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NEWS


Pupil size forecasts longevity in heart failure patients


Pupil size predicts death and hospital readmission in patients with heart failure, according to research published in ESC Heart Failure, a journal of the European Society of Cardiology (ESC).


Around 26 million people worldwide currently live with heart failure. It is a life- threatening condition in which the heart is unable to pump enough blood to meet the body’s needs. Symptoms include shortness of breath, swollen limbs and fatigue. Up to 45% of patients admitted to hospital with heart failure die within one year of admission and the majority die within five years of admission. One of the causes of worsening


heart failure is disturbed function of the body’s autonomic system, which controls heart rate, digestion, respiration, and so on. Autonomic function is typically evaluated by measuring changes in heart rate. However, this method is ineffective in patients with a heart rhythm disorder called atrial fibrillation, which is common in those with heart failure. Pupil area is another way to assess autonomic function and has been used in patients with Parkinson’s disease and diabetes. This study examined whether pupil area could predict prognosis in patients with heart failure. After adjusting for other factors that could affect prognosis, patients with a small pupil area had an 28% lower risk of all-cause mortality and an 18% reduced risk of readmission due to heart failure compared to patients with a large pupil area. Large pupil area was consistently linked with favourable survival regardless of age, sex, and the presence of either normal heart rhythm or atrial fibrillation. “Our results suggest that pupil area is a novel way to identify heart patients at elevated risk of death or hospital readmission,” said study author Dr. Kohei Nozaki of Kitasato University Hospital, Kanagawa, Japan. “This provides an opportunity to intervene and improve outlook.”


Device could increase COVID-19 exposure


A new study shows that aerosol boxes that have been manufactured and used in hospitals in the UK and around the world in order to protect healthcare workers from COVID-19 can actually increase exposure to airborne particles that carry the virus, and thus casts doubt on their usefulness. The authors – who include Drs Peter


Chan, Joanna Simpson and colleagues, Intensive Care and Anaesthesia Specialists at Eastern Health, Melbourne, VIC, Australia – commented that “the consequences of promotion of such untested devices include either a false sense of security using these devices, or paradoxical increase in healthcare workers exposure to COVID-19”. Aerosol boxes have been promoted by multiple worldwide news organisations as not only a quick and simple solution to protecting frontline workers but also an example of private industries stepping up production to support frontline healthcare workers. However, these devices were produced outside the normal regulatory framework and, thus, were never clinically


tested or validated for effectiveness and safety. In this new study, Drs Chan and Simpson and colleagues partnered with Ascent Vision Technologies, a Melbourne- based engineering company, to test the effectiveness of varying methods of aerosol containment, including the so-called aerosol box, which various private companies have offered their services to manufacture. Compared with no device use, the aerosol box surprisingly showed an increase in airborne particle exposure – often by a factor of five times or more. Dr. Chan commented: “If this box was sold as a product, and therefore regulated, it would likely need to be immediately recalled due to a potential infection risk to the healthcare worker. Unfortunately, because these devices have been donated and are not regulated in any way, healthcare workers might be continuing to increase their exposure to COVID-19 while thinking they are protecting themselves.” The study was published in Anaesthesia (journal of the Association of Anaesthetists).


10 l WWW.CLINICALSERVICESJOURNAL.COM


Financial boost to prepare A&E


facilities for Winter


Trusts across the UK have been promised a share of £300m to upgrade their facilities ahead of winter. Hospitals could use the new funding to expand waiting areas and increase the number of treatment cubicles, helping them boost A&E capacity by providing additional space, reducing overcrowding and improving infection control measures. They could also increase the provision of same day emergency care and improve patient flow in the hospital to help the NHS respond to winter pressures and the risk from further outbreaks of coronavirus. Projects will be completed by the start of next year, so hospitals benefit during the peak of winter.


Cases of rare tick-borne infection reported by PHE


The diagnosis of a case of babesiosis and a probable case of tick-borne encephalitis (TBE) has recently been confirmed. This is the first record of a UK-acquired case of babesiosis and the second case of TBE being acquired in the UK.


Babesiosis is caused by a parasite which infects red blood cells while TBE is a viral infection that affects the central nervous system. Both are rare infections spread by the bite from an infected tick. Both patients have been transferred to hospital, where they are receiving appropriate treatment and supportive care. Dr Katherine Russell, a consultant in emerging infections and zoonoses, said: “It is important to emphasise that cases of babesiosis and TBE in England are rare and the risk of being infected remains very low. Lyme disease remains the most common tick-borne infection in England.”


SEPTEMBER 2020


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