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Lithium is a mood stabiliser widely used in the treatment and prophylaxis of mania, bipolar disorders and recurrent depression. Treatment with lithium can give rise to various endocrine and metabolic abnormalities, including thyroid dysfunction, nephrogenic diabetes insipidus and hypercalcaemia. Lithium may induce hypercalcaemia through both acute and chronic effects. The initial acute effects are potentially reversible and occur as a result of lithium's action on the calcium-sensing receptor pathway and glycogen synthase kinase 3, giving rise to a biochemical picture similar to that seen in familial hypocalciuric hypercalcaemia. In the long term, chronic lithium therapy leads to permanent changes within the parathyroid glands by either unmasking hyperparathyroidism in patients with a subclinical parathyroid adenoma or possibly by initiating multiglandular hyperparathyroidism. The latter biochemical picture is identical to that of primary hyperparathyroidism. Lithium-associated hyperparathyroidism, especially in patients on chronic lithium therapy, is associated with increased morbidity. Hence, regular monitoring of calcium levels in patients on lithium therapy is of paramount importance as early recognition of lithium-associated hyperparathyroidism can improve outcomes. This review focuses on the definition, pathophysiology, presentation, investigations and management of lithium-associated hyperparathyroidism.

Prophylaxis at discharge is important in mitigating venous thromboembolism events from colorectal cancer and major abdominopelvic surgery, both of which are risk factors for venous thromboembolism. Foundation doctors frequently rotate between departments, and so rely on departmental induction and/or handing down of knowledge to prescribe extended venous thromboembolism prophylaxis upon discharge.

A retrospective audit of all patients who underwent surgery for colorectal cancer at The County Hospital, Hereford, between 1 August 2018 and 31 August 2019, was undertaken to assess departmental compliance with guidance from the National Institute for Health and Care Excellence.

A total of 181 patients underwent elective surgery and 29 patients had emergency surgery. The initial audit revealed a cyclical 4-monthly decline that coincided with foundation doctors' rotations. Six multidisciplinary interventions were implemented. Reaudit demonstrated 100% compliance with prescribing of extended venous thromboembolism prophylaxis at discharge. No venous thromboembolism events 30 days post operation were noted.

A multidisciplinary approach involving educating health professionals about the importance of extended venous thromboembolis prophylaxis in patients who have undergone surgery for colorectal cancer can be effective in improving compliance with prescribing practices at discharge.

A multidisciplinary approach involving educating health professionals about the importance of extended venous thromboembolis prophylaxis in patients who have undergone surgery for colorectal cancer can be effective in improving compliance with prescribing practices at discharge.The number of people with kidney transplants has increased rapidly over the last 20 years. They are often medically complex and have a significant need for both routine and urgent care. Patients who have received a kidney transplant can be challenging to manage in the medical assessment unit. They are vulnerable to infections and acute kidney injury; disease presentation and course may be atypical and they are at risk of rapid deterioration. This review describes a systematic approach to their assessment and management and highlights specific considerations to be borne in mind.

This article reports on the career choice of foundation doctors going through a local foundation programme and whether they planned to take an F3 year. The authors also prospectively gathered views relating to their career choice and the need for an F3 year.

Data were gathered from 193 foundation doctors training in Nottinghamshire between 2015 and 2020 through an unstructured interview process. Data were anonymised and used to learn about career pathway choices and whether they planned to take an F3 year option. Reasons for this pathway were also explored.

Data showed that there was a steady increase in the proportion of trainees opting for F3 over time.

The local picture in terms of trainees taking an F3 option reflects the national trend. Some trainees find foundation training a stressful time and so need to be offered support. The authors comment on the factors that make a career appealing to trainees.

The local picture in terms of trainees taking an F3 option reflects the national trend. Some trainees find foundation training a stressful time and so need to be offered support. The authors comment on the factors that make a career appealing to trainees.Hand fractures are the most common fractures of the upper extremity, with a reported incidence of 3.7 per 1000 per year for men and 1.3 per 1000 per year for women. Understanding the diagnosis and management of these injuries is vital for any clinician working in the emergency department, plastic or orthopaedic surgery or providing community care. This review identifies the most common presentations and outlines how to assess and manage such fractures appropriately, with an emphasis on clinical and radiographic examination. The majority of hand fractures are managed conservatively and operative management should be carefully considered on a case-by-case basis with analysis of patient and fracture-related factors, in order to achieve optimal hand function following treatment.Traumatic digit amputations account for 1% of all trauma admissions and are an important cause of morbidity in young, working people. It is essential that patients are worked up appropriately and referred promptly to a specialist unit for consideration of replantation. This review summarises the acute management of a patient presenting to the emergency department with an amputated digit. It discusses the assessment, initial management in the emergency department, how to make the decision to replant and operative steps.This article summarises the recommendations of the new American Thoracic Society guidelines on the pharmacological management of chronic obstructive pulmonary disease, comments on how they differ from other guidelines, and considers the research needs and unanswered questions posed.This article provides a comprehensive overview of hand tendon injuries. It has been tailored towards healthcare professionals who will be the first to assess these injuries and instigate appropriate management. It discusses the essential hand anatomy to be aware of, how to assess tendon injuries, their initial management and also the definitive surgical interventions used, if required. Rehabilitation techniques are also discussed, as this is also key to good functional outcomes. Missed injuries, or delay in their diagnosis and referral to specialist hand surgeons, can cause a large amount of morbidity for patients and therefore it is important that they are picked up in a timely manner.This year marks the 400th anniversary of the birth of Richard Wiseman, acknowledged to be the best known surgeon in this country in the 17th century. His authorship of the surgical textbook Several Chirurgical Treatises gave him the well-deserved reputation for being regarded as the father of English surgery.Nystagmus is the repetitive to and fro movement of the eyes, which may be physiological or pathological. The movements can be horizontal, vertical, torsional or a combination of these movements. It starts by a slow movement of the eye away from the visual target. The second movement brings the eye back to the visual target. If this second movement is quick, the nystagmus is called jerk nystagmus. If the second movement is slow, the nystagmus is said to be pendular. Amlexanox Maintaining steady gaze is dependent upon visual fixation, the vestibulo-ocular reflex and the gaze-holding neural integrator system. Pathological nystagmus typically presents with the symptom of oscillopsia, which is the illusory movement of the surrounding environment. Nystagmus that develops outside of early infancy is termed acquired nystagmus. There may be serious underlying pathology that will require further investigation and management. This article reviews the terminology, pathophysiology, causes and treatment of acquired nystagmus.Current best practice in placement of arterial lines is to attempt to cannulate the radial artery in the first instance. However, if the radial artery is difficult to cannulate there is no consensus among clinicians on how best to proceed. This article looks at the evidence for the different options.The hand is an extremely versatile organ adapted for fine tasks with various clinicoanatomical compartments. This article reviews the types of common hand infections that present to the emergency department and/or hand surgeon, with relevant investigations and strategies for diagnosis and treatment, with the emphasis on distinguishing between superficial and more serious infections.Evaluating the physiological demands of BMX cycling on a track provides coaches with the information required to prescribe more effective training programmes. To determine the relative importance of physiological factors during simulated BMX race, 12 male riders (age 19.2 ± 3.5 years, height 1.76 ± 0.06 m, mass 68.5 ± 4.3 kg) completed a maximum aerobic capacity (V̇O2max) test in a laboratory, and a week later, completed six laps on a BMX track interspersed by 15 min passive recovery. Peak power, immediate post-lap V̇O2peak, blood lactate, and heart rate were measured in each lap. Peak power to weight ratio was significantly correlated with lap time, however, the strength of this association decreased in each subsequent lap. Mean V̇O2peak was greater than 80% of laboratory-measured V̇O2max in every lap, indicating a strong contribution of the aerobic energy system during BMX racing. This study also identified that mean blood lactate was significantly associated with lap time, which showed the importance of the anaerobic energy system contribution to BMX race. Despite the short period of pedalling during BMX racing, both aerobic and anaerobic energy systems are important contributors to lap performance. Coaches should consider maximising both anaerobic power and aerobic capacity to improve riders' overall performance in multiple laps.

Platypnoea-Orthodeoxia Syndrome is an uncommon phenomenon characterized by dyspnea/arterial desaturation in the standing position, resolving in recumbency. Some patients present with Platypnoea-Orthodeoxia Syndrome in the early-or-late post-operative period after major lung resection (lobectomy/pneumonectomy). The main cause of Platypnoea-Orthodeoxia Syndrome is an intracardiac anomaly (Patent Foramen Ovalis/Atrial Septal Defect) leading to right-to-left shunt.

To identify the causes of post-lobectomy Platypnoea-Orthodeoxia Syndrome, and the possible pathophysiologic mechanism.

A Pubmed database-EMBASE systematic review was performed in order to find all reports, reporting the occurrence of dyspnea/hypoxemia after lobectomy.

8 studies were found concerning ten patients during the period from 1983-2019.There was 6 male/4 female. The mean age was 62 years. All patients underwent resection of the right lung. The time-interval between the operation and the Platypnoea-Orthodeoxia Syndrome was from 2 days to 3 years.