The Physician vol 6 issue 1 May 2020

Volume: 6 Issue: 1 May 2020

British Association of Physicians of Indian Origin

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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

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, Rehan Khan

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Triya Chakravorty, Indranil Chakravorty 46 Sarah Siddiqui, Indranil Chakravorty

Kassiani Iliadou

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Editorial Policy & Oversight

CBE MBBS FRCPsych MISM OBE MBBS MD FRCPCH MD, MPhil, FRCP, FACP

Editors

Indranil Chakravorty

Public Health:

International Editorial Board

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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

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ananthakrishnan.raghuram@hee.nhs.uk

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A Short Review of Evidence and Mechanisms

k.srinivasan@btinternet.com Asthma, COPD, COVID19, ACE2 receptors

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Subsequently,

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Inhaled corticosteroids

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REFERENCES

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This has also

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admin@bapio.co.uk Abstract

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Analysis

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mental health issues

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Figure 4: Pie chart showing ability to comply with Social Distancing (SD)

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CPD - Radiology Quiz kassianiiliad@gmail.com

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Subarna Chakravorty PhD MRCPCH FRCPath Kings College Hospital, London, UK subarna.chakravorty@nhs.net, admin@bapio.co.uk

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inability

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Sahana.Rao@ouh.nhs.uk Keywords;

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1 1 St George’s University Hospital, London 2 Maritime Hospital, Kent, UK

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BARBAR S, NOVENTA F, ROSSETTO V, FERRARI A,

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sunildaga@nhs.net twitter @sunildaga23

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ethnicity

Figure 1: Median waiting time for a kidney as per ethnicity in UK (adapted from ref 10)

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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

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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

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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].

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Picture sourcemultibriefs.com

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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 -

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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

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Indranil.chakravorty@stgeorges.nhs.uk

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Aetiology

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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

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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.

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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

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consolidation

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Abstracts SUPPLEMENTARY

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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.

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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

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BAPIOAC19-03

P12232168@my365.dmu.ac.uk

Abstracts

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Picture source:healthline.com

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. ph918@ic.ac.uk Cite as;

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swastishekhar@gmail.com

Abstracts

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drsvenkateshwaran@gmail.com cite as:

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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

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triya.chakravorty@queens.ox.ac.uk cite as:

Source: GATA1 - Interbnet

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Non-coding RNAs

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Correspondence to s.basker@nhs.net cite as:

siba@doctors.org.uk

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Elaine Jackson Indranil Chakravorty

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