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Background:This review aims to summarize associations of the perinatal environment with arterial biophysical properties in childhood, to elucidate possible perinatal origins of adult cardiovascular disease (CVD).Methods:A systematic search of PubMed database was performed (December 2020). Studies exploring associations of perinatal factors with arterial biophysical properties in children 12 years old or less were included. Properties studied included: pulse wave velocity; arterial stiffness or distensibility; augmentation index; intima–media thickness of aorta (aIMT) or carotids; endothelial function (laser flow Doppler, flow-mediated dilatation). Two reviewers independently performed study selection and data extraction.Results:Fifty-two of 1084 identified records were included. Eleven studies explored associations with prematurity, 14 explored maternal factors during pregnancy, and 27 explored effects of low birth weight, small-for-gestational age and foetal growth restriction (LBW/SGA/FGR). aIMT was consistently higher in offspring affected by LBW/SGA/FGR in all six studies examining this variable. The cause of inconclusive or conflicting associations found with other arterial biophysical properties and perinatal factors may be multifactorial: in particular, measurements and analyses of related properties differed in technique, equipment, anatomical location, and covariates used.Conclusion:aIMT was consistently higher in LBW/SGA/FGR offspring, which may relate to increased long-term CVD risk. Larger and longer term cohort studies may help to elucidate clinical significance, particularly in relation to established CVD risk factors. Experimental studies may help to understand whether lifestyle or medical interventions can reverse perinatal changes aIMT. The field could be advanced by validation and standardization of techniques assessing arterial structure and function in children.

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UNSTRUCTURED This is a personal view about our perspectives, as medical students at Imperial College London, on our experiences during our infectious diseases placement at Northwick Park Hospital, touching upon other students’ experiences at other sites. These highlight some of the main drivers and barriers that motivate or dissuade medical students from seeing COVID-19 positive patients.

Vats 1999 USA Retrospective pilot study (n=43) Closed Head Injuries, Intracranial neoplasm, fulminant hepatic failure, viral encephalopathy Higher CPP than baseline in HTS group TBI: Traumatic brain injury; CNS: Central nervous system.

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Wheeze is one of the most common presentations in children, with evidence that up to half of all children experience an episode by 6 years of age. Wheezing is transient in the majority of cases; however, some children develop recurrent symptoms. Different phenotypes have been recognised based on symptoms patterns, physiologic measurements and risk factors. Childhood wheezing is particularly relevant to general practice, as about a quarter of pre-school-aged children present with wheeze annually. This article aims to explain the pathophysiology and differential diagnoses of wheezing, focusing on common presentations of wheeze that can be managed in the community.

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