The academic progress of female general surgery and orthopaedic surgery trainees in South Africa

BACKGROUND

Globally, medical institutes have seen an increase in female graduates, however surgical disciplines remain male-dominated. An epidemiological shift towards non-communicable diseases and trauma may result in a shortage of surgical specialists. One strategy to improve the surgical workforce is the recruitment of female graduates.

METHODS

A non-validated questionnaire was administered to females registered for the Master of Medicine (MMED) degree in General and Orthopaedic Surgery at the University of KwaZulu-Natal (UKZN) between 2000 and 2015. The study evaluated reasons for choice of surgery as a career, challenges faced on the domestic and work front, as well as factors that assisted with successful completion of training.

RESULTS

Seventy-two female trainees in General Surgery and Orthopaedics were identified from the UKZN databases. The contact details for 62 of these trainees were available. The overall response rate was 71.0% (44/62). A total of 95.5% (42/44) of participants selected surgery due to a passion for the field. Major challenges identified were a poor home and work-life balance (72.1%, 31/43) and poor working conditions (62.8%, 27/43). Female trainees perceived that they were viewed as inferior by patients (65.9%, 29/44). Successful trainees had a good home support system (89.3%, 25/28) and mentorship during training (60.7%, 17/28), and 85.7% (24/28) did not regret their career choice.

CONCLUSION

The recruitment and retention of females in surgery will contribute to maintaining an adequate surgical workforce. Training programmes need to improve work-life balance without compromising on producing competent surgeons. Improved visibility of female surgeons in leadership roles should be encouraged to promote mentorship and recruitment of trainees.

Sulfur and nitrogen co-doped carbon quantum dots as fluorescent probes for the determination of some pharmaceutically-important nitro compounds

In this study, highly fluorescent sulfur and nitrogen co-doped carbon quantum dots (SN-CQDs) were synthesized by a simple one-pot hydrothermal method using thiosemicarbazide and citric acid as starting materials. Various spectroscopic and microscopic techniques were applied to characterize the prepared SN-CQDs. The synthesized SN-CQDs' maximum fluorescence emission was obtained at 430 nm after excitation at 360 nm. Rifampicin (RFP), tinidazole (TNZ), ornidazole (ONZ), and metronidazole (MNZ) all quantitatively and selectively quenched the SN-CQDs' native fluorescence, which was the base-for their-spectrofluorimetric estimation without the need for any tedious pre-treatment steps or high-cost instrumentation. SN-CQDs demonstrated a "turn-off" fluorescence response to RFP, TNZ, ONZ, and MNZ over the ranges of 1.0-30.0, 10.0-200.0, 6.0-200.0, and 5.0-100.0 μM with detection limits of 0.31, 1.76, 0.57, and 0.75 μM and quantitation limits of 0.93, 5.32, 1.74, and 2.28 μM respectively. The suggested method was successfully used to determine the investigated drugs in their commercial dosage forms. The method was further extended to their determination in spiked human plasma samples, with satisfactory mean % recoveries (99.44-100.29) and low % RSD values (< 4.52). The mechanism of fluorescence quenching was studied and discussed. The suggested method was validated in accordance with ICH recommendations.

888 Utility of a Virtual Mock Interview Course to Prepare Trainees on UK Core Surgical Training Interviews – a Cross-Sectional Study

Aim

To assess the usefulness of a virtual mock interview course to prepare trainees for UK Core Surgical Training (CST) interviews.

Method

Junior doctors interested in applying for CST attended a one-day interview course delivered by highly ranked surgical trainees. All attendees were invited to complete pre- and post-interview course questionnaires to assess usefulness in improving the confidence and preparedness for interviews.

Results

A total of 60 trainees attended the course with an 87% (52/60) response rate to both pre- and post-course surveys. Most trainees were FY2 doctors (50%) applying to CST for the first time (78%). Before the course, 60% of attendees reported feeling “not so confident” for their upcoming interview; 38% of participants felt “somewhat confident” whilst 2% reported feeling “very confident.” 100% of doctors found the pre-mock interview presentations “very useful” or “extremely useful”. Matched data revealed an improvement in attendees’ overall confidence (p&lt;0.0001), with 98% reporting they felt “somewhat” or “very confident” and 2% reporting feeling “extremely confident” about upcoming interviews.

Conclusions

We demonstrate evidence of a successful CST virtual mock interview course that significantly aids preparation and improves confidence for junior doctors.

One-step electrodeposition of a polypyrrole/NiO nanocomposite as a supercapacitor electrode

An electrochemical deposition technique was used to fabricate polypyrrole (Ppy)/NiO nanocomposite electrodes for supercapacitors. The nanocomposite electrodes were characterized and investigated by Fourier transform infrared spectroscopy (FTIR), X-ray Diffraction (XRD), scanning electron microscopy (SEM), cyclic voltammetry (CV), galvanostatic charge–discharge (GCD) and electrochemical impedance spectroscopy (EIS). The performance of supercapacitor electrodes of Ppy/NiO nanocomposite was enhanced compared with pristine Ppy electrode. It was found that the Ppy/NiO electrode electrodeposited at 4 A/cm⁻² demonstrated the highest specific capacitance of 679 Fg⁻¹ at 1 Ag⁻¹ with an energy density of 94.4 Wh kg⁻¹ and power density of 500.74 W kg⁻¹. Capacitance retention of 83.9% of its initial capacitance after 1000 cycles at 1 Ag⁻¹ was obtained. The high electrochemical performance of Ppy/NiO was due to the synergistic effect of NiO and Ppy, where a rich pores network-like structure made the electrolyte ions more easily accessible for Faradic reactions. This work provided a simple approach for preparing organic–inorganic composite materials as high-performance electrode materials for electrochemical supercapacitors.

1668 Buying Your Way into A Run-Through Surgical Training Post: The Way Forward?

Introduction

Competition for core surgical training (CST) applications has increased significantly over the last few years. This has been largely attributable to the introduction of limited run-through surgical posts which avoids the bottleneck at ST3 applications. We sought to assess how financial factors may affect current or potential future surgical trainees in their pursuit for run-through posts.

Method

A 10-point questionnaire was designed to assess various financial considerations for surgical trainees applying to the 2021 CST cycle who had the sole goal of securing a run-through post. Results were analysed using Chi-squared test.

Results

Of the 40 respondents, 95% were foundation doctors and 5% were core trainees. There was a significant association between willingness to achieve full marks in the CST interview and attending an interview course and obtaining 1-1 coaching sessions (p &lt; 0.05). Familial income was not found to be a significant barrier to spending money on interview courses and coaching sessions (p &lt; 0.05).

Conclusions

Applicants are willing to pay a significant premium to secure a run-through surgical post. Further research is required to fully understand the reasons behind this phenomenon and the impact on those from widening participation backgrounds.

Difficult Central Venous Cannulation under Laryngeal Mask Airway Anesthesia in Adolescent

We report a case of difficult central venous cannulation under general anesthesia with laryngeal mask airway in a young female child. Our case demonstrated a difficulty in surgically finding the right internal jugular vein due to neck veins displacements by laryngeal mask airway, which caused morbidity such as prolonged surgical duration and excessive blood loss. Once the laryngeal mask airway was replaced with endotracheal tube, the internal jugular vein appeared on surface and procedure was successfully completed in a few minutes. Such difficulties warrant an alternate approach in airway management in order to prevent major adverse effects.

Orphenadrine in treatment of muscle cramps in cirrhotic patients: a randomized study

OBJECTIVE

Many patients of liver cirrhosis are complaining of muscle cramps, which are annoying to them. There is no effective treatment for muscle cramps in cirrhotic patients till now. This study purposed to evaluate efficacy and safety of orphenadrine in the treatment of muscle cramps in cirrhotic patients.

METHODS

One hundred and twenty four patients who had muscle cramps three or more times weekly were included. They were divided into two arms: 62 patients administrated orphenadrine and 62 administrated placebo. They were followed up till 2 weeks after the end of therapy. Muscle cramps were evaluated using questionnaire as regards severity, duration, and frequency. Also, side effects of orphenadrine were recorded.

RESULTS

Frequency, duration of muscle cramps, and pain score improved significantly after 1 month of orphenadrine therapy in comparison to placebo. Few side effects were recorded in the form of dry mouth, drowsiness, and nausea.

CONCLUSION

Orphenadrine is considered as promising safe drug for treatment of muscle cramps associated with liver cirrhosis.

Breast Cancer and HIV: a South African perspective and a critical review of the literature

BACKGROUND

The diagnosis of breast cancer and concurrent HIV in South Africa is common. The limited current evidence on this subject suggests that the patients thus afflicted appear to be younger, have a more advanced stage of breast cancer, have a higher treatment related complications and poorer outcomes. This paper reviews the literature related to HIV and breast cancer, with a view to improving the standard and quality of care of HIV positive breast cancer patients.

METHOD

Pubmed, EBSCOhost, Google scholar and Science Direct electronic databases were searched from 2001 and 2015. using the terms ('HIV' OR 'human immunodeficiency virus' OR 'AIDS' OR 'Acquired Immunodeficiency Syndrome') and 'breast cancer' or 'breast carcinoma' to identify all publications related to HIV and breast cancer. Titles and abstracts were evaluated for eligibility and appropriate full text articles obtained. The data extraction variables included the type of study, year of publication, study setting, participants, sample size, outcome measures and main findings.

RESULTS

Only five studies fulfilled the criteria, in respect of the aforementioned maladies, with twenty or more participants in each study. Evidence suggested that breast cancers develop at a much younger age in the HIV positive patient compared to the HIV negative patients, with more aggressive appearing tumour biology. Overall, it appears that HIV positive patients experienced a higher cancer-specific mortality than HIV negative patients, and this is independent of the stage of the cancer or the cancer therapy received, further the relationship between the HIV syndrome and breast cancer is currently marginal and inconclusive, and hence requires further investigation.

CONCLUSION

The prescription and administration of chemotherapy is a challenge, with potential complications impacting on the morbidity and mortality in HIV positive patients. Currently there are no reliable predictors of those at risk to complications from chemotherapy; however, being on ART appears to provide an acceptable safety profile. HIV positive patients are best managed in the context of a multi-disciplinary team in order to achieve favourable outcomes in the treatment of cancer. Well-designed prospective trials to assess the response to multimodal therapy, and the long-term outcomes of HIV positive patients with breast cancer are needed.

Self-organization of waves and pulse trains by molecular motors in cellular protrusions

Actin-based cellular protrusions are an ubiquitous feature of cells, performing a variety of critical functions ranging from cell-cell communication to cell motility. The formation and maintenance of these protrusions relies on the transport of proteins via myosin motors, to the protrusion tip. While tip-directed motion leads to accumulation of motors (and their molecular cargo) at the protrusion tip, it is observed that motors also form rearward moving, periodic and isolated aggregates. The origins and mechanisms of these aggregates, and whether they are important for the recycling of motors, remain open puzzles. Motivated by novel myosin-XV experiments, a mass conserving reaction-diffusion-advection model is proposed. The model incorporates a non-linear cooperative interaction between motors, which converts them between an active and an inactive state. Specifically, the type of aggregate formed (traveling waves or pulse-trains) is linked to the kinetics of motors at the protrusion tip which is introduced by a boundary condition. These pattern selection mechanisms are found not only to qualitatively agree with empirical observations but open new vistas to the transport phenomena by molecular motors in general.

HIV-associated salivary gland enlargement: a clinical review

Salivary gland disease is well established as an important HIV associated oral lesion. It manifests as salivary gland swelling involving one or both parotid glands with or without xerostomia. In the context of HIV, the swelling may be due to a wide spectrum of pathological conditions that include reactive or inflammatory disorders, acute and chronic infections, and neoplasms. This paper reviews the epidemiology, pathogenesis, clinical presentation, aspects of diagnosis and management of HIV associated salivary gland enlargement, in particular parotid gland enlargement, due to benign lymphoepithelial cysts (BLEC). Parotid gland enlargement is typically an early manifestation in the HIV-positive patient and should alert healthcare professionals to the likelihood of HIV infection. FNAC of the parotid gland is required to confirm the diagnosis and instituting HAART forms an important part of the management. There is a shift away from surgery in the treatment of this essentially 'benign' condition.

FOOD ACQUISITION AND INTRA-HOUSEHOLD CONSUMPTION PATTERNS: A STUDY OF LOW AND MIDDLE INCOME URBAN HOUSEHOLDS IN DELHI, INDIA

BACKGROUND

Food habits and choices in India are shifting due to many factors: changing food markets, fast urbanization, food price inflation, uncertain food production and unequal distribution during the past decade. This study aims to explore food acquisition and intra-household consumption patterns in urban low and middle income (LMI) households in Delhi.

METHODS

Twenty households were randomly selected from the Center for Cardio-metabolic Risk Reduction in South Asia (CARRS) surveillance study. Data were derived from 20 questionnaires administered to women responsible for food preparation, four key-informant-interviews, and 20 in-depth interviews with household heads during September-November 2011. STATA and ATLAS.ti software were used for data analysis.

RESULTS

Half of the households spent at least two-thirds of their income on food. The major expenditures were on vegetables (22% of total food expenditure), milk and milk products (16%), and cereal and related products (15%). Income, food prices, food preferences, and seasonal variation influenced food expenditure. Adults usually ate two to three times a day while children ate more frequently. Eating sequence was based on the work pattern within the household and cultural beliefs. Contrary to previous evidence, there was no gender bias in intra-household food distribution. Women considered food acquisition, preparation and distribution part of their self-worth and played a major role in food related issues in the household.

CONCLUSION

Women's key roles in food acquisition, preparation and intra household food consumption should be considered in formulating food policies and programs.

Prevalence and risk factors for self-reported asthma in an adult Indian population: a cross-sectional survey

BACKGROUND AND METHODS:

We estimated the prevalence of self-reported asthma in adult Indians and examined several risk factors influencing disease prevalence. Analysis is based on 99 574 women and 56 742 men aged 20–49 years included in India’s third National Family Health Survey, 2005–2006. Multiple logistic regression analysis was used to estimate the prevalence odds ratios for asthma, adjusting for various risk factors.

RESULTS:

The prevalence of self-reported asthma was 1.8% (95%CI 1.6–2.0) among men and 1.9% (95%CI 1.8–2.0) among women, with higher rates in rural than in urban areas and marked geographic differences. After adjustment for known asthma risk factors, women were 1.2 times more likely to have asthma than men. Daily/weekly consumption of milk/milk products, green leafy vegetables and fruits were associated with a lower asthma risk, whereas consumption of chicken/meat, a lower body mass index (BMI; <16 kg/m², OR 2.08, 95%CI 1.73–2.50) as well as a higher BMI (>30 kg/m², OR 1.67, 95%CI 1.36–2.06), current tobacco smoking (OR 1.30, 95%CI 1.12–1.50) and ever use of alcohol (OR 1.21, 95%CI 1.05–1.39) were associated with an increased asthma risk.

CONCLUSIONS:

There are wide regional variations in the prevalence of asthma in India. With the exception of the findings for BMI, however, most of the associations of asthma with the risk factors are relatively weak and account for only a small proportion of cases.

Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011

Intima-media thickness (IMT) provides a surrogate end point of cardiovascular outcomes in clinical trials evaluating the efficacy of cardiovascular risk factor modification. Carotid artery plaque further adds to the cardiovascular risk assessment. It is defined as a focal structure that encroaches into the arterial lumen of at least 0.5 mm or 50% of the surrounding IMT value or demonstrates a thickness >1.5 mm as measured from the media-adventitia interface to the intima-lumen interface. The scientific basis for use of IMT in clinical trials and practice includes ultrasound physics, technical and disease-related principles as well as best practice on the performance, interpretation and documentation of study results. Comparison of IMT results obtained from epidemiological and interventional studies around the world relies on harmonization on approaches to carotid image acquisition and analysis. This updated consensus document delineates further criteria to distinguish early atherosclerotic plaque formation from thickening of IMT. Standardized methods will foster homogenous data collection and analysis, improve the power of randomized clinical trials incorporating IMT and plaque measurements and facilitate the merging of large databases for meta-analyses. IMT results are applied to individual patients as an integrated assessment of cardiovascular risk factors. However, this document recommends against serial monitoring in individual patients.