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Time is brain when it comes to door-to-needle times for acute ischaemic stroke, right? A retrospective study of 61 426 people aged over 65 treated with intravenous tissue plasminogen activator shows that long delays before therapy are significantly associated with higher all-cause mortality at a year and higher likelihood of all-cause readmission at a year. With every increase in 15 min, the hazard-ratio increases by 1.02. In this study, 5.6% were treated within half an hour and 37.5% after 75 min. The authors conclude that therapy within 45 min is optimum.

JAMA. 2020;323(21):2170–2184.


Providing career advice used to be simple, it was like being a Vice President. You had to bide your time and hope for the good fortune for someone to die in office. Nowadays, there is an industry preparing people for Consultant posts and their advice starts with ‘knowing one’s self’. Once you have performed the modern tea-leaf reading which is Myers-Briggs, deciphered your star sign and personality blood-type, where next? 251 residents from a Carolina Medical Center were asked their theoretical Hogwarts House. You will remember that Gryffindors are brave, Slytherins are conniving, Ravenclaws are brainy and Hufflepuffs have none of these talents but work hard. What did they find? Surgeons were more likely to be Slytherins, orthopaedics particularly so. Paediatrics was the home of the Hufflepuffs, Obs & Gynae welcomed Ravenclaws and not one general practitioner self-identified as a Slytherin.

J Surg Educ. 2020;S1931-7204(20)30004-0.

In a post-pandemic world, we have become aficionados of Zoom-quizzes and also been asked to look out for each other’s mental health. What better time therefore to ask yourself—is that a Tolkien character or an antidepressant?


The ABN’s case competition is a fine place to cut your teeth and test your mettle. Cases should be rare, treatable and have a twist. Buckle up, we have a doozie from the archives of NEJM. A microbiology technician was driving her 3-year-old boy to a local shop, after her rounds of collecting Agar plates from physicians’ offices. As she popped into the store, he climbed out of his seat, into the back seat and found a series of packaged treats; culture dishes containing ‘chocolate’ Agar. The case does not report the look on her face, or what she said when she discovered that her little boy had not only devoured these precious medical samples but also a sprinkling of Neisseria gonorrhoeae that was growing on the plate. Immediate help was sought, and he tested negative on swabs taken at 1, 4 and 6 days, but positive on day eight. Probenecid ice cream and penicillin G brought about a prompt cure. In a world where driving to Barnard Castle is an acceptable substitute for an ophthalmic examination, it is worth remembering that sometimes truth is stranger than fiction.

N Engl J Med. 1984;311(7):470


  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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