Proximie in the operating theatre: evaluation of a virtual operating platform for medical student education.

INTRODUCTION: Medical students often hesitate to enter the operating theatre because of poor visibility of the surgical field and anxiety about the theatre environment. In addition, ear, nose and throat (ENT) surgery is underrepresented in many medical curricula. Virtual systems like Proximie offer flexible viewing of surgeries with surgeon commentary, potentially addressing these issues. METHODS: This descriptive survey study aimed to evaluate the use of Proximie as a surgical education tool for delivering ENT teaching to medical students. Live ENT procedures were recorded at the ENT Department of the John Radcliffe Hospital and shared with interested clinical medical students through Proximie accounts. Students were added to a private group chat to ask questions and provided feedback through structured forms, assessing procedural effectiveness and the platform's technology. Live-streaming and recording of procedures were facilitated by ENT surgeons providing commentary. RESULTS: Conducted over four virtual theatre days, the study gathered 52 responses: 96% of students rated Proximie's educational value as 4 of 5 or higher; 57% preferred the virtual experience over physical attendance because of its convenience and the improved view of the surgical field. Students valued the live commentary and showed interest in using Proximie for a broader range of surgeries. Suggested improvements included fixing technical issues, better communication of theatre lists, and expanding surgical specialty coverage. CONCLUSIONS: Proximie has been highly rated by medical students for its effective and engaging approach in the instruction of surgical skills, underscoring its value as an educational tool. Future research is needed to formally assess knowledge acquisition and retention across multiple surgical subspecialties. This work is the first step towards evaluating the utility of virtual operating theatre platforms for medical student education.

Nurse-led renal cell carcinoma clinic: a single center review.

BACKGROUND: In 2015 our centre introduced a nurse-led renal cell cancer follow-up protocol and clinic for patients who have undergone partial or radical nephrectomy for organ-confined kidney tumours. The main aims of this clinic were to improve healthcare efficiency and standardize follow-up processes. OBJECTIVES: The primary objective was to assess the effectiveness of a nurse-led renal cell cancer follow up clinic in regard to surveillance protocol compliance and the timely identification and appropriate management of recurrences. A secondary objective was to evaluate this locally developed follow up protocol against the current European Association of Urology (EAU) guidelines surveillance protocol. PATIENT AND METHODS: All patients who underwent a partial or radical nephrectomy between 2015 and 2021 at a single Western Australia institution for a primary renal malignancy were included. Data was collected from local clinical information systems and protocol adherence, recurrence characteristics and management were assessed. The current EAU guidelines were applied to the cohort to assess differences in risk-stratification and theoretical outcomes between the protocols. RESULTS: After a mean follow up period of 31.2 months (range 0-77 months), 75.5% (185/245) of patients had all follow up imaging and reviews within 1 month of the timeframe scheduled on the protocol. 17.1% (42/245) had a delay in their follow up of more than a month at some stage, 5.7% (14/245) did not attend for follow up but had documented attempts to facilitate their compliance, and 0.4% (1/245) were lost to follow up with no evidence of attempted contact. 15.5% (38/245) of patients had recurrence of malignancy detected during follow up and these were all discussed in a multi-disciplinary team (MDT) meeting. The recurrence rate was 2.5% (3/119) for low risk, 17.7% (14/79) for intermediate risk, and 44.7% (21/47) for high risk patients when they were re-stratified according to EAU risk categories. No recurrences were detected through ultrasound (USS) or chest x-ray (CXR) in this cohort and our protocol tended to place patients in higher risk-stratification groups as compared to current EAU guidelines. CONCLUSION: Nurse-led renal cell cancer follow up is a safe, reliable and effective clinical framework that has significant benefits in regard to resource utilization. USS and CXR are ineffective in detecting recurrence and Computerized tomography (CT) should be considered the imaging modality of choice for this purpose. The EAU surveillance protocol appears superior to our protocol, and we have therefore transitioned to the EAU guideline protocol going forward.

CAnceR IN PreGnancy (CARING) - a retrospective study of cancer diagnosed during pregnancy in the United Kingdom.

BACKGROUND: The incidence of cancer diagnosed during pregnancy is increasing. Data relating to investigation and management, as well as maternal and foetal outcomes is lacking in a United Kingdom (UK) population. METHODS: In this retrospective study we report data from 119 patients diagnosed with cancer during pregnancy from 14 cancer centres in the UK across a five-year period (2016-2020). RESULTS: Median age at diagnosis was 33 years, with breast, skin and haematological the most common primary sites. The majority of cases were new diagnoses (109 patients, 91.6%). Most patients were treated with radical intent (96 patients, 80.7%), however, gastrointestinal cancers were associated with a high rate of palliative intent treatment (63.6%). Intervention was commenced during pregnancy in 68 (57.1%) patients; 44 (37%) had surgery and 31 (26.1%) received chemotherapy. Live births occurred in 98 (81.7%) of the cases, with 54 (55.1%) of these delivered by caesarean section. Maternal mortality during the study period was 20.2%. CONCLUSIONS: This is the first pan-tumour report of diagnosis, management and outcomes of cancer diagnosed during pregnancy in the UK. Our findings demonstrate proof of concept that data collection is feasible and highlight the need for further research in this cohort of patients.

Rapid divergence of mussel populations despite incomplete barriers to dispersal.

Striking genetic structure among marine populations at small spatial scales is becoming evident with extensive molecular studies. Such observations suggest isolation at small scales may play an important role in forming patterns of genetic diversity within species. Isolation-by-distance, isolation-by-environment and historical priority effects are umbrella terms for a suite of processes that underlie genetic structure, but their relative importance at different spatial and temporal scales remains elusive. Here, we use marine lakes in Indonesia to assess genetic structure and assess the relative roles of the processes in shaping genetic differentiation in populations of a bivalve mussel (Brachidontes sp.). Marine lakes are landlocked waterbodies of similar age (6,000-10,000 years), but with heterogeneous environments and varying degrees of connection to the sea. Using a population genomic approach (double-digest restriction-site-associated DNA sequencing), we show strong genetic structuring across populations (range FST : 0.07-0.24) and find limited gene flow through admixture plots. At large spatial scales (>1,400 km), a clear isolation-by-distance pattern was detected. At smaller spatial scales (<200 km), this pattern is maintained, but accompanied by an association of genetic divergence with degree of connection. We hypothesize that (incomplete) dispersal barriers can cause initial isolation, allowing priority effects to give the numerical advantage necessary to initiate strong genetic structure. Priority effects may be strengthened by local adaptation, which the data may corroborate by showing a high correlation between mussel genotypes and temperature. Our study indicates an often-neglected role of (evolution-mediated) priority effects in shaping population divergence.

Dietary exposure to heterocyclic amines in high-temperature cooked meat and fish in Malaysia.

The intake of heterocyclic amines is influenced by the amount and type of meat and fish ingested, frequency of consumption, cooking methods, cooking temperature, and duration of cooking. In this study, the dietary intake of heterocyclic amines in Malaysia and their main sources were investigated. Forty-two samples of meat and fish were analysed by high-performance liquid chromatography with photodiode array detector to determine the concentration of the six predominant heterocyclic amines, namely: 2-amino-3-methylimidazo[4,5-f] quinoline (IQ), 2-amino-3,4-dimethylimidazo[4,5-f] quinoline(MeIQ), 2-amino-3,8-dimethylimidazo[4,5-f] quinoxaline (MeIQx), 2-amino-3,4,8-trimethylimidazo[4,5-f] quinoxaline (4,8-DiMeIQx), 2-amino-3,7,8-trimethylimidazo[4,5-f] quinoxaline (7,8-DiMeIQx), and 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP). Dietary intake data were obtained using a food-frequency questionnaire when interviewing 600 Malaysian respondents. The level of total heterocyclic amines in food samples studies ranged from not detected to 38.7 ng g(-1). The average daily intake level of heterocyclic amine was 553.7 ng per capita day(-1). The intake of PhIP was the highest, followed by MeIQx and MeIQ. The results reveal that fried and grilled chicken were the major dietary source of heterocyclic amines in Malaysia. However, the heterocyclic amine intake by the Malaysian population was lower than those reported from other regions.

Total phenolic compounds, flavonoids, and radical scavenging activity of 21 selected tropical plants.

UNLABELLED: Free radical scavenging activity of 21 tropical plant extracts was evaluated using 1,1-diphenyl-2-picrylhydrazyl assay (DPPH). Total phenolic compounds and flavonoids were determined using Folin-Ciocalteu and HPLC, respectively. Results of the study revealed that all the plants tested exhibited excellent antioxidant activity with IC(50) in the range of 21.3 to 89.6 microg/mL. The most potent activity was demonstrated by Cosmos caudatus (21.3 microg/mL) and Piper betle (23.0 microg/mL) that are not significantly different than that of -tocopherol or BHA. L. inermis extract was found to consist of the highest concentration of phenolics, catechin, epicatechin, and naringenin. High content of quercetin, myricetin, and kaempferol were identified in Vitex negundo, Centella asiatica, and Sesbania grandiflora extracts, respectively. Luteolin and apigenin, on the other hand, were found in Premna cordifolia and Kaempferia galanga extracts. Strong correlation (R = 0.8613) between total phenolic compounds and total flavonoids (R = 0.8430) and that of antioxidant activity of the extracts were observed. The study revealed that phenolic, in particular flavonoids, may be the main contributors to the antioxidant activity exhibited by the plants. PRACTICAL APPLICATION: Potent antioxidant from natural sources is of great interest to replace the use of synthetic antioxidants. In addition, some of the plants have great potential to be used in the development of functional ingredients/foods that are currently in demand for the health benefits associated with their use.

Executive function and attention span in euthymic patients with bipolar 1 disorder.

This is a cross sectional comparison study to assess executive function and attention span in euthymic patients with bipolar 1 disorder. It compares the performance of these two cognitive domains in 40 patients with bipolar 1 disorder to that of 40 healthy normal subjects using Trail Making (TMT), Digit Span (Forward and Backward) and Verbal Fluency (VF) tests. The association between demographic, clinical characteristics and performance in all tests were examined. Patients with bipolar illness showed significant impairment with moderate to large effect sizes (VF = 0.67, TMT A = 0.52, TMT B = 0.81, Digit Forward = 0.97, Digit backward = 1.10) in all tasks of executive and attention functioning. These impairments are observed in the absence of active mood symptoms while duration and severity of illness are not found to have an effect on both cognitive domains. Medications received by patients with bipolar disorder have significant association with performance on executive tasks. The results of this study add on to the existing global evidence of cognitive impairment in bipolar illness despite its cross cultural differences. Its presence in the absence of mania, depression or mixed episode indicates that cognitive impairment is stable even after symptoms recovery.

Inhibitory effect of morinda citrifolia L. On lipoprotein lipase activity.

Efficacy of Morinda citrifolia L. leaf (MLE) and fruit extracts (MFE) in inhibiting lipoprotein lipase (LPL) was determined in vitro. The result of the study showed that the highest inhibition on the LPL activity was exhibited by MLE (66%+/- 2.1%), which is significantly higher than that demonstrated by MFE (54.5%+/- 2.5%), green tea extract (GTE) (54.5%+/- 2.6%), and catechin (43.6%+/- 6.1%). Percent of LPL inhibition increase with concentration of the extracts. Quantitative analysis of the extracts revealed the presence of high levels of (+)-catechin at 63.5 +/- 17 and 53.7 +/- 5.7 mg/g in MLE and MFE, respectively, although not as high as that found in GTE (530.6 +/- 42 mg/g). Appreciable amount of epicatechin was found in all extracts tested, while rutin was only found in MLE and MFE. The study suggested that both leaf and fruit of M. citrifolia may be used as antiobesity agents in body weight management.

Private medical education--the doctor's perspective.

The Government's decision to drastically and speedily increase the number of doctors in the country needs to be reviewed. The standard and quality of health care does not depend on the number of doctors, but on the improvement of the health care infrastructure. Increasing the number of government medical schools and increasing the intake of students should be done on a need-to basis, with the above perspective in mind. The selection criteria of candidates must not be compromised and the teaching staff must be adequate and experienced. The number of doctors should be gradually increased over the years in tandem with the development of the health care infrastructure and the deployment of doctors must be directed at providing equitable care to the people at all economic levels and geographic locations. The strength of academic staff in existing government medical schools must be upgraded to provide high level of teaching and research, perhaps reinforced with the recruitment of suitably qualified and experienced foreign teachers. The infrastructure of existing government medical schools must be upgraded to cater for the gradual increasing demand for more doctors as the country develops. The selection of candidates for the government medical schools must be based on merit and without undue emphasis on ethnic considerations, for it is only in the arena of fair competitiveness that excellence can be born. The considerations of merit in selection must include assessment of attitude, self-development, moral ethics and reasoning. If the above perspectives are fully appreciated, then there is really no requirement for private medical colleges in Malaysia.

Why do so few older people with aortic stenosis have valve replacement surgery?

BACKGROUND: Many older patients with severe aortic stenosis do not have valve replacement surgery. OBJECTIVE: To determine the proportion of older people with symptomatic aortic stenosis referred for specialist assessment and the reasons for non-referral. METHODS: Retrospective study of all patients over 75 attending the geriatric department of an English teaching hospital. Confirmation was by reviewing all echocardiographic reports. RESULTS: Of 40 patients with symptomatic aortic stenosis, only four had undergone surgery. Seven patients refused operation; five were medically unfit (for reasons other than heart failure) and reasons for not referring could not be found in 13 casenotes. Of the 15 patients referred to a cardiologist, eight were considered suitable for surgery. CONCLUSION: Only one in five patients over 75 with echocardiographically-confirmed aortic stenosis was considered for surgery. Prospective studies are needed to determine why patients and geriatricians do not seek specialist assessment for this treatable condition.

The treatment of femoral neck fractures by percutaneous pinning.

Sixty two patients with displaced femoral neck fractures treated by percutaneous pinning are reviewed. There were 37 females and 25 males with an average age of 63.7 years. There were 36 Garden grade III and 26 grade IV fractures. Twenty three patients had other medical conditions. Fourteen patients were operated under local anaesthesia. Superficial wound infection was found in three cases with no deep infection. Union occurred in 41 patients by eight months. Of the 21 non-unions 15 remained painless. The pins migrated outwards in seven cases but caused no clinical problem. Avascular necrosis was seen in 11 patients by 18 months. Avascular necrosis and non-union occurred together in six patients. Secondary hemiarthroplasty was performed in only ten patients. Routine hemiarthroplasty for femoral neck fractures is not always indicated. Femoral head preservation should be attempted before prosthetic replacement. The pinning surgery is simple, fast and can be performed under local anaesthesia. Hemiarthroplasty should be reserved for failed cases only.

Slipped capital femoral epiphysis caused by an implant--a case report.

A nine-year old boy sustained a traumatic fracture of the neck of left femur and was treated by closed reduction and cancellous screw fixation. Fourteen months later the tips of the screws were found to be at the epiphyseal plate and there was evidence of slip of the upper femoral epiphysis. The opposite hip was normal and no other abnormalities were detected. It is postulated that the slip was caused by the implant.

First dorsal interosseous compartment syndrome.

Compartment syndromes of the interosseous muscles in the hand are difficult to diagnose because of their atypical presentation, and are often not recognised, especially when the syndrome presents as a chronic affliction. Such a syndrome affecting the first dorsal interosseous muscle in a dominant hand, and undiagnosed for nearly eight years, is described. Simple fasciotomy proved to be the only definitive treatment necessary.