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CONCLUSION We present the first published case of intravenous poppers abuse. Our patient suffered from methaemoglobinaemia and was rapidly discharged after treatment with toluidine blue. No specific treatment regarding the contents of the poppers bottle, apart from isopropyl nitrite, was necessary. © Royal College of Physicians 2020. All rights reserved.Thrombolytic treatment with tissue plasminogen activator is an established therapy for selected patients with ischaemic stroke within a narrow time window of 3 hours from the onset of symptoms. However, severe complications and poor outcomes are likely to ensue if a patient with acute aortic dissection is inadvertently treated with thrombolytic agents.We describe a patient presenting as facial droop, arm weakness, speech disturbance and time to call emergency services (FAST) positive (clinical picture of ischaemic stroke) who received thrombolysis and in whom the underlying diagnosis of acute thoracic aortic dissection was made by a combination of chance and a high clinical suspicion. © Royal College of Physicians 2020. All rights reserved.A 31-year-old man presented with central chest heaviness. He was a smoker of 15 pack-years, but otherwise had no other comorbidities. He was also a professional footballer. There was no family history of sudden cardiac deaths of note. In view of a low to intermediate pre-test probability for coronary artery disease (CAD), computed tomography coronary angiography (CTCA) was performed, revealing an anomalous, malignant right coronary artery (RCA), originating from the left main coronary stem. Malignant RCAs are rare, and the majority of patients remain asymptomatic. However, malignant RCAs have been associated with both myocardial infarctions and sudden cardiac deaths, which has led to difficulty in deciding on whether a 'watchful waiting' approach or more proactive approach should be adopted. Unfortunately, there remains a lack of evidence to help guide treatment decisions. Furthermore, there are no known guidelines on managing coronary anomalies in athletes, such as the case presented. As the majority of national guidelines have largely recommended CTCA as first-line investigation in patients with low to intermediate risk of CAD with chest pain, incidental finding of coronary anomalies will become more common, urging the need for guidelines to help with directing management in such cases. © Royal College of Physicians 2020. All rights reserved.We report a case of a 72-year-old woman who presented with ST-elevation myocardial infarction (STEMI). However, coronary angiography showed unobstructed arteries while echocardiography (ECHO) showed severe left ventricular (LV) apical hypokinesia with ejection fraction (EF) of 25-30%. Seven months later she presented with a transient ischaemic attack and a repeat ECHO showed a normal EF.A few months later, she was diagnosed with breast cancer and as part of staging procedure, an incidental left adrenal mass was identified. This was biochemically confirmed as phaeochromocytoma (PY) and she underwent laparoscopic adrenalectomy.PY is a rare catecholamine secreting tumour arising from adrenomedullary chromaffin cells. Excessive catecholamine-induced stimulation can present as transient, reversible cardiomyopathy similar to Takotsubo cardiomyopathy and cerebrovascular events. The diagnosis of PY is often delayed but it is important to recognize PY as a cause of reversible cardiomyopathy. Early intervention is essential to improve mortality from cardiovascular and cerebrovascular complications. © Royal College of Physicians 2020. All rights reserved.Although the medical humanities are increasingly well established in terms of scholarly research and undergraduate medical education, a notable deficit has been its low profile in postgraduate training and continuing professional development (CPD).We undertook to develop a programme in the medical humanities to address the deficit in CPD and specialist training, working with colleagues in a range of colleges and disciplines in Ireland. We describe the first element, a masterclass embedded in a series devoted to more traditionally recognised clinical aspects of CPD, webcast live to a range of hospitals across Ireland, whose focus was an introduction to the medical humanities by a panel of clinician scholars each of whom had published in peer-reviewed journals on the topic.Postgraduate colleges of medicine can play an important role in developing medical humanities strands in their postgraduate training and CPD activities. Given the relative novelty of developing postgraduate training and CPD in medical humanities, it may be worthwhile developing an intercollegiate platform among the wider range of medical colleges in the British Isles to jointly develop the most effective mechanisms to further propagate medical humanities and leverage the expertise of a larger pool of faculty in medical humanities. © Royal College of Physicians 2020. All rights reserved.OBJECTIVE The objective was to assess burnout in senior hospital doctors (consultants and staff grade, associate specialist and specialty (SAS) doctors) within a UK-based NHS district general hospital (DGH). METHOD A web-based survey was created using the validated abbreviated Maslach Burnout Inventory (aMBI) with consultants and SAS doctors in a DGH. PRIMARY AND SECONDARY OUTCOME MEASURES We measured scores on aMBI subscales depersonalisation, emotional exhaustion, personal accomplishment and efficacy. RESULTS One-hundred and seventy-eight senior clinicians (60% of consultant and SAS doctors) completed the survey with 85% of these being substantive consultants. Forty-nine per cent of senior clinicians were found to be at high risk of burnout using metrics from the aMBI. CONCLUSIONS Burnout is prevalent among senior clinicians at this DGH. © Royal College of Physicians 2020. selleck kinase inhibitor All rights reserved.INTRODUCTION Providing comprehensive tobacco addiction treatment to smokers admitted to acute care settings represents an opportunity to realise major health resource savings and population health improvements. METHODS The CURE project is a hospital-wide tobacco addiction treatment service piloted in Wythenshawe Hospital, Manchester, UK. The core components of the project are electronic screening of all patients to identify smokers; the provision of brief advice and pharmacotherapy by frontline staff; opt-out referral of smokers to a specialist team for inpatient behavioural interventions; and continued support after discharge. RESULTS From 01 October 2018 to 31 March 2019, 92% (13,515/14,690) of adult admissions were screened for smoking status, identifying 2,393 current smokers. Of these, 96% were given brief advice to quit by the admitting team. Through the automated 'opt-out' referral process, 61% patients completed inpatient behavioural interventions with a specialist cessation practitioner (69% within the first 48 hours of admission).