NHS Highland is one of the fourteen regions of NHS Scotland. Geographically, it is the largest Health Board, covering an area of 32,500 km2 (12,500 sq mi) from Kintyre in the south-west to Caithness in the north-east, serving a population of 320,000 people. In 2016–17 it had an operating budget of £780 million.
Frailty is a state of diminished physiological reserve and heightened vulnerability to stressors. Strong observational evidence shows that frailty is common in critically ill patients and is associated with prolonged hospitalization, functional decline, and increased mortality. To address these challenges, an international, multidisciplinary group of experts in critical care, frailty, rehabilitation, outcomes, and research methodology convened to review current evidence, identify gaps, and outline a research agenda to improve the recognition, management, and outcomes of critically ill patients with frailty. The consensus was that further research is needed to identify frailty assessment tools suitable for widespread use, determine which patient populations should undergo screening, and evaluate whether frailty assessments improve clinical outcomes. Additional priorities include investigating the biological mechanisms of frailty and their interaction with critical illness, and understanding how these factors influence treatment response. The development and evaluation of frailty-informed interventions, spanning acute care through post-ICU and after hospital recovery, are essential to improving function and quality of life. Finally, there is a need to refine outcome measures and determine which outcomes matter most to older adults living with frailty. Advancing care for this population will require high-quality evidence on how frailty-informed care can support decision-making and improve outcomes.
Sitosterolaemia is an autosomal recessive disorder in which the intestinal absorption of sterol molecules is unregulated, leading to elevated cholesterol. Recognition avoids unnecessary investigation. A low plant sterol diet reduces symptoms, anaemia and cardiovascular risk. We identified a patient in an isolated Scottish island community by recognising the key haematological finding of macrothrombocytopenia and haemolytic anaemia (without raised cholesterol). Serum gas chromatography demonstrated significantly raised sitosterol levels. Sequencing revealed homozygosity for the most common ABCG8 pathogenic variant, c.1083G>A, p.Trp361Ter (W361X), confirming the diagnosis. Homozygosity for a rare variant suggested its enrichment in Scottish island populations. Interrogation of data from the Viking Genes Project cohort confirmed a significant increase in variant heterozygosity in those with four Scottish island grandparents compared to the general UK population. We propose that sitosterolaemia is under-recognised. It should be considered in patients with macrothrombocytopenia and haemolytic anaemia, especially in those of Scottish island ancestry.
Bronchoscopic guidance is commonly used during percutaneous dilational tracheostomy (PCT) despite limited and conflicting evidence; this study aimed to evaluate whether bronchoscopy improves the safety of PCT in mechanically ventilated patients. This prospective, randomized controlled study compared two approaches of percutaneous tracheostomy; with and without bronchoscopy assistance. The primary outcome measured was a composite of procedure-related complications at 24 hours, classified as minor (e.g., bleeding, desaturation) or major (e.g., airway loss, tracheal rupture, severe pneumothorax). Secondary outcomes included procedure duration, 30-day mortality, and hospital length of stay. PCT performed with or without bronchoscopic guidance. 307 adults requiring PCT between 2016 and 2024 were randomized to PCT with bronchoscopy (n=154) or without (n=153). Minor complications, particularly intra - procedural hypertension, were more frequent in the bronchoscopy group versus the non bronchoscopy (37.6
Unsafe abortion, though preventable, contributes significantly to maternal morbidity and mortality, especially in countries with restrictive abortion laws. Post-abortal tetanus is a rare but life-threatening complication associated with high mortality. An 18-year-old single P0+1 Senior Secondary School (SSS) 2 student with eight weeks history of amenorrhoea who presented with complaints of generalised spasms, difficulty with speech and a fever of three days duration. This followed an unsafe surgical termination of pregnancy at a patent medicine shop a month before presentation. Her immunisation status was unknown. Examination revealed trismus and generalised muscle rigidity with opisthotonus. Laboratory findings showed leukocytosis (20,000cells/mm3) and mild anaemia (PCV 30%). A clinical diagnosis of septic abortion complicated by generalised tetanus was made. A multidisciplinary team was instituted to care for the patient; she received intravenous fluids, parenteral antibiotics, tetanus toxoid, human tetanus immunoglobulin, analgesics, diazepam infusion for spasm control, and other supportive care in a low-stimulation environment. Despite resuscitative efforts, the patient deteriorated rapidly and died within three hours of admission. Various complications, including tetanus infection, can arise following an unsafe abortion, leading to an increase in our already high maternal mortality rates. Ensuring access to contraception, providing post-abortion care services, promoting adolescent health-friendly services, promoting women's rights, health and status and expanding the legal conditions for abortion will help to curtail this menace.
Abstract Aims To evaluate risk of colonic polyps in patients with high BMI in highlands. Background The modifiable lifestyle factors such as obesity increased the risk of colon cancer. Association of High BMI with colonic polyps is not very conclusive and been investigated in the past with mixed results. We retrospectively analysed patients diagnosed with colonic polyps to see any strong relationship with High BMI. Methods We studied 334 patients who were diagnosed with polyps on colonoscopy at our Hospital in NHS Highland. Eligible subjects were 30-83 years old and were free of invasive cancer, hyperplastic polyps and familial polyposis. For this study the focus was association of polyps in patients with high BMI but other Risk factors also examined such as smoking (never, past, and current/pack years), as well as age, sex, alcohol, and family history of colorectal cancer (CRC). BMI was calculated using NHS online app. Results Retrospective analysis of 334 patients with diagnosis of colonic polyps. Majority were males (181) and 153 females. Most of the patient with polyps had high BMI with a median of 28.4, range 34.5 (17.7-52.2), IQR 7.35. The Age was median of 65, range 53 (30-83), IQR 15. Most of patients with polyps were of high BMI. Conclusions We conclude that high BMI is a risk factor for the development of colonic polyps as mentioned in other studies. The number of patients included are small but it is important that we recognize obesity as a risk factor to augment our screening strategies.
