Extensively drug resistant tuberculosis in a HIV-infected patient in a UK hospital.

Tuberculosis (TB) is a major cause of mortality in the HIV-infected population, with growing concern about increasing incidence in extensively drug-resistant (XDR) TB worldwide. We describe the first published case of XDR TB and HIV co-infection in the UK. The case describes a patient newly diagnosed with smear-positive pulmonary TB and HIV.

Retrospective study of the effect of enhanced systematic sexually transmitted infection screening, facilitated by the use of electronic patient records, in an HIV-infected cohort.

Objectives: The aim of the study was to assess the impact of electronic checklists in enhancing sexually transmitted infection (STI) screening in routine HIV care.

Methods: This was a retrospective cohort study. In two HIV clinics, new STIs were recorded for three consecutive 12-month periods between 2009 and 2012 in a cohort of 882 HIV-infected patients.

The great deception: tranexamic acid and extensive pulmonary emboli.

Pulmonary embolism (PE) is a common and life-threatening condition. The British Thoracic Society PE guidelines state that PE is reliably excluded in patients with low-intermediate clinical probability and a negative D-dimer. We are reporting the case of a 47-year-old lady, taking tranexamic acid for menorrhagia, who presented with shortness of breath and was diagnosed with extensive bilateral PE.

Simulation to develop tomorrow's medical registrar.

Background:  Critical incident analysis reveals that poor performance in 'human-factor' or non-technical skills, such as decision making, leadership, teamwork and situational awareness, are frequently identified as key underlying features leading to adverse events. Simulation technology is a rapidly emerging modality used to develop technical and non-technical skills within specialist training as increasing shift-pattern work reduces work-based exposure and learning opportunities. To date, however, there is little literature regarding its use within core medical training to develop crisis resource management skills and medical registrar competency.

Primary nodal anthracosis identified by EBUS-TBNA as a cause of FDG PET/CT positive mediastinal lymphadenopathy.

Isolated mediastinal lymphadenopathy can result from a number of potentially serious aetiologies. Traditionally those presenting with mediastinal lymphadenopathy would undergo mediastinoscopy to elucidate a final diagnosis or receive empirical treatment. There is now increased utilization of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), in this setting.

Preoperative neutrophil to lymphocyte ratio >5 is a prognostic factor for recurrent colorectal cancer.

Aim: Previous studies have demonstrated that raised preoperative neutrophil to lymphocyte ratio (NLR) is associated with poor prognosis in colorectal cancer (CRC). The aim of this study was to assess whether preoperative NLR could predict patients at risk of recurrence of CRC.

Method: All consecutive patients who underwent surgical resection for CRC over a 2-year period at our institution were analysed.

Safety trial of Floseal(®) haemostatic agent in head and neck surgery.

Introduction: Floseal(®) can be of value in reducing blood loss and haematoma rates. The manufacturer's warnings include allergic reaction, poor wound healing and intravascular thrombosis. We aimed to determine whether Floseal(®) is safe to use in various head and neck surgery procedures.

Cervical osteophytes causing vocal fold paralysis: case report and literature review.

Objectives: To increase awareness of cervical osteophytes as an extremely rare cause of recurrent laryngeal nerve palsy; to outline the clinical approach to patients with unilateral vocal fold paralysis and to provide an update on the current management of osteoarthritis and osteophytes.

Case Report: An elderly man presented with right unilateral vocal fold immobility and a small phonatory gap. By a diagnosis of exclusion, a cervical osteophyte at the level of the sixth and seventh cervical vertebrae was shown to be the cause.

The chameleon in the neck: Nodular fasciitis mimicking malignant neck mass of unknown primary.

Introduction: Difficulties with the correct diagnosis and treatment of nodular fasciitis in head and neck region has been reported in the literature. Nodular fasciitis was mistaken for sarcoma, papillary thyroid carcinoma, Burkitt's lymphoma, pleomorphic adenoma, or as a vascular lesion.

Presentation Of Case: We present a patient with a single node in the neck with accelerated growth, which clinically appeared as a malignant epithelial tumor with unknown primary.

Parotid surgery for benign tumours.

Purpose: The majority of parotid tumours are benign, making parotid surgery a compromise between adequate tumour excision and preservation of function and facial harmony. Besides the traditional superficial or total parotidectomy, less invasive techniques have been described with similar recurrent rates. The aim of this review is to assess the evidence in the published literature and to summarise the advantages and disadvantages of the available techniques.

The use of an electronic checklist in the electronic patient record to achieve annually recommended outcomes based on British HIV Association guidelines.

An electronic search was performed of the electronic patient record (EPR) system to identify whether each of 13 key interventions recommended by the British HIV Association (BHIVA) had been performed for all eligible patients attending in 2009 and 2010 at one of our HIV clinics: 345 and 358 eligible HIV-positive patients were identified in 2009 and 2010, respectively. The success rates for having completed each intervention in 2009 and 2010, respectively, were all better for 2010 and none was <94%. These improved results in 2010 over those of 2009 could be attributed to the clinicians' improved experience in using the checklist and the facility of EPR to provide flagged reminders.

Intestinal failure and home parenteral nutrition: implications for oral health and dental care.

Background & Aims: Background disease processes, medication and therapies in people with intestinal failure receiving home parenteral nutrition may affect their oral health. To inform oral health advice for this group a study of their oral health status was carried out.

Methods: Fifty-two HPN outpatients recruited from specialised nutrition clinics at a national referral centre listed their medical and medication history, perceived oral health and dental treatment experience in a structured interview and underwent an oral health examination.

Evaluation of disinfection of flexible nasendoscopes using Tristel wipes: a prospective single blind study.

Introduction: The otorhinolaryngology department at Northwick Park Hospital uses the Tristel wipes system for cleaning nasendoscopes in the outpatient clinics. This system uses chlorine dioxide as its only disinfectant. The manufacturer claims the system provides safe sterilisation of nasendoscopes.

The implications of a raised maternal BMI: a DGH experience.

This retrospective analysis evaluated the association between maternal body mass index (BMI) and the incidence of maternal and neonatal complications in those women delivering at a North West London hospital between January 2002 and December 2007. Of the women examined, obese mothers (BMI ≥ 30) were shown to be at significantly higher risk from multiple morbidities (p < 0.05), including gestational diabetes; antepartum haemorrhages; pre-term delivery before 37 and 33 weeks' gestation; induction of labour; analgesia use (beyond inhalational methods and local infiltration); caesarean sections; massive postpartum haemorrhages; higher birth weights; Apgar scores < 8 at 1 min and 5 min; cord base deficits less than-12 and a greater need for neonatal care (SCBU, HDU, NICU) compared with mothers with a BMI < 30.

Analysing lateral soft tissue neck radiographs.

A lateral soft tissue neck radiograph is a useful adjunct in diagnosing and managing the patient presenting with upper airway symptoms but is often inadequately reviewed. We present some common findings and robust systems to improve analysis of these radiographs.

Bilateral atypical insufficiency fractures of the proximal tibia and a unilateral distal femoral fracture associated with long-term intravenous bisphosphonate therapy: a case report.

Introduction: Atypical insufficiency fractures of the femur in patients on long-term bisphosphonate therapy have been well described in recent literature. The majority of cases are associated with minimal or no trauma and occur in the subtrochanteric or diaphyseal region.

Case Presentation: We describe the case of a 76-year-old British Caucasian woman who presented initially to an emergency department and then to her primary care physician with a long-standing history of bilateral knee pain after minor trauma.

Glaucoma detection using optic disc images from the English national screening programme for diabetic retinopathy.

Purpose: We performed this study to determine the positive predictive value of a Diabetic Retinopathy Screening Program (DRSP) in detecting early glaucoma using diabetic retinopathy screening images.

Patients And Methods: The study was carried out on patients referred to the glaucoma clinic from the local DRSP. Retinal images considered by DRSP graders to show possible glaucomatous optic discs were referred to the final referral grader, a medical retina specialist (MR).

Instigating change: trainee doctors' perspective.

In the 21st century, the core skills of trainee doctors are evolving as clinicians, leaders and innovators. Leadership skills are an essential tool for all doctors and need to be an integral part of their training and learning as set out in the General Medical Council's Good Medical Practice. It is essential to develop these skills at an early stage and continually improve them.

Regular long-term red blood cell transfusions for managing chronic chest complications in sickle cell disease.

Background: Sickle cell disease can cause severe vaso-occlusive crises and dysfunction of most organ systems. The two most common chronic chest complications due to sickle cell disease are pulmonary hypertension and chronic sickle lung disease. These complications can lead to morbidity (such as reduced exercise tolerance) and increased mortality.