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The seroprevalence of Fasciola hepatica infection in a population of commercial dairy herds in England and Wales was estimated using an ELISA that detected antibodies to F hepatica in bulk tank milk. A total of 3130 milk samples, obtained as convenience samples from two commercial milk-testing laboratories, were tested during the winter of 2006/07. Herds considered to be seropositive were categorised as low positive, medium positive or high positive. A geospatial map was drawn to show the distribution of infected herds and the seroprevalence of exposure at regional level, using the Nomenclature of Units for Territorial Statistics boundaries, and at a finer spatial level defined by postcode area. Overall, 76 per cent (95 per cent confidence interval [CI] 74 to 77 per cent) of herds carried antibodies to F hepatica; the seroprevalence in England was 72 per cent (95 per cent CI 70 to 74 per cent) and in Wales it was 84 per cent (95 per cent CI 82 to 86 per cent). The highest prevalences of exposure were found in north-west England, where more than 47 per cent of herds were in the high positive exposure category. [ABSTRACT FROM AUTHOR]

Liver fluke (Fasciola hepatica) infection caused weight loss, diarrhoea, decreased milk yield and occasionally death in cattle in East Anglia during the winters of 2001 to 2003. The condition had previously been limited mainly to stock imported into this part of Britain from endemically infected areas. In composite faecal samples collected by 16 farm animal veterinary practices in Norfolk. Suffolk and Essex, fluke eggs were found in 15 (28.8 per cent) of 52 previously unaffected suckler herds and 10 (16.7 per cent) of 60 dairy herds. Antibodies to F hepatica were detected by ELISA in 32 (53.3 per cent) of the bulk milk samples from these 60 dairy herds, including the 10 in which fluke eggs were found. The emergence of fasciolosis in East Anglia was attributed to recent higher summer rainfall, which favoured the intermediate snail host Lymnaea truncatula and the free-living stages of F hepotico, the increased influx of sheep from endemic fluke areas for seasonal grazing, and the wetter grazing conditions associated with the Environmentally Sensitive Area scheme. [ABSTRACT FROM AUTHOR]

Introduction: Hyponatraemia is associated with increased morbidity and mortality, and is commoner in elderly patients. The aetiology and outcomes of hyponatraemia in the elderly has not been defined in prospective studies. Methods: A single-centre 9 month prospective observational study of hyponatraemic (HN) patients (≤130 mmol/L) was performed. Clinical outcomes in patients ≥65 years (Elderly patients, EP) and those <65 years (Young Patients, YP) were analysed, and compared with age-matched eunatremic controls, Analysis was performed using Graphpad-Prism 7. Results: 1321 consecutive admissions with hyponatraemia (67% EP, median age of EP 77 (65–98) years) and 1122 eunatremic controls (63% EP, median age of EP 77 (65–99) years) were analysed. Median nadir plasma sodium was similar in both groups withHN, 128 (107–130) mmol/L EP vs 128(110–130) mmol/L YP (p=0.62). EP hyponatraemic patients were more likely to have hypovolaemic hyponatraemia (34%) compared with YP with hyponatraemia (28%, p=0.03). Diuretic-induced hyponatraemia was twice as common in EP (8%) compared with YP (4%, p=0.01). Malignancy-induced SIAD occurred with similar frequency in both groups (7% in EP SIAD vs 8% in YP SIAD, p=0.65). Respiratory disease was causative in 10% cases of EP SIAD, compared with 4% in YP SIAD, p=0.0004. Hyponatraemia was corrected in 53% of EP, compared with 64% of YP, p=0.0001. Length of stay and re-admissions rates were similar across hyponatraemia age groups. EP with HN were 2.4 times more likely to die in hospital, compared with eunatremic age-matched controls, (OR 2.4, 95% CI 1.6–3.7, p<0.0001). Conclusions: The causation of hyponatraemia is different in elderly patients. Hyponatraemia in EP is often uncorrected, despite increased mortality compared with eunatremic age-matched controls. [ABSTRACT FROM AUTHOR]

An ELISA developed to diagnose Fasciola hepatica infection in cattle by detecting serum antibodies was adapted and validated for use with samples of bulk-tank milk. The prevalence of the infection in 61 dairy herds was established by using serum antibody levels or faecal egg counts measured in a proportion of the cows in each herd. The correlation between the results of the ELISA and the herd seroprevalence was 0.83. Using a cut-off value of 27 per cent positive, the bulk-tank ELISA identified herds in which more than 25 per cent of the cows were infected with a diagnostic sensitivity of 96 per cent (95 per cent confidence interval 89 to 100 per cent) and a diagnostic specificity of 80 per cent (95 per cent confidence interval 66 to 94 per cent). By applying the ELISA to 623 herds in England and 445 herds in Wales, the prevalence of F hepatica infection in England was estimated to be 48 per cent (95 per cent confidence interval 46 to 54 per cent), and in Wales 86 per cent (95 per cent confidence interval 84 to 90 per cent).

It is often accepted by hospital staff that patients would prefer to be at home for the Christmas and Easter holiday periods. This is one of the reasons that elective surgery is reduced at these times. However there is very little evidence to prove whether this is true. To investigate this question 310 patients attending surgical or urological outpatients were given a self completion questionnaire asking them whether they would accept admission over these holidays if offered it. Overall 77 per cent of males and 76 per cent of females would accept admission over the Christmas period for elective surgery. This rises to 87 per cent and 88 per cent over the Easter period. Older patients, widows or widowers, retired patients and patients with subjectively severe symptoms and conditions were groups that independently accepted such admissions more readily than others. Contrary to the perceived opinion in hospital staff, in this sample of surgical and urological patients most patients appear willing to accept admission for elective surgery over the Christmas or Easter holiday periods.