Background:Correct nasal spray techniqueand patient compliance are the two mostimportant factors in the use of steroid nose spray. Objectives:To find out if patientsuse steroid nasal spray with a correctspray technique and if they are compliant in using the spray. Design: Patient-reported survey Participants: 100 participants (1 excluded) Main outcome measures 1) Nasal spray technique 2) Patient compliance Results: Out of 99 participants included in this study only one patient used steroid nose spray with a completely correct spray technique. 40% of patients received guidance instructions from the prescriber about the spray technique. 70% of patients reported using their spray regularly and 53% of patients were found using the correct dosage of the spray. Conclusions: Wrong spray technique and patient noncompliance is common and can be corrected. This survey emphasizes the importance of giving written and verbal instructions about the use of spray to the patients.

BACKGROUND Hirschsprung's disease is the commonest cause of functional intestinal obstruction in children. Majority of children with Hirschsprung's disease will have delayed passage of meconium in newborn period with abdominal distension and older children present with chronic constipation. This study describes the clinical characteristics and outcome of management of this disease in our setting where frozen section facilities are difficult. MATERIALS AND METHODS A total of three hundred and nineteen patients were analysed over twelve years' duration; stage I 147 patients and stage II 172 patients. The presentation, diagnostic investigations, operative management and complications were described. Study Design-This is a retrospective study with record based analysis. RESULTS Patients of Hirschsprung's disease both in stage I (Colostomy) and stage II (Pull-through) developed significant number of complications with severity ranging from minor to major. CONCLUSION Although complications are common, majority of the complications are manageable and attain a socially satisfactory bowel habit.

Objectives; To investigate spray technique and compliance among patients using steroid nasal spray. Design: Patient-reported survey Setting; Single centre study-a tertiary care hospital Participants: 100 participants (1 excluded) Main outcome measures 1) Nasal spray technique 2) Patient compliance Results: Out of 99 participants included in this study only one patient used steroid nose spray with a completely correct spray technique. Only 40% of patients received guidance instructions from the prescriber about the spray technique. 70% of patients reported using their spray regularly while 14% and 16% reported using mostly and sometimes respectively. 53% of patients were found using the correct dosage of the spray while 34% of patients were using incorrect dose and 13% cases dosage was unknown. Conclusions: Wrong spray technique is extremely common and can be easily corrected. Patient compliance can also be improved further. This survey emphasizes the importance of giving written and verbal instructions about the use of spray to the patients. We recommend following the written instructions for the use of steroid nasal spray from "British Society for Allergy and Clinical Immunology" or/and video tutorial from "asthma.org.ukhow to use nasal spray" Key Points:• Only 1 patient out of 99, used steroid nasal spray with a completely correct spray technique.• Nasal spray technique was taught only to 40% of the patients • 70% of the patients reported regular use of the steroid nose spray and 53% of patients were found to use correct spray dosage. • Wrong spray technique and non-compliance can be the reason behind the treatment failure with steroid nasal spray. • We recommend following "British Society for Allergy and Clinical Immunology-how to apply a nasal spray" and/or video instruction from "asthma.org.uk-how to use nasal spray" for the correct spray technique.

We report an unusual case of vocal cord palsy secondary which developed following insertion of a central line. A 46-year-old gentleman was admitted with seizure activity and reduced GCS. Following failed attempts at establishing intravenous or intraosseous access, a central line was placed into the right internal jugular vein. After extubation, the patient was found to have a right vocal cord palsy. Contemporaneous computed tomography (CT) imaging of the neck and thorax was performed to determine the cause of the palsy. Although this CT was clear, review of the original trauma CT showed a haematoma within the right carotid sheath. This led to a diagnosis of neuropraxia secondary to haematoma from central venous catheterisation. The patient went on to make a full recovery. We discuss our case with review of previous literature and discussion of management in such situations.

Objectives; To investigate spray technique and compliance among patients using steroid nasal spray. Design: Patient-reported survey Setting; Single centre study-a tertiary care hospital Participants: 100 participants (1 excluded) Main outcome measures 1) Nasal spray technique 2) Patient compliance Results: Out of 99 participants included in this study only one patient used steroid nose spray with a completely correct spray technique. Only 40% of patients received guidance instructions from the prescriber about the spray technique. 70% of patients reported using their spray regularly while 14% and 16% reported using mostly and sometimes respectively. 53% of patients were found using the correct dosage of the spray while 34% of patients were using incorrect dose and 13% cases dosage was unknown. Conclusions: Wrong spray technique is extremely common and can be easily corrected. Patient compliance can also be improved further. This survey emphasizes the importance of giving written and verbal instructions about the use of spray to the patients. We recommend following the written instructions for the use of steroid nasal spray from "British Society for Allergy and Clinical Immunology" or/and video tutorial from "asthma.org.ukhow to use nasal spray"