Recovering from COVID-19: lessons learnt from an intensive secondary care follow-up service.

In response to the first COVID-19 surge in 2020, secondary care outpatient services were rapidly reconfigured to provide specialist review for disease sequelae. At our institution, comprising hospitals across three sites in London, we initially implemented a COVID-19 follow-up pathway that was in line with expert opinion at the time but more intensive than initial clinical guidelines suggested. We retrospectively evaluated the resource requirements for this service, which supported 526 patients from April 2020 to October 2020.

Intestinal perforation due to miliary tuberculosis in a patient with myasthenia gravis.

A man in his early 70s presented to the emergency department with a fall, following a history of fatigue and malodorous urine. On presentation, he was feverish, tachycardic and confused and was treated for presumed urinary sepsis. A chest radiograph showed increased opacification in the left upper lobe with calcification.

Educational opportunities for postgraduate medical trainees during the COVID-19 pandemic: deriving value from old, new and emerging ways of learning.

The COVID-19 pandemic has had a significant impact on postgraduate medical training across all specialties. Although some traditional learning opportunities have been curtailed, there have been numerous examples of highly valuable educational experiences that have arisen during this time. Here, from a trainee perspective, we consider the educational merits of the re-emergence of 'firm-based' teams, new online learning opportunities, use of digital technologies and the rise of telephone clinics and new COVID-19 clinical services.

When to consider tuberculosis: bronchiectasis in the elderly population.

In England patients aged 65 years and over experience a delay of more than 4 months between onset of symptoms and diagnosis of pulmonary TB. This report examines three cases of patients experiencing significant delays in both diagnosis and treatment. Each case had a background of bronchiectasis.

Secondary syphilis presenting with acute unilateral vision loss and a widespread maculopapular rash.

Syphilis infection has shown a marked resurgence over the past several years. Ocular involvement is a rare complication of syphilis, occurring in approximately 1% of cases. We present the case of a man in his 50s who presented to hospital with acute unilateral vision loss and a widespread maculopapular rash.

Homeless healthcare: raising the standards.

Over the past 3 years the number of homeless people in the UK has increased by 34%. Most will die young, largely due to treatable conditions. Secondary care can, and must, do more for the silent killer that homelessness is.

The future hospital: a rewarding place to train and work? A perspective from the shop floor.

The provision of medical care for the next 40 years lies in the hands of the trainees of today. In order to deliver the care our patients deserve in the way in which they wish to receive it, this future workforce needs to be trained appropriately and to be supported and encouraged to develop into the doctors needed to fulfil this mission. This personal view authored by a trainee of today discusses some of the likely demands placed upon the physician of tomorrow, placed in the context of the Shape of Training report commissioned by the GMC, and the report of the Future Hospital Commission of the Royal College of Physicians, to which the author contributed.

The destructive combination of Scediosporium apiosperum lung disease and exuberant inflammation in cystic fibrosis.

This paper describes a patient whose decline over two years was precipitous, from an active independent life with lung function (FEV1) above 50% to requiring transplantation. The main pathogen on sputum culture throughout that period was Scediosporium apiosperum. The epidemiology pathogenicity and treatment of this fungal pathogen are discussed.