Good facts inform good ethics. It is therefore obligatory to look into the current research knowledge about xenotransplants (organs from one species to another, for example animal to human) in more detail. The advocates of xenotransplantation argue that it could provide organs “relatively quickly” and hence save more lives. If animal organs were easily available for transplantation most eligible recipients would receive the transplantation much earlier on in their illness. It is argued that this may decrease distress and suffering. Whilst xenotransplantation may theoretically increase the survival time, it is unclear, however, whether the negative impact on recipients’ quality of life due to long-term immunosuppressant therapy and the risk of zoonotic infections would in fact worsen the overall long-term outcome3. Recent research suggests that xenotransplantation may be associated with the transmission of pig microorganisms including viruses, bacteria, fungi, and parasites. Because of the recipient’s likely immunosuppressed state, infection and pathologic consequences may be more pronounced. Transmission of most microorganisms with the exception of the porcine endogenous retroviruses may be prevented by screening the donor pig and qualified pathogen- free breeding. However, porcine endogenous retroviruses represent a special risk as they are present in the genome of all pigs and infect human cells in vitro. Until now, no porcine endogenous retrovirus transmission was observed in experimental and clinical xenotransplantations as well as in numerous infection experiments4. Nevertheless, strategies need to be developed to prevent their transmission to humans.

Background: It is a compulsory requirement that a hospital produces a discharge summary. This is often the only documentation a GP receives in relation to a recent admission. Traditionally the discharge summary is hand-written and commonly known as the TTA (‘to take away’). Recently the EDS (electronic discharge summary) has been introduced. This audit provides a comparison of the TTA and EDS. Methods: A random sample of 50 TTAs and 50 EDSs were selected from one ward over a two-month period. Completion rates for criteria of the discharge summary were analysed. Results: The EDS is a superior form of discharge summary, significantly for documenting diagnosis, co-morbidities, investigations, drug history and instructions for the GP. Conclusions: Junior doctors should be more aware of the importance of the discharge summary; therefore, they should provide clear, complete and concise information. In order to ensure EDSs are completed correctly training on using the computer programme should be more thorough. Documenting co- morbidities has implications on clinical coding. Other healthcare professionals should contribute to the discharge summary

This case report discusses an interesting case of drug- induced autoimmune hepatitis following the long-term use of nitrofurantoin for recurrent urinary tract infections (UTIs). Recurrent UTIs are common and the evidence for long term antibiotics are discussed along with the difficulty in deciding whether drugs are implicated as the cause of deranged liver function tests.

Thyrotoxic periodic paralysis (TPP) is an alarming and potentially lethal complication of hyperthyroidism characterized by muscle paralysis and hypokalemia. It is often not recognized when first seen because of lack of familiarity with the disorder and partly due to the subtleness of thyrotoxicosis. Early diagnosis and treatment can prevent severe cardiopulmonary complications. We hereby report a male patient who was evaluated and diagnosed to have TPP.

Objective: Painful legs and moving toes (PLMT) is a syndrome consisting of pain in the lower legs with involuntary movements of the toes or feet. Its incidence and prevalence remain largely unknown since it is still a relatively rare disorder. We are reporting a case of PLMT along with the first review of literature on all previously reported cases and a discussion on its clinical management. Methods: A review of published literature on PLMT was done using MEDLINE and PubMed databases. Searches were conducted to find articles from 1971 – 2010. Medical subject headings used to search the databases included PLMT with subheadings of painful legs/moving toes, electromyography, polysomnography, as well as keyword search using “PLMT”. Single author reviewed titles and abstracts of potentially relevant articles. Results: We reviewed approximately 19 PLMT articles that have been published to date, with a total of 72 patients: 30.5% males and 69.5% females (median age 55 & 64 yrs, respectively). The most common predisposing conditions were neuropathy and radiculopathy. Numerous treatments including antiepileptics, benzodiazepines, antispasmodic agents, and antidepressants have been tried with little success. GABAergic agents such as gabapentin and pregabalin were the most effective in attenuating the pain and the movements, possibly via both central and peripheral mechanisms. Conclusion: Physicians should be aware of this rare debilitating condition. Though much progress has been made in elucidating its etiology, the exact mechanism still remains a mystery. It is important to consider PLMT in a patient with painful legs and/or restless leg syndrome without any significant history of neurological disease or trauma. Diagnosis is essentially clinical and treatment is complex, which includes different combinations of medications and invasive techniques that generally produce a poor outcome.