Anaesthetic preconditioning and its role in protecting patients at risk of myocardial ischaemia

Ischaemic preconditioning is a phenomenon where prior minor ischaemic events allows organs to better withstand further episodes of ischaemia. Preconditioning downgrades the effects of ischaemia from necrosis to apoptosis to cell survival. It occurs in a wide variety of tissues, but it is most widely studied in the heart, and it occurs after a range of stimuli including hypoxia and the use of volatile anaesthetic agents. In this article, we look at the basic science, mechanisms, and potential uses of preconditioning.

An evaluation of the performance of the Point of Care Test iCHROMA™ AFP method: Precision and accuracy

The estimation of serum alpha-fetoprotein (AFP) is useful in the diagnosis and monitoring of primary hepatocellular carcinoma, hepatoblastoma, non-seminomatous testicular germ cell tumours and other germ cell tumours. The iCHROMA™ AFP is a lateral flow chromatography, fluorescence immunoassay (FIA) for the quantitative determination of AFP in serum or plasma. In this study, the Boditech iCHROMA™ AFP assay had a very good precision of 9.8%. It showed a very good correlation with the following 12 methods: Abbott Architect (r2 = 0.9705), BioMerieux VIDAS (r2 = 0.9717), Roche Cobas 6000/8000 (r2 = 0.9738), Siemens Centaur XP/XPT/Classic (r2 = 0.9654), Siemens/DPC/Immulite 2000/2500 (r2 = 0.9673), Siemens/DPC/Immulite 1000 (r2 = 0.9670), Beckman Dxl 600/800 (r2 = 0.9676), Roche Elecsys (r2 = 0.9683), Roche Cobas 4000/e411 (r2 = 0.9688), Roche Modular E170 (r2 = 0.9692), SNIBE Maglumi (r2 = 0.9457) and Ortho Vitros 3600/5600/ECi (r2 = 0.9714). In summary, the iCHROMA™ AFP, a rapid point of care test method, has a within-run precision value of less than 10% and excellent correlations with traditional laboratory methods. There is a consistent overestimation with the iCHROMA™ method, which must be taken into consideration when setting a reference range.

Two-year longitudinal observational study of junior doctors as clinical teachers: the Associate Clinical Teaching Fellow Program

Introduction: Most clinical teachers are not trained to teach, though they are critical to determining the quality of clinical learning environment. The General Medical Council, United Kingdom, recognises that being a good teacher is not innate, but that skills and attributes can usually be acquired. Clinical teaching is part of training of junior doctors in the United Kingdom, and from learners’ perspectives, junior doctors are effective clinical teachers, but there are few structured opportunities to learn how to teach during clinical training. The Associate Clinical Teaching Fellow (ACTF) program was developed to provide such structured platform for clinical trainees. The aim of this paper is to evaluate the quality of teaching by the trainees against the current-standard of clinical teaching in the first 2 years of its inception, and to adapt validated feedback questionnaires for practical use. Methods: A prospective longitudinal observational study was done over 2 years in a large 1,215 bed tertiary hospital. Multiple cross-sectional assessments of teachings by ACTFs and consultant teachers were done using two validated questionnaires, the Stanford Faculty Development Program-26 (SFDP-26) and the Clinical Teaching Effectiveness questionnaire (CTEQ), and an in-house global (IHG) feedback form prepared by third- and fifth-year students. Both trainees and consultants were unaware of the timing of the SFDP-26 and CTEQ feedbacks. A graphical representation of all responses was used to create a grading system for practical feedbacks. Results: A total of 507 of 765 (66%) of SFPD-26 and CTEQ and 224 of 286 (78%) of IHG questionnaires were returned for 26 trainees and 31 consultants by 266 medical students. There was a statistically significant higher ratings of trainees in seven of eight domains of SFDP-26, and the median (interquartile ranges [IQR]) overall score was 115 (105–126) and 108 (99–121) for trainees and consultants, respectively (P < 0.0001). Similarly, trainees were rated significantly higher in seven of nine CTEQ domains, and this was reflected in the overall score. The patterns were similar for third- and fifth-year students, and the type of learning exposure did not make a difference. With these students, the overall teaching effectiveness correlated (Spearman Correlation Coefficient [SCC]) the most with enthusiastic and stimulating (SCC 0.711; P < 0.0001), establishes rapport (SCC 0.69; P < 0.0001) and is accessible (SCC 0.67; P < 0.0001) in CTEQ, and with learning climate (SCC 0.62; P < 0.0001), communication of goals (SCC 0.54; P < 0.0001) and evaluation (SCC 0.52; P < 0.0001) in SFDP-26. At the end of their rotations, 30% of both groups of students were neutral or disagreed that consultants were essential to their clinical programs compared to 15% (P = 0.001) and 11% (P < 0.0001) of third- and fifth-year students, respectively, felt about trainees. By applying a new grading system derived from the full database of responses, the trainees would be graded 1 and consultants 7 out of 10 possible grades. Conclusions: Teaching delivered by doctors in training within a formal teaching program is of good quality and well received by medical students. There is a need for an equivalent program for trainee clinical educationalists like the Integrated Academic Training scheme of the National Institute of Health Research (NIHR), UK, for trainee academics. More qualitative studies are needed to analyse some of the findings in this study.

Professor Adelola Adeloye (1935–2021): An icon in the annals of medicine

We celebrate the life of a great physician-surgeon, Adelola Adeloye, an Emeritus Professor of Neurosurgery at Nigeria’s premier medical school, The College of Medicine, University of Ibadan, and retired Consultant Neurosurgeon, University College Hospital, Ibadan.

Parkinson’s disease – a review of pathogenesis, recent advances in management, and challenges of care in sub-Saharan Africa

Parkinson’s disease (PD) remains a common neurodegenerative movement disorder with significant morbidity, which is expected to increase worldwide in the coming decades. Since its initial description, much has been elucidated about its etiology, pathogenesis, and the role of genetic and environmental risk factors. Effective treatments, including surgical therapies, have been discovered. Despite these strides, many questions remain unanswered; PD remains an active research area with ongoing efforts to discover newer treatment modalities and identify neuroprotective strategies. As with many neurological conditions, there is an unequal distribution of health resources, resulting in some management challenges in low resource settings, especially sub-Saharan Africa (SSA). In this communication, we provide an overview of PD etiopathogenesis, including genetics and management strategies, including some recent advances with respect to treatment options and disease modification approaches. Finally, we discuss some challenges of PD management in low-resource settings and highlight efforts to turn the tide.

The Handbook of Forensic Mental Health in Africa

Book Review of The Handbook of Forensic Mental Health in Africa by Ogunwale A, Ogunlesi A, Shepherd SM, Serpa KI and Singh JP, Eds (2021) 1st ed. London and New York, Routledge, Taylor & Group. ISBN 978-0-367-45607-8