A census of general surgery consultants in England and Wales: implications for the current and future surgical workforce.

INTRODUCTION: This study aimed to describe the composition of the current general surgical consultant body in England and Wales and quantify levels of inequality within it as well as describe future workforce challenges. METHODS: This is an observational study of all general surgical departments in England and Wales. Consultant general surgeons were identified and data regarding their gender, country of undergraduate medical education, subspecialty and private practice were recorded. RESULTS: Of the 2,682 consultant general surgeons in England and Wales identified for this study, just 17% are women, with gender inequality most marked in university teaching hospitals and among certain subspecialties. Almost 40% of consultants did not obtain their primary undergraduate degree in the United Kingdom and there are considerably fewer surgeons who studied abroad in university teaching hospitals. Over 40% of current general surgical consultants have been qualified for more than three decades and there is no equivalent sized group of younger consultants. CONCLUSIONS: There remains considerable gender and racial inequality in the consultant general surgical workforce, with pockets of a lack of diversity within university or teaching hospital surgical departments and some subspecialties. The proportion of surgeons in their fourth decade of clinical practice represents the largest group of current practising consultants, which points towards an impending workforce crisis should senior clinicians seek to reduce activity or consider taking early retirement.

Profile of neonatal candidiasis in tertiary neonatal intensive care unit: A report from a developing country.

BACKGROUND: Systemic candidiasis is an important nosocomial infection in neonatal intensive care units. The objective of this study was to identify the change in the profile of neonatal candidiasis in a tertiary neonatal intensive care unit (NICU) in eastern India in recent times. METHODS: It was a retrospective review of case records from 2014 to 2019 from a tertiary NICU of eastern India. Data of the fungal sepsis, demographic details, risk factors of fungal sepsis and mortality were collected from 103 neonates. RESULTS: One hundred and three neonates had blood culture positive for fungal species of which 91 (88.3%) infants weighed ≥1500 g and 66 (64%) infants were term. There was significant higher incidence of candidiasis among outborn (Relative risk of outborn 18.84, 95% CI 10.74-33.05). Prolonged antibiotic usage (>14 days), meropenem usage (>5 days), central catheterization (>5 days), invasive mechanical ventilation (>5 days), surgical intervention were found in 64 (62.1%), 46 (44.6%), 31(30.0%), 40 (38.8%) and 39 (37.8%) infants. Non albicans candida (NAC) was isolated as the predominant species (82/103, 79.6%). Resistance to both of fluconazole and amphotericin B were found in 19 (18.4%) babies. Presence of NAC infection and resistance to both amphotericin B and fluconazole were independent predictors of candida associated mortality in NICU. CONCLUSION: Neonatal candidiasis is found among outborn infants with higher birth weight and gestational age. NAC species are predominant organisms with resistance to common antifungal drugs.

Clinical and echocardiographic characteristics associated with evolution of patent ductus arteriosus in preterm neonates: A prospective cohort study.

BACKGROUND: In preterm infants, persistence of ductus arteriosus is an important medical condition. Functional echocardiography for patent ductus arteriosus (PDA) may guide clinical decision-making regarding treatment requirement strategies. Objectives of the study were to assess the trends of clinical and functional echocardiographic parameters with evolution of ductus arteriosus in babies≤1250 gm of birth weight and to evaluate whether there is any association of these parameters with persistence of ductus. METHODS: In this prospective observational study, recruited babies were assessed serially for clinical events and functional echocardiography. Babies were classified into three groups: without PDA, with PDA but PDA spontaneously closed (within 7 days) and persistent PDA. RESULT: We included 143 infants (Birth weight 1017±179 g, gestational age 30.8±2.7 weeks). Out of 60 babies with PDA, PDA failed to close spontaneously in first week in 32 (53.4 %) infants. PDA Doppler flow pattern on day 3 was found to be one of the most significant markers for future ductus. The highest frequency of growing pattern (37.5%) and pulsatile pattern (59.4%) was seen in persistence ductus group. PDA diameter and LA/Ao ratio were found strongly correlated with all other variables except E/A ratio. CONCLUSION: We noticed persistence of ductus in preterm infants had significant clinical and echocardiographic association. PDA doppler flow pattern on day 3 was found to be a significant marker for future behaviour of ductus. Significant correlation was found among individual functional echocardiographic parameters in babies with PDA. This would guide judicious treatment of PDA in preterm neonates.

Salt Intake Behaviors among Type 2 Diabetic Patients of a Tertiary Level Hospital in Dhaka City.

Hypertension and diabetes co-exist frequently. Therefore, salt intake behavior, a risk factor of hypertension, in diabetic patients plays an important role in determining their cardiovascular outcome. The purpose of this study was to assess the knowledge and behaviors of health risks associated with a salt intake in adults with type 2 diabetes. This cross-sectional study was conducted among the type 2 diabetic in-patients of Bangladesh Institute of Health Sciences General Hospital, Dhaka, Bangladesh from October to December 2016. Data were collected from 131 respondents through interview using WHO STEPS module of salt with adaptation to local context like on amount of added salt while taking meal. Information on blood pressure, body mass index and relevant co-morbidities were also collected. About half of the respondents were women (56.5%). Mean age of the respondents was 54.3±14.4 years. More than six in 10 of them (62.6%) took added salt while taking meal; and 40.5% took processed foods with high salt. The mean amount of added salt intake among the users was 4.4±1.6gm per day having no significant difference between men and women. Though 47.3% of the respondents believed that lowering salt in meal is very important and 77.9% of them believed that excess salt or salty sauce can cause health problems. Salt intake behavior is poor in patients with type 2 diabetes even having regular contacts with doctors and other health professionals. Appropriate measures can be taken to increase awareness, change their attitude and behavior regarding salt consumption.

Prediction of ductus closure and development of adverse clinical outcome by functional echocardiography in very low birth weight newborn.

OBJECTIVE: To evaluate the role of functional echocardiography for prediction of patent ductus arteriosus (PDA) closure and development of adverse outcome in very low birth weight newborn. METHODS AND STUDY DESIGN: Functional echocardiography was done in 143 neonates with birth weight less than 1250 g on day 3. Nine echocardiographic parameters were analyzed for babies with PDA for prediction of spontaneous closure and development of one or more adverse outcomes (bronchopulmonary dysplasia, necrotizing enterocolitis≥stage 2 and intraventricular hemorrhage > grade 2) during hospital stay. RESULT: The mean (±SD) birthweight and gestational age of the cohort were 1017 (±17) g and 30.8 (±2.7) weeks. PDA was found in 60 (41.9%) babies on day 3 among the recruited babies. Binary logistic regression model showed strong prediction ability of early (day 3) functional echocardiography markers in predicting future spontaneous closure of PDA and development of one or more adverse clinical outcome. In multivariate analysis, abnormal flow pattern (growing or pulsatile) was found to have increased risk for persistence of PDA (adjusted OR 22.9, CI 1.97-269) in comparison to PDA with closing/bidirectional pattern. CONCLUSION: Early functional echocardiography, especially the flow pattern, is useful for prediction of PDA closure. Adverse clinical outcome prediction is possible with functional echocardiography markers when combined with gestational age and PDA closure status.

Effect of Annealing on Optical, Electrical and Charge Trapping Properties of TiO2 NPs Arrays.

Glancing angle deposition technique has been carried out to synthesize TiO2 nanoparticles over SiO(x) thin film. The samples were annealed at different temperatures 550 °C and 950 °C. The average grain sizes and surface RMS roughness have been increased from 9 nm, 0.62 nm (as deposited); 21 nm, 2.47 nm (550 °C annealed) to 37 nm, 4.2 nm (950 °C annealed). Fivefold maximum increase in optical absorption has been recorded for the 950 °C annealed sample as compared to that of the as grown. The absorption and photoluminescence peaks show the red shift with an increase in annealing temperature and grain sizes. Transmission electron microscopy (TEM) has been used to investigate phases of nanoparticles. The junction capacitance of the Au/TiO2 NPs device was observed to decrease with an increase in frequency. A minimum change in junction capacitance of 1 pF was calculated for 950 °C annealed device for the variation of frequency from 500 Hz to 1 MHz. The results are used to simulate the capacitance as a function of frequency and voltage characteristic of TiO2 NPs based device in different temperature. Simulated results are exceptionally close to experimental results. The TiO2 NPs based device annealed at 950 °C possessed higher impedance and lower conductance among all three type of devices. The sample annealed at 950 °C showed the maximum capacitance (0.09 pF at 0 V) as well as charge (˜0.6 Coulomb at +8 V) retention compared to that of the 550 °C annealed and as deposited samples.

Characterization of Klebsiella granulomatis pathogenic to silkworm, Bombyx mori L.

Bacterial disease of silkworm causes significant reduction of silk production leading to huge economic loss. This study aims to isolate bacteria from diseased silkworm and to determine its pathogenicity and antibiotic resistance. A strain of Klebsiella granulomatis has been isolated from silkworm haemolymph which was later identified on the basis of biochemical tests and 16S rRNA gene sequencing. The optimum culture condition of K. granulomatis was determined at pH 7.0 and 37 °C temperature. The strain was resistant to most of the antibiotics used in this study except azithromycin, gentamycin and ciprofloxacin. The strain is capable to reproduce flacherrie like symptoms with high mortality rate when re-injected into healthy silkworm. Treatment with low dose of ciprofloxacin was found to be effective to prevent flacherrie induced by the isolated K. granulomatis strain.

Evaluation of the validity of high serum antistreptolysin o titre only, as an indication for tonsillectomy.

Serum Antistreptolysin O (ASO) titre is raised when there is infection of any organ of the body, by Group A beta haemolytic streptococci (GABHS), Group C or Group G streptococci [1]. Increased serum ASO titre should not be the only deciding criterion for tonsillectomy if GABHS is not present in the palatine tonsils. In this study, we evaluate the rationality of performing tonsillectomy in raised serum ASO titre only, in absence of GABHS in palatine tonsil. The study was designed as a prospective cohort study in which the main out come measure is to find out: The main outcome measure is to find out whether only the raised serum ASO titre is to be considered to perform tonsillectomy or not. Fifty consecutive patients (both children and adults) clinically diagnosed to have chronic tonsillitis were included in this prospective cohort study. Throat swab culture, tonsilar core tissue culture and Serum ASO titre tests were performed in all the patients. The results showed that out of the 50 patients 45 had raised ASO titre and 5 patients had normal ASO titre. GABHS was found in 5 cases (10 %) in throat swab culture and 8 cases (16 %) in FNA of tonsil core culture. The sensitivity of throat swab culture as compared to FNA Tonsil core culture was 62.5 % and positive predictive value was 100 %. The sensitivity of ASO titre as compared to core culture was 100 % and positive predictive value was 17.8 %. Specificity was only 12 %. From the results of this study, it is evident that FNA culture of the tonsil core is a valid and a reliable test for the diagnosis of bacterial micro flora in recurrent tonsillitis. One should perform throat swab culture and FNA culture from tonsil core along with ASO titre before doing tonsillectomy in absence of any other indications. Identifying GABHS in the tonsil by FNA test and/or in the throat swab culture along with high serum ASO titre may be one of the ideal indications for tonsillectomy.

Tubular duplication of the oesophagus presenting with dysphagia.

Duplications of the alimentary tract are rare congenital malformations, with the ileum being the most commonly affected site, followed by the oesophagus. Among oesophageal duplications, cystic duplication is the most common and the tubular variety, the rarest. Herein, we report a rare case of tubular oesophageal duplication, complicated by adenosquamous carcinoma at the lower end of the oesophagus, in a 32-year-old man who presented with progressive dysphagia. Although proton pump inhibitors may relieve dysphagia, oesophagectomy and gastric interpositioning should be the first-line treatment for patients with tubular oesophageal duplication, in order to reduce the risk of malignant transformation at the lower end of the oesophagus.

Neu-Laxova syndrome: a case report.

Neu-Laxova syndrome (NLS) is a rare lethal syndrome found in both consanguinous and non-consanguinous couple. This is characterized by terrible face with unusual craniofacial appearance with exophthalmos, spectrum of central nervous system malformation, like microcaphaly, hypoplastic cerebellum, cleft lip/palate, ichthyosis and oedema. The diagnosis is made on the basis of clinical parameter. We report a 4 hour old male term newborn with IUGR of Neu-Laxova syndrome presented with anencephaly, rudimentary cerebellum, exophthalmos of right eye, bilateral cleft lip and palate and cryptorchidism. Anencephaly and cryptorchidism are two recently reported findings of NLS. We are presenting this case in addition from Bangladesh to lend further support to those two new findings as component of Neu-Laxova syndrome. Outcome of this syndrome is not good. Most of the patients are died of infection within hours to days.

Prevalence of Gingivitis, Plaque accumulation and Decayed, Missing and Filled Teeth among slum population in Bangladesh.

A cross-sectional survey, using cluster sampling technique, of slum population, was done to explore the oral health status and the prevalence of common oral diseases. A close ended questionnaire comprising Decayed, Missing and Filled Teeth (DMFT) Index, Gingival Index (Löe and Silness) and Plaque Index was applied to evaluate and record oral diseases, in both male and female population, covering a wide range of age groups. Clinical examination was carried out in different shum set ups, including slum schools by trained and calibrated examiners. Three thousand nine hundred and four (3904) slum dwellers participated in the survey. Prevalence of Caries was expressed in mean DMFT, recording of gingival status followed the method of Löe and Silness, oral hygiene status was evaluated using Plaque index. Mean decayed component, of the DMFT, was significantly higher than filling and missing component. Both decayed and missing components showed increasing trend, and filling components decreased as the age progressed. Prevalence of gingivitis and plaque accumulation was remarkably high among slum dwellers. Significantly high level of common oral diseases was found among Tongi slum dwellers.

Isozymic variations in specific and nonspecific esterase and its thermostability in silkworm, Bombyx mori L.

Esterase isozymic variations were documented in the haemolymph of developed multivoltine and bivoltine silkworm breeds during unfavorable seed crop seasons of May - September using á- and â- napthylacetate separately to identify specific and nonspecific esterase having thermotolerant potentiality. Variations existed in the isozyme pattern with three bands (Est-2, 3 and 4) in pure Nistari race and other developed multivoltine and bivoltine breeds. Est-2 and Est-3 were non-specific esterases as they were observed when both á- and â-napthylacetate was used as substrates separately. Est-4 band was observed only with á-napthylacetate as substrate and was therefore confirmed to be specific á-esterase band in the haemolymph of silkworm, Bombyx mori L. Zymograms showed that the non-specific esterase band (Est-3) with R1 of 0.43 and specific á-esterase band (Est-4) with R(f) of 0.32 predominately withstood a temperature of 70 +/- 2 degrees C for a duration of 10 min and were confirmed as thermostable esterases in haemolymph of silkworm, Bombyx mori L. This also categorized the presence of thermostable esterases in developed multivoltine and bivoltine breeds of silkworm, even though the qualitative activity was more in the former than the latter. The qualitative presence of thermostable esterases and their activity could be adopted as an indicative biochemical marker in relation to thermotolerance in silkworm.

Bancroftian elephantiasis in Nilphamari, Bangladesh.

The parasitic nematodes Wuchereria bancrofti, causes a dreadful disease in humans known as lymphatic filariasis, which afflicts more than 250 million people in tropical countries. Twelve districts with about 20 million people are endemic out of 64 districts in Bangladesh affecting more on Northern districts. This study was done in the Nilphamari, Kisorgonj and Sayedpur Thana under Nilphamari district, which is the most endemic for filariasis. In the present study, nineteen unions were investigated. Average 1.34% people were infected with filariasis (0.87% male and 1.81% female) out of 2,32,005 populations in those area. The highest percentage of infected unions was Alam Biditor (1.35%) under Kisorgonj Thana and lowest infected unions was Khatamadhupur (0.21%) under Sayedpur Thana. Among the affected people, 69.48% were poor, 28.88% were middle class and 1.63% was rich. The age group, 26-45 years, showed the highest rate (53.07%) of infection and the age group, 6-15 years, showed the lowest rate (1.92%) of infection. The relationships between infection status of male and female were statistically significant.

Prognostic factors for survival after curative resection of Dukes' B colonic cancer.

AIM: Data on the prognostic factors for survival in patients with locally advanced, node-negative colon cancer are limited. This study aimed to determine which factors might predict survival in patients with Dukes' B (T3 or T4, N0) colon cancer. METHOD: One hundred and eighty (93 male; median age 75 [range, 38-96] years) consecutive patients who had resection of a primary Dukes' B (on final histopathological analysis) colonic cancer between 1998 and 2003 were studied. No patient received neoadjuvant chemotherapy. Multivariate Cox regression modelling was used to assess the prognostic value of variables. Median follow up was 85 (60-125) months. RESULTS: Thirteen (7%) patients had a perforation at presentation. The median distance from tumour to the nearest longitudinal resection margin was 6 (0.3-27) cm. One hundred and twenty-four (69%) patients had a lymph node yield of 12 or more nodes. Actual 5-year survival was 59%. On multivariate regression analysis, tumour perforation (perforation vs no perforation, 5-year survival, 23%vs 61%; hazard ratio (HR), 3.7; 95% confidence interval (CI), 1.6-8.4; P = 0.002), tumour-to-margin distance (< 5 cm vs ≥ 5 cm, 48%vs 65%; HR, 1.7; 95% CI, 1.1-2.7; P = 0.039) and older age (≥ 75 years vs < 75 years, 45%vs 72%; HR, 3; 95% CI, 1.8-5; P < 0.001) were independent significant variables. CONCLUSION: A lymph node yield of 12 or more nodes is not a significant prognostic factor for survival after resection of Dukes' B colonic cancer. Patients with tumour perforation or limited resection have worse prognosis.

Studies on the antidiarrhoeal, antimicrobial and cytotoxic activities of ethanol-extracted leaves of yellow oleander (Thevetia peruviana).

This study screened the antidiarrhoeal, antimicrobial and cytotoxic effects of ethanol-extracted leaves of yellow oleander (Thevetia peruviana). The extract was tested against castor oil-induced diarrhoea in a model of albino rats and showed significant antidiarrhoeal activity (P<0.01). Disc diffusion technique was used to test the in vitro antibacterial activities of the extract and exhibited poor antibacterial activities against both Gram positive and Gram negative bacteria (mainly Bacillus sp). Ethanol-extracted leaves of yellow oleander showed narrow zone of inhibition in the bacterial lawns of Shigella flexineri, Salmonella typhi, Klebsiella sp, Staphylococcus aureus and Shigella sonnei. Cytotoxicty was determined against brine shrimp nauplii and LC50 of the plant extract was determined as 627.21µg/ml. The wide range of LC50 value denotes the safety effect of the extract.

Influence of ghrelin and growth hormone deficiency on AMP-activated protein kinase and hypothalamic lipid metabolism.

Current evidence demonstrates that the stomach-derived hormone ghrelin, a potent growth hormone (GH) secretagogue, promotes feeding through a mechanism involving the short-term activation of hypothalamic AMP-activated protein kinase (AMPK), which in turn results in decreased hypothalamic levels of malonyl-CoA and increased carnitine palmitoyltransferase 1 (CPT1) activity. Despite this evidence, no data have been reported about the effect of chronic, central ghrelin administration on hypothalamic fatty acid metabolism. In the present study, we examined the differences in hypothalamic fatty acid metabolism in the presence and absence of GH, by using a model for the study of GH-deficiency, namely the spontaneous dwarf rat and the effect of long-term central ghrelin treatment and starvation on hypothalamic fatty acid metabolism in this animal model. Our data showed that GH-deficiency induces reductions in both de novo lipogenesis and beta-oxidation pathways in the hypothalamus. Thus, dwarf rats display reductions in fatty acid synthase (FAS) mRNA expression both in the ventromedial nucleus of the hypothalamus (VMH) and whole hypothalamus, as well as in FAS protein and activity. CPT1 activity was also reduced. In addition, in the present study, we show that chronic ghrelin treatment does not promote AMPK-induced changes in the overall fluxes of hypothalamic fatty acid metabolism in normal rats and that this effect is independent of GH status. By contrast, we demonstrated that both chronic ghrelin and fasting decreased FAS mRNA expression in the VMH of normal rats but not dwarf rats, suggesting GH status dependency. Overall, these results suggest that ghrelin plays a dual time-dependent role in modulating hypothalamic lipid metabolism. Understanding the molecular mechanism underlying the interplay between GH and ghrelin on hypothalamic lipid metabolism will allow new strategies for the design and development of suitable drugs for the treatment of GH-deficiency, obesity and its comorbidities.

Pre-operative lymphoscintigraphy before sentinel lymph node biopsy for breast cancer.

Pre-operative lymphoscintigram for axillary sentinel lymph node biopsy (SLNB) may not be required for successful SLNB. The 117 consecutive patients who underwent SLNB had pre-operative lymphoscintigraphy. The operating surgeon was blinded to the results of the lymphoscintigram before SLNB. After SLNB was complete, the surgeon was unblinded to the results of the lymphoscintigram; re-exploration carried out if more nodes were predicted on the lymphoscintigram. 116 patients (99%) had successful SLNB before unblinding. In 85 patients (73%), operative findings corresponded with scintigraphic findings. In 26 patients (22%), the lymphoscintigram predicted more sentinel nodes than had been found; further nodes were identified and excised in only 4 patients (3%). None were positive for cancer. SLNB was successful in 99% of cases without pre-operative lymphoscintigraphy. Only 3% of patients had further nodes identified as a result of the lymphoscintigram. Pre-operative lymphoscintigraphy does not improve the ability to perform axillary SLNB during breast cancer surgery.