and milestone of the Department of Neurology, SGPGIMS, Lucknow and summarizes its achievements and facilities. The uniqueness of the department lies in being sensitive to the expectation of the patients, students and its faculty's own aspirations in research, keeping the patient as the center of focus.


Keywords: History, Lucknow, milestones, neurology, research, SGPGIMS, teaching, training


How to cite this article:
Misra UK, Kalita J. Neurology at Sanjay Gandhi PGI: Beginning, progress and hope. Neurol India 2016;64:1010-5

How to cite this URL:
Misra UK, Kalita J. Neurology at Sanjay Gandhi PGI: Beginning, progress and hope. Neurol India [serial online] 2016 [cited 2019 Dec 6];64:1010-5. Available from: http://www.neurologyindia.com/text.asp?2016/64/5/1010/190247





 » Concept and Beginning Top


Uttar Pradesh is the most populous state of India and has several reputed medical institutions of which King George Medical College and Agra Medical College are the oldest. There are central universities- Banaras Hindu University and Aligarh Muslim University, which also provide medical education. A number of state medical colleges at Allahabad, Jhansi, Meerut and Gorakhpur have established undergraduate and postgraduate programmes. Recently, the government of Uttar Pradesh has established medical colleges in Ambedkar Nagar, Kannauj, Azamgarh, Saifai, Jalaun and many small districts to meet the growing demand of doctors especially in rural India. Besides the increasing number of medical colleges, the state government had been keen to establish a center of excellence for medical education on the pattern of All India Institute of Medical Sciences, New Delhi. However, there was debate on whether to upgrade the King George (KG) Medical College or to build a new institute at a separate place. In 1981, finally, it was decided to establish a Medical Institute and its foundation stone was laid at the sports ground of KG Medical college. This highlighted the dilemma of the administration wherein a group of administrators wanted to upgrade KG Medical college but later on, the dominant opinion was that a new Institute at Raebareilly Road, Lucknow, be established [Figure 1]. A rare constellation of events occurred; Mr. Rajiv Gandhi visited Japan and agreed to cooperate in the health sector; and, there was a complete political and bureaucratic commitment to establish a state-of- the-art Medical Institute in Uttar Pradesh. The government and policy makers were committed to start an ambitious project in which the envisaged hospital was proposed to be one of the best in the country. Chief Minister Mr. ND Tiwari, and Health Minister Mr. Lokpati Tripathi provided the necessary direction; and, the bureaucracy provided the much needed force to shape the upcoming Institute [Figure 2]. The Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS) received JICA (Japan International Cooperation Agency) grant-in aid and Nagoya University provided the academic cooperation. The first Director, Dr. BC Joshi, and then Professor PB Sethi, did the initial work in directing construction, helping in the procurement of equipment, and in the recruitment of manpower. A team of educationists and bureaucrats visited a number of world renowned institutes to prepare a blue print of this new institute. The aim was to develop an outstanding institute to generate specialized manpower, in the mandate of which excellence in teaching and research were also incorporated.
Figure 1: Foundation stone of Sanjay Gandhi PGI in 1980 at Raebareilly Road, Lucknow

Click here to view
Figure 2: Chief Minister N D Tiwari, health minister Mr. Lokpati Tripathi and Director, Dr BC Joshi in a meeting to finalize the SGPGI project

Click here to view



 » Sgpgi, a New Idea Top


There were many innovations in the planning and development of SGPGI, which had been tried for the first time in the country. Some of the important and seminal innovations were as follows:

  • Super-specialty nature of Institute: The teaching institutes in India are based on undergraduate and postgraduate medical courses, and some of them have super-specialty curriculum as well. SGPGI was aimed primarily to conduct super-specialty education. It was decided that there would be no undergraduate (MBBS) and specialty (MD, MS) education, instead only DM and MCh courses were planned
  • Developing sciences rather the subjects: SGPGI has an integrated plan to develop sciences- cardiac, neuro, renal, endocrinal and gastrointestinal sciences; and, genetics and immunology. There were 6 sciences initially and these sciences included medical, surgical and basic science disciplines. The supporting departments such as radiation sciences (radiology, radiotherapy and nuclear medicine), microbiology, pathology, anesthesia and transfusion medicine were also developed. These departments started MD courses in due course of time. Further super-specialty courses were started in transplant pathology, cardiac and neuroanesthesia, pediatric endocrinology, and many others. These were 1 year courses for further specialization. SGPGI started new courses such as clinical immunology, genetics, critical care medicine, transfusion medicine, surgical endocrinology, pediatric gastroenterology and pediatric gastrosurgery for the first time.
  • SGPGI was the first institute to start a 3-year DM and MCh program, whereas it was a 2-year course at other centers. Subsequently, the 3-year DM and MCh program was adopted all over the country.


A unique model, where payment for the services rendered, was introduced in a public institute

SGPGI was serving the patients from economically backward areas such as Uttar Pradesh, Bihar, Madhya Pradesh and Nepal but was also aiming to provide state-of-the-art medical services that were based upon the limited resources of the state government. Sustaining such health facilities on the meager resources from state government was a great challenge. It was, therefore, decided to charge the patients for the incurring cost of all the investigations, medicines and procedures on a no-profit basis. This fund generation by SGPGI facilitated its rapid growth and development and many new facilities could be timely started without any difficulty.

SGPGI has may other unique features. SGPGI was one of the first government institutes to have computerized patient and financial data. It has an excellent library, which opens 24 hours throughout the year, with free internet facilities widely available. Through intramural grants, SGPGI supports faculty to initiate new research ideas and get funding from national and international agencies.

Due to these innovations and unique efforts, SGPGI, within a short period of time, established its excellence in the academic world. SGPGI has been regarded as a low output high impact institute. High quality publications, patient care and educational standard have made SGPGI a favored destination for the patients and medical students, for getting treatment and education, respectively.


 » Neurology at Sgpgi Top


Faculty: Dr. UK Misra was the first faculty to join in 1987 in the Department of Neurology. In the next year, Dr. S Pradhan and Dr. A Kohli were inducted into the department. In 1993, Dr. S Jha; in 1997, Dr. J Kalita; in 2007, Dr. V Paliwal; and, in 2013, Dr. S Bhoi, joined the department. Basic neurochemistry is an essential component of neurology and to facilitate work in this arena, Dr GN Babu was appointed in 1988 [Figure 3]. Neurology at SGPGI offers facilities for the diagnosis and management of all neurological disorders, and mainly, patients with stroke, epilepsy and central nervous system (CNS) infections are admitted in large numbers. Since SGPGI charges for its services, it is the effort of faculty to focus on admissions mainly for treatable disorders and keep the patients admitted for the minimum possible duration. In spite of this, there is a high bed occupancy in the 68-bedded neurology ward.
Figure 3: Faculty members and residents of Neurology department in a Continuing Medical Education program organized in 2014

Click here to view


SGPGI neurology has a 12 bedded intensive care unit (ICU) and a very active neurophysiology laboratory offering facilities for nerve conduction, evoked potentials, electroencephalography (EEG), video EEG, sleep study and non-invasive transcranial magnetic stimulation for diagnosis and therapeutic indications. A neurophysiology laboratory in the ward block has been established in 2013 for an easy and timely monitoring of critically ill patients, mainly related to the acute encephalitis syndromes but the facility is available for other patients as well [Figure 4]. Among the recent developments is the introduction of facility for membrane plasmapheresis in the neurology ward that is being carried out by neurology faculty and residents. This is useful in the management of critically ill neurological patients mainly suffering from the Guillain Barre syndrome, myasthenia gravis and chronic inflammatory demyelinating neuropathy [Figure 5]. The neurology department has two basic laboratories with polymerase chain reaction (PCR), real time PCR, spectrophotometer, ultracentrifuge, florescence microscopy and other facilities, which are needed for basic investigations and research. The 'Center of Excellence of Encephalitis Research' is also located in this laboratory. A lot of equipment that are being used in the basic laboratory were procured through the 'Center of Excellence of Encephalitis Research' fund.
Figure 4: Director General, Indian Council of Medical Research, Dr BM Katoch, visiting the intensive care unit and ward block neurophysiology laboratory in 2013

Click here to view
Figure 5: Professor VA Voinov, Saint Petersburg State Medical University, Russia supervising the technique of membrane plasmapheresis in the neurology ward

Click here to view



 » Teaching Top


The DM neurology program was started after MCI (Medical Council of India) inspection by Prof M C Maheshwari in 1990 [Figure 6]. The first batch of DM students was admitted in 1991. Initially 2 DM students were selected after a national examination. The DM seats were increased to 6 in 2010. Periodically, a number of leading experts from the country and abroad have visited the department and shared their knowledge and expertise [Figure 7]. The DM programme at SGPGI has a unique curriculum. During their DM training, the students have dedicated training in clinical neurophysiology, neuroradiology, neurosurgery, neuropathology and psychiatry. The students also have dedicated training in basic subjects under 01 and 02 programme at SGPGI. Students are also trained in the management of critically ill mechanically ventilated patients and get hands-on experience on membrane plasmapheresis.
Figure 6: Prof. M C Maheswari, conduction the Medical Council of India inspection for starting DM neurology programme on 1st Dec 1990. He is assisted by Drs UK Misra and S Pradhan

Click here to view
Figure 7: Prof NH Wadia, Jaslok Hospital, Mumbai, in an informal discussion with the faculty and residents of Neurology department, after the ward round in 1992

Click here to view


The Department of Neurology was the first to start post-doctoral (DM) fellowships programme in critical care neurology and neurophysiology of a one-year duration since 2011. These fellowships have been also been started in other institutes in the country because of its usefulness and the high demand for trained manpower in this field. The institute has awarded DM degree in neurology to 55 students, PhD to 8, and post-doctoral fellowship to 8 students.


 » Research Top


The neurology department has a major research interest in areas of central nervous system infection, stroke, neuromuscular disorders, neurodegenerative disorders and clinical neurophysiology. Following the local demand, neurology department has shifted the emphasis on acute neurology and critical care neurology during the year 2000-2001. The major research contributions of the department are helping in understanding the pathophysiology of movement disorders in Japanese encephalitis, worsening of Wilson's disease, pathophysiology of migraine, mechanism of vitamin B12 deficiency, mechanism of cellular injury in Japanese encephalitis, cerebral venous sinus thrombosis and copper toxicity. The research in the diagnosis of neurological disorders are focused on investigating thalamic lesions in Japanese encephalitis, muscle involvement in dengue and scrub typhus, pattern of muscle hypertrophy in various muscular dystrophies and magnetic resonance features of gliosis in neurocysticercosis. The major therapeutic studies which have influenced treatment include the high rate repetitive transcranial magnetic stimulation in migraine prophylaxis, role of divalproate and amitriptyline in migraine prophylaxis, superiority of valproate over phenytoin in status epilepticus, safety of levetiracetam over lorazepam in status epilepticus, adjunctive use of levofloxacin and aspirin in tuberculous meningitis, randomized controlled trial on mannitol in brain hemorrhage, efficacy of low molecular weight heparin over unfractionated heparin in cerebral venous sinus thrombosis and role of prednisolone in post stroke complex regional syndrome. Some of these treatment protocols have been initiated in patients for the first time. These contributions have been summarized in [Table 1].[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28] In the field of medical education, the department has contributed by writing 4 books, namely, Clinical Neurophysiology, Clinical Electroencephalography, Tropical Neurology and Management of Neurological Disorders. So far, the department has published over 500 original research papers in reputed peer-reviewed journals suggesting the commitment of the department to teaching and research. As a result of these contributions, faculty members have been awarded several academic and civilian (Padamshri to Dr. S Pradhan) awards.
Table 1: Summary of important research contributions of the neurology department of SGPGI

Click here to view



 » Center of Excellence of Encephalitis Research Top


In the year 2010, through the support of Council of Science and Technology, Uttar Pradesh a “Center of Excellence of Encephalitis Research” was started with the aim of conducting research and training in clinically relevant areas of encephalitis. Under this programme, the Neurology faculty members and residents have visited the encephalitis endemic areas of Gorakhpur almost every year. The Encephalitis Center supported in the diagnosis and care of patients with the help of local experts and has proposed the low-cost intensive care unit and the syndromic approach of encephalitis. The department has conducted a one week intensive care unit workshop for training the trainers on how to start a low-cost intensive care unit in different areas of the country and state, which was sponsored by the Vector Borne Disease Control Cell of the Health and Family Welfare Deparmtent, Government of Uttar Pradesh. The center has maintained a website www.encephalitisindia.org, where the description of all the encephalitis related activities including the research and training imparted, are available online.


 » Hope Top


The Department of Neurology has been sensitive to the local and regional needs. The journey, which started with Japanese encephalitis, through dengue, and then scrub typhus, prompted the development of Critical Care Neurology and intensive care unit facilities. These facilities are unique in the country and have improved the patient care and teaching programs. Recently, it has been proposed to start an ambitious stroke program with Critical Care Neurology, Interventional Radiology and Neurosurgery. The department is sensitive to the expectation of the patients, students and its faculty's own aspirations in research, keeping the patient as the center of focus.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 » References Top

1.
Misra UK, Kalita J, Tripathi GM, Bhoi SK. Is β endorphin related to migraine headache and its relief? Cephalgia. 2013;33:316-22.  Back to cited text no. 1
    
2.
Kalita J, Bhoi SK, Misra UK. Is lack of habituation of evoked potential a biological marker of migraine? Clin J Pain. 2014;30:724-9.  Back to cited text no. 2
    
3.
Misra UK, Kalita J, Somarajan BI, Kumar B, Das M, Mittal B. Do ACE (rs4646994) and αADDUCIN (rs4961) gene polymorphisms predict the recurrence of hypertensive intracerebral hemorrhage? Neurol Sci 2012;33:1071-7.  Back to cited text no. 3
[PUBMED]    
4.
Kalita J, Kumar V, Chandra S, Kumar B, Misra UK. Worsening of Wilson Disease following penicillamine therapy. Eur Neurol 2013;71:126-31.  Back to cited text no. 4
[PUBMED]    
5.
Kalita J, Kumar V, Ranjan A, Misra UK. Role of oxidative stress in the worsening of neurologic Wilson disease following chelating therapy. Neuromolecular Med 2015;17:364-72.  Back to cited text no. 5
[PUBMED]    
6.
Kalita J, Uniyal R, Bhoi SK. Is palinopsia in migraineurs an enhanced physiological phenomenon? Cephalalgia. 2016 Jan 14. pii: 0333102415625610. [Epub ahead of print].  Back to cited text no. 6
    
7.
Misra UK, Kalita J. Movement disorders in Japanese encephalitis. J Neurol 1997;244:299-303.  Back to cited text no. 7
[PUBMED]    
8.
Misra UK, Kalita J, Pandey S, Khanna VK, Nagesh Babu G. Cerebrospinal fluid catecholamine levels in Japanese encephalitis patients with movement disorders. Neurochemical Research 2005;30:1075-8.  Back to cited text no. 8
    
9.
Singh SK, Misra UK, Kalita J, Bora HK, Murthy RC. Nitrous oxide related behavioral and histopathological changes may be related to oxidative stress. Neurotoxicology 2015;48:44-9.  Back to cited text no. 9
[PUBMED]    
10.
Misra UK, Kalita J, Kumar S, Mathur A. radiological and neurophysiological changes in Japanese encephalitis. J Neurol Neurosurg Psychiat 1994;57:1484-7.  Back to cited text no. 10
    
11.
Misra UK, Kalita J. Anterior horn cells are also involved in Japanese encephalitis. Acta Neurol Scand 1997;96:114-7.  Back to cited text no. 11
[PUBMED]    
12.
Misra UK, Kalita J, Mani VE, Chauhan PS, Kumar P. Central nervous system and muscle involvement in dengue patients: A study from a tertiary care center. J Clin Virol 2015;72:146-51.  Back to cited text no. 12
[PUBMED]    
13.
Pradhan S. Valley sign in Becker muscular dystrophy and outliers of Duchenne and Becker muscular dystrophy. Neurol India 2004;52:203-5.  Back to cited text no. 13
[PUBMED]  Medknow Journal  
14.
Pradhan S. Poly-hill sign in facioscapulohumeral dystrophy. Muscle Nerve 2002;25:754-5.  Back to cited text no. 14
[PUBMED]    
15.
Pradhan S. Calf-head sign in Miyoshi myopathy. Arch Neurol 2006;63:1414-7.  Back to cited text no. 15
[PUBMED]    
16.
Pradhan S. Diamond on quadriceps: A frequent sign in dysferlinopathy. Neurology 2008;70:322.  Back to cited text no. 16
[PUBMED]    
17.
Pradhan S, Kathuria MK, Gupta RK. Perilesional gliosis and seizure outcome: A study based on magnetization transfer magnetic resonance imaging in patients with neurocysticercosis. Ann Neurol 2000;48:181-7.  Back to cited text no. 17
[PUBMED]    
18.
Kalita J, Misra UK, Mani VE, Mahadevan A, Shankar SK. A study of muscle involvement in scrub typhus. J Neurol Sci 2015;348:226-30.  Back to cited text no. 18
[PUBMED]    
19.
Misra UK, Kalita J, Bhoi SK. High-rate repetitive transcranial magnetic stimulation in migraine prophylaxis: A randomized, placebo-controlled study. J Neurol 2013;260:2793-801.  Back to cited text no. 19
[PUBMED]    
20.
Kalita J, Vajpayee A, Misra UK. Comparison of prednisolone with piroxicam in complex regional pain syndrome following stroke: A randomized controlled trial. QJM 2006;99:89-95.  Back to cited text no. 20
[PUBMED]    
21.
Kalita J, Bhoi SK, Misra UK. Amitriptyline vs divalproate in migraine prophylaxis: A randomized controlled trial. Acta Neurol Scand 2013;128:65-72.  Back to cited text no. 21
[PUBMED]    
22.
Misra UK, Kalita J, Patel R. Sodium valproate vs phenytoin in status epilepticus: A pilot study. Neurology 2006;67:340-2.  Back to cited text no. 22
[PUBMED]    
23.
Misra UK, Kalita J, Maurya PK. Levetiracetam versus lorazepam in status epilepticus: A randomized, open labeled pilot study. J Neurol 2012;259:645-8.  Back to cited text no. 23
[PUBMED]    
24.
Misra UK, Kalita J, Nair PP. Role of aspirin in tuberculous meningitis: A randomized open label placebo controlled trial. J Neurol Sci 2010;293:12-7.  Back to cited text no. 24
[PUBMED]    
25.
Kalita J, Misra UK, Prasad S, Bhoi SK. Safety and efficacy of levofloxacin versus rifampicin in tuberculous meningitis: An open-label randomized controlled trial. J Antimicrob Chemother 2014;69:2246-51.  Back to cited text no. 25
[PUBMED]    
26.
Misra UK, Kalita J, Betai S, Bhoi SK. Outcome of tuberculous meningitis patients requiring mechanical ventilation. J Crit Care 2015;30:1365-9.  Back to cited text no. 26
[PUBMED]    
27.
Misra UK, Kalita J, Chandra S, Kumar B. Low molecular weight heparin versus unfractionated heparin in cerebral venous sinus thrombosis: A randomized controlled trial. Eur J Neurol 2012;19:1030-6.  Back to cited text no. 27
    
28.
Misra UK, Kalita J, Ranjan P, Mandal SK. Mannitol in intracerebral hemorrhage: A randomized controlled study. J Neurol Sci 2005;234:41-45.  Back to cited text no. 28
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow