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Background Epidemiological studies suggest that black, Asian and minority ethnic (BAME) patients may be at risk of worse outcomes from Coronavirus-19 (COVID-19) but the pathophysiological drivers for this association are unknown. This study sought to investigate the relationship between findings on echocardiography, mortality and race in COVID-19 pneumonia. Methods This was a multicenter, retrospective, observational study including 164 adults (61±13years; 78% male; 36% BAME) hospitalized with COVID-19 undergoing echocardiography between March 16 and May 9, 2020 at 3 days (IQR 2 – 5) from admission. The primary outcome was all-cause mortality. Results After a median follow up of 31 days (IQR 14 – 42 days), 58 (35%) patients had died. The right ventricle (RV) was dilated in 62 (38%) patients, and 58 (35%) patients had RV systolic dysfunction. Only 2 (1%) patients had left ventricular (LV) dilatation and 133 (81%) had normal or hyperdynamic LV systolic function. Reduced tricuspid annulus planar systolic excursion was associated with elevated D-dimer (ρ = −0.18, p = 0.025) and high-sensitivity cardiac Troponin (ρ = −0.30, p < 0.0001). Reduced RV systolic function (HR, 1.80; 95% CI, 1.05 – 3.09; p = 0.032) was an independent predictor of all-cause mortality after adjustment for demographic and clinical risk factors. Comparing white and BAME individuals, there were no differences in echocardiography findings, biomarkers or mortality. Conclusions In patients hospitalized with COVID-19 pneumonia, reduced RV systolic function is prevalent and associated with all-cause mortality. There is however, no racial variation in the early findings on echocardiography, biomarkers or mortality., This is the first study to assess the influence of race on echocardiographic findings in patients hospitalized with COVID-19 disease. In high-risk patients hospitalized with advanced COVID-19 disease, right ventricular (RV) dilatation and dysfunction are common; RV dysfunction (measured using the simple standard measures FAC and TAPSE) is independently associated with early mortality, and is associated with elevated D-dimer and high-sensitivity cardiac Troponin. There are, however, no racial differences in echocardiographic findings, biomarkers, or mortality.

Objective To assess the diagnostic performance of CT fractional flow reserve (CT-FFR) and to assess whether its use in addition to CT coronary angiography (CTCA) changed the investigation and management of patients with suspected coronary artery disease (CAD). Method A retrospective case note review was carried out for 200 consecutive patients at Russells Hall Hospital, Dudley, United Kingdom, who had CTCA sent for Heartflow CT-FFR analysis (HeartFlow, Redwood City, CA) between January 2018 and December 2019. Results Patients with CT-FFR > 0.8 were significantly less likely to require further investigation with coronary angiography (p: < 0.00001) than those with CT-FFR < 0.8. The use of CT-FFR significantly reduced need for further functional imaging (6% vs 26%) (p: 0.00012). A total of 15 patients in this study had both a CT-FFR and an invasive FFR measured, with seven (46.66%) of the CT-FFRs correlating with the invasive FFR. Approximately 54% of patients who had a CT-FFR < 0.8 were found to have an invasive FFR of >0.8. Of the 56 patients who underwent coronary angiography, the CT Coronary Artery Disease-Reporting and Data System (CAD-RADS) and angiography CAD-RADS were the same in 66% of the cases with 82% of CT CAD-RADS results being within ±1 of the angiography CAD-RADS. Conclusion The use of CT-FFR alongside CTCA led to a significant reduction in need for coronary angiography and functional testing. Further studies are required to look at the diagnostic accuracy of CT-FFR in direct comparison with invasive FFR.

In 2016 an outbreak of Cryptosporidium potentially linked to swimming pools occurred in the West Midlands region in England. This highlighted the importance of prompt identification of Cryptosporidium by primary care and notification to Public Health England (PHE) to assist with patient management and outbreak control. This article outlines the epidemiology and processes to be followed should suspected Cryptosporidium cases present to primary care. Infection with the protozoan parasite Cryptosporidium results from ingestion of oocysts from faecally-contaminated water or food, direct person-to-person contact, or zoonotic spread. The incubation period (the time between exposure to Cryptosporidium and development of symptoms) varies but is on average between 5–7 days.1,2 Infection usually results in an acute illness lasting up to 3 weeks in otherwise healthy people, although asymptomatic infections are common and can be a source of infection for others.2 The symptoms are characterised by an abrupt onset of profuse watery diarrhoea with mucus (rarely blood) and abdominal cramping that may be associated with nausea, anorexia, and possibly fever. Although the infection is self-limiting in most patients, in the very young, older people, and in immunosuppressed individuals it can be a debilitating illness. Cryptosporidium occurs worldwide and is the fourth most common cause of gastrointestinal …