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Extranodal NK/T‐cell lymphoma (ENKL) is a rare, aggressive form of non‐Hodgkin's lymphoma with a distinct ethnic predilection favouring populations from Asia and Central and South America. The nasopharynx is the most commonly affected anatomical site. One of the key markers of this disease entity is infection with Epstein‐Barr virus (EBV), which is detected by in situ hybridisation. Histopathology and immunohistochemistry play a vital role in the diagnostic process, with cells typically expressing CD56, TIA‐1 and CD3ε. We present here a very unusual case of ENKL in a Caucasian female with an extranasal presentation, absence of CD56 expression and presence of EBV‐positive cells in the bone marrow. The unusual presentation of the disease in this case, as well as the many diagnostic challenges encountered, are detailed in this paper. It is hoped that this case will prompt clinicians to consider the possibility of an underlying malignant process in cases of refractory oral ulceration with concurrent clinical signs and symptoms. [ABSTRACT FROM AUTHOR]

Abstract: In March 2017, a group of teachers of human disease/clinical medical science (HD/CMSD) representing the majority of schools from around the UK and Republic of Ireland met to discuss the current state of teaching of human disease and also to discuss how the delivery of this theme might evolve to inform improved healthcare. This study outlines how the original teaching in medicine and surgery to dental undergraduate students has developed into the theme of HD/CMSD reflecting changing needs as well as guidance from the regulators, and how different dental schools have developed their approaches to reach their current state. Each school was also asked to share a strengths, weakness, opportunities and threats (SWOT) analysis of their programme and to outline how they thought their HD/CMSD programme may develop. The school representatives who coordinate the delivery and assessment of HD/CMSD in the undergraduate curriculum have extensive insight in this area and are well‐placed to shape the HD/CMSD development for the future. [ABSTRACT FROM AUTHOR]

Rationale: Insulin‐like peptide 5 (INSL5) is a hormone produced by enteroendocrine L‐cells in the colon that has recently been implicated in the control of metabolic homeostasis. However, research into its physiology has been hindered by the reported unreliability of commercially available immunoassays and additional detection assays would benefit this emerging field. Methods: Peptides from purified murine L‐cells and homogenates from both human and mouse colonic tissues were extracted by precipitating larger proteins with acetonitrile. Untargeted liquid chromatography/tandem mass spectrometry (LC/MS/MS) analyses, followed by database searching, were used to detect and identify various INSL5 gene derived peptides and characterise their precise sequence. A similar approach was developed to quantify INSL5 levels in primary intestinal culture supernatants after purification and concentration by solid‐phase extraction. Results: Mass spectral analysis of purified enteroendocrine cells and tissue homogenates identified the exact sequence of A and B chains of INSL5 endogenously expressed in L‐cells. Differences in the endogenously processed peptide and the Swissprot database entry were observed for murine INSL5, whereas the human sequence matched previous predictions from heterologous expression experiments. INSL5 was detected in the supernatant of human and mouse primary colonic cultures and concentrations increased after treatment with a known L‐cell stimulus. Conclusions: The first LC/MS/MS‐based method capable of the detection and semi‐ quantitative analysis of endogenous INSL5 using MS‐based techniques has been demonstrated. The methodology will enable the identification of stimulants for INSL5 secretion from murine and human primary colonic epithelial cultures. [ABSTRACT FROM AUTHOR]

Objective Coronary artery bypass grafting using arterial conduits may improve survival and minimise harvest site complications. However, in diabetes, the outcomes of coronary artery bypass grafting performed exclusively using arterial conduits are uncertain. We reviewed our experience with this approach. Methods From 1996 to 2008, 400 patients with diabetes (managed with oral hypoglycaemics, insulin or both) underwent primary isolated coronary artery bypass grafting for triple vessel coronary disease. In 246 (61.5%), total arterial revascularisation was achieved using single or bilateral internal thoracic arteries supplemented by one or more radial arteries (arterial group), while in the remaining 154 (38.5%), at least one venous conduit was used (mixed conduits group: mean 1.5 veins per patient). Propensity-score matching was used to adjust for bias. Results Total arterial revascularisation patients were more likely to be younger (arterial: 63 ± 10 years vs mixed: 67 ± 10 years, P < 0.0001), of elective priority (85% vs 75%, P = 0.018) and less likely to have moderate-severe left ventricular dysfunction (23% vs 36%, P = 0.024). Use of bilateral internal thoracic arteries was similar between groups (16% vs 11%, P = 0.19). There was a comparable in-hospital mortality (1.9% vs 2.0%, P > 0.99) and major morbidities, except the arterial group who experienced less stroke (0.4% vs 3.2% vs P = 0.04) and harvest site infections (0.4% vs 4%, P = 0.016). Mean follow was 7.8 ± 3.7 years. Estimated survival at 12-year survival in the arterial group was 80% ± 3.2% vs 54% ± 5.5% ( P < 0.0001). Subsequently, 103 propensity-score-matched patient pairs were created between the two groups. After matching, in-hospital mortality (1% vs 2%, P > 0.99) and major morbidities were similar, as was an estimated 12-year survival (69% ± 6.1% vs 59% ± 6.5%, P > 0.99). Conclusions The use of veins to supplement arterial conduits did not deleteriously affect survival. However, the significant number of patients receiving arterial grafts in both groups may have masked any potential difference. Greater numbers and longer follow-up will reveal the potential of this approach. [ABSTRACT FROM AUTHOR]

Cocaine misuse is increasing and it is evidently considered a relatively safe drug of abuse in Ireland. To address this perception, we reviewed the database of an 18-bed Dublin intensive care unit, covering all admissions from 2003 to 2007. We identified cocaine-related cases, measuring hospital mortality and long-term survival in early 2009. Cocaine-related admissions increased from around one annually in 2003–05 to 10 in 2007. Their median (IQR [range]) age was 25 (21–35 [17–47]) years and 78% were male. The median (IQR [range]) APACHE II score was 16 (11–27 [5–36]) and length of intensive care stay was 5 (3–9 [1–16]) days. Ten patients died during their hospital stay. A further five had died by the time of follow-up, a median of 24 months later. One was untraceable. Cocaine toxicity necessitating intensive care is increasingly common in Dublin. Hospital mortality in this series was 52%. These findings may help to inform public attitudes to cocaine. [ABSTRACT FROM AUTHOR]

Introduction A 54-year-old woman presented with an inferior MI & post infarction pericarditis. Incomplete LV rupture was confirmed by MRI. She was managed with pericardial patch repair of her LV. Case Our patient presented with 1 week of chest pain, elevated Troponin T & ECG suggesting a recent inferior MI. Angiography showed an occluded obtuse marginal artery, left ventriculogram a 1 cm endocardial defect in a hypokinetic segment of the infero-lateral LV & transthoracic echo a small LV wall defect with a haemodynamically insignificant pericardial effusion. Cardiac MRI confirmed an infero-lateral infarct & an anatomical defect suggesting incomplete rupture of the LV free wall. Operatively straw colored pericardial fluid & a shaggy pericarditis were noted. Myocardium supplied by the obtuse marginal artery had appearances of recent infarction & on cardiopulmonary bypass a pericardial patch was glued over this area. The patient required elective drainage of a persistent pericardial effusion and was discharged on the 13th post-operative day. 4 weeks after discharge she was asymptomatic with echo showing a resolving pericardial effusion. Discussion Incomplete LV rupture following MI is rare & caused by haemorrhagic dissection of the ventricular wall leaving a defect lined by epicardium alone. The natural history is not well described but may include free wall rupture with an in-hospital mortality of 70%. Pericardial patch augmentation of the LV may reduce the risk of free wall rupture. Conclusion Management of incomplete LV rupture is poorly described but reinforcement of the area with a pericardial patch may be performed safely to reduce the risk of free wall rupture. [ABSTRACT FROM AUTHOR]

Introduction: The United Kingdom and Ireland teachers of Human Disease/Clinical Medical Science for Dentistry (HD/CMSD) group continue to work together and most recently collaborated to review current and future assessments., Materials and Methods: The first part of the review of assessments in HD/CMSD took place at a face-to-face meeting with presentations from delegates on assessments in their home institutions. The second and larger part comprised an online survey where all eighteen schools in the UK and Ireland participated., Results: All schools had some element of formative assessment, and the majority had a stand-alone summative assessment at the end of the HD/CMSD teaching block. Most schools had a written paper and practical elements to their assessments, most commonly a combination of a multiple-choice type question combined with an objective structured clinical examination (OSCE). There was a trend towards the use of single best answer (SBA) questions and a willingness amongst participants to share a question bank. All schools incorporated elements of HD/CMSD in their final examinations., Discussion and Conclusion: This collaboration promoted the sharing of developments in assessment for HD/CMSD and demonstrated a willingness to cooperate between institutions. Assessment in HD/CMSD in the UK and Ireland continues to be refined by those responsible for its content and delivery, and assessment methods are progressing following evidence-based best practice., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: Blood tests are requested for approximately 50% of patients attending the emergency department (ED). The time taken to obtain the results is perceived as a common reason for delay. The objective of this study was therefore to investigate the turnaround time (TAT) for blood results and whether this affects patient length of stay (LOS) and to identify potential areas for improvement., Methods: A time-in-motion study was performed at the ED of the John Radcliffe Hospital (JRH), Oxford, UK. The duration of each of the stages leading up to receipt of 101 biochemistry and haematology results was recorded, along with the corresponding patient's LOS., Results: The findings reveal that the mean time for haematology results to become available was 1 hour 6 minutes (95% CI: 29 minutes to 2 hours 13 minutes), while biochemistry samples took 1 hour 42 minutes (95% CI: 1 hour 1 minute to 4 hours 21 minutes), with some positive correlation noted with the patient LOS, but no significant variation between different days or shifts., Conclusions: With the fastest 10% of samples being reported within 35 minutes (haematology) and 1 hour 5 minutes (biochemistry) of request, our study showed that delays can be attributable to laboratory TAT. Given the limited ability to further improve laboratory processes, the solutions to improving TAT need to come from a collaborative and integrated approach that includes strategies before samples reach the laboratory and downstream review of results., (© 2010 Blackwell Publishing Ltd.)

In this prospective randomised study, pruritus and pain were evaluated in patients undergoing abdominal surgery in which intrathecal morphine was administered. Each patient received intrathecal morphine 0.3 mg prior to induction, followed by a standard anaesthetic. The patients were randomly allocated to one of two groups. One group received 100 mg of rectal diclofenac immediately post-induction. Patients receiving diclofenac had significantly lower pruritus scores at 30 min (p = 0.0076), 2, 4, 8 and 24 h postoperatively, as well as significantly reduced pain scores at each time point (p < 0.0001 at each study interval). Morphine consumption in the first 24 h was also significantly lower in this group. In conclusion, rectal administration of diclofenac significantly reduces the incidence and severity of postoperative pruritus. It also significantly reduces pain and further analgesic requirements postoperatively.