bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP23 - A rare case of “Gastric Outlet Obstruction (GOO) Secondary to Hydrops of Gallbladder” caused by recurrent acalculous cholecystitis: a variant of Bouveret’s Syndrome -a rare case and review of literature
Authors: Haji Altaf , Elhassan Ali , Abraham John , Piramanayagam Bala , Lourdusamy Selvam , Haider SyedIjlal 
Published: September 2024

Abstract
We present an extremely rare case of gastric outlet obstruction (GOO) in a young male attributed to hydrops of the gallbladder resulting from recurrent episodes of acute acalculous cholecystitis. Remarkably, approximately one and half years prior to this presentation, the patient was diagnosed with confirmed acute acalculous cholecystitis and had tested positive for Covid 19, despite exhibiting no respiratory symptoms.
While it is established that Patients with acute acalculous cholecystitis can develop gallbladder mucoceles due to the mechanism akin to mechanical cystic duct obstructions. This functional condition leads to a non-emptying, distended gallbladder where biliary mucus replaces bile salts (1). Conventionally, hydrops of the gallbladder is associated with prolonged blockage of the cystic duct, often caused by an impacted gallstone in neck / cystic duct or a stricture in cystic duct.
Bouveret’s Syndrome, characterized by GOO results from the impaction of a large gallstone in the duodenum or pyloric channel, typically secondary to a cholecystoenteric fistula (2),is a recognized rare entity. However, our case stands apart as it elucidates an infrequently reported cause of GOO- hydrops of gall bladder inducing extrinsic compression of the duodenum / pylorus and this case also emphasizes the distinction from Bouveret’s syndrome.
This case underscores the importance of considering unusual etiologies in the diagnosis of GOO and emphasizes the need for timely recognition and intervention in such rare instances to ensure optimal patient outcomes. Additionally, we provide a comprehensive review of existing literature, highlighting the scarcity of reported cases with such relevant presentations.
EP33 - Nil by mouth in GI surgery: are we starving our patients longer than we need to?
Authors: Hern Daniel 
Published: September 2024

Abstract

Aim
Fluid intake preoperatively reduces postoperative nausea, vomiting and headache, and oral intake allows the patient to be metabolically active to respond better to surgery. However, a known risk to oral intake preoperatively is aspiration. Current guidelines state that a patient should be fasted from 6 hours preoperatively and should take clear fluids up to 2 hours preoperatively. We assessed how long GI patients admitted to the Surgical Assessment Unit (SAU) remained nil by mouth (NBM).

Method
Data was collected throughout November from SAU. Inclusion criteria was GI surgical patients and exclusion criteria was patients on home leave. We used electronic and paper notes to determine how long patients were kept NBM and their surgical outcome. We assumed that a patient was kept NBM from their admission (as per local protocol), until either noted to no longer be NBM, having surgery or being discharged.

Results
50 patients were identified. We found that only 20% of patients kept nil by mouth went on to have surgery. Of the remaining 80%, 60% were kept nil by mouth for &gt;6 hours, with no surgical procedures.

Conclusions
Many patients are kept NBM unnecessarily. We need to reduce this as well as the time patients are starved. Furthermore, clearer documentation is needed for commencing patients NBM, and when they can resume eating. We can move away from the culture of prolonged fasting in surgical patients by improving organisation and planning as well as increasing education on preoperative fasting.
EP45 - Improving Management of Patients undergoing Inguinal Hernia Repair Who Experience Post-Operative Urinary Retention
Authors: Laurie Alex , Spellar Kayleigh , Bunting David 
Published: September 2024

Abstract

Aims
Post-operative urinary retention (POUR) is a common complication following inguinal hernia repair. Left untreated POUR can result in significant patient discomfort, acute kidney injury, detrusor muscle damage and infection. It was observed that the detection and management of POUR in our trust following planned day case inguinal hernia repair was varied, often resulting in unplanned admission. We therefore carried out a review of how our trust is managing these patients.

Methods
A retrospective analysis of all patients undergoing planned day case inguinal hernia repair in a single institution between March 2023 and August 2023 was performed. Patients having open, laparoscopic, or robotic repair were included. Data was collected on demographics, documentation of POUR, time to diagnosis, bladder scan volume, catheterisation, overnight stay and follow up for all patients.

Results
124 patients underwent inguinal hernia repair. 13 patients reported experiencing POUR (10.4%). 9 patients experienced POUR during their initial admission, of which 8 had unplanned overnight admissions. 5 patients were not managed with catheterisation despite having significant volume of urine detected on bladder scan (&gt;700ml). Time to diagnosis varied with POUR not being detected for 24 hours for one patient. 4 patients went into retention after discharge and re-presented via the emergency department.

Conclusion
Significant variation in the detection and management of patients with POUR was noted in this cohort. Introduction of a POUR pathway in day-surgery describing both diagnosis and management has therefore been created to try and address this, to improve outcomes and reduce hospital admission.
EP51 - Uses of pharmaceutical and mechanical VTE prophylaxis - A clinical audit
Authors: Ravendran Kapilraj 
Published: September 2024

Abstract

Aim
Venous thromboembolism (VTE) is a serious global health care safety concern for both patients and staff. Although it has been amply demonstrated that pharmaceutical and mechanical methods of prophylaxis against VTE are effective, their application has been uneven and insufficient. The purpose of this audit was to assess junior physicians working in general surgery, regarding their adherence to local and NICE guidelines regarding the pharmacological VTE prophylaxis practice as well as the mechanical prophylaxis

Methodology
Pre-intervention audit took place for two weeks. Throughout the course, it covered every adult general surgical emergency inpatient admission at conquest hospital who were deemed indicated for VTE prophylaxis.
Each evening while the patients were still in the hospital, data was collected using the prescription charts, nursing and medical notes. The proforma used for data collection detailed the characteristics of VTE risk, the prophylactic medication prescribed for each patient, TED stockings and whether or not this aligned with the NICE clinical guideline (CG) 46,6.8.
Post intervention took place for two weeks after teaching of junior doctors and the same as above was carried out, using the new proforma

Results
Pre-intervention showed that 87% of patients had the proforma filled in and 100% of patients received the appropriate dose of pharmaceutical prophylaxis. However, less than 40% of patients received the appropriate mechanical prophylaxis. Therefore, intervention was made in the form of a new proforma and teaching to junior. Post intervention data is currently being carried out

Conclusion
Implementation was necessary to ensure that at-risk patients receive appropriate prophylaxis.
EP142 - "Unravelling the Enigma: Navigating the Diagnostic Dilemma of Abdominal Toxoplasmosis"
Authors: Anwar Kehkashan , Talal Muhammad Nasir , O’Connor Adam , Ullah Sana 
Published: September 2024

Abstract

Introduction
Abdominal toxoplasmosis, an infrequent yet medically significant manifestation of Toxoplasma infection, primarily caused by the protozoan parasite Toxoplasma gondii. Although toxoplasmosis can affect various organs, its occurrence in the abdominal region introduces unique diagnostic complexities, presenting symptoms such as abdominal pain, gastrointestinal disruptions, and systemic complications.

Case Report
In a notable case, a middle-aged patient presented with perplexing gastrointestinal symptoms, including nausea, vomiting, abdominal pain, and irregular bowel habits. With a history of anaemia and thrombocytopenia necessitating transfusions and yielding inconclusive bone marrow biopsies, the patient underwent OGD and colonoscopy with biopsies during initial management, revealing a hiatus hernia and diverticulosis that did not explain the symptoms. Despite being discharged pending biopsy results, subsequent normal findings failed to clarify.
Upon readmission with persistent gastrointestinal complaints, a CTAP revealed two suspicious neoplastic focal areas of small bowel wall thickening and enlarged mesenteric lymph nodes. The MDT discussions ensued to rule out malignancy, leading to a follow-up PET scan suggesting nodal disease, raising concerns about lymphoma, small bowel adenocarcinoma, or carcinoid tumour and recommended an ultrasound-guided lymph node biopsy, 5 HIAA if asymptomatic, and diagnostic laparoscopy if symptomatic or obstructed.
Subsequent core biopsy of a neck lymph node unveiled appearances consistent with toxoplasmosis, prompting treatment with anti-parasitic drugs. The patient awaits capsule endoscopy, and a follow-up CT scan displayed a reduction in bowel lesions and lymph nodes.

Conclusion
This case highlights the swift and precise identification of toxoplasmosis, resulting in an optimal patient outcome. The clinical manifestations of toxoplasmosis are diverse and lack distinct characteristics, making it challenging to definitively diagnose, particularly in immunocompetent individuals.
EP191 - Laparoscopic right hemicolectomy in a patient with malrotation of bowel and ascending colon tumour
Authors: Pal Shreya , Pangeni Anang , Nai Shaun , Aravind Biju 
Published: September 2024

Abstract

Aims
Ascending colon (AC) tumour in a patient with malrotation of bowel can present diagnostic and surgical challenges.
We present such a case managed by laparoscopic resection, and share the difficulties encountered and our preparation to achieve a good outcome

Methods
A 72-year-old female with iron deficiency anaemia underwent CT colonography after an incomplete optical colonoscopy. The scan revealed malrotation, a pelvic caecum and a midline ascending colon, and a lesion suspicious of cancer in ascending colon with a CT staging of T3N0M0. Patient was scheduled for elective laparoscopic right hemicolectomy.

Results
Review of vascular anatomy was carried out with radiologist. Several modifications to standard procedure was used – first port-entry site, number of ports, plan of dissection, and site of specimen extraction. Additional challenges were due to the high BMI (40 kg/m2).
Patient was discharged on day-7 without major complications.

Conclusion
Multidisciplinary discussion, optimal pre-operative preparation, and thorough understanding of the vascular profile leads to successful management of these rare presentations by minimally invasive surgery. Pre-operative CT-scan is essential before planning surgical management. Laparoscopic right-hemicolectomy although challenging, can be successfully performed with appropriate expertise.
EP334 - What does ERAS mean to foundation doctors?
Authors: Pereira Fiona , Kynaston Liam , Chaudhary Osman , Torrance Andrew 
Published: September 2024

Abstract

Aims
To quantify the Enhanced Recovery After Surgery (ERAS) protocol knowledge of foundation doctors on the general surgical rotation from August 2023 to December 2023. ERAS protocol has decreased recovery time, length of stay, complications, and readmission rates. [1] ERAS protocol can be categorised into 5 domains: diet, pre-operative medications including bowel preparation, post-operative medications including nutritional drinks, mobilisation, and discharge. Foundation doctors should be aware of the details within ERAS protocol.

Methods
Survey questions were devised alongside a senior registrar to probe foundation doctors understanding of ERAS protocol. The questions were either single best answer questions out of 5 or had multiple correct answers. Foundation doctors who worked on general surgery between 2nd August 2023 and 5th December 2023 undertook this survey, carried out from 6th December 2023 to 28th January 2024. There were 10 respondents to the survey, out of 21 foundation doctors.

Results
Out of 10 surveys, foundation doctors correctly answered 47% of questions, with scores ranging from 36% to 57%. On further sub analysis the lowest scoring domains were mobilisation (21%), medication (post-op) (23%), and medication (pre-op) (50%).

Conclusions
Foundation doctors should have more knowledge of the ERAS protocol to improve the quality of patient care. Our proposed method of improving this involves presenting study findings and the ERAS protocol to foundation doctors at the next departmental Clinical Governance meeting, alongside ERAS nurses and senior team members. We aim to re-audit to identify whether an ERAS induction makes a difference to their understanding of ERAS.
EP366 - A single surgeon experience of total extraperitoneal inguinal hernia repair in a district general hospital
Authors: Azam Muhammad , Elshazly Mohammed , Jmor Sabah 
Published: September 2024

Abstract

Methods
This was a retrospective review of a prospectively collected and maintained data on elective TEP hernia repairs. All theatre list has been collected prospectively. All patient who had inguinal hernia repair between 2004 and 2021 has been identified from the list. The notes of all Patients who had laparoscopic hernia repair were reviewed including the operative notes, postoperative complications, and any subsequent referral to the surgical department at the Trust to see any recurrence. The data collections included age, sex, type of the mesh, fixing device, primary or recurrent, unilateral or bilateral and conversion to open procedure. Since 2014 all notes were electronic and restored on evolve application.

Result
All patients records were retrieved from the electronic database system. Out of this cohort, some of patients records were missing. The mesh was not fixed in primary hernia if it was small or medium size, but it was fixed in primary large direct hernia to reduce the risk of blowing in of the mesh inside the defect. Our results showed a recurrence rate with acceptable incidence of post operative pain and wound related complications compliant with the NICE guidance.

Conclusion
A TEP repair for both primary and recurrent inguinal hernia has a minimal recurrence rate when performed by the specialists in this area giving full attention to the details.
EP406 - Exploring the Nexus: Serum Fluoride, Lipid Profiles, and Gallstone Formation in a Cross-Sectional Study
Authors: Sreeramulu Pradhay , Nagaraj Shashidhar Krupad , Kamisetty Krishna Prasad , Nadipanna Sreeramulu Patrapalli , Rangareddy Harish 
Published: September 2024

Abstract

Objectives
Assessing and comparing serum fluoride and lipid profiles in individuals with gallstones and in healthy controls. Investigating the correlation between serum fluoride levels and lipid profiles specifically in gallstone cases. Estimating concentrations of fluoride, cholesterol, triglycerides, bilirubin, calcium, and magnesium in gallstones.

Methods
This cross-sectional study recruited twenty-five gallstone patients seeking evaluation and treatment at the General Surgery department over a two-month period. Twenty-five age- and gender-matched controls were enrolled using purposive sampling.

Results
Our findings revealed that, regardless of age group (26-70), individuals with higher serum lipid levels and gallstones exhibited fluoride levels in the gallstones ranging from 0.5 to 1 PPM, suggesting a positive impact of fluoride on gallstones. Notably, calcium and uric acid levels were significantly elevated, measuring 19 and 14 mg per gram, respectively. These finding prompts clinicians to consider the independent role of fluoride in regions with higher exposure and chronicity.

Conclusion
Our study uncovered a positive correlation between elevated serum lipid levels and gallstones, highlighting fluoride concentrations in gallstones ranging from 0.5-1 PPM. Increased calcium and uric acid levels, particularly in regions of heightened exposure, point to fluoride's independent role in gallstone formation. Patients with gallstones showed heightened lipid levels, positioning fluoride as an influential factor. Notably, cations like calcium and magnesium, alongside non-protein substances such as uric acid, displayed stronger associations with gallstones, with negligible gender-based differences. These findings offer clinicians valuable insights, underscoring the potential significance of fluoride and related factors in understanding and addressing gallstone disease.
EP480 - Auditing antiplatelet and statin prescription around admission on an inpatient vascular surgical unit
Authors: Magrangeas Thibault , Gouda Yasmeen , Lee Yeon Joo , Proctor Matthew , Gambhir Raghvinder 
Published: September 2024

Abstract

Aims
Antiplatelet and Statin management is crucial in ensuring optimal outcomes for patients after peripheral arterial interventions (Vitturi et al, 2023; National Institute for Health and Care Excellence, 2020). The aim of this study was to interrogate if the patients were being discharged on the correct drugs and dosages following hospitalisation.

Methods
We investigated antiplatelet and statin prescription around admission and matched this with documented management plan on an inpatient vascular unit. Ward rounds were done by registrars along with Foundation Year 1 doctors (FY1s). Newly graduated FY1s with no prior vascular training rotated through the unit every four months. In October 2022, FY1s were educated on existing guidelines and they then handed over verbally to new FY1s in December, when a template was implemented documenting ward rounds and discharge planning. Two sets of data collection were done in October 2022 and then January 2023.

Results
Of 24 patients discharged in October 2022, 17(71%) received a statin, 7 did not. 15 (63%) patients received their planned antiplatelets, 1 received a different regimen; 8 (33%) had no clear plan outlined. Of 25 patients discharged in January, 15 (60%) received a statin; 10 were discharged without, but only 1 had a documented plan for this. 16 (64%) patients received antiplatelets as planned; 9 (36%) had no clearly documented plan.

Conclusions
Established guidelines recommend statin and antiplatelet treatment in Peripheral arterial disease. A clear plan should be outlined at discharge, with tools to ensure this particularly when working with juniors without prior experience. Of note, the documentation template developed was not used consistently.
EP484 - Triple negative male breast cancer: a case report
Authors: Kumar Shashi 
Published: September 2024

Abstract

Background
Male breast cancer (MBC) is a rare malignancy, may present at advanced disease stage. Triple negative breast cancer (TNBC) known to have the poorest prognosis of all other histological types of breast cancer. This paper presents a case of 71 years old gentleman diagnosed with TNBC.

Materials and Methods
A 71 years old male patient, presented with a right breast lump. Clinically he had a skin dent and a palpable 3cm lump underneath in the right breast axillary tail. Mammogram and breast US showed suspicious lesion in right breast axillary tail in addition to a suspicious lymph node in right axilla. Imaging guided core biopsies were taken from the breast and axillary abnormalities. The histology revealed grade1 invasive ductal carcinoma NST, ER 0, PR 0 and HER 2 negative. The Breast-Multidisciplinary Team meeting advised for mastectomy and axillary clearance, this has been performed.

Result
The postoperative Pathomorphology report revealed 23 mm triple negative invasive ductal carcinoma NST, grade 1with Ki67 10%, T2N1M0. The postoperative MDT recommended annual surveillance with mammogram for 5 years.

Conclusions
MBC is uncommon entity, accounting for &lt; 1% of all breast cancer diagnosed in both genders and the MTNBC still is rarer, and mastectomy is the mainstay of surgical treatment in addition to chemotherapy and radiotherapy , however the later doesn’t affect the cause-specific survival rate.
EP525 - A Survey of Medical Students’ Attitudes Towards Sustainable Healthcare
Authors: Stephen Sarah , d'Souza Hanna , Divekar Omkaar , Kanegaonkar Rahul 
Published: September 2024

Abstract

Aims
As the climate crisis becomes increasingly prevalent, so does emphasis on environmental sustainability. The healthcare sector (a significant contributor to environmental impact) is particularly of interest: sustainable healthcare and awareness within the NHS is crucial. However, few medical schools include environmental teaching in their curricula. We undertook this survey to assess environmental awareness and perspectives amongst medical students.

Methods
An online questionnaire was distributed to London medical students. Participants were asked demographic data, questions concerning the environmental impact of products and practices in the NHS, and methods to reduce healthcare’s environmental impact.

Results
87% of students stated that healthcare’s environmental impact is of concern to them, 97% agreed that the environmental impact of products should be considered during development. 65% agreed that the environmental impact of a product should influence its use, but 95% agreed that a device being recyclable/reusable would influence their practice. Students felt the factor most negatively impacting the environmental burden of healthcare was ‘disposable plastic items’, in 57% of responses, and ‘general waste’ in 44%.

Conclusions
Most medical students found healthcare's environmental impact concerning, expressing a desire to choose the most sustainable options. Whilst the distribution of academic year and the London demographic limited this study, we believe it is the first of its kind assessing medical student's attitudes towards the environmental impact of healthcare. With this initial benchmark, we hope future surveys will assess and improve the environmental awareness of doctors in training, as well as the inclusion of environmental teaching in medical school.
Reflections on the absence of stomata on the gametophyte generation of extant land plants: a focus on poikilohydry
Authors: Duckett Jeffrey G , Renzaglia Karen S , Pressel Silvia 
Published: September 2024

Abstract
The recent realization that bryophyte sporophytes are homoiohydric enabled the present analysis of morphological features specifically associated with poikilohydry. The only morphological feature absolutely diagnostic of poikilohydry is schizolytic intercellular spaces. In vascular plants these are gas-filled from the outset, but in bryophytes are liquid-filled initially. They remain in this condition in liverwort gametophytes but become gas-filled following stomatal opening in hornworts and mosses. These have fixed apertures and are completely unresponsive to environmental cues. Stomata in Devonian fossils may have had similarly fixed apertures. Unistratose lamellae, characteristic of moss and liverwort leaves and pteridophyte gametophytes, are optimal structures for reversible cell shrinkage and recovery accompanying de- and rehydration. In 1 M sucrose, gametophytic tissues and filmy fern leaves undergo shrinkage, whereas sporophyte cells plasmolyse. Under extreme desiccation, hydroids are the only bryophyte cells to undergo cavitation. Like bryophytes, desiccation-tolerant streptophyte algae undergo reversible cell shrinkages. Mucilage secretion is unimportant in bryophyte desiccation biology and developmental differences rule out homology between the mucilage clefts and stomata in hornworts and Blasiales. Elaborate placental walls in basal liverwort lineages and a stomatal toolkit in the capsule walls of Haplomitrium suggest that liverworts’ ancestors may have had more complex sporophytes than those in extant taxa.