Infective endocarditis (IE) is a severe bacterial infection of the endocardial surface of the heart; it usually involves damaged or synthetic heart valves. Improvement in surgical and medical therapeutics have been encouraging, however, if managed poorly it can still have a poor prognosis. In the developed world, rheumatic heart disease is an uncommon risk factor whereas intravenous drug use, degenerative valvular disease in the elderly population and use of prosthetic heart valves are becoming more common. In terms of the microbiological cause of IE, Staphylococcus aureus is the most common cause in the Western world. It is therefore important for GPs to be aware of and be able to identify these risk factors. This article aims to examine the pathophysiology, risk factors, changing trends in epidemiology and recent guidelines on the management of IE.
Background: Patients living with chronic pain are typically resource intensive, their care requirements are long term and referral to secondary care is not always expeditious. To provide more appropriate, accessible and cost-effective care, Tower Hamlets Primary Care Trust reviewed the needs of the patients, their current care and the numbers requiring treatment for non-malignant chronic pain, initially starting with musculoskeletal pain. Method: We estimated the number of people with chronic pain being treated outside general practice by the NHS in Tower Hamlets. A working group established set criteria to define a chronic pain patient. We surveyed appropriate clinicians to determine the approximate number of patients who fitted our inclusion criteria, the approximate number of follow-up appointments they required and their care pathways. Secondly, we estimated the cost of care for chronic pain patients using NHS national tariff and reference cost data. We also took a convenience sample of chronic pain patients and recorded their history of care. Findings: The routes and pathways of care are complex and multiple. We estimate between 4.0% and 5.5% of new patients in rheumatology, orthopaedics, occupational therapy and musculoskeletal physiotherapy and up to 90% in the pain clinic are people living with chronic pain. The cost of this care ranged from £296 for a course of physiotherapy to £1911 for a patient seen in physiotherapy, orthopaedic and the pain clinics. Conclusion: There is no facility in current management information services that identifies people being treated for non-specific chronic pain; therefore, estimating both the numbers and costs for treating these people is difficult. National tariff and notional cost data provide estimates only, of an 'average patient'; the real cost of these patients is unknown.
Simple SummaryAnaemia refers to a low red blood cell count and is common during pregnancy in women. Anaemia has been reported in sheep undergoing surgery during pregnancy for biomedical research projects. The incidence and severity of anaemia during pregnancy in sheep is unknown. Three groups of sheep were established: non-pregnant; pregnant with a single lamb; and pregnant with twin lambs. The stage of pregnancy was known as the sheep were mated on a known date and pregnancy was confirmed 50 days later by ultrasound examination. During pregnancy, blood samples were collected to measure red cells in the blood and protein levels. Samples were also collected to ensure that the sheep did not have any risk factors for anaemia, such as nutritional deficiency and internal parasites. Anaemia did not occur in any sheep during the study. Anaemia did not develop during pregnancy and red cell counts and protein levels were similar between each group. All the sheep lambed as expected, except for one that was expecting twins delivered a single lamb.AbstractThe aim of this study was to document the haematological profile of pregnant ewes throughout gestation. Sheep were divided into three groups (n = 8 per group): non-pregnant, singleton, or twin pregnancy. Blood samples were collected every 14 days from day 55 of gestation for haemoglobin concentration; packed cell volume; total protein; and albumin concentration. On days 55 and 125 of gestation blood was collected for trace element estimation: soluble copper and zinc; glutathione peroxidase (GSHPx); and methylmalonic acid (MMA). Pooled faecal samples were collected on days 55, 97, and 139 of gestation. Pasture cuts were collected on days 97 and 153 of gestation. The haematology and protein concentrations were not different between groups throughout the study. Copper concentration increased in all animals during the study (p < 0.0001). Zinc concentration was lowest in the singleton and twin pregnant sheep on day 55 of gestation (p = 0.04). GSHPx was not different between groups during the study. MMA decreased in all animals during the study (p < 0.0001), but was not different between groups. Faecal samples were consistently negative for strongyle and nematode eggs, and coccidian oocysts. The pasture was good quality. Pregnant sheep in a farm environment with normal trace element status, no parasites, and an adequate diet, did not develop anaemia (PCV < 0.27).
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