gistfile1.txt

var contentItemIdsByLetter = this.cacheManager.Get(
  string.Concat("Patient.Contenttypes.Az.Ids.For.", letter),
  ctx => {
      ctx.Monitor(this.clock.When(Timespan.FromDays(1)));
      return this.letterRepository.Fetch(x => x.Title.StartsWith(letter)).toList();
  }
  
var items = this.cacheManager.Get(
  string.Concat("Patient.Contenttypes.Az.Items.For.", letter, ".By.", contentType),
  ctx => {
      ctx.Monitor(this.clock.When(Timespan.FromDays(1)));
      
      var content = this.contentManager.GetMany(contentItemIdsByLetter.Select(x => x.ContentItemId), VersionOptions.Published) 
      .Where(x => x.ContentType.Name == contentType);// im not sure if you can pass contentypes to getmany?
      
      var altTitles = new List<KeyValuePair>();
      
      foreach (var contentItem in content)
      {
          var titles = contentItemIdsByLetter.Where(x => x.ContentItemId == contentItem.Id);
          foreach (var title in titles)
          {
            altTitles.Add(new KeyValuePair(title, contentItem.As<IAliasAspect>().Path));
          }
      }
      
      return altTitles;
  }
  
  // do something with items, like display them :)