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HMG Co-A reductase inhibitors (statins) are a group of drugs which lower cholesterol by inhibiting the conversion of HMG Co-A to mevalonate early in the cholesterol synthetic pathway. They are used in the primary and secondary prevention of cardiovascular events in patients deemed to be at increased risk and their benefit in patients with ischaemic heart disease is well supported. Their use in patients with heart failure (HF) however, is controversial. Evidence from observational and mechanistic studies suggests that statins should benefit patients with HF. However, larger randomised controlled trials have failed to demonstrate these expected benefits. The aim of this review article is to summarise the data from trials of statin use in patients with HF and attempt to explain the apparent conflict between recent placebo controlled trials and earlier observational and mechanistic studies.

Cardiac magnetic resonance (CMR) is used in the diagnosis and risk stratification of hypertrophic cardiomyopathy (HCM) and can detect myocardial replacement fibrosis (anindependent predictor of adverse cardiac outcomes) using late gadolinium enhancement (LGE). We retrospectively analysed CMR studies carried out over a 2 year period identifying those which were diagnostic of HCM. 117 cases were analysed. Mean age of subjects was 53 years and 78 (67%) were male. Mean ejection fraction (EF) was 68.3% with a mean left ventricular (LV) mass index of 89.4 g/m². Hypertrophy was predominantly asymmetric in 94 (80%). All subjects received gadolinium and 80 (68%) had evidence of LGE. LVEF was lower (67 vs. 71%; p = 0.015) and LV mass index higher (94 vs. 81 g/m²; p = 0.007) in the LGE group. The proportion of patients with at least 1 clinical risk factor for sudden cardiac death (SCD) was similar in groups with and without LGE (48% vs. 32%; p = 0.160). In this study, a significant proportion (62%) of patients without clinical risk factors for SCD were found to have LGE on CMR. These patients would not currently be considered for therapy with an implantable cardiac defibrillator. 1. Patients with HCM are at increased risk of SCD, but identifying patients who may benefit from implantable defibrillators is difficult. 2. LGE is associated with adverse cardiovascular outcomes in HCM, but is present in a large proportion of patients. 3. Many patients without clinical risk factors for SCD have LGE and would not currently be considered for an implantable cardiac device.

We report a case of myocarditis complicating gastroenteritis caused by Campylobacter jejuni. The patient had an uncomplicated course and made a full recovery. Cardiac MRI was useful in securing an early diagnosis and establishing baseline heart function. Myocarditis should be considered in younger patients presenting with chest pain and elevations in serum troponin. The occurrence of myocarditis complicating Campylobacter jejuni gastroenteritis is reviewed.

Modern external beam radiation therapy (EBRT) techniques rely on the accurate positioning of the patient using the treatment couch. These motorized couches have weight limits that have decreased over time and are not able to support severely obese patients requiring EBRT. We aimed to develop a technique to support obese patients who are above their weight tolerance while accurately delivering radiation treatment to a brain tumor. This technique was used on a patient receiving adjuvant radiation for gliosarcoma, a variant of glioblastoma. The patient was CT scanned, and the 3D conformal radiation therapy plan was created. A custom treatment couch was created using a transport stretcher, Styrofoam, a CT couch-top, and an IMRT board, which allowed for a thermoplastic mask to be used for a reproducible setup. AP and lateral portal films were taken prior to each treatment to confirm the accuracy of the manual daily setup of the patient on the custom couch. The patient received 60 Gy in 30 daily fractions of 3DCRT in a reproducible fashion. The average deviation from the isocenter fell within the 10 mm and 8 mm planning margins applied to the clinical target volume (CTV) for the initial and boost fields, respectively. The average daily shifts in the anterior-posterior (AP) direction for the patient were 7.97 (-16.19 to 12.04) mm and 1.98 mm (-1.1 to 4.3) mm for the initial and boost treatments, respectively. The average daily shifts in the superior-inferior (SI) direction were 2.2 (-5.08 to 9.04) mm and 3.88 (-2.9 to 8.0) mm for the initial and boost treatments, respectively. This novel approach allowed treatment at 60 Gy for a gliosarcoma patient who had previously been denied treatment due to his weight. By utilizing readily available materials within the department, our team was able to create a reproducible setup technique to safely treat the patient.

We describe the case of a 72-year-old patient admitted to intensive care following abdominal surgery. Venous oxygen saturations from the right atrium and superior vena cava (SVC) showed large variation due to ongoing ischemia in the mesentric circulation. If trends in venous oxygen saturation are to be followed, serial samples must be taken from the same central venous catheter (CVC) port.

Modern radiation therapy has heavily evolved over the past decade: the introduction of technologies such as multi-leaf collimators (MLCs) and enhancement dynamic edges (EDWs) have allowed one to maximize dose to the target volume while minimizing dose to organs-at-risk. Along with these, new treatment techniques have also evolved in order to increase the efficiently of treatment planning. The introduction of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) have maximized the ability to create optimal treatment plans. Within the past few years, there has been a focus on studying the clinical impact of the treatment couch in treatment planning. With the heavy use of arc therapy, there are portions of the beam that will pass through the treatment couch on the posterior sides of the patient. It was originally thought that the couch did not have any significant dosimetric effects, due to the light density of the carbon fiber shell and interior foam that makes up the treatment couch. However, new studies have disproved this, and heavy research has gone into modeling the treatment couch in the treatment planning system in order to study the dosimetric impact. The goal of this research was to study this effect using the RayStation v.8A treatment planning system. For this study, a kVue Calypso 6D couch support by guard rails for an Edge linear accelerator, and a TrueBeam utilizing a Varian IGRT couch was analyzed. Both couch tops involve a carbon fiber shell that contains a low-density foam interiorly. A paper written by Alessandro Savini et al presents two methods to couch modeling: the use of CT scans and the use of geometric modeling. Since the modeling approach is both easier to implement and agrees closely to the use of CT scans, this method was used. The geometric models of the couches were made using the MIM_64 contouring software, and the appropriate densities of the materials were assigned in RayStation 8A. With the couch models in Raystation, treatment plans for the following sites were created using VMAT: brain, breast, lung, liver, and prostate. For each site, 5 patients were selected, and plans were created on both the Edge and TrueBeam linear accelerators. With these plans made on both machines, the quality assurance (QA) plans were generated in RayStation and compared with and without the treatment couch. These plans were measured using an ArcCheck, as well as using a special insert for an A16 micro ion chamber to compare the dose per fraction with and without the treatment couch model.

A 14-year-old boy was referred to the ophthalmology department with a 4-day history of rapid-onset right upper lid pain, swelling and erythema starting 9 hours after his first dose of COVID-19 mRNA vaccination (BNT162b2/Comirnaty, Pfizer-BioNTech). On examination, he had significant right upper lid ptosis, oedema and erythema, with associated limitation of right eye abduction and elevation. He was found to have acute dacryoadenitis with orbital inflammatory disease on clinical and laboratory investigations. He was given tapering oral prednisone and had full resolution of symptoms within 2 weeks. This is the first known case of orbital inflammation after COVID-19 mRNA vaccination. Given the temporal association between the patient’s vaccination and symptom onset, we believe it is likely that immunisation prompted the onset of disease.