bluuebunny/crossref_metadata_2025 huggingface dataset:
A RANDOMISED, DOUBLE‐BLIND STUDY OF ITRACONAZOLE VERSUS PLACEBO IN THE TREATMENT AND PREVENTION OF ORAL OR OESOPHAGEAL CANDIDOSIS IN PATIENTS WITH HIV INFECTION
Authors: Smith D , Midgley J , Gazzard B
Published: April 2023

HIV‐infected patients presenting with oral or oesophageal candidosis were randomised to four weeks treatment with itraconazole 200 mg, followed by itraconazole or matching placebo for a prophylaxis phase of 24 weeks. Clinical and mycological evidence of candidosis infection was assessed on a four‐weekly basis. Seventy patients were enrolled, of whom 50 completed 28 days of itraconazole therapy; 74% (37 patients) were clinically cured and 40% were also mycologically cured. Fifteen patients were withdrawn for a variety of reasons including non‐compliance, adverse events and the use of excluded medications. Forty‐four patients were enrolled in the prophylactic phase. There were significantly more relapses of candidosis, and time to candidosis was significantly shorter in the placebo group than in the itraconazole treated group (p=0.0001). Itraconazole 200 mg daily is effective and well tolerated for the treatment and prevention of oral and oesophageal candidosis in HIV‐infected patients.
ERECTILE DYSFUNCTION AND CARDIOVASCULAR DISEASE
Authors: Jackson G
Published: April 2023

Patients with cardiovascular disease are at increased risk of developing erectile dysfunction (ED). This may be a consequence of atherosclerosis of the penile arteries, a reduced cardiac output, or a side‐effect of drugs used to reduce cardiovascular risk factors (particularly β‐blockers, thiazide diuretics and, occasionally, lipid‐lowering drugs). ED is a distressing condition, which often diminishes the patient's self‐esteem, with the potential for damage to his psychological health and his relationship with his partner and family. When treating ED, the underlying aetiology should be established by careful examination and consideration of medical history and concurrent medication. Until recently, pharmacological treatment options involved intracavernous injections (alprostadil or moxisylyte) or intraurethral alprostadil. These treatments are often inconvenient and not well accepted by the patient. The recent introduction of oral sildenafil promises to revolutionise the treatment of ED. In double‐blind, placebo‐controlled trials in patients with ED, sildenafil improved erectile function and quality of life and was well tolerated. ED is a clinically important complication of cardiovascular disease and should be asked about and treated accordingly. It is important that effective treatments, including sildenafil, should be available for treating patients with cardiovascular disease and ED.
TREATMENT GUIDELINES FOR HYPERCHOLESTEROLAEMIA: TIME TO CONSIDER SOLUBLE FIBRE
Authors: MacMahon M
Published: April 2023

Lowering raised serum cholesterol levels is firmly established as an effective intervention for reducing the mortality and morbidity due to coronary heart disease (CHD). Recent European and British guidelines for the management of hypercholesterolaemia recommend dietary modification as first‐line therapy. However, dietary measures alone do not significantly reduce cholesterol levels. There is ample evidence that soluble fibre, such as ispaghula, lowers cholesterol and could therefore potentially reduce the risk of CHD. As CHD management costs spiral upwards, prescribing lipid‐lowering drugs for all indicated patients is not sustainable within current NHS resources. It is suggested that treatment guidelines be revised to include a soluble fibre product, such as ispaghula, as an adjunct to diet for patients where diet alone has failed and where lifelong therapy with lipid‐lowering drugs is inappropriate.
THE MANAGEMENT OF YOUNG DYSPEPTIC PATIENTS IN THE ERA OF HELICOBACTER PYLORI
Authors: Phull PS , Jacyna
Published: April 2023

The management of young dyspeptic patients remains controversial in the modern Helicobacter pylori era. The use of non‐invasive screening for H. pylori in one proposed strategy has demonstrated a substantial reduction in the endoscopy workload by excluding H. pylori negative patients under the age of 45 years with uncomplicated dyspepsia. An alternative screening strategy proposes a ‘test and treat’ approach, with H. pylori positive patients proceeding directly to an empirical course of eradication therapy. Ednoscopy would be reserved for patients who failed to respond symptomatically or who were H. pylori negative on intial screening. At present there are few data available from clinical studies of putting the ‘test and treat’ policy into practice. Although there is likely to be a role for screening young dyspeptic patients for H. pylori in primary care, subsequent management requires well‐planned studies in order to assess the benefits of any particular strategy.
AN UNUSUAL CAUSE OF FALLS IN AN ELDERLY PATIENT
Authors: Hussain A , Qadiri  , Rees PJ , O'Brien MD , Lewis RR
Published: April 2023

Falls are common in the elderly, often causing considerable morbidity and mortality. Prevention is therefore important and is based on determining the cause. We present an elderly patient who had multiple falls during the day due to recurrent daytime sleep episodes, an entity we believe has not previously been reported.
UPDATE ON SOME ASPECTS OF THE USE OF EPIDURAL ANALGESIA IN LABOUR
Authors: Okojie P , Cook P
Published: April 2023

The aim of the study was to investigate the effect of epidural analgesia on blood pressure, duration of the second stage and mode of delivery. In a prospective controlled study carried out in a district general hospital, 122 parturients made up the study population; 81 had epidural blocks and 41 had other forms of analgesia during labour. Data were collated using questionnaires within 48 hours of delivery: 58/81 (71.6%) of those who chose epidural were Primigravidae compared with 14/41 (34%) in the non‐epidural group (p<0.001). During labour, minimum diastolic blood pressure was significantly lower in the epidural group: 65.8 versus 72.4 mmHg (p=0.003). Mean duration of the second stage of labour was significantly longer in the epidural group: 108.3 versus 41.6 minutes (p<0.0001); 28/81 (34.6%) of the epidural group had operative vaginal deliveries compared with 6/41 (14.6%) of the non‐epidural group (p=0.0004). Epidural analgesia provides an effective form of pain relief in labour, which has a particularly strong appeal to Primigravidae. It has a hypotensive effect which can be put to beneficial effect in hypertensive disease of pregnancy, but is significantly associated with a lengthened second stage of labour, resulting in an increased operative vaginal delivery rate.
123I‐METAIODOBENZYLGUANIDINE SCANS IN PHAEOCHROMOCYTOMA DIAGNOSIS: CURRENT CLINICAL PRACTICE AND RELATIONSHIP TO BIOCHEMICAL SCREENING
Authors: Tormey WP , Keeling F , Lee MJ
Published: April 2023

The use in practice of 123I‐metaiodobenzylguanidine (MIBG) scans in phaeochromocytoma diagnosis in a teaching hospital over an eight‐year period is reported. MIBG scans were performed in 43 patients and the clinical context is reviewed and reported in 42 of these. A paraganglioma and five phaeochromocytomas were found in the MIBG series. There were no false negative MIBG scans. CT was performed in 61.9%, abdominal ultrasound in 45.3% and MRI in 7.1% of the patients. Urinary catecholamines and metanephrines are considered the best screening tests for phaeochromocytoma and false positive biochemistry values were associated with MIBG scans in 35% of the cases. Despite published limitations on its sensitivity, MIBG scans were the only modality used in 21.4%; 25% of the scans were performed for clinical reasons when the biochemical screen was within the reference range. MIBG is superior to CT and MRI for the localisation of suspected recurrence after surgery and is also useful for the detection of extra adrenal tumours and metastases.
CHRONIC INFECTIONS AND CORONARY HEART DISEASE
Authors: Smith D , Gupta S , Kaski JC
Published: April 2023

The rapidly changing patterns of coronary heart disease (CHD) prevalence and presentation fail to be explained by conventional cardiovascular risk factors alone. An infectious basis to atherosclerosis may, at least in part, be contributing to the variable rates of prevalence of CHD in different parts of the world. The evidence for such an association appears to be strongest for Chlamydia pneumoniae. Results of recent anti‐chlamydia antibiotic intervention pilot studies have renewed interest in the role of C. pneumoniae, and corroborated the evidence from sero‐epidemiological, pathological and animal‐model studies. The results of larger, on‐going, purpose‐designed intervention studies should help to increase our understanding of the role of infection in atherogenesis and potentially lead to a novel and effective treatment strategy for patients with CHD – broad spectrum antibiotics.
CLINICAL COURSE OF A PITUITARY MACROADENOMA IN THE FIRST TRIMESTER OF PREGNANCY: PROBABLE LYMPHOCYTIC HYPOPHYSITIS
Authors: Ôzbey N , Kahraman H , Yilmaz L , Orhan Y , Sencer E , Molvalilar S
Published: April 2023

Recent findings revealed that the clinical features of lymphocytic hypophysitis are more complicated than previously thought. It is rarely described in the first trimester of pregnancy and signs of meningeal irritation are infrequently reported. In this study, a pregnant woman in her first trimester of pregnancy with clinical and radiological characteristics of a pituitary macroadenoma is described. The patient's pituitary profile revealed a relatively low prolactin for her stage of pregnancy. Unusual findings were neck stiffness associated with headache, nausea and vomiting. She was treated conservatively. Spontaneous complete resolution of the pituitary mass in the postpartum period led us to conclude that the correct diagnosis should be hypophysitis. Hypophysitis should be considered in the differential diagnosis of a pituitary mass presenting in early stages of pregnancy with symptoms mimicking hyperemesis gravidarum and/or meningeal irritation.
HAEMANGIOPERICYTOMA OF THE ADULT MALE BREAST
Authors: Talwar S , Prasad N , Gandhi S , Prasad P
Published: April 2023

Haemangiopericytoma is an uncommon, usually benign, soft tissue tumour which has been rarely reported to occur in the female breast. Haemangiopericytoma of the adult male breast has been reported only once before. We report another such case.
A PROSPECTIVE AUDIT OF HOSPITAL‐ACQUIRED DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM
Authors: Wright G , Elliott K , Wilkie C , Cuschieri RJ , Bittiner B , Hughes KB
Published: April 2023

The incidence of symptomatic deep vein thrombosis and pulmonary embolism acquired in hospital was studied, and the effectiveness of current thromboprophylaxis was assessed in an open study of 8648 admissions to the Doncaster Royal Infirmary between April and July 1994. On admission, all patients were assessed for their likely risk of thromboembolic problems according to THRIFT criteria. Treatment, prophylaxis, complications and outcome were recorded on discharge. A high risk sub‐group was followed up for up to 42 days after discharge. The overall rate of clinically apparent hospital‐acquired thromboembolic complications was 0.4% (n=35). The rate of clinically apparent thromboembolic disease in the high risk group was 2.1% (n=17). The incidence of thromboembolic problems appeared not to be reduced by prophylaxis apparently even when stratified by risk group. These findings suggest that thromboembolic complications may be less common than would be expected from published literature. Thromboprophylaxis as currently practised within our institution does not seem to affect the incidence of deep vein thrombosis or pulmonary embolism, and these results would appear to argue against a ‘blanket’ policy for pharmacological thromboprophylaxis.
AN ASSESSMENT OF THE EFFICACY OF ATORVASTATIN IN TREATING PATIENTS WITH DYSLIPIDAEMIA TO TARGET LDL‐CHOLESTEROL GOALS: THE ATORVASTATIN MATRIX STUDY
Authors: McVey D , Patel H , Eminton Z , Maton S
Published: April 2023

A total of 531 patients from 57 hospital centres across the UK, who had previously been treated with lipid‐lowering agents in combination or alone, in whom the degree of cholesterol reduction was insufficient to achieve European Atherosclerosis Society target levels, were treated with atorvastatin over a 12‐week period. The dose of atorvastatin (10, 20 or 80 mg/day) was determined by assignment of risk based on entry level cholesterol levels and the presence of other established CHD risk factors. Atorvastatin was successful in achieving target LDL‐cholesterol levels in 86% of mild risk patients, 88% of moderate risk patients and 52% of high risk patients. Compliance with atorvastatin was 96% and treatment was well tolerated. This study demonstrates that atorvastatin is effective in achieving target lipid levels in a large proportion of patients and that the dose required can be predicted by an assessment of the patient's risk profile.
UNSTABLE ANGINA: A REVIEW AND PRACTICAL GUIDE TO MANAGEMENT
Authors: Mishra B , Jackson G
Published: April 2023

The syndrome of increasing angina leading to myocardial infarction was first recognised in the 1930s and the term unstable angina coined in 1971 by Fowler.1 Since then the importance of acute coronary syndromes as a presentation of ischaemic heart disease has been fully recognised. Recently several new pharmacological agents have been developed for the treatment of these syndromes. We aim to review the current treatments available for unstable angina and give a practical guide to its management.
NUTRITIONAL FACTORS IN OSTEOPOROSIS
Authors: Swaminathan R
Published: April 2023

Nutritional factors are important but correctable factors in the pathogenesis of osteoporosis. The rate of bone loss in the elderly can be reduced and the peak bone mass in the young can possibly be increased by dietary manipulation, thereby reducing the risk of fracture. Dietary manipulation likely to be of benefit are increased calcium intake, increased vitamin D intake, moderate reduction in intake of salt protein, caffeine and phosphate and increased intake of potassium and magnesium. The possible mechanisms by which these dietary factors influence bone metabolism are discussed.
NARATRIPTAN
Authors: Salonen R
Published: April 2023

The new 5‐HT1B/1D agonist naratriptan, introduced in many countries in 1997 and 1998 for the acute treatment of migraine, was designed to complement the sumatriptan portfolio of offerings (including the injection, the tablets, the nasal spray, and in some countries, the suppository) by offering patients excellent tolerability and a sustained duration of action. Clinical studies on naratriptan, including more than 4000 patients treating more than 15,000 migraine attacks, show that naratriptan tablets 2.5 mg are distinguished from other 5‐HT1B/1D agonists for migraine on the basis of their excellent tolerability profile, which does not differ from that of placebo. In addition to its tolerability, naratriptan tablets 2.5 mg possess a long duration of action with a low incidence of headache recurrence (17‐28% in phase II and III clinical trials). With its tolerability profile and long duration of action, naratriptan tablets 2.5 mg may be particularly appropriate as a single‐dose alternative to NSAIDs and analgesics, which often are not effective in migraine but are used because of tolerability considerations.
RATIONAL PRESCRIBING: PRACTICE AUDIT AND DRUG SWITCH IN DYSPEPSIA MANAGEMENT
Authors: Dott AG , Johnson L
Published: April 2023

Growing demands on limited healthcare resources and budgets have led to an increased focus on the costs associated with the purchase of drugs. Consequently, approaches to treatment for various disease states are now dictated not only by issues such as best medical benefits, but also by the cost of the drug that is used. As such, drug‐switching strategies have become increasingly common practice where, although the clinical benefits offered by the various medications for a specific condition may be similar, the cost differentials are notable. Application of this switch procedure has recently been assessed in the context of the management of acid‐related gastrointestinal disorders and has demonstrated that switching patients to therapy with the proton pump inhibitor lansoprazole from H2‐receptor antagonists or other proton pump inhibitors not only offers therapeutic advantages but also has important financial implications in general practice with regard to cost savings.
PIVMECILLINAM FOR THE TREATMENT OF ACUTE UNCOMPLICATED URINARY INFECTION
Authors: Nicolle LE
Published: April 2023

Pivmecillinam is a beta‐lactam antimicrobial marketed almost two decades ago. It has been used widely for the treatment of acute cystitis in selected areas of the world, particularly in Scandinavia. With increasing resistance of community Escherichia coli isolates to trimethoprim and trimethoprim/sulphamethoxazole, as previously observed for ampicillin and sulphonamides, reassessment of empiric antimicrobial regimens for acute uncomplicated urinary infection is necessary. Thus, it is timely to revisit the role of pivmecillinam for the treatment of acute cystitis. Clinical studies document the efficacy of this antimicrobial with short course therapy for acute cystitis, and clinical practice in countries where it has been used for many years confirms its efficacy and tolerability. If this agent were more widely used for empiric treatment for acute cystitis, use of antimicrobials such as the quinolones might be avoided. Further trials to define the comparative efficacy of pivmecillinam with other antimicrobials, and further studies of community resistance in E. coli isolates to this agent are needed.
PARKINSON'S DISEASE SURGERY: ADVANCES AND FUTURE STRATEGIES
Authors: Tan E‐K
Published: April 2023

The recent resurgence of surgical treatment of Parkinson's disease has generated enormous interest in the scientific community and with the general public. Both ablation (pallidotomy, thalamotomy), deep brain stimulation (thalamus, pallidum, subthalamus), and neural transplantation (human, porcine) have been demonstrated to be effective for specific subsets of Parkinson's disease patients. Future studies need to define better the ideal target sites and lesion volume of ablation and stimulation procedures, and optimising graft survival in neural transplantation. Numerous potential surgical interventions are currently being evaluated.
IV. THE ORIGINAL SIN OF MADNESS ‐ OR HOW PSYCHIATRISTS CAN STIGMATISE THEIR PATIENTS
Authors: Allison‐Bolger VY
Published: April 2023

A stigma is a mark of infamy or disgrace. People who are stigmatised are subject to abuse and social exclusion. Negative attitudes towards people with mental illness are attributed to stigma. In the literature, stigma is regarded as something that is attached to a person ‐ like a badge or label. This is undermined by two facts. Firstly, it is the person who is regarded as disgraceful, not the illness or diagnosis, and secondly, the diagnosis of mental illness is itself evaluative. Mental illness is by definition bad, so to be diagnosed as mentally ill is to be defined as bad (or somehow wrong). The stigmatisation of the mentally ill will not stop until this negative evaluation is removed from diagnosis.
CALCIUM DOBESILATE: PHARMACOLOGICAL PROFILE RELATED TO ITS USE IN DIABETIC RETINOPATHY
Authors: Berthet P , Farine J‐C , Barras J‐P
Published: April 2023

Calcium dobesilate (Doxium®) is used in the treatment of diabetic retinopathy. Clinical studies show a slowdown of the progression of the disease after long‐term oral treatment. The main action of the drug is related to a reduction of microvascular permeability as measured by different parameters and methods (vitreous fluorophotometry, retinal haemorrhages, skin capillary resistance, blood albumin leakage, blood viscosity) leading to improved visual acuity. The pharmacological activity may be explained in part by the antioxidant properties of calcium dobesilate and its action on endothelium through the synthesis of nitric oxide, increasing the endothelium‐dependent relaxation. The antioxidant effect was demonstrated in different in vitro and in vivo models by decreasing the peritoneal permeability in rats induced by pro‐oxidant substances. Moreover, vascular leakage was also decreased by calcium dobesilate in a reperfusion model in streptozotocin induced diabetic rats after ischaemia of the central artery of the retina. Doxium may also preserve vascular endothelial function by acting directly as antioxidant to protect lipids from peroxidation.
COMBINATION THERAPY WITH BETA‐ADRENERGIC BLOCKADE AND AMLODIPINE AS SECOND LINE TREATMENT IN ESSENTIAL HYPERTENSION
Authors: Mettimano M , Pichetti F , Fazzari L , Migneco A , Specchia L , Spica V Romano , Savi L
Published: April 2023

In hypertension both beta‐blockers and calcium antagonists are drugs with proved efficacy. Because only half the patients respond to a single drug, even at full dosage, a second hypotensive agent is frequently required to obtain adequate blood pressure control. The combination of a dihydropyridine calcium antagonist and a beta‐blocker can be justified by their different mechanisms of action. A randomised double blind parallel group study versus placebo was performed, in order to assess the efficacy of atenolol combined with amlodipine in the treatment of stage I‐II essential hypertension not controlled by atenolol alone. Twenty‐four‐hour arterial blood pressure monitoring showed that amlodipine added to atenolol produced a statistically significant reduction of blood pressure values compared with placebo in patients whose blood pressure was not controlled by atenolol alone. Blood pressure circadian rhythm was unchanged. The reduction of side‐effects, obtained by adding a dihydropyridine derivate to a beta‐blocker, confirms the effectiveness of this combination.
BENEFITS OF A STANDARDISED FEEDING REGIMEN DURING A CLINICAL TRIAL IN PRETERM NEONATES
Authors: Patole SK , Kadalraja R , Tuladhar R , Almonte R , Muller R , Whitehall JS
Published: April 2023

The feeding regimen was standardised for a trial of erythromycin to reduce the time to reach full feeds (150 ml/kg/day) by 30% in neonates of ≤32 weeks gestation. No significant improvement was noted in the primary outcome (median time: erythromycin 93.5 vs placebo 104 hours, p=0.60). However, necrotising enterocolitis ≥stage II disappeared and the time to full feeds was reduced by over 50% in all neonates during the 18‐month trial, and for more than two years after the trial, when the standardised feeding regimen was adopted as routine policy for feeding neonates of ≤32 weeks (<28 weeks: 13 vs 4.8 days, p<0.05; >28 weeks: 8 vs 3.9 days, p<0.05). This was in contrast to an average of six cases of NEC per year with 45% mortality during the previous five years. The benefits of standardised feeding schedules — improved detection/treatment of signs/symptoms of feed intolerance — are emphasised.
CHRONIC VIRAL HEPATITIS
Authors: Alexander G , Walsh K
Published: April 2023

Both hepatitis B and hepatitis C are spread parenterally. Chronic hepatitis C is fast becoming the leading indication for liver transplantation. Most infected patients go on to develop chronic hepatitis, with approximately 20% developing liver cirrhosis or hepatocellular carcinoma after 20 years. Standard treatment now is with a combination of alpha‐interferon and ribavirin, which is successful in up to 40% of patients. A vaccine is still a remote possibility and prevention remains all‐important. Despite having a successful vaccine, chronic hepatitis B remains an important cause of liver cirrhosis and hepatocellular carcinoma. Treatments for active hepatitis include alpha‐interferon and the newer nucleoside analogues such as lamivudine and adefovir. In patients undergoing liver transplantation, recurrence of hepatitis B in the graft can be reduced with a combination of hepatitis B immunoglobulin and these nucleoside analogues.
MYOCARDIAL INFARCTION COMPLICATING HORMONE REPLACEMENT THERAPY IN A YOUNG WOMAN WITH NORMAL CORONARY ARTERIES
Authors: Steiner MK , Clarkson PBM , Lip GYH
Published: April 2023

We describe a 30‐year‐old Afro‐Caribbean woman with a history of secondary amenorrhoea, who had been treated with HRT because of a presumed diagnosis of premature ovarian failure, and subsequently presented with an acute infero‐lateral myocardial infarction. Subsequent coronary angiography demonstrated normal coronary arteries.
SCALP PAIN AND HYPERLIPIDAEMIA
Authors: Aravinoan PD , Lloyd‐Mostyn RH
Published: April 2023

Acute pancreatitis and eruptive xanthomata are the only recognised direct complications of severe hyperthglyceridaemia, although peripheral neuropathy has been described in patients with hyperlipidaemia. We describe a patient with mixed hyperlipidaemia presenting with severe scalp pain and eruptive xanthomata. Both resolved with treatment. We suspect that high triglyceride concentration can affect the function of sensory nerve fibres.
MOXIFLOXACIN VERSUS CEPHALEXIN IN THE TREATMENT OF UNCOMPLICATED SKIN INFECTIONS
Authors: Parish LC , Routh HB , Miskin B , Fidelholtz J , Werschler P , Heyd A , Haverstock D , Church D
Published: April 2023

The efficacy and safety of oral moxifloxacin (400 mg once daily, 7 days) versus cephalexin (500 mg three times daily, 7 days) were compared in a prospective, multicentre, randomised, double‐blind trial in 401 adults with uncomplicated skin infections. Clinical outcome was evaluated in 351 patients. Moxifloxacin proved to be as effective as cephalexin both clinically (90% versus 91%, respectively) and bacteriologically in eradicating the most frequently isolated pathogen Staphylococcus aureus (92% and 93%, respectively). Moxifloxacin was more effective than cephalexin in eliminating Streptococcus spp. (90% and 82%, respectively). Drug‐related adverse events were comparable in both treatment groups with the most frequently reported being nausea in the moxifloxacin‐treated patients and headache in the cephalexin‐treated patients. Medication was discontinued due to unwanted reactions in 3% of the moxifloxacin‐ and 4% of the cephalexin‐treated patients. Moxifloxacin, 400 mg once daily for 7 days, is as safe and effective as cephalexin 500 mg three times daily for 7 days in the treatment of uncomplicated skin infections.
CAN PROPHYLACTIC ORAL ERYTHROMYCIN REDUCE TIME TO FULL ENTERAL FEEDS IN PRETERM NEONATES?
Authors: Patole SK , Almonte R , Kadalraja R , Tuladhar R , Muller R , Whitehall JS
Published: April 2023

Efficacy of oral, prophylactic erythromycin in reducing the time to establish full enteral feeds (150 ml/kg/day) was assessed in neonates <32 weeks, ready for enteral feeds. Seventy‐three consecutive neonates were randomised to receive oral erythromycin ethyl succinate (n=36) or placebo (n=37) in a double‐blind trial until full enteral feeds or 14 days of therapy were reached. A prospectively designed feeding regimen, including plan of action for signs of feed intolerance, was common for all enrolled neonates. The median gestational age, birth weight and postnatal age at start of feeds were 29 versus 30 weeks (p=0.40), 1232 versus 1280 g (p=0.96) and 5 versus 5 days (p=0.84) for erythromycin and placebo group, respectively. Time to achieve full feeds was not significantly different in the two groups. (median times: erythromycin 93.5 versus placebo 104 hours, p=0.60). Erythromycin‐related side‐effects did not occur.
A COMPARISON OF NISOLDIPINE ER AND AMLODIPINE FOR THE TREATMENT OF MILD TO MODERATE HYPERTENSION
Authors: Whitcomb C , Enzmann G , Pershadsingh HA , Johnson R , Ciuryla V , Reisin E
Published: April 2023

This multicentre, double‐blind, double‐dummy, randomised trial compared the efficacy and tolerability of nisoldipine extended release (10–40 mg) and amlodipine (2.5–10 mg) in 161 patients. The primary end point was a between‐treatment comparison of change from baseline to week 8 in mean office diastolic blood pressure (DBP). The least squares mean reductions in systolic (S)BP/DBP (± standard error) for nisoldipine and amlodipine were ‐11.7/‐9.3 ± 1.4/0.8 and ‐14.3/‐12.0 ± 1.4/0.8 mmHg, respectively. The DBP treatment difference was 2.7 mmHg (90% confidence interval: 1.1 to 4.3 mmHg; p=0.005). Tolerability profiles were similar between treatments. The drug acquisition cost per mmHg DBP reduction was 40% lower with nisoldipine; an acquisition cost analysis revealed that amlodipine was 80% more expensive than nisoldipine for treating hypertension. In summary, nisoldipine and amlodipine provide clinically equivalent antihypertensive efficacy; however, nisoldipine is more economical than amlodipine.
SKELETAL MUSCLE RELAXANTS: PHARMACODYNAMICS AND PHARMACOKINETICS IN DIFFERENT PATIENT GROUPS
Authors: Booij LHDJ , Vree TB
Published: April 2023

Muscle relaxants can be safely administered during anaesthesia, providing the basic pharmacodynamic and pharmacokinetic characteristics of the compounds together with the physiological status of the patient are known. In this review the pharmacodynamics and pharmacokinetics of the neuromuscular blocking agents are discussed and related to the physical health or disease state of groups of patients.
MYOCARDIAL BRIDGING
Authors: Felmeden DC , Lip GYH
Published: April 2023

We present a case of myocardial bridging, which was seen following urgent cardiac catherisation for post‐infarction unstable angina in a 55‐year‐old man who was initially admitted with an acute inferior myocardial infarction.
PROGRESSIVE HEART BLOCK IN ACTIVE RHEUMATOID ARTHRITIS
Authors: Adhiyaman V , Oke A , Aziz K , White AD
Published: April 2023

A 68‐year‐old woman presented with active rheumatoid arthritis (RA) and severe extraarticular manifestations. During the course of her treatment, her electrocardiogram (ECG) transformed from normal sinus rhythm to left bundle branch block and finally to complete heart block (CHB). Investigations ruled out an ischaemic event. A permanent pacemaker was inserted due to the symptoms of heart failure and she made an uneventful recovery. CHB in RA is probably a marker of seventy of the disease.
A CASE OF HAEMOPHAGOCYTIC SYNDROME AND KIKUCHI‐FUJIMOTO DISEASE OCCURRING CONCURRENTLY IN A 17‐YEAR‐OLD FEMALE
Authors: Kelly J , Kelleher K , Khan MK , Rassam SMB
Published: April 2023

An unusual case in which a young Asian female presenting with fever, lymphadenopathy and cytopaenia was found to have distinct histological features of both haemophagocytic syndrome (HS) and histiocytic necrotising lymphadenitis (Kikuchi‐Fujimoto disease, KFD) is presented. We review the clinical features of each of these rare, but important, diagnoses and propose the hypothesis that they may form part of a disease continuum, rather than representing separate entities.
THE IMPACT OF A STRUCTURED PROGRAMME OF ASTHMA CARE IN GENERAL PRACTICE
Authors: Swanson V , Wright S , Power KG , Duncan B , Morgan J , Turner E , Gordon D
Published: April 2023

The impact of a new GP programme of asthma care was examined using: a) a retrospective pre‐ and post‐casenote survey of 400 asthma patients, comparing patients in practices using the health board programme (HBP) and other programmes (OP); and b) a patient satisfaction questionnaire, completed by 532 people on asthma clinic lists in HBP and OP practices. Outcomes assessed were health service use, perceived change in symptoms and asthma self‐management. The casenote survey indicated improved health service use by patients in HBP practices, with fewer patient‐initiated (p<0.05), emergency (p<0.05) and other chest‐related attendances (p<0.01) and increased clinic attendance (p<0.05) post intervention. OP practices also showed reduced patient‐initiated (p<0.01) and increased asthma clinic use (p<0.01). Increased use of management plans (p<0.01) and peak flow diaries (p<0.01) was noted post intervention for HBP practices. Responders to the questionnaire survey perceived that clinic attendance improved asthma symptoms, including severity and control, sleep disturbance and early morning wheeze. People in HBP practices were more likely than those in OP practices to possess a peak flow meter, a diary and a personal management plan (all p<0.01 or above) but were not more likely to use a peak flow diary. Notwithstanding methodological difficulties in the selection of practices, both studies showed trends towards improvement in health service use and asthma self‐management. The HBP was associated with greater improvement in self‐management processes and outcomes, and greater patient satisfaction with asthma care.
LATEX ALLERGY: AN EMERGING PROBLEM IN THEATRES
Authors: Keh C , Soon Y , Wong LS
Published: April 2023

With the increasing use of natural rubber products, latex allergy is becoming a major health concern among patients and healthcare workers. The aim of this study was to determine the availability of a latex allergy protocol and essential latex‐free products in theatres. The number of latex allergy complaints among patients and theatre personnel were also studied. Postal questionnaires were sent to theatre managers in 205 hospitals in England, Scotland and Wales, 120 (58.5%) of which were returned. Nearly two‐thirds of the theatres did not have a latex allergy protocol. Overall less than one‐third of theatres in the UK have latex‐free products set aside for use. A total of 505 patients with latex allergy underwent surgery; of these, there were four deaths, 18 major anaphylaxes and 483 minor complaints such as skin rash; 239 theatre personnel reported latex allergic reactions and one had a severe anaphylactic reaction. The number of cases with latex‐related complications might be reduced if all hospitals had a latex allergy protocol and a range of essential latex‐free products.
ORAL ANTIMICROBIAL SUSCEPTIBILITIES OF STREPTOCOCCUS PYOGENES RECENTLY ISOLATED IN FIVE COUNTRIES
Authors: Bandak SI , Turnak  , Allen BS , Bolzon LD , Preston DA
Published: April 2023

Between July 1998 and July 1999 1050 clinical isolates of Streptococcus pyogenes were collected from 11 study centres in five countries. Isolates were shipped to a co‐ordinating laboratory for NCCLS specified broth microdilution susceptibility testing for penicillin, cefaclor, azithromycin, clarithromycin, erythromycin and roxithromycin. All 1050 isolates of S. pyogenes tested were susceptible to penicillin (MIC <0.12 ug/ml) and cefaclor (MIC ≤0.25 μg/ml). Azithromycin, clarithromycin and erythromycin resistance rates were 15.9%, 15.4% and 15.8%, respectively. MIC90s for penicillin, cefaclor, azithromycin, clarithromycin, erythromycin, and roxithromycin were 0.015, 0.12, >4, 8, >1 and 16 μg/ml, respectively. Macrolide (erythromycin) resistance rates were highest in study centres in Italy (31.0%) and Spain (26.6%). Lower macrolide resistance rates were identified in study centres in Turkey (4.8%), France (3.8%), and Sweden (3.7%). In conclusion, the isolates of S. pyogenes tested were universally susceptible to β‐lactam antibiotics such as penicillin and cefaclor, while resistance to macrolides was significant and ranged from 3.2% to 31%.
THE EPIDEMIOLOGY OF HYSTERECTOMY AND IRRITABLE BOWEL SYNDROME IN A UK POPULATION
Authors: Kennedy TM , Jones RH
Published: April 2023

The prevalence of hysterectomy in the UK general population has not been previously reported. In addition, although it is known that many women with irritable bowel syndrome (IBS) have had a hysterectomy, the relationship between these two conditions has never been quantified. A random community sample of 2238 women aged 20–69 from Teesside was surveyed to determine the prevalence of hysterectomy and of IBS, the relationship between these and the influence of socioeconomic status and consultation behaviour on these variables. We analysed data from 1718 women, 13.6% of whom had a hysterectomy, 22.9% had IBS and neither condition was related to socioeconomic status. More women with IBS reported having had a hysterectomy than did non‐sufferers, odds ratio 1.6 (1.1–2.2), p<0.01; this association was also unaffected by socioeconomic status and was not fully explained by consultation behaviour. This is the first study to determine the prevalence of hysterectomy in a UK general population. The procedure is common and the excess of hysterectomy among women with IBS is considerable. Possible explanations include misdiagnosis of IBS resulting in hysterectomy, IBS symptoms occurring as a result of hysterectomy, a single underlying disorder which produces symptoms in both gastrointestinal and genitourinary tracts, or a combination of these factors.
ARE PREOPERATIVE SERUM GASTRIN LEVELS RELATED TO RESECTABILITY AND SURVIVAL IN GASTRIC CANCER?
Authors: Soran A , Aslar AK , Çöl C
Published: April 2023

The aim of this study was to determine the correlation between serum gastrin and resectability in patients with gastric cancer, and to see whether any difference could be demonstrated according to the histologic type and survival. Between 1994 and 1996 records of 34 consecutive patients with gastric carcinoma serum gastrin levels were measured and correlated with age, gender, lymph node positiveness, metastasis, Lauren's classification and survival. The mean serum gastrin level of patients was 98.38 pg/ml (normal range: 25–125 pg/ml). Twenty‐six of 34 patients (76.5%) had normal gastrin levels and eight patients (23.5%) had high gastrin levels. Sixty‐five per cent of patients with normogastrinaemia underwent resection with extended lymphadenectomy, while 38% patients with hypergasthnaemia underwent extended resection. All the hypergastrinaemic patients died within the first year, but in the normogastrinaemic group one, two and five‐year survival rates were 39%, 23% and 4%, respectively. Even though these results are not statistically significantly different in regard to preoperative serum gastrin levels, we conclude that preoperative hypergasthnaemia is associated with unresectability and poor survival in patients with gastric cancer.
AN EPIDEMIOLOGICAL STUDY OF FALLS ON INTEGRATED GENERAL MEDICAL WARDS
Authors: Vassallo M , Azeem T , Pirwani MF , Sharma JC , Allen SC
Published: April 2023

Reducing falls in hospital requires an environmental as well as a patient‐orientated approach. We studied patient and ward characteristics relating to falls in an acute setting. In a prospective open observational study, we examined fall characteristics in two nuclear designed wards (A and B) and a longitudinal ward (C). We recorded 63 falls among 1609 patients. Ward C had the most falls (31vs18/14; p=0.01), fall positive days (29vs15/10; p=0.002) and fallers (27 vs 13/12; p=0.001; OR 2.54, CI‐1.41–4.57). Ward C had a higher cumulative risk of falls (p=0.006) and fall positive days (p=0.003). Choice of ward was a significant independent risk factor for falls (p=0.01) when controlled for age, sex, and diagnostic variation between the wards. Most falls were intrinsic (A 66.7%, B 64.2%, C 61.3%, p=0.45). A significantly higher proportion of falls on ward C occurred by the bed (p=0.04). Significant differences exist between the wards, and fall reduction programmes should identify and compensate for adverse ward‐related factors to increase the effectiveness of patient‐targeted fall risk assessments.
HAEMOGLOBIN SC DISEASE PRESENTING WITH A COMPARTMENT SYNDROME SECONDARY TO A DEEP VEIN THROMBOSIS
Authors: Ivil KD , Mannion SJ
Published: April 2023

A patient presented with a deep vein thrombosis (DVT), which resulted in a compartment syndrome of both the thigh and the calf. Subsequently, the patient was found to have haemoglobin SC disease. Prompt fasciotomies were performed; however, some muscle and nerve damage was later clinically apparent. This case highlights the value of prompt diagnosis of compartment syndrome and the need for urgent formal fasciotomies. The case also demonstrates the value of seeking an underlying cause for a DVT when none is apparent.
SOLITARY CALCANEAL METASTASIS IN SUPERFICIAL BLADDER CARCINOMA
Authors: Sarlak A , Gündes H , Özkürkçügil C , Özkara S , Gökalp A
Published: April 2023

We report a case of a solitary calcaneal metastasis in a patient with superficial bladder carcinoma. The patient underwent transurethral tumour resection twice because of local recurrence. Both histologic examinations revealed a grade 2 PT1 superficial transitional cell carcinoma of the bladder. The metastasis was detected four months after the initial cystoscopy, due to severe leg pain. The lesion was curetted and filled with bone cement. A year later, a below knee amputation was performed because of local recurrence. This case deserves special attention, for two reasons. First, metastatic carcinoma to the bones of the foot is very rare. Although bony metastasis by transitional cell carcinoma of the bladder can be seen, presenting as a symptomatic solitary lesion after superficial bladder carcinoma is extremely unusual. Second, failure to control bladder tumours by local means might be an indication for an early cystectomy, even in tumours with no evidence of muscle invasion, in order to prevent distant metastasis.
A STUDY OF THE EFFICACY AND SAFETY OF IRBESARTAN IN COMBINATION WITH CONVENTIONAL THERAPY, INCLUDING ACE INHIBITORS, IN HEART FAILURE
Authors: Tonkon M , Awan N , Niazi I , Hanley P , Baruch L , Wolf RA , Block AJ ,   Irbesartan Heart Failure Group
Published: April 2023

Because heart failure therapy with angiotensin‐converting enzyme (ACE) inhibitors may not be optimal, owing to persistent levels of angiotensin II occurring through incomplete blockade and alternate pathways, the benefit of adding irbesartan, an angiotensin receptor antagonist, to conventional therapy, including ACE inhibitors, was examined. In this multicentre, randomised, double‐blind, placebo‐controlled study, 109 patients with heart failure (New York Heart Association functional class II and III) and left ventricular ejection fraction (LVEF) ≤40% received stable doses of ACE inhibitors and diuretics before and throughout the study. Irbesartan was titrated as tolerated to 150 mg once daily in all patients. Exercise tolerance time (ETT), LVEF and clinical status were assessed at baseline and after 12 weeks. Compared with placebo, irbesartan in combination with conventional therapy, including ACE inhibitors, produced favourable trends in ETT and LVEF and was well tolerated in patients with mild to moderate heart failure. (Int J Clin Pract 2000; 54(1): 11‐18)
OUTCOME IN CHILDREN UNDER 5 YEARS OF AGE WITH CONSTIPATION: A PROSPECTIVE FOLLOW‐UP STUDY
Authors: Elshimy N , Gallagher B , West D , Stringer MD , Puntis JWL
Published: April 2023

Constipation in the pre‐school child is common and causes considerable distress to children and their parents. There is a lack of information regarding prognosis in this group of patients although some are clearly at risk of developing long‐term difficulties with defaecation. We have previously reported characteristics of children under 5 years of age referred to hospital over a one‐year period with idiopathic constipation. We now report outcome data after 18 months of follow‐up in 41 of the original cohort of 42 children. We have also summarised what we regard as good practice in managing constipation in this age group. Eighteen months after initial outpatient assessment, the symptoms of constipation were reported to have resolved in 36 (88%), although seven of these were still needing regular laxative treatment. It was our subjective impression that the five children who apparently did not improve came from families that had a greater degree of psychosocial problems and where compliance with treatment was suspect. This study shows that with simple treatment measures and ongoing support, an optimistic prognosis can be given to families from the outset. The minority of pre‐school children who do not improve may benefit from a more intensive psychological approach to management. (Int J Clin Pract 2000; 54(1): 25‐27)
TREATMENT OF STATUS EPILEPTICUS WITH MIDAZOLAM IN THE CRITICAL CARE SETTING
Authors: Hanley DF , Pozo M
Published: April 2023

Status epilepticus (SE) is a potentially life‐threatening condition that requires prompt and aggressive treatment. Prolonged status seizures are associated with significant physiological sequelae and neurological deficits. Although systemic events such as hyperthermia and anoxia contribute to neuronal damage, SE in and of itself can induce cell death. In general, the sooner it is brought under control, the more favourable is the prognosis. Benzodiazepines, as a group, are the most frequently used anticonvulsants in the management of status seizures. Midazolam, a water‐soluble benzodiazepine, is a potent anticonvulsant that offers many advantages over typical benzodiazepines. Because of its stability in aqueous media, midazolam dissolves in common diluents such as normal saline or dextrose water. Consequently, midazolam both intravenously (i.v.) and intramuscularly (i.m.) is well tolerated locally and is associated with less venoirritation than benzodiazepines or antiepileptics that require organic solvents. The water solubility of midazolam also allows rapid and reliable absorption of the drug from the i.m. injection site. Because it is rapidly metabolised and its metabolites are pharmacologically inactive, midazolam has a short duration of action. Most patients regain full conscious state and can be evaluated soon after the cessation of treatment. Midazolam by continuous i.v. infusion and by the i.m. route has been successfully used in the treatment of SE. Although some respiratory and haemodynamic side‐effects have been associated with midazolam, no clinically significant side‐effects were observed with its use for the indication of SE. It is suggested that midazolam is a safe and rapidly effective treatment option in the management of SE in the critical care setting.(Int J Clin Pract2000;54(10):30‐35)
THE ROLE OF ALPHA1‐BLOCKERS IN COMBINATION THERAPY FOR HYPERTENSION
Authors: Zusman RM
Published: April 2023

Antihypertensive monotherapy provides adequate blood pressure control in less than 50% of patients with hypertension (BP>140/90 mmHg), especially those with stage 2‐3 disease. This article reviews clinical studies that demonstrate that add‐on therapy with an alpha1‐blocker (doxazosin, terazosin or prazosin) is an effective and well‐tolerated regimen for improving blood pressure control in patients with inadequately controlled hypertension. Furthermore, alpha1‐blockers have therapeutic benefits that go beyond blood pressure management. They have a small but positive effect on the serum lipid profile and they have favourable or benign effects on conditions that frequently coexist with hypertension, such as type 2 diabetes mellitus and benign prostatic hyperplasia. (Int J Clin Pract 2000; 54(1): 36‐41)
GIANT PILOMATRICOMA SIMULATING CARCINOMA OF THE MALE BREAST
Authors: Ismail W , Pain S , Al‐Okati D , Al Sewan M
Published: April 2023

We present the case of a 65‐year‐old man with a large calcifying epithelioma in the right breast. The case is unusual not only for the size of the tumour but also for its location in a male breast. Despite its large size (12 × 10 × 7 cm), the tumour did not show any clinical, radiological or histological evidence of malignancy or aggressive behaviour. One year after surgery there was no recurrence or metastatic disease. The possibility of malignancy, recurrence or metastasis of these large tumours, as well as the necessity of follow‐up and investigations, are emphasised. (Int J Clin Pract 2000; 54(1): 55‐56)