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Key Points Question What are the long-term ocular sequelae for young adults born extremely preterm (≤25 weeks’ gestation)? Findings In this cohort study conducted in the UK and Ireland with 19 years of follow-up comparing 128 former extremely preterm infants with 65 age-matched full-term controls, extreme prematurity was associated with an increased prevalence of visual and ocular deficits. These deficits varied with, but were not fully explained by, neonatal retinopathy of prematurity status. Meaning Extreme prematurity may have lifelong ocular implications that extend into adulthood; this study suggests that, for individuals born extremely preterm, ocular sequelae may be independent of the presence of neonatal retinopathy of prematurity and may be due to other causes., Importance Children born preterm (, This birth cohort study evaluates visual function and ocular morbidity in young adults born extremely preterm compared with controls born full term.

Miller Fisher syndrome is an acute demyelinating polyneuropathy classically presenting with ataxia, areflexia, and ophthalmoplegia. The authors report the case of a 27-year-old female, who presented with limb weakness and double vision following a prodromal pharyngitis. Ophthalmic examination revealed fluctuant ophthalmoplegia eventually consistent with bilateral sixth cranial nerve palsies, prompting investigation for anti-ganglioside antibodies, which returned positive. Due to disabling diplopia, the patient was treated with botulinum toxin, with a resulting favourable reduction in the size of strabismus. Four months following her presentation, the patient was orthophoric and resumed normal activities.

The substantial public health impact of hospitalization for acute decompensated heart failure, from an economic and clinical perspective, has generated substantial interest in understanding predictors of risk in this syndrome. Utilization of classification and regression tree (CART) analysis on the Acute Decompensated Heart Failure National Registry (ADHERE) dataset has provided important risk stratification from readily available clinical variables. Increasingly, high-risk patients were identified by combination of blood urea nitrotgen level of 43 mg/dL, serum creatinine level of 2.75 mg/dL, and systolic blood pressure less than 115 mm Hg, which were all independent predictors of high risk for in-hospital mortality. On the basis of these 3 variables, acutely decompensated heart failure patients can be readily stratified into groups at low, intermediate, and high risk for in-hospital mortality, with mortality risks ranging from 2.1% to 21.9%. Although risk stratification alone cannot improve outcomes, identification of patients at high and low risk may improve resource utilization and better focus the intensity of care according to outcome.

Several pivotal clinical trials have generated new knowledge regarding drug therapy for heart failure. Thus, the Heart Failure Society of America (HFSA) and the American College of Cardiology-American Heart Association (ACC-AHA) guidelines were updated in 2006 and 2005, respectively. We review the evidence from these trials and summarize the changes to the HFSA and ACC-AHA guidelines. Based on data from these studies, the new guidelines include broader, stronger recommendations for beta-blocker therapy, and strong recommendations for angiotensin II receptor blockers. The aldosterone antagonists, spironolactone and eplerenone, are also included in the guidelines. Pharmacists should have a basic level of familiarity with the new guidelines on heart failure and the evidence from recent clinical studies. They should be able to relate how this information contributes to the evolving understanding of treatment strategies for heart failure.