Congenital junctional ectopic tachycardia in the paediatric emergency department

Congenital junctional ectopic tachycardia is a rare but serious cardiac arrhythmia seen in neonates and young infants. It is frequently resistant and refractory to first-line treatment options such as cardioversion with adenosine and direct current shock, and it carries a high morbidity and mortality rate. The aim of this article is to present the case of congenital junctional ectopic tachycardia observed in a 14-day-old neonate, highlighting the role of ivabradine in the management, followed by a discussion about current approaches to treatment.

Updates on sphingolipids: Spotlight on retinopathy

The sphingolipids ceramide (Cer), ceramide-1-phosphate (C1P), sphingosine (Sph), and sphingosine-1-phosphate (S1P)) are key signaling molecules that regulate many patho-biological processes. During the last decade, they have gained increasing attention since they may participate in important and numerous retinal processes, such as neuronal survival and death, proliferation and migration of neuronal and vascular cells, inflammation, and neovascularization. Cer for instance has emerged as a key mediator of inflammation and death of neuronal and retinal pigment epithelium cells in experimental models of retinopathies such as glaucoma, age-related macular degeneration (AMD), and retinitis pigmentosa. S1P may have opposite biological actions, preventing photoreceptor and ganglion cell degeneration but also promoting inflammation, fibrosis, and neovascularization in AMD, glaucoma, and pro-fibrotic disorders. Alterations in Cer, S1P, and ceramide 1- phosphate may also contribute to uveitis. Furthermore, use of inhibitors that either prevent Cer increase or modulate S1P signaling, such as Myriocin, desipramine, and Fingolimod (FTY720), have been shown to preserve neuronal viability and retinal function. Collectively, the expanding role for these sphingolipids in the modulation of vital processes in retina cell types and in their dysregulation in retinal degenerations makes them attractive therapeutic targets.

A comparison of characteristics and outcomes of patients with community-acquired and hospital-acquired COVID-19 in the United Kingdom: An observational study

BACKGROUND AND OBJECTIVES

Reports comparing the characteristics of patients and their clinical outcomes between community-acquired (CA) and hospital-acquired (HA) COVID-19 have not yet been reported in the literature. We aimed to characterise and compare clinical, biochemical and haematological features, in addition to clinical outcomes, between these patients.

METHODS

This multi-centre, retrospective, observational study enrolled 488 SARS-CoV-2 positive patients - 339 with CA infection and 149 with HA infection. All patients were admitted to a hospital within the University Hospitals of Morecambe Bay NHS Foundation Trust between March 7th and May 18th^, 2020.

RESULTS

The CA cohort comprised of a significantly younger population, median age 75 years, versus 80 years in the HA cohort (P = 0·0002). Significantly less patients in the HA group experienced fever (P = 0·03) and breathlessness (P < 0·0001). Furthermore, significantly more patients had anaemia and hypoalbuminaemia in the HA group, compared to the CA group (P < 0·0001 for both). Hypertension and a lower median BMI were also significantly more pronounced in the HA cohort (P = 0·03 and P = 0·0001, respectively). The mortality rate was not significantly different between the two cohorts (34% in the CA group and 32% in the HA group, P = 0·64). However, the CA group required significantly greater ICU care (10% versus 3% in the HA group, P = 0·009).

CONCLUSION

Hospital-acquired and community-acquired COVID-19 display similar rates of mortality despite significant differences in baseline characteristics of the respective patient populations. Delineation of community- and hospital-acquired COVID-19 in future studies on COVID-19 may allow for more accurate interpretation of results.

Student Perspectives on Ophthalmology Training in The Slovak Medical Education System: A Pilot Study

This article was migrated. The article was not marked as recommended. Introduction: Conditions of the eye and vision seen in ophthalmology constitute some of the largest disease burdens in the world. Evidence from other parts of the world indicate that exposure to ophthalmology in medical school can be lacking. We aimed to conduct a pilot study assessing students' exposure to, and confidence in treating, common ophthalmic conditions. We hoped to see how this compares to a global cohort and whether there are indications that the nature of ophthalmology teaching in Slovakia necessitates change. This will further inform the need to expand the study nationally to more accurately distinguish areas of improvement. Methods: A single-centre cross-sectional survey was conducted at Univerzita Pavla Jozefa Šafárika v Košiciach, Slovakia. A 24-item questionnaire was distributed to final year medical students via a web-based platform and was available to complete for a period of 1 week. Results: A total of 25 responses were collected from approximately 100 students (25% response rate). 7/25 (28%) respondents declared an interest in ophthalmology as a future career option, with males predominating [8% of females vs. 50% of males, OR = 0.09, CI = 0.009-0.0943, P=0.045]. 40% of individuals, however, reported a lack of adequate exposure to make an informed decision. Average hours of clinical placement and classroom teaching equated to 1.5 ± 0.6 weeks (mean ± SD) and 18 ± 13 hours, respectively. 13/25 (52%) students reported adequate teaching in direct ophthalmoscopy and slit lamp examination. 15/25 (60%) of respondents reported inadequate clinical exposure. 7/25 (28%) of participants reported having witnessed cataract surgery, whereas 14 (56%) reported having not seen any ophthalmic surgery. 9/25 (36%), 15/25 (60%), 7/25 (28%), 7/25 (28%) and 13/25 (52%) of students felt competent in managing cataract, conjunctivitis, glaucoma, diabetic eye disease and dry eye, respectively. Conclusions: From this pilot study we have identified that there is a relative lack of confidence in managing common eye conditions among this select cohort of students and this may stem from a lack of clinical exposure or classroom teaching hours. This warrants further evaluation with a larger, national cohort.