O021 Evaluating the impact of neurosurgical rotation experience in Africa on the interest and perception of medical students towards a career in neurosurgery: a continental, multi-centre, cross-sectional study

Introduction

Africa has the second-highest neurosurgical workforce deficit globally, and many medical students in Africa lack exposure to the field. This study aims to assess the impact of a neurosurgical rotation during medical school in shaping the perception and interest of students towards a career in neurosurgery.

Methods

This is a continental, multi-centre, cross-sectional study. A Google Form e-survey was disseminated to African clinical medical students between February 21st and March 20th, 2021. Data was analysed using descriptive statistics and adjusted logistic regression modelling.

Results

Data was received from 539 students in 30 African countries (n=30/54, 55.6%). The majority of participants were male (n=289/539, 53.6%) and were from Kenya (n=83/539, 15.4%). Most students had undertaken a clinical neurosurgery rotation (n=278/539, 51.6%); the majority reported a rotation length of four weeks or less (n=181/278, 65.1%). Students with clinical experience were less likely to pursue the specialty (p=0.02) and had a stronger perception that it is more difficult for women to pursue neurosurgery (p=0.0001) when compared to those without clinical experience. However, after adjusting for other factors, students with greater than four weeks of neurosurgical exposure were more likely to express a career interest in neurosurgery (odds ratio [OR]=1.75, p<0.04) and men were more likely to express interest in a neurosurgical career compared to women (OR=3.22, p<0.001).

Conclusion

Our findings support standardised, continent-wide, curriculum development, and advocacy supporting improved gender inclusivity in education and policy-making to improve the quality of neurosurgical exposure during medical school and tackle the workforce deficit across Africa.

Take-home message

A continent-wide, standardised curriculum guide to neurosurgical rotations, and advocacy for gender inclusivity in education and policy-making efforts across the African continent is required to shape the perception and interest of medical students towards a career in neurosurgery.

O2: TOWARDS A LIVING BIOBANK OF SURGICALLY-RELEVANT 3-DIMENSIONAL GLIOBLASTOMA STEM CELL MODELS TO EVALUATE NOVEL THERAPEUTICS AND INTERROGATE INTRATUMOURAL HETEROGENEITY

Introduction

Glioblastoma is the most common cancer arising within the brain. Despite surgery, followed by DNA-damaging chemoradiotherapy, average survival remains between 12-15 months. Unacceptable survival rates underline the need to develop preclinical research models which recapitulate features underpinning therapeutic resistance in patients, such as intratumoural heterogeneity and treatment resistant glioblastoma stem cell (GSC) subpopulations which demonstrate elevated DNA damage response (DDR) activity.

Method

Tumour specimens from patients were used to generate 2D and 3D scaffold-based GSC models, with a range of preclinical survival and molecular assays used to interrogate cancer biology and assess therapeutic responses.

Result

We have developed a ‘living biobank’ of 20+ ex-vivo GSC models which reflect key clinicopathological diversity. These models include residual disease models based on careful macrodissection of rare en-blocpartial lobectomy specimens to liberate parallel GSC lines from the tumour core and adjacent infiltrated brain, to represent cells typically left behind after surgery. Therapeutic strategies targeting fundamental DDR processes demonstrate preclinical efficacy, for example dual inhibition of ATR and the FA DNA damage repair pathways elicits profound radiosensitisation (sensitiser enhancement ratio of 3.23 (3.03-3.49, 95%-CI)) with evidence of delayed DNA damage repair on single-cell gel electrophoresis. Finally, characterisation of our surgically-relevant resected and residual models reveals numerous divergent properties including elevated stem cell marker expression in residual models (p=0.0021), which may partially explain treatment resistance in disease left behind after surgery.

Conclusion

Our living biobank represents a useful resource for preclinical glioblastoma research and demonstrates the value of partnership between surgeons and laboratory-based scientists.

Take-home message

Our living biobank represents a useful resource for preclinical glioblastoma research and demonstrates the value of partnership between surgeons and laboratory-based scientists.

Colon cancer presenting with polymyositis-A case report

INTRODUCTION

Colorectal cancer most often presents with a change in bowel habit, weight loss or with bleeding per rectum. Much less commonly, colorectal cancer may present as part of a paraneoplastic syndrome. Polymyositis is a rare disease most often considered a complement-mediated idiopathic inflammatory myopathy manifested by proximal muscle weakness. However, polymyositis may also be part of a paraneoplastic syndrome associated with an underlying malignancy. The relationship between polymyositis and malignancy is well known, but it has been suggested that tumours of the large bowel are rarely complicated by myositis.

PRESENTATION OF CASE

The authors describe a case report of an 82-year-old gentleman with a presumed musculoskeletal or neurological deficit who was subsequently diagnosed with metastatic colon cancer in the setting of progressive fatigue and muscle weakness. Concurrently, we review the current literature looking at the relationship between cancer and polymyositis.

DISCUSSION

Colorectal cancer rarely presents with symptoms such as muscle weakness, however it is important to be aware of the possibility of an underlying malignancy when seeing patients with symptoms which are suggestive of polymyositis.

CONCLUSION

The diagnosis of polymyositis in the elderly population should raise suspicion of an underlying malignancy.