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A 9-year-old boy admitted to a district general hospital with a 1-week history of fever and a 2-day history of right hip pain. Initial workup revealed raised inflammatory markers and unremarkable imaging studies. After clinical review, there was minimal improvement of the patient's condition 5 days after presentation; therefore, an MRI of the pelvis/hips was carried out, which supported a clinical diagnosis of right-sided infective sacroiliitis. Infective sacroiliitis is rare and only represents 1%-2% of septic arthritis in children. The condition still remains a diagnostic challenge first due to poor localisation of symptoms with referred pain to the hip, thigh and lower back and second due to a lack of awareness by non-specialist clinicians. Early diagnosis is a key to avoid sequelae such as an abscess, degenerative changes of the sacroiliac joint and can be achieved by a thorough clinical examination, monitoring inflammatory markers and MRI.

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Hand and foot eczema is a common chronic, distressing skin condition with varying etiology. A patch test can be useful to confirm the presence of allergy and to identify the actual allergen. This study aimed to identify the common allergens causing hand and foot eczema with the help of patch testing. A total of 82 cases with hand and/or foot eczema underwent patch test using Indian Standard Series. Overall, the rate of positive patch test reactions reported in hand and foot eczema was 47.6%. Potassium bichromate was the common allergens in males and Nickel sulphate was the commonest allergen in females. The commonest presentation was chronic eczema in 51.22% and morphologically unspecified eczema (40.24%) followed by hyperkeratotic eczema was the most common. The rate of positive patch test reactions encountered was high. We suggest that patch test should be used to improve therapeutic outcome in hand and feet eczema.

Aim NICE guidelines currently recommend offering patients presenting with acute cholecystitis a laparoscopic cholecystectomy within 1 week of diagnosis. We compared peri-operative outcomes for patients undergoing emergency laparoscopic cholecystectomy with a BMI of <30 kg/m2 (Group 1) and ≥30 kg/m2 (Group 2). Methods A retrospective review of patients undergoing an emergency laparoscopic cholecystectomy at a District General Hospital between January 2018 and November 2020. Results 159 patients were included. Group 1 had 97 patients (BMI range 18.8–29.9 kg/m2, age range 27–82 years, 56 females: 41 males). Group 2 had 62 patients (BMI range 30–56.3 kg/m2, age range 19–88 years, 38 females: 24 males). ASA breakdown was 1(25.8%), 2(64.9%) and 3(9.3%) for Group 1 and 2(71%) and 3(29%) for Group 2. Indications for surgery included biliary colic, acute cholecystitis and gallstone pancreatitis. Operating surgeons had training in both Upper GI and Bariatric surgery. There were no significant differences between Group 1 and Group 2 for anaesthetic time (minutes, 32.74 vs 32.50 p=0.91), operative time (minutes, 95.82 vs 93.67 p=0.75), total length of stay (days, 6.15 vs 5.17 p=0.30) or readmission rate within 30 days (22.68% vs 19.35% p=0.62). 4 patients in each group had acute complications during the index admission. Conclusion Emergency laparoscopic cholecystectomy for patients with a BMI ≥30 kg/m2 has similar peri-operative outcomes when compared to patients with a BMI <30 kg/ m2 and is safe to be performed in a District General Hospital by operating surgeons with an interest in Upper GI and Bariatric surgery.