Guidelines for the safe practice of total intravenous anaesthesia (TIVA): Joint Guidelines from the Association of Anaesthetists and the Society for Intravenous Anaesthesia.

Guidelines are presented for safe practice in the use of intravenous drug infusions for general anaesthesia. When maintenance of general anaesthesia is by intravenous infusion, this is referred to as total intravenous anaesthesia. Although total intravenous anaesthesia has advantages for some patients, the commonest technique used for maintenance of anaesthesia in the UK and Ireland remains the administration of an inhaled volatile anaesthetic.

Early Late Removal of Internally Fixated Kirschner's Wires for Displaced Lateral Condyle Fracture of Humerus in Children.

Introduction: Lateral condyle fracture of the distal humerus is the second most common paediatric elbow fracture. Unstable, rotated and displaced (>2 mm) fractures are managed with open reduction and internal fixation with Kirschner's wires or screws. Debate persists as for how long the Kirschner's wires should be placed in situ after internal fixation.

Profile of Caesarean Section in Mid-Western Regional Hospital in Nepal.

Background: Rising rate of caesarean section since few decades has been a global public health issue.This study is aimed to determine the rate of caesarean section plus examine the indications and complications of caesarean section.

Methods: A retrospective cross-sectional study was conducted using secondary data sources at Mid-Western Regional Hospital in Surkhet, Nepal.

Prevalence, associated factors, awareness, treatment, and control of hypertension: Findings from a cross sectional study conducted as a part of a community based intervention trial in Surkhet, Mid-western region of Nepal.

Background: Hypertension is one of the leading public health problems globally. About half of the deaths from cardiovascular diseases were attributed to hypertension in 2008. Reduction of blood pressure to normal range is one of the major challenges in preventing complications and future burden of cardiovascular diseases.

Prenatal prediction of significant intertwin birthweight discordance using standard second and third trimester sonographic parameters.

Introduction: Our study aim was to evaluate standard ultrasound-derived fetal biometric parameters in the prediction of clinically significant intertwin birthweight discordance defined as ≥18%.

Material And Methods: This was a secondary analysis of a prospective cohort study of 1028 unselected twin pairs recruited over a two-year period. Dichorionic twins underwent two-weekly ultrasonographic surveillance from 24 weeks' gestation, with surveillance of monochorionic twins two-weekly from 16 weeks.

The expansion and performance of national newborn screening programmes for cystic fibrosis in Europe.

Background: Newborn screening (NBS) for cystic fibrosis (CF) is a well-established public health strategy with international standards. The aim of this study was to provide an update on NBS for CF in Europe and assess performance against the standards.

Methods: Questionnaires were sent to key workers in each European country.

Randomized Phase III Trial of Erlotinib versus Docetaxel in Patients with Advanced Squamous Cell Non-Small Cell Lung Cancer Failing First-Line Platinum-Based Doublet Chemotherapy Stratified by VeriStrat Good versus VeriStrat Poor. The European Thoracic Oncology Platform (ETOP) EMPHASIS-lung Trial.

Introduction: Docetaxel and erlotinib are registered second-line treatments for wild-type EGFR NSCLC. Previous studies suggested a predictive value of the VeriStrat test in second-line therapy of NSCLC, classifying patients as either VeriStrat good or VeriStrat poor. EMPHASIS-lung aimed at exploring this predictive effect in patients with squamous cell NSCLC.

Safety and Efficacy of Azathioprine as a Second Line Therapy for Primary Immune Thrombocytopenic Purpura.

Introduction: Immune thrombocytopenic purpura remains common blood disease in Nepal. Azathioprine is an oral immunosupressive medicine which has been used widely in various autoimmune disease and solid organ transplant patients. It is inexpensive, easily available and well tolerated medicine.

Prophylactic Negative Pressure Dressing Use in Closed Laparotomy Wounds Following Abdominal Operations: A Randomized, Controlled, Open-label Trial: The P.I.C.O. Trial.

Objective: A randomized controlled trial was undertaken to investigate the effect of prophylactic negative pressure dressings on postoperative surgical site infection (SSI) rates in closed laparotomy wounds.

Summary Of Background Data: Laparotomy wounds are associated with high rates of SSI. The effect of prophylactic negative pressure dressing of closed incisional wounds on SSI rate is unknown.

End-Expiratory Volume and Oxygenation: Targeting PEEP in ARDS Patients.

Introduction: Changes in end-expiratory lung volume (∆EELV) in response to changes in PEEP (∆PEEP) have not been reported in mechanically ventilated patients with ARDS. The purpose of this study was to determine the utility of measurements of ∆EELV in determining optimal PEEP in ARDS patients.

Methods: Nine patients with ARDS were prospectively recruited.

Profile of energy expenditure in people with rheumatoid arthritis.

Background: No definitive conclusions have been made on the levels of physical activity in the rheumatoid arthritis (RA) population. Similarly no clear consensus has been reached on the correlates and predictors of physical activity in the population.

Objective: To profile total energy expenditure (TEE), resting energy expenditure (REE) and physical activity related energy expenditure (PAEE) levels using a validated objective measurement tool and to determine demographic and health related factors which influence and predict TEE and PAEE levels in individuals with RA.

Reconstruction of orbital floor blow-out fractures with autogenous iliac crest bone: a retrospective study including maxillofacial and ophthalmology perspectives.

This is a 10-year retrospective study of patients with an isolated unilateral orbital floor fracture reconstructed with an autogenous iliac crest bone graft. The following inclusion criteria applied: isolated orbital floor fracture without involvement of the orbital rim or other craniofacial injuries, pre-/post-operative ophthalmological/orthoptic follow-up, pre-operative CT. Variables recorded were patient age and gender, aetiology of injury, time to surgery, follow-up period, surgical morbidity, diplopia pre- and post-operatively (Hess test), eyelid position, visual acuity, and the presence of en-/or exophthalmos (Hertel exophthalmometer).

Reporting of occupational exposures to blood and body fluids in the primary dental care setting in Scotland: an evaluation of current practice and attitudes.

Objectives: To evaluate experience, practice and beliefs regarding occupational exposures to blood and oral fluids among a random sample of 300 dentists working in Scotland's NHS primary dental services.

Method: A cross-sectional postal survey assessed occupational exposure policies and procedures, recent occupational exposure incidence and current management. Beliefs were measured using constructs from the theory of planned behaviour, shown to influence behaviour in this population.

Buccal mucosa urethroplasty: a 10-year retrospective review of maxillofacial and urological outcomes.

Background: Reconstruction of a urethral stricture poses a difficult surgical problem. Anastomotic repair remains the gold standard. Strictures longer than 2 cm may require substitution urethroplasty.

Mucoepidermoid carcinoma of lung masquerading as urothelial carcinoma of bladder.

Background: Mucoepidermoid carcinoma (MEC) of the lung is a rare subtype of non-small cell lung cancer. There is no consensus regarding optimal management for this disease.

Case Report: We present a case of MEC of the lung in a 75 year-old female with a history of superficial urothelial carcinoma of the bladder.

Olanzepine-induced neuroleptic malignant syndrome in a case of multiple sclerosis.

Suspicion of neuroleptic malignant syndrome (NMS) is a frequent cause of emergent psychiatric consultation. Despite early recognition, NMS has remained a syndrome that causes high rates of morbidity and mortality. A 25-year-old male with multiple sclerosis presented to the accident and emergency department and E with ataxia.

A national house-staff audit of medical prophylaxis in medical patients for the PREVENTion of Venous ThromboEmbolism (PREVENT-VTE).

We established a national audit to assess the thromboprophylaxis rate for venous thromoembolism (VTE) in at risk medical patients in acute hospitals in the Republic of Ireland and to determine whether the use of stickers to alert physicians regarding thromboprophylaxis would double the rate prophylaxis in a follow-up audit. 651 acute medical admission patients in the first audit and 524 in the second re-audit were recruited. The mean age was 66.

Effectiveness of 'in-cast' pneumatic intermittent pedal compression for the pre-operative management of closed ankle fractures: a clinical audit.

Background: Timing of surgery for ankle fractures is largely dependent on the condition of the surrounding soft-tissues. This study aimed to determine the clinical effectiveness of a pre-operative in-cast artero-venous (AV) impulse device in the management of closed ankle fractures requiring surgery.

Methods: A consecutive series of 64 closed ankle fractures were managed using the AV impulse system prior to surgery.

Metastatic seminoma presenting as flank pain.

Seminoma is the most common single histological sub-type of testicular carcinoma. Patients usually present with a painless lump and stage I disease. We describe a case of an incidental meta-static seminoma in a 28-year-old man post-renal trauma with a dramatically elevated β-human chorionic gonadotropin (βHCG).

Inflammatory bowel disease and thromboembolism. Is inflammation at the centre of the clot?

Thromboembolic events are well recognised in patients with inflammatory bowel disease (IBD). We present three cases which highlight the need for vigilance with respect to this complication. We also propose that consideration be given to re-evaluating disease activity in those patients who develop thromboembolic complications.

Correlation between Nottingham Prognostic Index and Adjuvant! Online prognostic tools in patients with early-stage breast cancer in Mid-Western Ireland.

Background: Prognostic tools are widely used in the practice of oncology and have been developed to help stratify patients into specific risk-related grouping. We sought to apply tool such tools used for patients with early-stage breast cancer (EBC) and correlate them to actual outcomes.

Methods: A retrospective analysis was designed to include EBC cases seen at the Mid-Western Regional Hospital from January 1, 2002, to December 31, 2002.

Induced sputum compared to bronchoalveolar lavage in young, non-expectorating cystic fibrosis children.

Background: Induced sputum (IS) is feasible and safe in young CF children and is a readily accessible, non-invasive technique. However, it has not been compared to bronchoalveolar lavage (BAL), the gold standard for diagnosing lower airway infection.

Methods: We compared bacterial yield from IS and BAL in 11 non-expectorating CF children, aged 3 to 7.