bluuebunny/crossref_metadata_2025 huggingface dataset:
The post‐registration monitoring of glyphosate‐treated plants using anecic earthworms
Authors: Stroud Jacqueline L. , Halsey Kirstie
Published: April 2023

Glyphosate N‐(phosphonomethyl) glycine is a widely‐used herbicide in agriculture. The anecic earthworm, Lumbricus terrestris feeds and forages for surface plant materials meaning that this species has a unique and direct exposure to agrichemicals. At the recommended product rates, significantly (F1,44 = 8.67, p = .005) higher numbers of L. terrestris middens were found in the glyphosate treated areas of an arable crop field. Laboratory feeding assays using field aged plant materials indicated that previous glyphosate treatment was a statistically significant factor affecting earthworm L. terrestris biomass (F1,12 = 5.75, p = .03). Negligible glyphosate residues were detectable, and the field aged plant materials were encrusted with fungal hyphae. This suggests that glyphosate influences the colonisation of plant material by a litter‐fungus complex which improves the food quality to earthworms. Concentrations of epoxiconazole, a fungicide, were detected in some plant materials and may influence overall food quality to earthworms. Glyphosate treatment on fresh volunteer plant leaves (unwanted crop seedlings) was not a statistically significant factor affecting earthworm L. terrestris biomass (F1,6 = 0.16, p = .92). These results indicate fungal communities influence feeding behaviours, and plant materials are a direct source of agrichemicals to anecic earthworms.
Ordinance influences individuals' perceptions towards prospects of social circumstance but not the status quo: An experimental field study on sexual minorities issues in Japan
Authors: Miyajima Takeru , Nakawake Yo , Meng Xianwei , Sudo Ryunosuke
Published: April 2023

Scientific evidence shows that institutional decisions can change individuals' private attitudes towards relevant issues. However, little is known about their effect on individuals' perceptions of social norms. This intriguing question has gained the attention of scholars. Nonetheless, the findings are primarily observed only in samples of the Western, Educated, Industrialised, Rich, and Democratic countries, leading to doubts about their generalisability. This study experimentally tested residents' (N = 411) reactions to the new Tokyo ordinance prohibiting discrimination against sexual minorities enacted on October 5, 2018, and tested whether it dispelled self–other discrepancies regarding tolerance towards sexual minorities (i.e., pluralistic ignorance). The results showed that exposure to information about enactment increased future perceptions of support and understanding of sexual minorities. By contrast, private attitudes, perceptions of current social norms, and willingness to speak out did not change. Willingness to speak out was indirectly enhanced through increased perceptions of gaining future support. Furthermore, Tokyo residents overestimated other residents' negative attitudes towards sexual minorities. However, even when informed of the new ordinance, this self–other discrepancy in intolerance towards sexual minorities was not corrected. These findings suggest that institutional decisions can shape the perception of social norm change in the future beyond Western countries.
Comparison of decline in renal function between patients with chronic hepatitis B with or without antiviral therapy
Authors: Lee Jae Seung , Jung Chan‐Young , Lee Jung Il , Ahn Sang Hoon , Kim Beom Seok , Kim Seung Up
Published: April 2023

Background and Aims

Renal function can deteriorate in patients with chronic hepatitis B (CHB). We compared the risk of renal function decline between patients with untreated and treated CHB receiving antiviral therapy.

Methods

This retrospective study included 1061 untreated CHB patients, and 366 on tenofovir alafenamide (TAF), 190 on besifovir dipivoxil maleate (BSV), and 2029 on entecavir (ETV). The primary outcome was renal function decline, a ≥ one‐stage increase in chronic kidney disease for ≥3 consecutive months.

Results

The incidence and risk of renal function decline were significantly higher in the 1:1 propensity score‐matched treated group (588 pairs) than in the untreated (2.7 per 1000 person–years [PYs] vs. 1.3 per 1000 PYs, adjusted hazard ratio [aHR] = 2.29, all p < 0.001). The matched TAF group (222 pairs) showed a similar risk for the primary outcome (aHR = 1.89, p = 0.107) despite a significantly higher incidence thereof, compared to the untreated (3.9 vs. 1.9 per 1000 PYs, p = 0.042). The matched BSV and untreated groups (107 pairs) showed no significant differences in the incidence and risk. However, ETV users (541 pairs) carried a significantly higher outcome incidence and risk than the matched untreated (3.6 vs. 1.1 per 1000 PYs, aHR = 1.05, all p < 0.001). Compared to each matched untreated group, changes in the estimated glomerular filtration rate over time were greater in the ETV group (p = 0.010), despite being similar in the TAF (p = 0.073) and BSV groups (p = 0.926).

Conclusions

Compared with untreated patients, TAF or BSV users showed similar risk, whereas ETV users showed a higher risk of renal function decline.
Self‐rated eyesight among healthy older Australians: Baseline results of the ASPREE Longitudinal Study of Older Persons
Authors: McGuinness Myra B. , Robman Liubov D. , McNeil John J. , Tran Cammie , Woods Robyn L. , Owen Alice J. , Pham Thao , Guymer Robyn H.
Published: April 2023

Background

We aimed to describe the self‐reported level of eyesight amongst a cohort of relatively healthy older Australian adults, and to investigate associations between poorer self‐rated eyesight and demographic, health, and functional characteristics

Methods

The ASPirin in Reducing Events in the Elderly (ASPREE) Longitudinal Study of Older Persons (ALSOP) study was embedded in a multisite trial which recruited independently living Australians from general practices (2010–2014). Self‐rated eyesight was recorded on a paper‐based questionnaire as Excellent, Good, Fair, Poor, Very poor, or Completely blind at the baseline study wave

Results

Data from 14 592 participants (aged 70–95 years, 54.61% female) were included in this cross‐sectional analysis. Eighty percent of participants reported excellent or good eyesight (n = 11 677). People with complete blindness were precluded from enrolling but 299 participants (2.0%) reported poor or very poor eyesight, and 2616 rated their eyesight as fair (17.9%). Lower levels of eyesight were associated with being older, female, fewer years of formal education, a primary language other than English, smoking, and self‐reported macular degeneration, glaucoma, retinopathy, cataracts, and hearing problems (each p ≤ 0.021). People with lower levels of eyesight had a higher number of falls, frailty characteristics, and depressive symptoms, and lower mental and physical health functioning scores (each p < 0.001)

Conclusions

Whilst most of these healthy older Australians reported good or excellent eyesight, a notable minority reported poor or very poor eyesight, and this was associated with a range of poorer health measures. These findings support the need for additional resources to prevent vision loss and associated sequelae
Oral candidiasis in patients hospitalised in the intensive care unit: Diagnosis through clinical and cytopathological examinations
Authors: dos Santos Freire Fabiane Marques , Marques Letícia Côgo , da Silva Natasha Camargo , Cunha Karin Soares , Conde Danielle Castex , Milagres Adrianna , Gonçalves Lúcio Souza , Junior Arley Silva
Published: April 2023

Objective

To evaluate the prevalence and clinical aspects of oral candidiasis in patients hospitalised in the intensive care unit.

Methods

This is a longitudinal and prospective study that included 48 participants hospitalised in the intensive care unit. Sociodemographic data, presence of systemic disorders, use of medications, laboratory tests, cause of hospital admission, type of breathing, and length of hospital stay were obtained from medical records. Oral clinical inspection and cytopathological examinations were performed on all participants. The diagnosis of clinical candidiasis was based on the presence of clinical alterations together with positive cytopathological examination results. The diagnosis of subclinical candidiasis was based on the absence of clinical lesions and a positive cytopathological examination. The absence of oral candidiasis was considered when the participant did not present oral lesions and had a negative cytopathological examination.

Results

Clinical candidiasis was present in 18.8% of the 48 participants, and 45.8% of them had the subclinical form. Levels of urea (P = 0.005), creatinine (P = 0.009), haemoglobin (P = 0.009), haematocrit (P = 0.011), bands (P = 0.024), international normalised ratio (INR; P = 0.034), types of breathing (P = 0.017), length of hospital stay (P = 0.037), and outcome (P = 0.014) demonstrated statistically significant differences between the groups with and without oral candidiasis.

Conclusions

Clinical and subclinical forms of oral candidiasis are frequent in intensive care unit patients. Levels of urea, creatinine, haemoglobin, haematocrit, bands, INR, type of breathing, length of hospital stay, and outcome can be associated with the presence of candidiasis.
Gender differences on healthcare accessibility and outcomes of a electronic inter‐clinician consultation program at the cardiology department in a Galician Health Area
Authors: Mazón‐Ramos Pilar , Rey‐Aldana Daniel , Garcia‐Vega David , Portela‐Romero Manuel , Rodríguez‐Mañero Moisés , Lage‐Fernández Ricardo , Cinza‐Sanjurjo Sergio , González‐Juanatey José R.
Published: April 2023

Aims

To assess the longer‐term results (hospital admissions and mortality) in women versus men referred to a cardiology department from primary care using an e‐consultation in our outpatient care programme.

Methods

We selected 61,306 patients (30,312 women and 30,994 men) who visited the cardiology service at least once between 2010 and 2021: 69.1% (19,997 women and 20,462 men) were attended in e‐consultation (from 2013 to 2021) and 30.9% (8920 women and 9136 men) in in‐person consultations (from 2010 to 2012) without gender differences in the proportion of patients attended in each period. Using an interrupted time series regression model, we analysed the impact of incorporating e‐consultation into the healthcare model and evaluated the elapsed time to cardiology care, heart failure (HF), cardiovascular (CV), and all‐cause hospital admissions and mortality during the one‐year after cardiology consultation.

Results

The introduction of e‐consultation substantially decreased waiting times to cardiology care; during the in‐person consultation period, the mean delay for cardiology care was 57.9 (24.8) days in men and 55.8 (22.8) days in women. During the e‐consultation period, the waiting time to cardiology care was markedly reduced to 9.41 (4.02) days in men and 9.46 (4.18) in women. After e‐consultation implantation, there was a significant reduction in the 1‐year rate of hospital admissions and mortality, both in women and men iRR [IC 95%]: 0.95 [0.93–0.96] for HF, 0.90 [0.89–0.91] for CV and 0.70 [0.69–0.71] for all‐cause hospitalization; and 0.93 [0.92–0.95] for HF, 0.86 [0.86–0.87] for CV and 0.88 [0.87–0.89] for all‐cause mortality in women; and 0.91 [0.89–0.92] for HF, 0.90 [0.89–0.91] for CV and 0.72 [0.71–0.73] for all‐cause hospitalization; and 0.96 [0.93–0.97] for HF, 0.87 [95% CI: 0.86–0.87] for CV and 0.87 [0.86–0.87] for all‐cause mortality, in men.

Conclusion

Compared with the in‐person consultation period, an outpatient care programme that includes an e‐consultation significantly reduced waiting time to cardiology care and was safe, with a lower rate of hospital admissions and mortality in the first year, without significative gender differences.
Granite rock towers shaped by mesh‐like joint sets, which formed in the shallower portion of a granite body during cooling at depth
Authors: Chigira Masahiro , Kato Hironori
Published: April 2023

Granite is fractured according to the stress state during the cooling stage, providing predispositions for later topographic evolution. This study clarified that triangular mesh‐like joints can be made during granite cooling and that they can become the structural causes for the formation of rock towers and corestones on the ground. Tengu rock, which consists of rock towers and granite corestones in Hiroshima, was investigated using an unmanned air vehicle. The rock towers were shaped by high‐angle mesh‐like joints, which were likely made during the cooling of the granite and are dominated by three joint sets. All the joint sets have sharp planar surfaces, which suggests that they are brittle fractures. One joint set is cut by the other two joint sets, frequently accompanies aplite and quartz veins and is developed in the whole exposed granite; this set likely formed first during cooling and then was penetrated by aplite from depth. The other two joint sets are high‐angle conjugate joint sets, are limited to the shallower portion of the granite pluton and do not extend deeper, which strongly suggests that they formed in a rapidly cooled shallower portion of the pluton, probably near its roof. These three joint sets form rock columns with parallelogram cross‐sections, in which incipient corestones were made. Subsurface weathering along the joints and subsequent exhumation of the weathering products formed the present rock towers and corestones only in the shallower portion of the granite.
Memories that last: Dynamics of memory T cells throughout the body
Authors: Derksen Lyanne Y. , Tesselaar Kiki , Borghans José A. M.
Published: April 2023

Memory T cells form an essential part of immunological memory, which can last for years or even a lifetime. Much experimental work has shown that the individual cells that make up the memory T‐cell pool are in fact relatively short‐lived. Memory T cells isolated from the blood of humans, or the lymph nodes and spleen of mice, live about 5–10 fold shorter than naive T cells, and much shorter than the immunological memory they convey. The commonly accepted view is, therefore, that long‐term T‐cell memory is maintained dynamically rather than by long‐lived cells. This view is largely based on memory T cells in the circulation, identified using rather broad phenotypic markers, and on research in mice living in overly clean conditions. We wondered to what extent there may be heterogeneity in the dynamics and lifespans of memory T cells. We here review what is currently known about the dynamics of memory T cells in different memory subsets, locations in the body and conditions of microbial exposure, and discuss how this may be related to immunometabolism and how this knowledge can be used in various clinical settings.
Body image, interoceptive awareness, depression and eating disorder symptoms: Within‐group variability among sexual minority women
Authors: Tebbe Elliot A. , Simone Melissa , Greene Madelyne Z.
Published: April 2023

This study investigates within‐group differences in body image concerns among sexual minority women and their related association with eating disorders and depression. Cross‐sectional data were collected in 2017 and analysed in 2020 from 201 sexual minority women in the United States. Latent profile analyses and post hoc comparison analyses were conducted to investigate within‐group variability in body image concerns and to understand their impact on depressive and eating disorder symptoms. Results suggested that a 5‐class solution best fit the data, with five distinct profiles emerging in patterns of interoceptive awareness, sociocultural attitudes toward appearance, body shame, body surveillance and appearance anxiety. Significant differences in mean scores of depressive and eating disorder symptomatology emerged among the profiles; groups that reported low interoceptive awareness and high body image concerns experienced greater levels of eating disorder and depressive symptoms, compared to groups with average or higher levels of interoceptive awareness and average or lower body image concerns. Results underscore the significant within‐group variability that exists for sexual minority women with regard to the prevalence of body image concerns, depressive symptoms and eating disorder symptoms. Efforts that aim to increase interoceptive awareness (for example, mindfulness) alongside strategies aimed at addressing negative body image concerns may be particularly effective avenues for future depression and eating disorder prevention in this diverse group. Our reporting adheres to the STROBE research reporting checklist.
“I thought it would just be, like, older men in white coats”: A qualitative exploration of first encounters with mental health services
Authors: Goodwin John , Cummins John , O'Malley Maria
Published: April 2023

Individuals whose mental health is becoming a concern may not receive the care they require. Although efforts have been made to reduce barriers to accessing services, including stigma reduction campaigns and healthcare practitioner training, there remains a lack of understanding of individual perspectives regarding help‐seeking behaviour. The aim of this study was to explore people's first experiences accessing mental health services. A qualitative descriptive approach was adopted. Interviews were conducted with eight service users. Data were analysed using reflexive thematic analysis. The COREQ checklist guided this study (Tong et al., 2007, International Journal for Quality in Health Care, 19, 349). Three themes were identified: learning to navigate an unfamiliar system, making sense of mental health services, and promoting a positive image for those in need of care. Uncertainty about mental health services and stigmatizing images could be mitigated by developing positive media‐based interventions. Systemic barriers need to be addressed and services need to be better resourced to ensure the benefits of early intervention are available to those experiencing mental health challenges. To encourage people to access services earlier, services need to be promoted in a positive way.
Analysing the aspects of sustainable consumption and impact of product quality, perceived value, and trust on the green product consumption
Authors: Thakur Meenakshi , Madhu  , Kumar Rakesh
Published: April 2023

In the current scenario, consumers’ approach and decision to go for green products is a result of the environmental challenges faced by society at large. The benefits of using green products are well known in society. Green products are user‐friendly and contribute towards sustainable consumption. This paper investigates the effect of varied aspects of sustainable consumption on the consumption of green products. The empirical evidence focused on product quality, perceived value and trust as significant factors. A survey of 350 Indian consumers using green products was used to perform a descriptive quantitative study. The proposed hypotheses were tested using regression analysis. Findings revealed that product quality, perceived value and trust all had an impact on green product consumption. The study has found that consumers prefer green products because of their attribute of maintaining the natural environment. Therefore, based on the associated quality of green products, the relative value obtained and developed trust, an increase in green‐concept‐based product consumption can be achieved. This study recommends that future research should focus on further micro‐level aspects that constitute these important factors, namely product quality and perceived value, and trust all having a vital effect on green product consumption.
First report on the life history of the marine amphipod Ceradocus mizani and its implication for aquaculture
Authors: Shahin Sharif , Okomoda Victor Tosin , Ishak Sairatul Dahlianis , Waiho Khor , Fazhan Hanafiah , Azra Mohamad Nor , Azman B. Abdul Rahim , Wongkamhaeng Koraon , Abualreesh Muyassar H. , Rasdi Nadiah W. , Ma Hongyu , Ikhwanuddin Mhd
Published: April 2023

The search for alternative live feed for aquaculture stocks has inspired research into marine amphipods. In this study, the life history of Ceradocus mizani was evaluated to better understand how this amphipod might be used in aquaculture as an alternative feed. The amphipods did not display copulatory behavior during the study period. The females were multivoltine and attained sexual maturity on average in 23.6 days at a mean length of 4.64 mm. The incubation period lasted 8.8 days, and the mean number of juveniles produced per brood during that incubation period was relatively low (7.58). Females produced a mean of 5.2 consecutive broods and 39.4 total juveniles over the life span. (i.e., 0.33 juveniles/day). Sex ratio was female skewed (1.55:1). Female size and the number of juveniles produced per brood were positively correlated (R2 = 0.63). The mean life span for females and males was 119.4 and 91.2 days, respectively. Mean maximum length was 9.26 mm for males and 8.18 mm for females. This is the first account of the life history of C. mizani and forms the basis for future studies of this marine amphipod.
Double‐blind comparison of long acting propranolol and sustained release metoprolol in the treatment of angina pectoris
Authors: Irving J B , Edwards R E
Published: April 2023

A double‐blind cross‐over trial was performed in 11 patients with stable angina, comparing the effect of two once‐daily long acting beta‐blocker formulations, Inderal LA (propranolol) and Lopresor SR (metoprolol), each given for a four week period.

The patients' response to the two treatments was very similar and no significant differences were noted between the treatments. Patients may have benefited slightly more by Inderal LA therapy. Slightly fewer angina attacks and side effects were reported when the patients were receiving Inderal LA treatment, compared with Lopresor SR treatment. The patients' exercise tolerance, blood pressure and heart rate were assessed approximately 24 hours after the last dose of their once daily treatment. Inderal LA treatment may have allowed patients to exercise a little longer, and there was a trend towards slightly lower blood pressures and heart rates when the Inderal LA treatment period was compared with treatment during the metoprolol period.
Ceftizoxime prophylaxis in major gynaecological surgery
Authors: Hitchcock A , Cooper J C , Liu D T Y
Published: April 2023

Sixty women who were due to undergo major gynaecological surgery consented to enter the trial. Thirty six abdominal and twenty four vaginal procedures were performed for a wide range of gynaecological conditions. The patients were divided randomly into two groups. One group was given an intravenous infusion of 4g of ceftizoxime in one litre of normal saline, starting pre‐operatively to run in continuously over 24 hours. The other group was used as a control. There was no significant difference in post‐operative infection rate between the two groups of patients.
Double‐blind comparison of Inderal LA (160 mg), Half‐Inderal LA (80 mg), and Half‐Inderal LA plus bendrofluazide (2.5 mg) in the treatment of elderly hypertensive patients.
Authors: Agrawal R L
Published: April 2023

Thirty‐two elderly hypertensive patients completed this randomised, double‐blind, crossover study comparing once‐daily Inderal LA (160 mg) with Half‐Inderal LA (80 mg) and a combination of Half‐Inderal LA (80 mg) plus bendrofluazide. After a placebo run‐in period of two weeks, patients received each of the three treatment regimens in random order for a four week period. Blood pressures and heart rates were measured 24 hours after the last dose of each treatment.

All treatment regimens provided control of blood pressure and exercise tachycardia. Treatment with the combination of Half Inderal LA (80 mg) and 2.5 mg of bendrofluazide was well tolerated and achieved a significantly greater reduction in systolic blood pressure than either Inderal LA or Half‐Inderal LA alone. The blood concentrations of propranolol found 24 hours after the last dose of Half‐Inderal LA give pharmacokinetic support for the use of this formulation once daily in elderly hypertensive patients.
Rifampicin causing an exacerbation of pemphigus
Authors: Honeybourne D , Longworth S , Shaffer J
Published: April 2023

A 57‐year old man with pemphigus which was well controlled on prednisolone and azothioprine developed tuberculosis. One week after starting anti‐tuberculous chemotherapy, he developed a reactivation of his pemphigus. It is likely that the rifampicin reduced the efficacy of prednisolone by hepatic enzyme induction. With life‐threatening illnesses such as pemphigus, the dose of steroids should be doubled if the patient subsequently requires rifampicin.
Assessment of left ventricular function and prognosis in survivors of acute myocardial infarction using Doppler ultrasound: a comparison with radionuclide ventriculography
Authors: Singer M , Price C C , Monk H , Trotman I F
Published: April 2023

Doppler ultrasound was used to measure stroke distance and minute distance, and radionuclide ventriculography to measure left ventricular ejection fraction, before and after exercise, in 18 patients who had survived myocardial infarction a mean 90 days previously.

Stroke distance fell on exercise in nine of the subjects and left ventricular ejection fraction in eight. The greatest falls in both stroke distance and ejection fraction occurred in the same seven patients. Within 18 months post‐infarction, two of the seven had died and another had suffered a further non‐fatal infarct. There were no late cardiac events in those whose stroke distance or ejection fraction rose with exercise. The two fatalities were amongst three with the poorest increase in minute distance on exercise.

Assessment of left ventricular function in survivors of acute myocardial infarction as measured by Doppler ultrasound thus compares favourably with radionuclide ventriculography. The results suggest that this technique may have potential use as a quick, reliable and non‐invasive prognostic indicator.
An assessment of the clinical efficacy in general practice of cefuroxime axetil when used in the management of unidentified infections of the lower respiratory tract
Authors: Wight L J , Vandenburg M J , Griffiths G K , Gudgeon A C , Kelsey M
Published: April 2023

Patients aged 18‐65, presenting to their GP with an acute exacerbation of chronic obstructive airways disease (COAD) were entered into a therapeutic study of cefuroxime axetil 500 mg bd. Of those patients assessed, 87 per cent had a positive clinical response. All clinical signs and symptoms improved. Of those patients with a cough, 86 per cent had improved at Day 7, as had 75 per cent of those with shortness of breath. The quantity and character of sputum also improved consistently throughout the study. There was a significant improvement in peak flow results of 36 (SE 5) L/minute at the end of the study (p< 0.001).

Twenty‐six patients reported 36 adverse events, the most frequent being diarrhoea, in nine patients. No serious side effects occurred. Thus, cefuroxime axetil may be considered an appropriate antibiotic for use by GPs in these circumstances.
The investigation of anaemia in the asymptomatic elderly
Authors: Woo J , Au S Y , Teoh R
Published: April 2023

Since anaemia may be present in asymptomatic elderly men and women, an attempt was made to determine the haemoglobin value which represents anaemia associated with disease. The World Health Organisation criteria of anaemia were used: 13g/dl in men and 12g/dl in women. A cohort of 427 elderly men and women with no apparent illness living in the community were screened. Excluding anaemias due haemoglobinopathies, 4.0% of men and 4.8% of women had anaemia due to identifiable disease and 4.5% of men and 2.8% of women had anaemia without identifiable disease. The haemoglobin values for the latter group tended to be just below 13g/dl for males and 12g/dl for females. It is suggested that, in clinical practice, the criteria for further investigation of anaemia should be values below 12g/dl for men, and either 11g/dl or 12g/dl for women.
Combined administration of controlled release theophylline and ranitidine: a 53‐day controlled survey in patients with chronic obstructive lung disease (COLD) and peptic disease.
Authors: Negro R Dal , Turco P , Pomari C , Trevisan F , De Conti F , Cordaro C I
Published: April 2023

The mean‐term (53 days) effects of controlledrelease theophylline (Theo‐Dur®) alone or combined with ranitidine have been evaluated in two homogeneous groups of 15 patients with chronic obstructive lung disease (COLD) and peptic disease. The severity of the bronchospastic disease evaluated by FEV, and plasma theophylline level in mcg/ml has been monitored at baseline, ie, pre‐treatment, at steady‐state, at Day 18 and at Day 53 of therapy in both groups.

By comparing the trends of the two parameters, it was obvious that the bioavailability of Theo‐Dur® and the magnitude of its bronchodilating effect were not influenced by the concomitant use of a potent gastric acid inhibitor, such as ranitidine.

Theo‐Dur® is thus confirmed to be a controlled‐release formulation with an absorption independent from gastric pH. As ranitidine increases the lower oesophageal sphincter pressure and does not interfere with the kinetics of theophylline, it is concluded that the combined therapy with the two drugs can be considered a treatment of choice for COLD complicated by peptic disease.
Therapeutic efficacy and gastric tolerance of ibuprofen (Brufen®) at 1600–2400 mg dosage in rheumatoid arthritis
Authors: Porkodi R , Raghuram K , Parthiban M , Chandrasekaran A N
Published: April 2023

Twenty‐one adult patients of both sexes with active rheumatoid arthritis, diagnosed as per the criteria of the American Rheumatism Association, participated in an open, non‐comparative study to evaluate the therapeutic efficacy and tolerability of ibuprofen (Brufen®)* at doses of 1600 mg–2400 mg per day. The dose was adjusted to suit the needs of the individual as assessed by clinical response. Pain intensity, grip strength, duration of morning stiffness, 50 feet walking time, number of affected joints, swelling and functional capacity were assessed prior to and at weekly intervals for four weeks. Side effects were also recorded. Gastrointestinal tolerance was assessed by endoscopy prior to and at the end of four weeks' treatment. Routine haematological and biochemical investigations were carried out prior to and at the end of the treatment.

It is concluded that ibuprofen at a dose of 1600 mg–2400 mg per day is effective in providing symptomatic relief and is well tolerated in patients with active rheumatoid arthritis. Gastrointestinal tolerance, as assessed by endoscopy, is good, including in those patients with pre‐existing congestion or ulceration of the upper gastrointestinal mucosa.
Immunological hypersensitivity to environmental antigens in the irritable bowel syndrome
Authors: Finn R , Smith M A , Youngs G R , Chew D , Johnson P M , Barnes R M R
Published: April 2023

Fifty eight patients with the irritable bowel syndrome (IBS) have been investigated by skinprick testing, quantitation of total serum IgE levels and determination of serum antibodies reactive with common dietary proteins. An increased incidence of skin reactivity (48.3 per cent; p<0.05), as well as serum IgG antibodies reactive with chicken ovalbumin, bovine milk or wheat gliadin (52.6 per cent; p<0.01), was demonstrated in IBS patients compared with controls. These results provide evidence of immunological hypersensitivity in at least a proportion of IBS subjects and contrasts with the concept that IBS always results from psychological factors.
A comparison of diagnostic techniques in the diagnosis and management of allergic conditions
Authors: Cooper B S , Gerlis L
Published: April 2023

A comparison of diagnostic techniques was carried out in the management of 59 patients with allergies who received desensitisation with Migen or Pollinex vaccines. Patients were tested with radioallergosorbent test (RAST) as well as skin tests, IgE levels and eosinophil counts.

Significant differences were shown in the ability of RAST and skin tests to detect allergy (p<.05), skin tests being more sensitive. Significant clinical improvement was seen in 76 per cent of patients with house dust allergy and 92 per cent with grass pollen allergy.

RAST testing was found to be of little diagnostic assistance. Skin testing and clinical evaluation were the most reliable methods of diagnosing allergy and monitoring response to therapy. No patients had any adverse reactions to desensitisation.
Primary transitional cell carcinoma of the renal pelvis in a duplicated collecting system
Authors: Budd J S
Published: April 2023

A case of primary transitional cell carcinoma in a duplicated renal collecting system is reported. A few cases of transitional cell carcinoma in the ureter of a duplicated system have previously been reported but there appears to be no prior report of transitional cell carcinoma in the renal pelvis of a duplicated system.
Pre‐operative investigations — the anaesthetist's perspective
Authors: McCleane G J
Published: April 2023

The information gained when abnormalities are detected by pre‐operative investigations is of interest to the anaesthetist as it may change the anaesthetic technique and anaesthetic drugs used. Tests should not be routinely used in all patients, but only in those over the age of 50 or in those with an increased chance of abnormalities being detected.
Comparison of the effectiveness of slow‐release propranolol (Inderal LA) 80, 160 and 320 mg orally daily in the treatment of angina pectoris
Authors: Odemuyiwa O , Alberts C , Hall R J C , Peart I
Published: April 2023

Doses of 80, 160 and 320 mg of Inderal LA (slow‐release propranolol) were compared in 12 patients with stable angina pectoris. There was an unpredictable and variable individual response to treatment and hence no differences were detected between the effects of the three doses on mean treadmill exercise duration, time to angina, frequency of angina or glyceryl/trinitrate consumption. There was a marked deterioration in two patients whilst on 320 mg Inderal LA. In these patients, the time to angina fell by 2 minutes 50 seconds and 4 minutes 20 seconds on 320 mg daily and 160 mg daily respectively. Given the inter‐patient variability in response to Inderal LA, the dose for each patient should be individually titrated according to response. Two patients reported here suggest that some subjects may benefit from lower doses, although further work is required to clarify this point. Possible explanations for this finding are discussed.
An unusual femoral hernia
Authors: Mahdy H Al , Mohanaruban K
Published: April 2023

An elderly woman presented with a lump in the right groin, clinically suggestive of a femoral hernia, but surgical exploration revealed a cystic mass of poorly differentiated adenocarcinoma. Post mortem examination showed it to be a metastic deposit of carcinoma of the gall‐bladder. Presentation of gall‐bladder carcinoma as a femoral hernia has not been previously reported.
Cardiological manifestation of carcinoma of the oesophagus
Authors: Dzik‐Jurasz A , Atheodorou N
Published: April 2023

An unusual case of carcinoma of the oesophagus is reported which presented with the cardiological symptoms of a severe anaemia in the absence of overt blood loss or its usual symptoms.
Acute non‐calculous cholecystitis
Authors: Mayer M , Strosche H , Lindecken K D
Published: April 2023

Shock gall‐bladder is a complication that can arise following trauma or after an operation. The sex distribution, disease frequency and mortality rate associated with this condition are presented and possible pathophysiology is discussed.

Post‐traumatic cholecysitis seems to occur most often in the second to fourth decade of life. The aetiology remains unknown and may be multifactorial. An awareness of this complication and a resort to early surgery can largely protect the patient from severe consequences.
Problems with clinical trials in general practice — a double‐blind comparison of cream containing miconazole and hydrocortisone with hydrocortisone alone in the treatment of intertrigo
Authors: Hedley K , Tooley P , Williams H
Published: April 2023

A double‐blind comparative study between 1 % hydrocortisone cream and a combination of 1% hydrocortisone cream and 2% miconazole cream has highlighted some of the problems with this type of research in general practice. The collection of adequate patient numbers within a predefined time scale proved a major problem. However, the study demonstrated the safety and efficacy of both these preparations in the treatment of intertrigo.
Effect of ketotifen on the reactivity of eosinophils with the incubation of anti‐IgG
Authors: Kishimoto T , Sato T , Ono T , Takahashi K , Kimura I
Published: April 2023

Blood eosinophils obtained from 25 patients with bronchial asthma were reacted with anti‐IgG or with normal rabbit serum as the control. Morphological changes were examined by light microscopy, scanning electron microscopy and transmission electron microscopy. Reactive eosinophils in morphology with anti‐IgG (27.8 per cent) were significantly higher (p<0.001) than those with the control (1.2 per cent).

We also examined the effects of ketotifen and tranilast, both of which have eosinophil chemotactic inhibitory functions, on the morphological changes. Ketotifen altered the morphological reactivation of eosinophils and the generation of leukotrienes induced by anti‐IgG, and this inhibition occurred in a concentration‐dependent manner. Tranilast had no effect on the morphology of eosinophils and the generation of leukotrienes. These results suggest that eosinophil IgG receptors may have a role in the pathogenesis of asthma and that ketotifen may prevent their reactivity and, thus, could be of potential use in the treatment of asthma.
Three ‘silent’ mastoid abscesses
Authors: Wickham M H , Marven S S , Narula A A
Published: April 2023

Acute mastoiditis with abscess formation is uncommon, its incidence being modified by modern antibiotic usage for acute suppurative otitis media (ASOM). It tends to occur in young children who have no previous history of ear disease. The diagnosis is a clinical one, and treatment requires hospital admission and some form of surgical drainage procedure, in order to prevent intracranial complications, eg, meningitis and intracerebral abscess.
Pancreatic ascites in childhood
Authors: Mucklow E S , Freeman N V
Published: April 2023

A case is reported of pancreatic ascites in a 14‐year‐old girl who had acute and chronic pancreatitis associated with pancreatic duct stones and a ruptured pancreatic duct. Abdominal erythema ab igne was considered to be an important physical sign of genuine severe abdominal pain.
Zoster sine herpete
Authors: Rudra T
Published: April 2023

A 61‐year‐old man presented with acute facial pain and subsequently developed the rash of herpes zoster in a distal dermatome. Treatment with acyclovir was commenced before development of the rash. The atypical presentation and the benefits of early diagnosis and treatment are discussed.
Pulmonary agenesis associated with fourteen other congenital abnormalities
Authors: Courtney S P , MacKinnon A E
Published: April 2023

Pulmonary agenesis is a rare congenital defect associated with certain previously described anomalies. This is the first case described associated with exomphalos. In addition there were 13 other congenital defects, three of which have not previously been recorded with either condition.
Fournier's gangrene and crepitus in the perineum
Authors: Johnson N
Published: April 2023

The diagnosis of Fournier's gangrene is usually simple. However, as this case illustrates, there are occasions when the clinician may be misled.
Comparison of the efficacy and tolerability of diclofenac gel (Voltarol Emulgel) and felbinac gel (Traxam) in the treatment of soft tissue injuries
Authors: Bouchier‐Hayes T A , Rotman H , Darekar B S
Published: April 2023

In an observer‐blind, randomised study, the efficacy and tolerability of two topical NSAID preparations were assessed in 384 patients with acute soft tissue injuries. The patients were allocated to receive treatment with either diclofenac gel (Voltarol Emulgel) 4 g tds or felbinac gel (Traxam) 4 g tds for three or seven days, depending on the rate of recovery.

In every parameter studied (pain at rest, pain on movement, pain on local pressure, swelling, range of movement, bruising, degree of recovery, requirement for rescue analgesics, daily pain levels), diclofenac was found to be more effective at day 3 and day 7, with the single exception of bruising at day 7. Treatment differences were statistically significant in favour of diclofenac for pain at rest (p = 0.03) and bruising on day 3 (p = 0.03), and pain on pressure at day 7 (p = 0.009). The difference in favour of diclofenac in reduction of daily pain level (as recorded on diary cards) did not quite reach significance (p = 0.06). Both preparations were well tolerated, with no significant treatment‐related side‐effects reported.
Efficiency of treatment and monitoring of ablative radio iodine therapy for hyperthyroidism: a DGH centre study
Authors: Safe A F , Maxwell R T
Published: April 2023

Sixty‐three hyperthyroid patients received ablative dosages of radio iodine. The efficacy of this treatment and the follow‐up were assessed one to two and a half years later from case records and general practitioners. Fifty‐seven percent of patients were hypothyroid at six months and 65% at one year; 4.8% had failed to become euthyroid within one year; 68.2% of patients were on thyroxine at the time of survey. Two patients had not been seen by their doctor for follow‐up and one patient stopped her thyroxine. Most general practitioners preferred patients to be returned to their care once thyroxine treatment was stabilised. Rapid responses and predictable outcome are important advantages of this form of therapy over established methods of management. Intentional ablation is particularly convenient in situations where clinical and biochemical follow‐up may be difficult. Good communications and a computer‐controlled recall system should ensure effective follow‐up.
An aid for the removal of compression hip screws
Authors: Eyres Keith S
Published: April 2023

The compression hip screw has a wide application in fracture management and elective orthopaedics. Due to the design of the sliding screw, bone ingrowth behind the threads can lead to difficulties in metalwork removal, especially in the younger patient. A simple technique is described using the plate to assist nail removal.
THE EFFECT OF SUSTAINED‐RELEASE THEOPHYLLINE IN NOCTURNAL ASTHMA
Authors: Freeman W , Packe G E , Cayton R M
Published: April 2023

SUMMARY Nocturnal symptoms are common and often disabling in asthmatic subjects. Furthermore, they often persist, in spite of appropriate dosages of inhaled β2‐agonists and topical steroids. In such a clinical situation, theophylline preparations may have a therapeutic role. This double‐blind, placebo‐controlled, cross‐over trial was designed to evaluate the effectiveness of a twice‐daily Bioavail slow‐release theophylline capsule in a group of out‐patient asthmatics, with a history of nocturnal and/or early morning wheeze or chest tightness. Theophylline was initially prescribed and monitored in an ‘open’ phase to obtain the drug dosage required to achieve a serum level in the therapeutic range of 10‐20 mg/l. In the ten patients who completed the study, serum theophylline levels were stable throughout.

During active treatment there was an improvement in morning peak expiratory flow rate (PEFR), and a reduction in measurements of diurnal variation. In addition, the bronchodilator response to an inhaled β2‐agonist was preserved. Bioavail theophylline has thus been shown to be an effective agent in the management of adults with nocturnal asthma.
THE DANGERS RESULTING FROM INACCURATE COMPUTER‐BASED OPERATIVE RECORDS
Authors: Knight L , Yardley M , Jones A
Published: April 2023

SUMMARY The accuracy of a computer‐based recording system of operative procedures was audited at a major district general hospital. The system is supposed to provide accurate records of theatre activity, to allow for improved nursing resource allocation and provide surgeons with a basic record of their operations. Mistakes were present in the details of 27% of the cases entered. Such inaccuracies highlight a major danger to surgeons with regard to their accountability for operations attributed to them. Mistakes can only cause further problems with regard to audit and future resource allocation.
MEDICAL EPONYMS UPDATED: BRIGHT'S DISEASE
Authors: Cameron J Stewart
Published: April 2023

The term ‘Bright's Disease’ is seldom used today, perhaps because Bright gave such a synoptic description of glomerulonephritis in all its phases that several terms are now needed to describe this group of conditions. However, its use is hallowed by tradition, and it appears in almost every popular work on medicine.
ISOLATED ENDOMETRIOSIS OF THE SMALL BOWEL PRESENTING AS ACUTE SMALL BOWEL OBSTRUCTION
Authors: Payne S P K , Pace R F , Benjamin I S , Clark D M
Published: April 2023

SUMMARYAlthough endometriosis is a common disease, small bowel involvement is unusual. We recently treated a patient in whom the diagnosis of endometriosis was made only after histological examination of a solitary lesion, which was obstructing the distal ileum and had the clinical appearance of a malignant tumour.
PATIENTS WITH RECURRENT BLACKOUTS ON CARBAMAZEPINE THERAPY
Authors: Safe A F , Maxwell R T
Published: April 2023

SUMMARY Two cases of cardiac syncope with epileptiform features are reported. The patients had been on carbamazepine for many months with increasing frequency of attacks until sinus arrest was documented. Their symptoms disappeared completely with permanent pacemaker implantation and anticonvulsant therapy withdrawal.
PRACTICAL CARDIOLOGICAL SKILLS AND ECG INTERPRETATION AMONGST DOCTORS
Authors: Khan M A , King D , Davies K N , Silas J H
Published: April 2023

SUMMARY ECG interpretation skills, confidence in performing cardiopulmonary resuscitation (CPR), inserting a temporary pacing electrode (TPE), awareness of the location of the arrest trolley and the number to dial in the event of a cardiac arrest was assessed in 100 doctors of all grades.
INVESTIGATION OF COLONIC SYMPTOMS : THE VALUE OF FLEXIBLE SIGMOIDOSCOPY
Authors: Fowlie S , Jones H W , Hignett C , Rosenberg W , Chapman RW
Published: April 2023

SUMMARY Colonic symptoms and large‐bowel disease are common in elderly people,1 but the optimum investigative schema is not well established. Double‐contrast barium enema (DCBE) and full colonoscopy share several drawbacks; both require colonic preparation which at best causes stool frequency and urgency, at worse dehydration and hypovolaemia. Many physicians feel that in the elderly this represents such a risk that inpatient preparation is preferred. Both investigations may involve much discomfort and distress.2,3 Rigid sigmoidoscopy is the traditional first colonic examination in patients with colonic symptoms, but will detect fewer than 10% of significant colonic lesions.4 Further investigation is almost always needed in elderly patients.
RAMSTEDT'S PYLOROMYOTOMY: A SPECIALIST PROCEDURE?
Authors: O'Donoghue J M , O'Hanlon D M , Gallagher M M , Connolly K D , Doyle J , Flynn J R
Published: April 2023

SUMMARY One hundred and twenty infants with infantile hypertrophic pyloric stenosis were operated on by two consultant general surgeons over a 13‐year period. General anaesthetic and a standard surgical approach was used in all cases. No mortality was recorded and there were no wound dehiscences. The overall postoperative wound infection rate was 9.2%. Prior to 1985 the infection rate was 15%. Following attention to a number of details including care of the umbilicus, the incidence decreased after 1985 to 4%. The most common postoperative complication was vomiting, which occurred in 25% of infants. There was one negative laparotomy in the 13‐year study period. Two children required a second procedure for persistent vomiting. The argument in favour of specialisation in managing this condition is questioned along with the need for intensive diagnostic investigation.