The recent Department of Health (DH) announcement of funding for training obstetric physicians to help run maternal medicine networks is a much needed initiative to address health inequalities and avoidable maternal deaths, but recognised training routes for these physicians are needed to guarantee
This unique text covers all aspects of valvular heart disease, including normal valve anatomy and physiology, pathophysiology, modes of investigation, assessment and treatment of specific valve lesions, valve surgery (both medical and surgical aspects), treatment in pregnancy or during non-cardiac surgery, and the devastating complication of infective endocarditis, in an easy-to-read, accessible format.
the advent of the HIV epidemic; worse still there has been a catastrophic explosion of tuberculosis in many of the developing countries particularly in Africa, again largely due to HIV infection. This is a good book and a timely publication. The book is written by three experts with wide experience both in Western Europe and in the developing countries. Written in a straightforward style, it is comprehensive and deals with all aspects of tuberculosis, not
Autologous blood transfusion is the collection of blood from a single patient and retransfusion back to the same patient when required. This is in contrast to allogenic blood transfusion where blood from unrelated/ anonymous donors is transfused to the recipient. The primary driving forces for the use of autologous blood transfusion are to reduce the risk of transmission of infection
Autologous blood transfusion is the collection of blood from a single patient and retransfusion back to the same patient when required. This is in contrast to allogenic blood transfusion where blood from unrelated/ anonymous donors is transfused to the recipient. The primary driving forces for the use of autologous blood transfusion are to reduce the risk of transmission of infection
Neisseria meningitidis (meningococcus) is a major infection risk globally. In the UK, it is the leading cause of death from infection in childhood1, with a mortality around 10%2. Most deaths from meningococcal infection are due to the development of fulminant septic shock23. Yet N. meningitidis is a frequent commensal of the human upper respiratory tract. Carriage rates increase from less than 1% in infancy to a maximum of 25% in adolescence, declining to around 10% in adulthood. The meningococcus is a Gram negative diplococcus. Pathogenic meningococci possess a polysaccharide capsule, differences in the structure of which form the basis of separation into subgroups. The lack of suitable vaccines for all the meningococcal serogroups is because of a high level of genetic diversity caused by intraspecies re combination and transformation. A single mutation or genetic exchange may lead to an outbreak of clinical disease if associated with a change in an immunologically important surface antigen.
Adolescents are poorly served by the medical community and probably only as few as one third of doctors like working with them1. Yet most doctors (apart from neonatologists and geriatricians) will be consulted by them, without having any special understanding or training in the care of these young people. Furthermore, the improved outlook for patients with a range of chronic diseases (such as congenital heart disease, cystic fibrosis, diabetes and asthma) means that an increasing number of adolescents will require medical care into adulthood. Recommendations to improve care of adolescents are straightforward, common sense and important2. Above all, expertise must be developed at all levels of health care delivery by appropriate training in adolescent issues. In addition, some specialist adolescent physicians are needed in order to develop research and education in this field of medicine. Specific adolescent clinics could improve standards both in general practice and some specialties. The hazardous transfer of the clinical care of young people from paediatrician to adult physician needs careful consideration and specific guidelines. Adolescent care is an NHS priority and is the subject of an intercollegiate working party, which will report later this year. Meanwhile, every physician should read the article by Dr Russell Viner in the CME section of this issue of JRCPL (ppi 2-15).
