3 year old with chronic wet cough : Intralobar Bronchopulmonary sequestration

Bronchopulmonary sequestration (BPS) is a rare congenital foregut anomaly of the lung, consisting of nonfunctioning primitive tissue that does not communicate with the healthy tracheobronchial tree. The abnormal segment has its own anomalous systemic blood supply, and typically drains into the pulmonary venous system. It is frequently asymptomatic and may be discovered incidentally. Symptoms may vary, with patients presenting with vague symptoms related to chronic respiratory infection. Early diagnosis and intervention decreases morbidity and mortality. We present a case of intralobar pulmonary sequestration involving the right lower lobe in a male child.peer-reviewe

Cysts of the jaws

The clinical behaviour of cysts of the jaws has been under close scrutiny over the last few years as it has been found that there is in some types a distinct risk of recurrence. This recurrence may occur even after as long as 20 years, so that long term follow-up is essential. The clinical and histological features may be important clues in determining the prognosis and the risk of recurrence of the various jaw cysts. The data of jaw cysts seen at the Dental Department, St. Luke's Hospital, Malta during the decade 1960 – 1969 is collected in order to establish a base line for future comparative studies. There were 49 patients with cysts of the jaws and histological examination was made in 31 cases. The preponderance of periodontal cysts (30.6%) agrees with most large surveys reported, as does the percentage incidence (16.3%) of dentigerous cysts.peer-reviewe

Perfusion dyssynchrony analysis

AIMS: We sought to describe perfusion dyssynchrony analysis specifically to exploit the high temporal resolution of stress perfusion CMR. This novel approach detects differences in the temporal distribution of the wash-in of contrast agent across the left ventricular wall.METHODS AND RESULTS: Ninety-eight patients with suspected coronary artery disease (CAD) were retrospectively identified. All patients had undergone perfusion CMR at 3T and invasive angiography with fractional flow reserve (FFR) of lesions visually judged &gt;50% stenosis. Stress images were analysed using four different perfusion dyssynchrony indices: the variance and coefficient of variation of the time to maximum signal upslope (V-TTMU and C-TTMU) and the variance and coefficient of variation of the time to peak myocardial signal enhancement (V-TTP and C-TTP). Patients were classified according to the number of vessels with haemodynamically significant CAD indicated by FFR &lt;0.8. All indices of perfusion dyssynchrony were capable of identifying the presence of significant CAD. C-TTP &gt;10% identified CAD with sensitivity 0.889, specificity 0.857 (P &lt; 0.0001). All indices correlated with the number of diseased vessels. C-TTP &gt;12% identified multi-vessel disease with sensitivity 0.806, specificity 0.657 (P &lt; 0.0001). C-TTP was also the dyssynchrony index with the best inter- and intra-observer reproducibility. Perfusion dyssynchrony indices showed weak correlation with other invasive and non-invasive measurements of the severity of ischaemia, including FFR, visual ischaemic burden, and MPR.CONCLUSION: These findings suggest that perfusion dyssynchrony analysis is a robust novel approach to the analysis of first-pass perfusion and has the potential to add complementary information to aid assessment of CAD.</p

The first case of the Reveal LINQ™ Insertable Cardiac Monitor implanted in a child in Malta

Background: The Reveal LINQ™ Insertable Cardiac Monitor (ICM) or Implantable Loop recorder (ILR), is a miniaturized, subcutaneous, single lead, electrocardiographic monitoring device which has been extensively used in the differential diagnosis of unexplained syncope and palpitations in adults. Patient Description: We describe an asymptomatic 20-month-old boy, noted to have incidental bradycardia on routine examination and in whom Holter monitoring revealed complete heart block (CHB). Over 1 year, the longest recorded pause lengthened from 1.8 seconds to 3.6 seconds. Results: The Reveal LINQ™ ICM was inserted for long-term monitoring of the CHB. The device will record the electrocardiogram (ECG) continuously for up to 3 years, freezing in its memory any significant arrhythmic events. This will enable the diagnosis of the longest pauses, confirm whether they are lengthening over time and assist with the decision of pacemaker implantation. Conclusion: The Reveal LINQ™ ICM is much smaller than the conventional loop recorder and has been shown to be ideal for close monitoring of asymptomatic yet potentially dangerous arrhythmias in young children.peer-reviewe

Training, status and migration of general practitioners / family physicians within Europe

The survey intended to explore and identify the training background and status of general practitioners/ family physicians (GPs) in member countries within EURACT (European Academy of Teachers in General Practice/Family Medicine), and to gain an overview of processes involved when GP-trained doctors migrate to work in another member country. A questionnaire, with closed and open-ended questions, was sent to representatives of all 39 EURACT-member countries in 2009. The main outcome measures were the training background and status of GPs in public/private settings in each country and the requirements of additional training and testing when migrating to another country. Forty-one completed questionnaires were received from 31 (79%) of the EURACT countries. The data indicate that specialist training for General Practice/ Family Medicine (GP/FM) is well established throughout and generally required for appointment to public career posts. The data also indicate that European Uniontrained GPs can move freely to most countries with usually no tests of medical knowledge or language proficiency. Orientation to the healthcare system in the destination country is usually not provided. work in public/private GP/FM posts in many European countries, although new appointments to public posts RESEARCH ARTICLE Training, status and migration of General Practitioners/Family Physicians within Europe in nearly all countries require specialist GP training. It was not possible to identify a uniform or agreed approach applied by employing agencies to confirm the medical competence and language skills of migrant doctors and to provide them with orientation to healthcare systems. In the high-context dependent discipline of GP/FM this is of concern.peer-reviewe

Transforming growth factor-beta promotes rhinovirus replication in bronchial epithelial cells by suppressing the innate immune response

Rhinovirus (RV) infection is a major cause of asthma exacerbations which may be due to a deficient innate immune response in the bronchial epithelium. We hypothesized that the pleiotropic cytokine, TGF-?, influences interferon (IFN) production by primary bronchial epithelial cells (PBECs) following RV infection. Exogenous TGF-?(2) increased RV replication and decreased IFN protein secretion in response to RV or double-stranded RNA (dsRNA). Conversely, neutralizing TGF-? antibodies decreased RV replication and increased IFN expression in response to RV or dsRNA. Endogenous TGF-?(2) levels were higher in conditioned media of PBECs from asthmatic donors and the suppressive effect of anti-TGF-? on RV replication was significantly greater in these cells. Basal SMAD-2 activation was reduced when asthmatic PBECs were treated with anti-TGF-? and this was accompanied by suppression of SOCS-1 and SOCS-3 expression. Our results suggest that endogenous TGF-? contributes to a suppressed IFN response to RV infection possibly via SOCS-1 and SOCS-3

Back trauma resulting in commotio cordis

Commotio cordis (Latin: "agitation of the heart") is a dysrhythmia provoked by praecordial trauma during the early part of cardiac repolarisation. Recorded rhythms include ventricular tachycardia/fibrillation, bradyarrhythmias, idioventricular rhythm, complete heart block and asystole. The quoted fatality rate is 65% even with prompt CPR and defibrillation, and exceeds 80% in the absence of such interventions. Above a certain threshold of trauma/impact, structural cardiac damage may also occur (contusio cordis).peer-reviewe

Co-Management of COVID-19 and heart failure during the COVID-19 pandemic. lessons learned

The COVID pandemic has brought many new challenges worldwide, which has impacted on patients with chronic conditions. There is an increasing evidence base suggesting an interaction between chronic heart failure (HF) and COVID-19, and in turn the prognostic impact of co-existence of the two conditions. Patients with existing HF appear more prone to develop severe complications on contracting COVID-19, but the exact prevalence in patients with mild symptoms of COVID-19 not requiring hospital admission is poorly investigated. In addition, hospitalization rates for acute HF over the pandemic period appear reduced compared to previous periods. Several key issues remain rather unaddressed and, importantly, a specific algorithm focused on diagnostic differentiation between HF and acute respiratory distress syndrome, a severe complication of COVID-19, is still lacking. Furthermore, recent data suggests potential interaction existing between HF treatment and some anti-viral anti-inflammatory drugs prescribed during the infection, raising some doubts about a universal treatment strategy for all patients with COVID-19. With this manuscript, we aim to review the current literature in this field in light of growing understanding of COVID-19 in the setting of the HF population, its associated morbidity and mortality burden, and the impact on healthcare systems. We hope that this may stimulate a discussion to guarantee a better, more tailored delivery of care for patients with HF in the setting of concomitant COVID-19 infection