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Since the COVID-19 pandemic started, there have been changes in clinical practice to limit transmission, such as switching from face-to-face to remote consultations. We aimed to study the influence of technical factors on remote consultations in our experience during the pandemic. 12 clinicians completed data collection forms after consultations, recording the technology used (video vs phone); technical problems encountered; discharge or subsequent appointment status; and technical aspects of the consultation process using 0–10 numerical rating scales (NRS) (Time Adequate; Relevant History; Physical Exam; Management Plan; and Communication Quality). Data were collated on an MS Access 2016 database and transferred to SPSS version 25 for statistics. Of 285 forms valid for analysis, 48 (16.8%) had video consultations. Of 259 forms with technical problems data recorded, 48 (18.5%) had a technical problem. Video patients were significantly younger (mean 49.3 vs 61.3 years, p < 0.001), had higher scores on Physical Exam scale (mean 4.0 vs 2.6, p < 0.001), but had no significant difference on Management Plan scale (7.3 vs 7.2). Those with technical problems were more common among video consultations (33.3% vs 15.4%, p = 0.005), had lower scores on Time Adequate scale (7.7 vs 8.7, p < 0.001) and Communication Quality scale (7.1 vs 8.4, p < 0.001), but had no significant difference on Management Plan scale (7.3 vs 7.2). The strongest correlation of Management Plan scale was with Communication Quality scale (Rho = 0.64). Of the NRS, a 1-point reduction in scores on Management Plan scale was the strongest predictor of subsequent face-to-face appointment (Odds Ratio 1.88, 95% CI 1.58–2.24), and this remained an independent predictor in multivariate analysis (adjusted OR 1.90, 1.57–2.31). Having a technical problem was inversely associated with the outcome of a subsequent face-to-face appointment (OR 0.17, 0.04–0.74), and this remained significant after adjustment for Management Plan in multivariate analysis (adjusted OR 0.09, 0.12–0.54). Video patients were younger suggesting a preference for video amongst younger patients. Although technical problems were more common with video, having a video consultation or a technical problem had no significant impact on management plan. Scoring lower on the Management Plan scale was the strongest predictor of, and independently associated with, requesting a subsequent face-to-face appointment. The inverse relationship of technical problems with subsequent face-to-face appointment request will need validation in further studies. [ABSTRACT FROM AUTHOR]

Objectives. Digital ischaemia, often progressing beyond RP to digital ulceration and sometimes even gangrene, is the most common vascular manifestation of SSc. Both microvascular and macrovascular disease can contribute and coexistence of microvascular and macrovascular (proximal vessel) disease in patients with SSc is potentially limb threatening. The aims of this study were to examine the change over time in the ankle brachial pressure index (ABPI) in a cohort of patients with SSc and to examine whether age, gender, smoking status, disease duration, disease subtype and ACA are associated with ABPI.Methods. The clinical and laboratory data of 217 patients attending the SSc clinic at a tertiary referral centre and who had their ABPIs checked between 1996 and 2011 were reviewed retrospectively. Data were analysed to see how the ABPI changed with time and linear mixed effects modelling was used to determine which factors were associated with ABPI.Results. In most patients with SSc, the ABPI remained constant over time [median rate of change 0 units/year, interquartile range (IQR) −0.01–0.01]. There was a significant association between lower ABPI and increasing age (P = 0.04), the limited cutaneous subtype of SSc (P = 0.01) and ACA positivity (P = 0.03). Additionally there was an association between ABPI and smoking status of borderline statistical significance (P = 0.08).Conclusion. This study provides further evidence for associations between the severity of vascular disease in patients with SSc and increasing age, smoking, limited cutaneous disease and positive ACA. Reassuringly, in most patients ABPI remains stable over time. [ABSTRACT FROM PUBLISHER]

The article describes the case of 43-year-old female patient with relapsing and refractory catastrophic anti-phospholipid syndrome (CAPS) which was treated successfully with eculizimab, a humanized monoclonal anti-body against complement C5. Topics covered include the patient's medical history, deterioration of renal function, profound thrombocytopaenia, microthrombi, meningococcal vaccination, antibiotic prophylaxis, improvement of platelet count, and efficacy of eculizumab.

The article describes the case of a female patient who was diagnosed with Lofgren's syndrome and whose high-resolution CT confirmed bilateral hilar lymphadenopathy and demonstrated the galaxy sign typical of alveolar sarcoidosis. Topics discussed include medical history of the patient, and brief information on alveolar sarcoidosis.

The article describes the case of a 64 year old presented with his left arm giving way while trying to trim the branches of the Christmas tree with manual shears where a PET CT confirmed stage 4 of diffused large B cell lymphoma.

A letter to the editor is presented concerning how adverse weather influences osteoporotic fractures in older people.

The article focuses on depression in old age. The author tells about his 78-year-old patient who was suffering from depression and has many illnesses. He states his observation that by spending some time with these patients will make one see their friendly and grateful disposition in life. Therefore, he urges junior physicians to try and spend some time with these kinds of patient whenever they have the time.

The article discusses the case of a 44 year old male presented with abdominal pain, low back pain and weight loss with a genetically proven diagnosis of Marfan's syndrome since age 8. A duodenal biopsy showed a focal increase in intraepithelial lymphocytes with focal epithelial cell disarray suggesting non-specific chronic inflammation. His therapy included oral prednisolone 40 mg daily and methotrexate that was later switched to mycophenolate 1 g twice daily due to intolerance.