pneumonia: a rare cause of infection in the multimorbid or immunocompromised.

is a rare, poorly understood commensal bacterium which has, on occasion, been shown to infect humans. We present two cases. The first patient presented with a 1-week history of dyspnoea, pleurisy and a productive cough, and the second with a prodrome of fatigue and night sweats.

Multicenter cohort study of patients with buried bumper syndrome treated endoscopically with a novel, dedicated device.

Background And Aims: Buried bumper syndrome (BBS) is a rare adverse event of percutaneous endoscopic gastrostomy (PEG) placement in which the internal bumper migrates through the stomal tract to become embedded within the gastric wall. Excessive tension between the internal and external bumpers, causing ischemic necrosis of the gastric wall, is believed to be the main etiologic factor. Several techniques for endoscopic management of BBS have been described using off-label devices.

An unexpected surprise: rare association of neuroendocrine tumours in inflammatory bowel disease.

Neuroendocrine neoplasms are rare malignancies, more so when cancerous metastasis occurs without a known primary source. Here we discuss a case of an ulcerative colitis sufferer, 43-year-old lady presented with what was thought to be a flare up. Situation deteriorated and was taken to theatre to find a significantly ischaemic colon, secondary to extensive venous thrombosis.

Effect of Flash Glucose Monitoring on Glycemic Control, Hypoglycemia, Diabetes-Related Distress, and Resource Utilization in the Association of British Clinical Diabetologists (ABCD) Nationwide Audit.

Objective: The FreeStyle Libre (FSL) flash glucose-monitoring device was made available on the U.K. National Health Service (NHS) drug tariff in 2017.

A cross-sectional study of periportal fibrosis and Schistosoma mansoni infection among school-aged children in a hard-to-reach area of Madagascar.

Background: A cross-sectional survey was performed to estimate the prevalence of periportal fibrosis in children based on ultrasound examination in the Marolambo district of the Atsinanana region of Madagascar. This is a remote area known to have a high prevalence of intestinal schistosomiasis.

Methods: School-aged children (5-14 y) were selected from six villages for parasitological and sonographic examination.

Systematic Review of Modular Bicompartmental Knee Arthroplasty for Medio-Patellofemoral Osteoarthritis.

Background: We aimed to locate, appraise, and synthesize the available literature to assess the functional outcome of modular bicompartmental knee arthroplasty (BKA) compared to total knee arthroplasty (TKA) for medio-patellofemoral osteoarthritis.

Methods: After an extensive literature search based on electronic databases such as MEDLINE, EMBASE, CINAHL, and PubMed, and grey literature, 9 articles satisfied our selection criteria which included 1 randomized controlled trial, 1 prospective cohort, 3 retrospective cohort, and 4 case series. Narrative synthesis was performed due to clinical, methodological, and statistical heterogeneity among the included studies.

A silent compartment syndrome following elective minimally invasive mitral valve repair.

A 63-year-old male with severe mitral valve regurgitation underwent an elective minimally invasive mitral valve repair. Peripheral cannulation of the right femoral vein and artery was performed with a total cardiopulmonary bypass time of 268 min. There were no intraoperative complications.

Exercise-induced cardiac troponin elevation: An update on the evidence, mechanism and implications.

Post-exercise cardiac troponin (cTn) elevation is a recognised phenomenon which historically has been detected using standard sensitivity assays. More recently high-sensitivity assays have been developed and are now the gold standard for detection of cTn in the clinical setting. Although the assay's enhanced sensitivity confers benefits it has created new challenges for clinicians.

Quality of Life Outcomes following Treatment of Hypopharyngeal Cancer.

Quality of life (QoL) is an important consideration in the management of individuals with head and neck cancer. The poor prognosis and significant impact of treatment modalities on function of the salivary glands, larynx and pharynx combine to make hypopharyngeal carcinoma a particularly challenging condition to treat. The impact of diagnosis and treatment on health related QoL is substantial.

Postoperative critical care and high-acuity care provision in the United Kingdom, Australia, and New Zealand.

Background: Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional 'high-acuity' beds capable of managing high-risk patients outside the ICU/HDU environment.

Methods: We used a modified Delphi consensus method to design a survey that was disseminated via investigator networks in the UK, Australia, and NZ.

Literature review and case series of haemorrhagic cholecystitis.

A diagnosis of haemorrhagic cholecystitis is difficult to make as it is rare and mimics other common disorders. We present three patients who presented with haemorrhagic cholecystitis, two of whom were on anti-coagulation at presentation. All 3 patients were treated conservatively, 2 with percutaneous cholecystostomy drainage and 1 patient with intravenous antibiotics.

Hypothyroidism conversion to hyperthyroidism: it's never too late.

Unlabelled: Primary hypothyroidism is a common endocrine condition, most commonly caused by autoimmune thyroiditis (Hashimoto's disease) while Graves' disease is the most common cause of hyperthyroidism. Hypothyroidism is usually a permanent condition in most patients requiring lifelong levothyroxine treatment. Transformation from Hashimoto's disease to Graves' disease is considered rare but recently been increasingly recognised.

Percutaneous Antegrade Colonic Stent Insertion Using a Proximal Trans-peritoneal Colopexy Technique.

Introduction: Conventionally, colonic stents are inserted with a retrograde trans-anal approach-however, stenting of right-sided or proximal transverse colon lesions may pose a challenge due to tortuosity or long distances. We report three successful cases of percutaneous antegrade colonic stenting in patients using a proximal trans-peritoneal colopexy technique.

Materials And Methods: Three patients underwent a proximal trans-peritoneal colopexy technique for antegrade colonic stent placement.

Identification of new risk factors for rolandic epilepsy: CNV at Xp22.31 and alterations at cholinergic synapses.

Background: Rolandic epilepsy (RE) is the most common genetic childhood epilepsy, consisting of focal, nocturnal seizures and frequent neurodevelopmental impairments in speech, language, literacy and attention. A complex genetic aetiology is presumed in most, with monogenic mutations in accounting for >5% of cases.

Objective: To identify rare, causal CNV in patients with RE.

Ultrasound-guided percutaneous retrieval of a dropped gallstone following laparoscopic cholecystectomy.

Removal of intraabdominal dropped gallstones remains a challenging problem for both surgeon and radiologist. We describe in this report a novel, minimally invasive technique to successfully remove a dropped gallstone, causing recurrent intra-abdominal infection, from a patient who had undergone laparoscopic cholecystectomy.

Tacrolimus therapy in moderate to subacute ulcerative proctocolitis: a large single-centre cohort study.

Objective: To explore the 'real world' effectiveness of tacrolimus therapy for refractory ulcerative proctocolitis (UC).

Design: Retrospective cohort study using prospectively collated clinical data.

Setting: A single district general hospital in Kent, UK.

Bilateral haemorrhagic basal ganglia infarction associated with early-onset group B streptococcus meningitis.

A 2-day-old infant presented with poor feeding and grunting. Investigations revealed a raised C reactive protein of 164. Full septic screen was done, which subsequently confirmed a diagnosis of group B streptococcus meningitis.

Ulcerative colitis: management in adults, children and young people - concise guidance .

Ulcerative colitis is a chronic, relapsing and remitting -inflammatory disease of the colon and rectum. Effective -management requires prompt recognition and treatment of those with acute relapses as well as appropriate choice and monitoring of drugs for maintenance of remission. This therefore involves specialist gastroenterology teams as well as acute and general physicians and primary care clinicians.

Clinical risk factors predicting genital fungal infections with sodium-glucose cotransporter 2 inhibitor treatment: The ABCD nationwide dapagliflozin audit.

Introduction: Treatment of type 2 diabetes with sodium-glucose cotransporter 2 (SGLT2) inhibitors may result in genital fungal infections. We investigated possible risk factors for developing such infections among patients treated with the SGLT2 inhibitor dapagliflozin.

Methods: The Association of British Clinical Diabetologists (ABCD) collected data on patients treated with dapagliflozin in routine clinical practice from 59 diabetes centres.

Spontaneous ruptured iliac artery aneurysm causing acute secondary AV fistula.

A 73-year-old woman presented with a 6-hour history of sudden onset lower abdominal pain. Her comorbidities included chronic obstructive pulmonary disease and hypertension. She was under surveillance for a known thoracoabdominal aneurysm.