The female medical workforce.

In the UK, the proportion of female medical students has remained static over the last decade, at around 55%; however, at consultant level, only 36.6% of doctors are women. The reasons for this drop in numbers are not clear. Given the increase in number of female doctors in training, the proportion of female doctors at consultant level is lower than might be expected. This article discusses issues affecting the female medical workforce in anaesthesia, intensive care and pain medicine. It explores how gender stereotypes and implicit gender bias can affect the way women are perceived in the workplace, especially in leadership positions, and discusses health issues particular to the female medical workforce. While the issues in this article may not affect all women, the cumulative effect of being subject to gender stereotypes within a workplace not designed to accommodate the health needs of women may contribute to a work environment that may promote the attrition of women from our specialties.

Acute Shortening and Re-Lengthening (ASRL) in Infected Non-union of Tibia - Advantages Revisited.

INTRODUCTION: A gap non-union in various conditions has been treated successfully by the Ilizarov method. The gap can be filled up either by an acute shortening and re-lengthening (ASRL) procedure or by an internal bone transport (IBT). We compared the functional and clinical outcome of ASRL and IBT in gap non-unions of the infected tibia. MATERIAL AND METHODS: A retrospective study was conducted in our department from the data collected in the period between 1997 and 2010. There were 86 cases of infected non-union of the tibia, in patients of the age group 18 to 65 years, with a minimum two-year follow-up. Group A consisted of cases treated by ASRL (n=46), and Group B, of cases by IBT (n=40). The non-union following both open and closed fractures had been treated by plate osteosynthesis, intra-medullary nails and primary Ilizarov fixators. Radical debridement was done and fragments stabilised with ring fixators. The actual bone gap and limb length discrepancy were measured on the operating table after debridement. In ASRL acute docking was done for defects up to 3cm, and subacute docking for bigger gaps. Corticotomy was done once there was no infection and distraction started after a latency of seven days. Dynamisation was followed by the application of a patellar tendon bearing cast for one month after removal of the ring with the clinico-radiological union. RESULTS: The bone loss was 3 to 8cm (4.77±1.43) in Group A and 3 to 9cm (5.31± 1.28) in Group B after thorough debridement. Bony union, eradication of infection and primary soft- tissue healing was 100%, 85% and 78% in Group A and 95%, 60%, 36% in Group B respectively. Nonunion at docking site, equinus deformity, false aneurysm, interposition of soft-tissue, transient nerve palsies were seen only in cases treated by IBT. CONCLUSION: IBT is an established method to manage gap non-union of the tibia. In our study, complications were significantly higher in cases where IBT was employed. We, therefore, recommend ASRL with an established protocol for better results in terms of significantly less lengthening index, eradication of infection, and primary soft tissue healing. ASRL is a useful method to bridge the bone gap by making soft tissue and bone reconstruction easier, eliminating the disadvantages of IBT.

Challenges and advantages of modern rural surgery: an experience of two secondary care centres of rural India

Background: Rural surgery refers to the practice of surgery in rural communities and geographically remote areas, facing multiple challenges like limitation of resources and manpower, poverty, multiple co-morbidities and superstitions. Assam has geographical and population diversity with more than 85 percent of rural population. This study was done to analyse the various challenges and advantages faced during surgical practice in two secondary care centres of rural Assam. Methods: This is a retrospective study done from 228 cases which were operated in Teok First Referral Unit and Titabor Sub-Divisional Civil Hospital, both secondary care centres of rural Assam, India between July 2022 to August 2023 by a single surgeon. Inclusion criteria were all patients who were operated following written and informed consent. Patients who opted not to operate and pregnant women were excluded from the study. Data collected were placed in charts and tables and statistical analysis done using IBM statistical package for the social sciences (SPSS) statistics version 2.0. Results: Study population has 46 percent adult male, 51 percent adult female and 3 percent children. 1.3 percent (3 patients) were operated under general anaesthesia, 14.5 under regional anaesthesia and 73.2 percent under local anaesthesia. 11 percent (25 patients) opted not to operate. Challenges were lack of manpower, lack of resources, infection control, fatigue, trust issues and socio-political pressure. Advantages are financial relief, homely environment, better diet and care, community support, avoiding unnecessary referral and better follow-up. Conclusions: Rural surgery can be a boon to modern healthcare if available resources and manpower are properly managed and challenges are overcome.

Developmental pattern of tibiofemoral angle in healthy north-east Indian children.

PURPOSE: Physiological range of tibiofemoral angle (TFA) is poorly defined and may lead to unnecessary therapeutic interventions. Studies on TFA developmental pattern suggest that racial and ethnic differences are present; children in north-east India who have not yet been studied need to be evaluated. PATIENTS AND METHODS: Cross-sectional study of clinical TFA, intermalleolar distance and intercondylar distance in 1020 healthy north-east Indian children aged from 2 to 18 years was done. Height, weight and body mass index were also recorded. RESULTS: At two years of age the mean TFA was valgus. The values reached a peak of 8.55° (standard deviation (SD) 1.01) valgus at seven years of age. The TFA then gradually stabilised to 3.18° (SD 1.18) valgus by 18 years of age. There was no significant difference in TFA between male and female patients. DISCUSSION: The present study is the largest and only the third such study on Indian children and the first on healthy northeast Indian children. By the end of two years most children had valgus angulation. This, along with the peak angulation observed, was similar to most of the other studies. The age at peak angulation and subsequent stabilisation of valgus angulation varied greatly among children of different origins, especially non-Indian children. CONCLUSIONS: Data can be used to identify children who require further follow-up/evaluation and can serve as guidelines during deformity correction and future studies. The development of TFA in this cohort is not different from other children of India but differs from children of other ethnic origins.

Prognostic significance of Bcl-2 and p53 protein expression in stage IIB and IIIB squamous cell carcinoma of the cervix.

Cervical cancer is the most common cancer among women in South India. More than 70% of the cases present in stage IIB and IIIB and of these more than 50% fail conventional treatment. The purpose of the present study was to determine the prognostic significance of Bcl-2 and p53 expression in squamous cell carcinomas of the cervix. Using immunohistochemistry, 40 cases of stage IIB and IIIB squamous cell carcinomas of the cervix treated with radiotherapy were studied for the expression of Bcl-2 and p53 protein and their prognostic value ascertained. Bcl-2 was expressed in 65% (n=26) of the tumours. There was a statistically significant association (p=<0.025) between Bcl-2 expression and poorer DFS and OS in stage IIB cases. In stage IIIB, these associations were not obvious probably due to additional genetic events overshadowing the significance of Bcl-2 expression. Only 4/40 (10%) of the cases were positive for p53 protein expression and there was an inverse correlation between p53 expression and Bcl-2 expression. This study suggests that Bcl-2 can be a useful marker to identify the poor prognostic group in stage IIB cases and needs to be confirmed in a larger series.

Primary intratesticular sarcoma.

Primary intratesticular sarcoma that is neither associated with germ cell elements nor paratesticular elements is a unique subset of intrascrotal sarcoma. It is a rare indolent tumor with potential for distant metastases. Although few data are available it is generally assumed to be quite uncommon. The definitive treatment recommendation are yet to be laid down. Four cases are reported.

Phytoremediation of abandoned crude oil contaminated drill sites of Assam with the aid of a hydrocarbon-degrading bacterial formulation.

Environmental deterioration due to crude oil contamination and abandoned drill sites is an ecological concern in Assam. To revive such contaminated sites, afield study was conducted to phytoremediate four crude oil abandoned drill sites of Assam (Gelakey, Amguri, Lakwa, and Borholla) with the aid of two hydrocarbon-degrading Pseudomonas strains designated N3 and N4. All the drill sites were contaminated with 15.1 to 32.8% crude oil, and the soil was alkaline in nature (pH8.0-8.7) with low moisture content, low soil conductivity and low activities of the soil enzymes phosphatase, dehydrogenase and urease. In addition, N, P, K, and C contents were below threshold limits, and the soil contained high levels of heavy metals. Bio-augmentation was achieved by applying Pseudomonas aeruginosa strains N3 and N4 followed by the introduction of screened plant species Tectona grandis, Gmelina arborea, Azadirachta indica, and Michelia champaca. The findings established the feasibility of the phytoremediation of abandoned crude oil-contaminated drill sites in Assam using microbes and native plants.

New Clerodane Derivatives from Teucrium scordium.

A reinvestigation of the aerial parts of TEUCRIUM SCORDIUM afforded in addition to several known diterpenes five new clerodane derivatives, all closely related to teucrin. The structures and the stereochemistry were elucidated by high resolution (1)H-NMR spectroscopy.

Adenoid cystic carcinoma - Clinical presentation and cytological diagnosis.

Adenoid cystic carcinoma is a tumor arising from the minor salivary glands, the palate being the commonest site. It accounts for about 1% of all head and neck malignancies. We report a case with the typical presentation of a palatal growth with extensive intra-cranial invasion. The diagnosis of this case and a brief review of literature is discussed. Final diagnosis of this case was made from cytological reports. The dry smears stained with MGG were found to be definitely superior to the alcohol fixed slides stained with papanicolaou. The aim here is to highlight the importance of cytology in the diagnosis of such tumors.

New Vernolepin Derivatives from Vernonia glabra and Glaucolides from Vernonia scorpioides.

The aerial parts of VERNONIA GLABRA afforded in addition to vernolepin, vernodalin and vernomenin, four further sesquiterpene lactones derived from vernolepin ( 1), two germacranolides and together with vernodalol the corresponding lactone 9. From VERNONIA SCORPIOIDES two further glaucolides ( 14) and ( 15) were isolated. The structure of the tiglate ( 16) is revised. The structure were elucidated by spectroscopic methods.

Primary intratesticular sarcoma.

Primary intratesticular sarcoma that is neither associated with germ cell elements nor paratesticular elements is a unique subset of intrascrotal sarcoma. It is a rare indolent tumor with potential for distant metastases. Although few data are available it is generally assumed to be quite uncommon. The definitive treatment recommendation are yet to be laid down. Four cases are reported.