Another lost tribe: Quantifying the experience of international medical graduates applying for a national training number (NTN) in the United Kingdom with a cross-sectional study.

BACKGROUND: International medical graduates (IMGs) have a primary medical qualification obtained from outside their country of practice. In the United Kingdom (UK), postgraduate medical training after foundation years involves obtaining a national training number (NTN) in their specialty of choice by national selection. In this paper, we aim to quantify how IMGs feel to obtain an NTN and what unique obstacles they may face in doing so. MATERIALS AND METHODS: A survey with a combination of closed and open-ended questions was circulated to IMGs via social media and text message. The survey was aimed at those IMGs practising at a middle grade (non-consultant) level, whether they had obtained a training number or not. Data collected included demographics, years of postgraduate experience before UK arrival, number of attempts at obtaining a training number, and the most significant perceived difficulty to obtaining a training number. We also asked whether difficulties in obtaining a training number would cause IMGs to contemplate changing specialty. Data from the survey responses were analysed using SPSS 22. RESULTS: Out of a total of 203 doctors approached, 197 responded, of which the majority were male. All responders had at least five years of postgraduate experience before relocating to the UK. Only 56 (28.8%) had a training number at the time of the survey. Almost all the responders had made at least one unsuccessful attempt to obtain a training number. In addition, 152 (76.6%) of responders felt that timely career progression in the UK was unlikely without having a training number. 57 (29.6%) of responders considered changing specialty due to inability to obtain a training number. CONCLUSION: Obtaining an NTN remains a crucial goal among IMGs in the UK, despite the obstacles and repeated failures in doing so.

A study of the treatment of cutaneous fungal infection in animal model using photoactivated composite of methylene blue and gold nanoparticle.

BACKGROUND: Onychomycosis is a widespread public health problem, in which T. rubrum and T. mentagrophytes is the commenest causative organisms. Current medical therapy has many drawbacks and side effects. Methylene blue (m.b) photodynamic therapy (pdt) proved efficacy but with lengthy sessions. OBJECTIVES: Optimizing methylene blue photodynamic therapy by combination of methylene blue photosensitizer and gold nanoparticles (aunps) in a composite as gold nanoparticles are efficient delivery systems and efficient enhancers of photosensitizers for antifungal photodynamic therapy. MATERIALS AND METHODS: Eighty newzealand rabbit (Oryctolagus cuniculus) were used and categorized in eight equal groups as follows; healthy and infection control, composite photodynamic therapy and five comparative groups. Photodynamic therapy was initiated at day three to five post inoculation, for four sessions forty eight hours apart. Each group divided and light exposure at two fluencies; 80J and 100J. All groups were investigated macroscopically and microscopically (histopathology and scanning electron microscope) also flowcytometry assessment for cell death and X-ray analysis for gold nanoparticles accumulation in brain and liver tissues were determined. RESULTS: Recovery from infection approaching 96% in gold nanoparticles+light group, around 40% in methylene blue photodynamic therapy and 34% in composite photodynamic therapy. The observed findings confirmed by apparent decrease of apoptosis, however small amounts of gold nanoparticles detected in brain and liver. CONCLUSION: Light stimulated gold nanoparticles is a promising tool in treatment of onychomycosis.

Pancreatico-enteric fistula post pancreatic duct ligation for delayed haemorrhage complicating pancreaticoduodenectomy.

INTRODUCTION: Pancreatic fistula remains the main cause for postoperative morbidity following pancreaticoduodenectomy. The coincidence of sentinel bleed prior to post pancreatectomy haemorrhage (PPH) and pancreatic fistula is associated with very high mortality. PRESENTATION OF CASE: We report a case of pancreaticoduodenectomy complicated by postoperative leak and hematemesis. Severe delayed haemorrhage from the pancreatico-jejunostomy necessitated re-laparotomy and complete disconnection of the pancreatic anastomosis. Hemodynamic instability precluded a pancreatectomy or creation of a new anastomosis. A follow up MRI done 3 weeks after the patient's discharge demonstrated a fistulous tract causing a communication between both the pancreatic and biliary systems and the enteric loop. DISCUSSION: Spontaneous development a pancreatico-enteric fistula despite ligation of the pancreatic duct and complete disconnection of the pancreatic anastomosis has never been reported in literature to date. CONCLUSION: Pancreatic duct occlusion may be considered over a completion pancreatectomy or revisional pancreatic anastomosis in hemodynamically unstable and challenging cases.

Surgical management of complicated intra-mural duodenal hematoma: A case-report and review of literature.

INTRODUCTION: Intramural duodenal hematoma (IDH) is a rare pathological entity that occurs as a complication of trauma, pancreatitis, peptic ulcer disease or endoscopic biopsy procedures. In this report, we present a case of IDH related to a duodenal diverticulum that was complicated by intra-abdominal bleeding and peritonitis. PRESENTATION OF CASE: We report a 31-year old male who presented with pancreatitis that was complicated with IDH, as diagnosed using endoscopy and CT scan of the abdomen. The condition was related to a duodenal diverticulum as appears on imaging. The patient was treated conservatively over a course of 1 week when he started to have intra-abdominal bleeding and developed peritonitis. The patient was successfully treated with laparotomy, drainage of intra-abdominal abscess, evacuation of IDH and repair of duodenal perforation. We discuss this case in the context of the current indications of surgery in cases of IDH. CONCLUSION: Despite shift towards conservative management of IDH cases over last few decades, these cases should be handled carefully as they might develop life-threatening complications.