Volume: 6 Issue: 1 May 2020
British Association of Physicians of Indian Origin
physicianjnl.net
Volume:6IIssue:1IMay 2020
The
Physician
Novel Coronavirus Pandemic
BAPIO
The Physician
GLOBAL REACH · OPEN ACCESS
BAPIO Publications bapio.co.uk/publications
sushrutajnl.net physicianjnl.net harmonynews.uk
2
Volume: 6 Issue: 1 MAY 2020
The Physician
Contents Pages Hyper Linked
Editorial Indranil Chakravorty Vipin Zamvar 8
Ananthakrishnan Raghuraman
Akash Srinivasan, Indranil Chakravorty, Koottalai Srinivasan
Indranil Chakravorty, Sunil Daga, JS Bamrah, Subarna Chakravorty,
, Subodh Dave OBE
Subarna Chakravorty 24 26
Sahana Rao CASE REPORT:
, Pakinee Pooprasert
34
, Rehan Khan
36
Triya Chakravorty, Indranil Chakravorty 46 Sarah Siddiqui, Indranil Chakravorty
Kassiani Iliadou
63
Volume: 6 Issue: 1 MAY 2020
3
The Physician
Editorial Policy & Oversight
CBE MBBS FRCPsych MISM OBE MBBS MD FRCPCH MD, MPhil, FRCP, FACP
Editors
Indranil Chakravorty
Public Health:
International Editorial Board
-
The Physician Volume 6 Issue 1 Published: 2020-05-31 Acknowledgment: Cover page original artwork by Aria Chakravorty ISSN 2732-513X (Print) ISSN 2732 - 5148 (Online) editor.thephysician@bapio.co.uk BAPIO Publications for British Association of Physicians of Indian Origin Administrative / Business contact - admin@bapio.co.uk +44 (0)1234 363272 +44 (0)1234 212879 The Physician, BAPIO The Chapel, Trinity Gardens, 9-11 Bromham Road Bedford MK40 2BP UK
4
Volume: 6 Issue: 1 MAY 2020
The Physician
Editorial
T
.
3
6
6
2 7
8
4
Volume: 6 Issue: 1 MAY 2020
5
The Physician
22
23
6
Volume: 6 Issue: 1 MAY 2020
The Physician
.
Volume: 6 Issue: 1 MAY 2020
7
The Physician
ananthakrishnan.raghuram@hee.nhs.uk
In
• •
Volume: 6 Issue: 1 MAY 2020
The Physician
•
•
• •
• • • • • • • •
uncommon
• • • • •
• • •
Prognosis
• Investigations • • • •
Volume: 6 Issue: 1 MAY 2020
:
9
The Physician
A Short Review of Evidence and Mechanisms
k.srinivasan@btinternet.com Asthma, COPD, COVID19, ACE2 receptors
2
4
10
Volume: 6 Issue: 1 MAY 2020
The Physician
7
Subsequently,
8
2
ACE2 is a
21
Volume: 6 Issue: 1 MAY 2020
11
The Physician
22
27
Possible mechanical 28
Inhaled corticosteroids
12
Volume: 6 Issue: 1 MAY 2020
The Physician 32
REFERENCES
36
This has also
.37
38
Volume: 6 Issue: 1 MAY 2020
13
The Physician
14
Volume: 6 Issue: 1 MAY 2020
The Physician
admin@bapio.co.uk Abstract
Cite as:
Analysis
Volume: 6 Issue: 1 MAY 2020
15
The Physician
mental health issues
16
Volume: 6 Issue: 1 MAY 2020
The Physician
Figure 4: Pie chart showing ability to comply with Social Distancing (SD)
Volume: 6 Issue: 1 MAY 2020
17
The Physician
Volume: 6 Issue: 1 MAY 2020
The Physician
Volume: 6 Issue: 1 MAY 2020
19
The Physician
CPD - Radiology Quiz kassianiiliad@gmail.com
20
Volume: 6 Issue: 1 MAY 2020
The Physician
Subarna Chakravorty PhD MRCPCH FRCPath Kings College Hospital, London, UK subarna.chakravorty@nhs.net, admin@bapio.co.uk
Abstract
4 6
as
7.
Volume: 6 Issue: 1 MAY 2020
21
The Physician
inability
23.
24
22
Volume: 6 Issue: 1 MAY 2020
The Physician
Volume: 6 Issue: 1 MAY 2020
23
The Physician
Sahana.Rao@ouh.nhs.uk Keywords;
• •
2
cases2
3
4
•
•
• • •
6
•
24
:
Volume: 6 Issue: 1 MAY 2020
The Physician • • •
-
-
6
-
-
Volume: 6 Issue: 1 MAY 2020
25
The Physician
1 1 St George’s University Hospital, London 2 Maritime Hospital, Kent, UK
26
2
Volume: 6 Issue: 1 MAY 2020
The Physician
Volume: 6 Issue: 1 MAY 2020
27
The Physician • •
BARBAR S, NOVENTA F, ROSSETTO V, FERRARI A,
• •
Volume: 6 Issue: 1 MAY 2020
The Physician
1
2
3
4
5
sunildaga@nhs.net twitter @sunildaga23
Cite as:
Volume: 6 Issue: 1 MAY 2020
29
The Physician
ethnicity
Figure 1: Median waiting time for a kidney as per ethnicity in UK (adapted from ref 10)
30
Volume: 6 Issue: 1 MAY 2020
The Physician Family consent for donation is much lower within the BAME community - 42% compared with 71% for white potential donors [5]. Although consent rates are increasing from donors of a BAME background, the new opt-out system is expected, along with change in allocation policy, to help a greater proportion of patients from BAME backgrounds.
the UK population, there is over-representation (n = 118,000) of opt-outs among traditional BAME communities, in comparison to White and Chinese people. Around 54% of these opt-outs were made by Asian people in 2018-19 (Table 1). While it remains a fundamental right to opt out, the concern is that some individuals are making this decision based on misinformation, misplaced fear or misconceptions About 1% of UK population (N=640,435) have opted- about faith beliefs. out of the organ donation register [5, 10]. Relative to Table 1: Ethnicity of Opt-Out ODR by year of registration [5, 10] Ethnicity
2016/17 (Number (%))
2017/18 (Number (%))
2018/19 (Number (%))
White Black Asian Indian Pakistani Bangladeshi
18,364 (80.2) 1178 (5.1) 2493 (11) 585 (2.6) 1018 (4.4) 371 (1.6)
22,942 (8) 44631 (15.5) 206,454 (72) 39,327 (13.7) 105,791 (36.8) 50,782 (17.7)
23,473 (21) 21812 (19.5) 60,380 (54) 7,720 (7) 31,968 (28.6) 17,221 (15.4)
Figure 2: BAME Summary of representations at various aspects of organ donation and transplantation (NHSBT 2020) (Note: data with unknown ethnicity excluded for analysis)
What initiatives can BAME communities take? Major religions support organ donation. Nevertheless, the most frequent reasons given by family members declining donation was either it was is against a patient’s religious or cultural beliefs (20-30%) or uncertainty of the patient’s wishes (12-14%) [5, 10] or
Volume: 6 Issue: 1 MAY 2020
how the body will be handle during organ retrieval surgery. BAME leaders and organisations now need to work in partnership with the NHS to improve community education, promote faith and cultural engagement including identify key opinion leaders to support awareness-raising campaigns. Less than half
31
The Physician of families agree to organ harvesting when they do not know the deceased’s last wishes regarding organ donation. However, rates increase to more than 9 out of 10 families when asked, if the conversation about organ donation had already been discussed with them prior to death. The body is handled with utmost respect and all procedures including analgesia and anaesthesia is performed by experienced surgeon and anaesthetists respectively. The majority of people opting in are of white ethnicity and elderly [11]. Attitudes towards organ donation among BAME communities vary depending on ethnicity (Figure 3). Recent data suggested an increase from 11 to 15 percent in positive attitude among people who would definitely donate some or all organs after their death [12]. The data also suggests there is a real opportunity to focus on the significant proportion of people who remain undecided, targeting education around clarifying myths and misconceptions. Funding is available for BAME organisations to promote organ donation. Sources include the Community Investment Scheme Fund from NHSBT [13] . Other available support includes the NHSBT Organ Donor Ambassador programme, the National BAME Transplant Alliance (NBTA) and BAME
charities such as South Asian Health Action (SAHA) and African & Caribbean Leukaemia Trust (ACTL). Community specific campaigns and events organised by SAHA have led to signing of many BAME donors. Similarly ‘Be the Hero’ campaign in Yorkshire has led organ donation promotion by community and public campaign. Individual families have also using social media campaign (such as Hope4Anya). There are also examples of national steering groups helping to influence outcomes such as Jain Hindu Organ Donation (JHOD) who partnership with NHSBT and Local Assembly in London [14]. Despite 62% of Londoners waiting for an organ transplant being from BAME backgrounds, only 1% of BAME Londoners are registered on ODR [14]. Finally, BAME medical professional bodies such as British Association of Physicians of Indian Origin (BAPIO) and British Islamic Medical Association (BIMA) are now taking on the campaign to increase organ donation from BAME communities. In conclusion, leaders of BAME communities through social events and digital campaigns can demystify the prevalent myths around organ donation and help fellow members with lifesaving organ transplantation. One donor can save up to eight lives and transfer up to 54 lives.
Figure 3: Attitudinal survey of black and Asian adults in England Survey carried out by Agroni Research Ltd 2019 [12].
32
Volume: 6 Issue: 1 MAY 2020
The Physician
Picture sourcemultibriefs.com
Volume: 6 Issue: 1 MAY 2020
33
The Physician
Triya Chakravorty BA (Oxon)1, Maria Memtsa MRCOG2, Rehan Khan MD FRCOG3 1 Clinical Medical School, University of Oxford, UK 2 University College London, UK 3 Royal London Hospital, London, UK triya.chakravorty@queens.ox.ac.uk -
Cite as:
The Physician
6
2
7
8
4.
Chen et al
34
Volume: 6 Issue: 1 MAY 2020
The Physician
2
loss2
Volume: 6 Issue: 1 MAY 2020
35
The Physician
Triya Chakravorty1 BA (Oxon) & Elaine Jackson 2 MSc 1 Medical Sciences Division, University of Oxford; 2 Chi Running Practitioner (www.chirunning.uk) triya.chakravorty@queens.ox.ac.uk
cite as:
7
8
3
36
Volume: 6 Issue: 1 MAY 2020
The Physician
Volume: 6 Issue: 1 MAY 2020
37
The Physician
Volume: 6 Issue: 1 MAY 2020
The Physician
1
2
Indranil.chakravorty@stgeorges.nhs.uk
Cite as:
Aetiology
2.
Volume: 6 Issue: 1 MAY 2020
39
The Physician
6 4
Thus,
7
8
40
Volume: 6 Issue: 1 MAY 2020
The Physician
• • • • • •
8.
Investigations
, These tools
Volume: 6 Issue: 1 MAY 2020
41
The Physician
26
8
22
23
24
42
Volume: 6 Issue: 1 MAY 2020
The Physician
Fig 1. Structure of human airway nerves. A – thin unmyelinated c-fibres located near the ¬epithelial membrane; B – sub-epithelial ¬myelinated Aδ fibres. Reprinted with permission of the American Thoracic Society. Copyright © 2016 American Thoracic Society
Volume: 6 Issue: 1 MAY 2020
43
The Physician
Copyright Š 2016 American Thoracic Society
Fig 2: Schematic diagram representing the cough reflex. Vagal afferents transmit stimuli from the airways to the nucleus tractus solitarius (nTS) and paratrigeminal nucleus (Para V) in the brainstem. Neuronal signals are then transmitted to the somatosensory cortex via the thalamus causing throat irritation and urge to cough. These sensations, if great enough, lead to cough via activation of spinal motor neurons.
Copyright Š 2016 American Thoracic Society
Fig 3: Schematic diagram representing cough hyper-responsiveness to airway stimuli displayed by chronic cough patients. Compared with healthy volunteers, patients with chronic cough predominantly exhibit heightened cough responses to airway stimuli, such as inhaled capsaicin and citric acid, in cough challenge test and report coughing triggered by changes in temperature, perfumes, aerosols, smoke and to small volumes of mucus.
44
Volume: 6 Issue: 1 MAY 2020
The Physician
Figure 4: (above) Case files showing serial Peak expiratory flow rate in a patient on treatment with chronic cough
Figure 5: (Right) Case files showing the cough counter data for a patient during treatment
Volume: 6 Issue: 1 MAY 2020
45
The Physician
1,
2
sarah.siddiqui@hee.nhs.uk
Cite as:
46
-
Volume: 6 Issue: 1 MAY 2020
The Physician
Most
Challenges
Volume: 6 Issue: 1 MAY 2020
47
The Physician
•
•
•
Volume: 6 Issue: 1 MAY 2020
The Physician •
2016
Simulated procedures Image Technology
Volume: 6 Issue: 1 MAY 2020
49
The Physician
consolidation
Chilaiditi
sign
Chilaiditi sign
50
Volume: 6 Issue: 1 MAY 2020
The Physician
Volume: 6 Issue: 1 MAY 2020
51
The Physician
The
Physician Volume:6IIssue:1IMay 2020
Abstracts SUPPLEMENTARY
52 BAPIOAC19
Volume: 6 Issue: 1 MAY 2020
The Physician
Abstracts Reference
Page No
Vivian Praveen Ignatius, Regina Divya & Rajeev Gupta
Abstracts
Parisah Hussain (presenter for oral presentation), Abdulwahab Ikar, Terrell Okhiria, Aran Sivapalan,
Venkateshwaran Sivaraj, Ruslan Artykov, James Drysdale, Sarah Cox, Cindy Sethi, Ranjababu Kulasegar
analysis Karol Basta & Chris John
Triya Chakravorty, Irene Roberts
62 Shanmugapriya Basker & Sunil Daga 62 Varathagini Balakumar, Paul Turner & Siba Paul. 63
Volume: 6 Issue: 1 MAY 2020
53
The Physician BAPIOAC19-01
md.sulaiman89@gmail.com cite as:
Abstracts BAPIOAC19-02
vivian.praveen@nhs.net Cite as: Ignatius, V.P., Divya, R. & Gupta, R. (2020) Importance of communication in reducing sepsis risk in children via administration of antibiotics in the golden hour. The Physician 6(1):c2 DOI: 10.38192/1.6.1.c2
54
Volume: 6 Issue: 1 MAY 2020
The Physician
BAPIOAC19-03
P12232168@my365.dmu.ac.uk
Abstracts
Cite as:
Picture source:healthline.com
Volume: 6 Issue: 1 MAY 2020
55
The Physician BAPIOAC19-04
. ph918@ic.ac.uk Cite as;
-
Abstracts Source:medics.academy
56
Volume: 6 Issue: 1 MAY 2020
The Physician BAPIOAC19-05
swastishekhar@gmail.com
Abstracts
Cite as:
BAPIOAC19-06
drsvenkateshwaran@gmail.com cite as:
Volume: 6 Issue: 1 MAY 2020
57
The Physician
BAPIOAC19-07
kb2014@ic.ac.uk Cite as:
Abstracts BAPIOAC19-08
shyamg@live.co.uk cite as: Gokani S, Elmqvist K, El-Koubani O, Ash J, Biswas S & Rigaudy M. (2020) A cost-utility analysis of small versus large bite sutures in the closure of midline laparotomies in the UK NHS. The Physician 6(1)c8 DOI: 10.38192/1.6.1.c8
Volume: 6 Issue: 1 MAY 2020
The Physician
Abstracts
BAPIOAC19-09
triya.chakravorty@queens.ox.ac.uk cite as:
Source: GATA1 - Interbnet
Volume: 6 Issue: 1 MAY 2020
59
The Physician BAPIOAC19-10
um15agm@leeds.ac.uk Cite as:
Abstracts BAPIOAC19-11
Lavakrishna@yahoo.com Cite as:
60
Volume: 6 Issue: 1 MAY 2020
BAPIOAC19-11
The Physician
Non-coding RNAs
Picture source: PASTERKAMP LAB
Abstracts
BAPIOAC19-12
sde29@cam.ac.uk Cite as:
Volume: 6 Issue: 1 MAY 2020
61
The Physician BAPIOAC19-13
Correspondence to s.basker@nhs.net cite as:
siba@doctors.org.uk
62
Volume: 6 Issue: 1 MAY 2020
Abstracts
BAPIOAC19-14
The Physician
Elaine Jackson Indranil Chakravorty
Volume: 6 Issue: 1 MAY 2020
63
The Physician
64
Volume: 6 Issue: 1 MAY 2020