Brit J Hosp Med
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Infective endocarditis is a rare but deadly disease, with a highly variable presentation. The clinical manifestations of the condition are often multisystemic, ranging from dermatological to ophthalmic, and cardiovascular to renal. ⋯ Recent decades have seen a transformation in the epidemiology and microbiology of infective endocarditis and yet, despite advances in diagnostics and therapeutics, mortality rates remain high. This review outlines the emerging studies and guidelines on the assessment and management of infective endocarditis, focusing on the evolving epidemiology of the condition, the role of new imaging modalities, updated diagnostic criteria, the latest on antimicrobial and surgical management, and the role of a multidisciplinary approach in the management of patients with infective endocarditis.
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NHS England is planning to abolish the long-standing 4-hour target for waits in emergency departments. The target has been criticised as an arbitrary management target that is unrelated to clinical outcomes, but waits much longer than 4 hours in the emergency department cause a notable increase in mortality for admitted patients, suggesting that the 4-hour target is clinically important and should not be abolished.
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Compressive syndromes of the cervical arteries caused by musculoskeletal structures include bow hunter's syndrome, beauty parlour stroke syndrome, carotid compression by the hyoid bone, carotid compression by the digastric muscle and Eagle syndrome. They are a rare but increasingly recognised group of syndromes, so a high level of suspicion is needed so the diagnosis is not missed. ⋯ Symptoms resulting from vertebrobasilar insufficiency or ischaemia of areas supplied by the internal carotid artery are caused by compression of the vertebral artery and the internal carotid artery respectively. Surgical procedures are the preferred treatment for most of these syndromes.