Medical Students' Perspectives Regarding the Use of a Slit-Lamp Smartphone Adapter for Clinical Slit-Lamp Photography

Background This study aimed to investigate medical students' perspectives regarding the ease and utility of smartphone slit-lamp photography. Methodology In this prospective experimental study, fourth and fifth-year medical students who were in or had finished ophthalmology rotation were included to attempt slit-lamp smartphone anterior segment photography on adult patients after a brief hands-on instruction course. Each medical student attempted to record five supervised slit-lamp videos of the anterior segment of five patients using the described adapter and their own smartphone. The time taken until photography was calculated for each attempt. After the fifth attempt, each medical student rated the ease of the use of this method of slit-lamp photography as well as their perspective regarding its utility as a potential means of medical education and telemedical consultations on a five-point Likert scale. Results A total of 33 medical students participated, with each successfully recording five slit-lamp examinations using their smartphones. The time used for the application of the adapter until the image capture ranged from 6 to 278 seconds (average = 39.51 ± 34.7 seconds) and markedly improved by the fifth attempt (30.5 ± 25.7 seconds) compared to the first attempt (67.3 ± 49.3 seconds). Learning this skill was perceived to be relatively easy (2.2 ± 1), with high potential in clinical education (4.6 ± 0.75) and teleconsultations (4.7 ± 0.65). Conclusions Smartphone slit-lamp photography is a relatively easy process. It can be quickly acquired by medical students and has the potential to enhance their medical education and telemedical consultation capabilities.

Transaminase levels reflect disease severity in children ventilated for respiratory syncytial virus (RSV) bronchiolitis

Bronchiolitis, often caused by respiratory syncytial virus (RSV), is the commonest cause of hospitalisation in infancy. Serum transaminases are sometimes raised in children with bronchiolitis. We tested the hypothesis that raised transaminases are associated with increased disease severity in children ventilated for bronchiolitis. Prospective observational cohort study of mechanically ventilated children with community-acquired RSV bronchiolitis. Alanine transaminase (ALT) and aspartate transaminase (AST) levels were measured daily. Children with normal transaminases were compared with those with elevated levels. Over 11 consecutive winters, 556 children with RSV bronchiolitis were mechanically ventilated – 226 had comorbidities and therefore excluded; 313 of remaining 330 were under 2 years age; 305 had early transaminase measurements. 57/305 (19%) had elevated transaminase (AST and/or ALT) levels. For the first time we show that duration of ventilation and length of admission were both significantly longer, and paediatric index of mortality and C-reactive protein higher, in those with elevated AST levels on admission (but not those with elevated ALT levels). Furthermore, transaminase elevations were transient, generally having normalised by seven days following admission. RSV bronchiolitis was more severe in children with early elevated AST levels and could be used early in the illness as a predictor for disease severity.