bluuebunny/crossref_metadata_2025 huggingface dataset:
Explainability and white box in drug discovery
Authors: Kırboğa Kevser Kübra , Abbasi Sumra , Küçüksille Ecir Uğur
Published: April 2023

Recently, artificial intelligence (AI) techniques have been increasingly used to overcome the challenges in drug discovery. Although traditional AI techniques generally have high accuracy rates, there may be difficulties in explaining the decision process and patterns. This can create difficulties in understanding and making sense of the outputs of algorithms used in drug discovery. Therefore, using explainable AI (XAI) techniques, the causes and consequences of the decision process are better understood. This can help further improve the drug discovery process and make the right decisions. To address this issue, Explainable Artificial Intelligence (XAI) emerged as a process and method that securely captures the results and outputs of machine learning (ML) and deep learning (DL) algorithms. Using techniques such as SHAP (SHApley Additive ExPlanations) and LIME (Locally Interpretable Model‐Independent Explanations) has made the drug targeting phase clearer and more understandable. XAI methods are expected to reduce time and cost in future computational drug discovery studies. This review provides a comprehensive overview of XAI‐based drug discovery and development prediction. XAI mechanisms to increase confidence in AI and modeling methods. The limitations and future directions of XAI in drug discovery are also discussed.
ROI Scissor: Interactive Segmentation of Feature Region of Interest in a Triangular Mesh
Authors: Moon Ji‐Hye , Ha Yujin , Park Sanghun , Kim Myung‐Soo , Yoon Seung‐Hyun
Published: April 2023

We present a simple and effective method for the interactive segmentation of feature regions in a triangular mesh. From the user‐specified radius and click position, the candidate region that contains the desired feature region is defined as geodesic disc on a triangle mesh. A concavity‐aware harmonic field is then computed on the candidate region using the appropriate boundary constraints. An initial isoline is chosen by evaluating the uniformly sampled ones on the harmonic field based on the gradient magnitude. A set of feature points on the initial isoline is selected and the anisotropic geodesics passing through them are then determined as the final segmentation boundary, which is smooth and locally shortest. The experimental results show several segmentation results for various 3D models, revealing the effectiveness of the proposed method.
Meta‐analysis of couple therapy in non‐randomized clinical trial studies: Individual and couple level outcomes
Authors: Owen Jesse , Sinha Sree , Polser Geneva Crabtree , Hangge Anna , Davis Jasmine , Blum Lena , Drinane Joanna
Published: April 2023

Couple therapy has outperformed control conditions in randomized clinical trials (RCTs). However, there have been some questions whether couple treatment in naturalistic settings is as effective as those with more rigorous controls. The current meta‐analysis examined 48 studies of couple therapy in non‐randomized clinical trials. The pre–post effect size was Hedge's g = 0.522 for relational outcomes and Hedge's g = 0.587 for individual outcomes. However, there was significant heterogeneity in the results. Several moderators explained some of the variance in these estimates. For relationship outcomes, studies who had older couples and longer length of relationship had better outcomes. Studies with a higher percentage of racial/ethnic minority (REM) couples and studies in Veteran Affairs Medical Centers (VAMC) had lower relational outcomes. For individual outcomes, studies that had more sessions, older couples, and VAMC had better outcomes. Studies with a higher percentage of REM couples also had worse individual outcomes. Trainee status was not consistently related to relational or individual outcomes. Implications for research and practice are provided.
Handling of wild Atlantic salmon smolts reduced marine survival more than hydropower turbine passage
Authors: Haraldstad Tormod , Johansen Kurt , Vollset Knut Wiik
Published: April 2023

Atlantic salmon smolts are sensitive to disturbance during their migration and negative effects experienced in freshwater may carry over into the marine environment. In this study, smolts were PIT‐tagged and detected during their subsequent spawning migration. A generalized linear model fitted to the return data predicted a return probability of 0.091 ± 0.0061 (±SE) for smolt that was released downstream of a hydropower dam. The additional effect of migrating through a Kaplan turbine associated with hydroelectric generation did not significantly reduce return rates, while the additional effect of being handled twice in a trap was significant and lowered the predicted return probability to 0.057 ± 0.0079 (±SE; model predictions from logistic regression). Catch‐mark‐recapture methods such as those using physical recapture of fish should be applied with great care to avoid multiple handling stress that may lead to reduced marine survival and biasing estimates intended to help monitor population statuses. Moreover, similar return rates in turbine and bypass migrating smolts emphasize that more knowledge is needed when evaluating mitigation actions for migratory fish at hydropower plants.
Inequalities and social sciences in neoliberal Indonesia
Authors: Rakhmani Inaya , Sakhiyya Zulfa
Published: April 2023

Rising wealth and social inequalities around the world place great pressure on social researchers to interpret and explain the impact. However, it is equally important to recognise that scientists too have been part of the reproduction of social inequalities. This article expands on Burawoy's (2015) appeal to social scientists to acknowledge that social inequalities are not only external to the social science community specifically – and the scientific community more generally – but they also pervade academic labour and the way universities are managed and reformed. By taking the case of Indonesia, the largest economy in understudied Southeast Asia, this article reveals types of social inequalities reproduced and sustained through policies and practices within universities. These inequalities are the exclusionary effects of internationalisation, selective inclusion and corporatist bureaucracies, as well as regional inequalities in terms of infrastructure and capacity. We problematise the detrimental effects of marketisation in higher education on academic imagination and how it extends authoritarian developmentalism (1966–1998) to suit neoliberal demands. The article ends with propositions on how academics from the Global South can better understand their social position in an increasingly networked yet disconnected world skewed by multiple configurations of social inequalities.
Epilepsy and pregnancy: A study of 188 pregnancies in 92 patients
Authors: Akhtar N , Millac P
Published: April 2023

In this retrospective study of gestation and epilepsy there was little change in fit frequency during pregnancy but a significant number of women had seizures during labour and the early post‐partum period. Obstetrical complications, babies' birth weights and perinatal mortality were analysed. Comparisons were made within the populations of Leicestershire. The fetal malformation rate was no higher than the expected frequency for our patients, but there was a three‐fold increase in the perinatal mortality rate against the control population.
A general practice study investigating the effect of minocycline (Minocin) 50 mg bd for 12 weeks in the treatment of acne vulgaris
Authors: Millar E D , Jolliffe D S , Leigh A P
Published: April 2023

In a multicentre general practice open study, 991 acne sufferers were treated with minocycline (Minocin) 50 mg bd (854 for 12 weeks).

A significant improvement trend (p< 0.001) was found following analysis of visual analogue scales measuring severity of acne, area covered by acne, distribution of inflamed lesions, density of acne lesions.

Overall, 81 per cent of patients thought the therapy to be effective or very effective; 72 per cent continued on the same therapy after the study period.

Mean first improvement was noted by the patients after four and half weeks of treatment.

The overall trends noted above were also seen in two subgroups, (a) patients who had failed on previous oxytetracycline treatment; (b) patients who had received either no previous therapy or topical therapy alone.

Adverse events were noted in five per cent of patients. Of these, three per cent were definitely drug related and only two per cent of patients left the trial because of adverse reactions. None of the reactions was serious in nature. The concurrent administration of Minocin and the oral contraceptive does not appear to be a clinically significant problem.

Minocin therapy is demonstrated to be an effective treatment for acne, with early onset of benefit and excellent patient tolerability and acceptability. Good efficacy was noted in patients who had failed on previous oxytetracycline therapy.
Brucellosis of the sacro‐iliac joint
Authors: Ferris B D , Scott J E
Published: April 2023

Brucellosis is an infection of animals which may be transmitted to man by direct contact or by drinking unpasteurised milk. Skeletal involvement was first reported in 1932 by Kulowski and Vinke1 when they described a case of spinal infection. Since then there have been further reports in English literature2‐4 but few of infection of the sacro‐iliac joint5,6. We present a further case and discuss the diagnosis and management.
A double‐blind study of Inderex in the treatment of essential hypertension
Authors: Crowe P F , Finnegan O C , Russell C J Mcl , Varma M P S
Published: April 2023

The antihypertensive effect of bendrofluazide 5 mg, long‐acting propranolol 160 mg, and the combination of these doses of bendrofluazide and long‐acting propranolol (Inderex)** was assessed in a double‐blind, cross‐over study in 25 patients with essential hypertension. Each treatment was given for four weeks and measurements were made 24 hours after the last dose. All three treatments produced a significant reduction of systolic and diastolic blood pressure. However, the combination product produced a greater reduction in systolic blood pressure than with the single treatments and helped counteract diuretic‐induced hypokalaemia. The combination of bendrofluazide and long‐acting propranolol in a single capsule (Inderex) proved an effective and well tolerated treatment for hypertension that may help improve patients' compliance with treatment.
Augmentin (intravenous then oral) compared with cefuroxime followed by cephalexin for chest infections in hospitalised patients
Authors: O'Donovan C , Rudd R , O'Neill S , Fitzgerald M X , McNicholas W , Flavell‐Matts S G , Howell F , McKenzie A , Whittaker J
Published: April 2023

Augmentin and cefuroxime were compared in the treatment of chest infections in hospital patients in a multicentre study. One hundred and six patients were randomly allocated to 48 hours treatment with intravenous Augmentin, (amoxycillin 1g + clavulanic acid 200mg), every eight hours. Sixty eight patients received cefuroxime (750mg) intravenously every eight hours. Patients receiving intravenous Augmentin were then given five days oral treatment with Augmentin. Patients receiving cefuroxime were subsequently given five days oral treatment with cephalexin. For severely ill patients, the intravenous phase of treatment was extended from 48 to 96 hours.

There was no significant difference in the numbers of patients showing a good overall response to the two therapies at 48 hours. However, at Day 7 significantly more patients were clinically improved or cured after receiving Augmentin as opposed to those taking cefuroxime/cephalexin.

There were no significant differences between treatment groups when analysed by indication or by key sign or symptom.

At the start of treatment bacterial organisms were isolated from the sputum of 29/87 (33 per cent) of patients who received Augmentin and from 19/48 (40 per cent) of patients producing sputum who received cefuroxime. Both treatment regimens proved effective against the organisms isolated at the start of treatment. At the end of treatment all of these organisms had been eradicated by Augmentin and 91 per cent had been eradicated by the cefuroxime/cephalexin regimen.

Both treatments were well tolerated, with no significant difference between treatments in the small number of adverse events noted.

Augmentin and cefuroxime have been shown to be similarly effective and well tolerated treatments for chest infection. In addition, it is shown that Augmentin has advantages in terms of speed of response and it is available as both intravenous and oral formulations. Thus, Augmentin would be a suitable first choice antibiotic for the treatment of lower respiratory tract infections.
Effect of 1 % mandelic acid as a bladder irrigation fluid in patients with in‐dwelling catheters
Authors: Robertson M H , Norton M S
Published: April 2023

The effect of 1% mandelic acid bladder washouts on 40 patients who were using in‐dwelling catheters was studied.

The procedure appeared to benefit those colonised with Pseudomonas species but not those colonised with Proteus species. The subject of bladder irrigation is briefly reviewed.
Rapid response to budesonide (Pulmicort) inhaled via the Nebuhaler in asthmatic children
Authors: McCarthy T P
Published: April 2023

Acute reversible airways obstruction in children, especially those aged under one year, who may respond poorly to inhaled beta2‐stimulants, is difficult to treat in general practice. In an open study, 48 episodes in 29 children, half aged under one year, were treated with budesonide (Pulmicort) 0.1–2.09 mg used to charge a Nebuhaler fitted with a face‐mask. In 45 instances, clinical improvement was observed, and with doses of 0.8 mg and above, this usually occurred within 10 minutes. This study suggests that budesonide via a suitable delivery system can evoke rapid improvement in reversible airways obstruction in young children.
The acute effect of the synthetic prostacyclin analogue iloprost in primary pulmonary hypertension
Authors: Scott J P , Higenbottam T , Work J Wall
Published: April 2023

Twelve patients with severe primary pulmonary hypertension and pronounced disability unresponsive to oral vasolidators were assessed as to their suitability for heart‐lung transplantation. During routine right heart catheterisation, intravenous infusions of both prostacyclin (PG12) and its synthetic analogue, iloprost (IL), were given in random order. The dose of each drug was increased whilst the improvements in cardiac output (Q) and pulmonary vascular resistance (PVR) were recorded. The maximum rate of each infusion was determined by the onset of side effects or a fall in mean systemic blood pressure of more than 20 per cent. The mean maximum dose of PG12 was 6 + 2 ng/kg/min and that of IL 3.4 ± 1.8 ng/kg/min, and both infusions achieved similar haemodynamic effects.

In this open, randomised study, intravenous IL was as effective as prostacyclin in lowering PVR, but with a lower infused dose. Iloprost may have an important role in the acute assessment of patients with primary pulmonary hypertension, and when available for prescription should be assessed as an alterative long‐term intravenous vasodilator to prostacyclin.
Large bowel obstruction due to metastatic breast cancer: an unusual presentation of recurrent disease
Authors: Eyres K S , Sainsbury J R C
Published: April 2023

Two cases of large bowel involvement from metastatic breast cancer are presented. The literature is reviewed and the clinical implications are discussed.
Neuroleptic malignant syndrome in a girl without psychosis
Authors: Thacker A K , Radhakrishnan K , Maloo J C , Bohlaga N H
Published: April 2023

We report a successfully managed case of neuroleptic malignant syndrome in which the diagnosis was delayed by one week because of the absence of an established psychiatric disease. A high degree of clinical suspicion must be maintained if the diagnosis of this rare, curable but often fatal, complication of neuroleptic therapy is not to be missed.
A DOUBLE‐BUND PLACEBO‐CONTROLLED TRIAL OF THEOPHYLLINE IN GENERAL PRACTICE
Authors: Neville R G , Crombie I K , McDevitt D G
Published: April 2023

SUMMARY Patients with moderate to severe asthma, from two urban general practices, entered a double‐blind randomised placebo‐controlled crossover trial of sustained‐release theophylline versus placebo. Theophylline was given in therapeutic dosage (to ensure serum levels of between 10 and 20 μg/ml) for two months, followed by two months of placebo or vice versa. The results from the 24 patients who entered both theophylline and placebo treatment arms were compared, using outcome measures relevant to general practice care. Theophylline is shown to be of value in the management of asthma in general practice.
PATIENTS' PREFERENCES FOR THE SITE OF INJECTION OF LOW‐DOSE SUBCUTANEOUS HEPARIN IN PROPHYLAXIS OF THROMBOEMBOLISM. REGIONAL ACUPHOBIA
Authors: Patel K S
Published: April 2023

SUMMARY The efficacy of low‐dose subcutaneous heparin in the prophylaxis of deep vein thrombosis and pulmonary embolism is now well established.1–3 The most common complication of heparin administration is haematoma formation, especially at the site of injection.

A number of patients were noted to have injection site haematoma in the deltoid region: after close inquiry it was found that these patients had refused injections in the anterior abdominal wall in the belief that these would be more painful than the upper arm. A study was set up to determine the prevalence of regional acuphobia.
PRESSURISED AEROSOL INHALERS: THE COST OF MISUSE
Authors: King D , Earnshaw S M , Delaney J C
Published: April 2023

SUMMARY Bronchodilator aerosols, if used correctly, have many advantages over other therapies in patients with chronic airflow limitation caused by asthma or chronic bronchitis. The use of pressurized aerosol inhalers was examined in a district general hospital: of 57 patients on these inhalers, 39 were unable to use the inhaler effectively, and 23 had never received any advice on inhaler technique. A single demonstration of correct technique decreased the failures to 21 patients and, after two demonstrations, to ten. The cost of the misused inhalers in this relatively small population was £450, and obviously this figure escalates when the prescription for these inhalers is repeated monthly. It is also increased when the total numbers of misused inhalers in the country are accounted for. The cost in terms of finance, in these days of medical audit and drug budgets, and, more importantly, in terms of patient health, is unacceptable and can be avoided by repeated tuition of technique.
THE LONG‐TERM SAFETY AND TOLERABILITY OF TRANSDERMAL GLYCERYL TRINITRATE, WHEN USED WITH A PATCH‐FREE INTERVAL IN PATIENTS WITH STABLE ANGINA
Authors: Wainwright R J , Foran J P M , Padaria S F , Akhras F , Jackson G , Clark A R
Published: April 2023

SUMMARY The safety and tolerability of intermittent (16 hours on/8 hours off) nitrate patch therapy (0.2, 0.4 or 0.6 mg/hr: dose adjusted as required) was studied for a median duration of 356 days in 106 patients (mean age 60.9 ±8.6 years) with angina pectoris. Most patients (82%) were on existing beta‐blocker and/or calcium antagonist therapy. Safety, tolerability and efficacy data were obtained by means of patient diary cards and regular clinic visits.

Almost 90 treatment years revealed no significant or serious adverse events, and there were no changes in haematology or biochemistry associated with intermittent nitrate patch therapy. The most frequently reported side‐effects were headache, skin reactions and dizziness (53%, 20% and 8% of patients respectively). Treatment resulted in a sustained reduction in the frequency and severity of angina attacks, reduced sublingual GTN consumption, an improvement in general wellbeing and a rise in the proportion of patients in whom angina was controlled.
OCCULT MALIGNANCY IS ASSOCIATED WITH VENOUS THROMBOSIS UNRESPONSIVE TO ADEQUATE ANTICOAGULATION
Authors: Adamson D J A , Currie J M
Published: April 2023

SUMMARY The increased incidence of intravascular thrombosis and thromboembolic episodes in patients with malignant disease is well documented.1–7 There have, however, been only two reports of covert malignancy in patients who continue to extend their deep vein thrombosis despite apparently adequate anticoagulation.1,8 Three patients are described in whom venous thrombosis steadily worsened despite a prothrombin time of at least twice normal. None had either obvious predisposing factors to thromboembolism or a family history of thrombotic disease. Recognition of this phenomenon can be helpful in avoiding delay in diagnosing malignancy in young patients.
VENEPUNCTURE CAUSES RAPID RISE IN PLASMA ACTH
Authors: Meeran K , Hattersley A , Mould G , Bloom SR
Published: April 2023

SUMMARY Serum cortisol and adrenocorticotropin (ACTH) levels were measured on nine sleeping volunteers at midnight, before and after the stress of being woken and exposed to a single standard venepuncture. In six volunteers, plasma ACTH levels were raised within 90 seconds of venepuncture, while it remained undetectable in the other three. Cortisol levels began to rise within 4 minutes. ACTH and cortisol levels may be greatly altered by the stress of venesection. Plasma ACTH measured after a difficult venesection in a subject with poor venous access may be misleading.
THE SURGICAL TREATMENT OF HYPERPARATHYROIDISM: A REGIONAL HOSPITAL EXPERIENCE
Authors: Rowley H , Kaar K , O'Sullivan S , Brady MP
Published: April 2023

SUMMARY Parathyroidectomy is an established surgical treatment for symptomatic hyperparathyroidism. In this regional hospital experience, 50 patients who had undergone a parathyroidectomy were looked at. We examined clinical indications and noted trends for hypertension, neuromuscular symptomatology and psychiatric complaints to occur commonly as presenting symptoms. Operative results and histology results are examined and correlated. Particular note is made of any postoperative complications.
POST‐MARKETING SURVEILLANCE OF LISINOPRIL IN GENERAL PRACTICE IN THE UK
Authors: Fallowfield JM , Blenkinsopp J , Raza A , Fowkes AG , Higgins TJC , Bridgman KM
Published: April 2023

SUMMARY A total of 4676 patients and 1759 patients were treated with lisinopril and nifedipine respectively in a post‐marketing surveillance study conducted in general practice in the UK. Patients were followed up for 12 months. Most of the lisinopril patients had hypertension, but a small number (180) had heart failure. Most of the nifedipine patients had uncomplicated hypertension, but some (22.57%) had other cardiovascular disease with or without hypertension. Lisinopril and nifedipine were equally effective in reducing blood pressure. During the study, 1.5% of hypertensive patients assigned to lisinopril died compared with 1.8% of patients assigned to nifedipine, and 15.1% of lisinopril patients compared with 19.7% of patients in the nifedipine group withdrew because of adverse events. Cough, malaise and fatigue, nausea and vomiting were more frequent causes of withdrawal from lisinopril than nifedipine. Conversely, headaches, pallor and flushing, oedema and palpitations caused more frequent withdrawals from nifedipine. Anaemia was more often encountered on nifedipine treatment than on lisinopril. In hypertensive patients, the frequency of first‐dose hypotension was similar on both treatments. Serious events occurred in 0.8% and 0.5% of patients given lisinopril and nifedipine respectively. Lisinopril was well tolerated by heart failure patients: 16 patients (8.88%) died and an incidence of 4.44% of serious adverse events was reported, a pattern to be anticipated in such patients; dizziness, giddiness, dyspnoea, cough, nausea and vomiting were the most frequent causes of withdrawal; the incidence of first‐dose hypotension was low (2.22%). Overall, this survey found no adverse events not already recognised in controlled clinical trials, and shows lisinopril to be an effective and well‐tolerated treatment for hypertension and heart failure.
VARYING THROMBOLYTIC ADMINISTRATION RATES IN ELDERLY PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
Authors: Farnsworth TA
Published: April 2023

SUMMARY Receipt of thrombolytic therapy in patients aged 75 or over with proven acute myocardial infarction admitted initially to either the coronary care unit (CCU) or a geriatric medical ward (GMW) was studied retrospectively in a hospital administering thrombolysis only in the CCU. Mean age and age distribution of patients admitted to each unit initially showed no significant difference. Of 50 patients admitted directly to the CCU, 28 (56%) received thrombolysis, compared with 13 of 50 (26%) GMW admissions (P<0.02). Of 37 GMW admissions, 14 (38%) failed to receive thrombolysis without documented contraindication compared with 2 of 22 (9%) CCU admissions (P<0.05). Aspirin was administered in 39 (78%) CCU and 31 (62%) GMW admissions (P<0.05). Non‐administration of aspirin without apparent contraindication occurred in 3 of 11 (27%) compared with 8 of 19 (42%) GMW admissions (NS). Elderly patients thus failed to receive thrombolytic therapy as a result of initial admission to a unit unable to administer this treatment.
PENICILLIN ALLERGY: A STUDY OF INCIDENCE AS REPORTED BY PATIENTS
Authors: Kerr JR
Published: April 2023

SUMMARY To assess the incidence of penicillin allergy as reported by patients to doctors, a 5‐month study was undertaken in a university teaching hospital. The study design was prospective, and included all hospital patients for whom advice on clinical management was given by one bacteriology registrar and in whom the previous response to penicillin was considered. Of the 271 patients included in the study, 21 reported penicillin allergy. The most commonly reported symptom was localised rash (8 cases), followed by unknown reaction symptoms (6), nausea with or without vomiting (3), generalised itchy rash with difficulty in breathing (3), and localised rash with chest pain (1). Three of 21 cases reported generalised rash with difficulty in breathing; two of these followed intravenous penicillin administration. If the three cases of generalised itchy rash with difficulty in breathing are taken as true type‐1 hypersensitivity to penicillin, the incidence of this was 1.11% (3 of 271), and the incidence of true allergy among patient‐reported allergy was 14.3% (3 of 21). In two cases of reported penicillin allergy a penicillin was administered for treatment of the current infection, despite the history and without any ill‐effects. Penicillins are non‐toxic and inexpensive and, despite the number of alternatives for antibacterial therapy, are still the treatment of choice for many infections. More attention should therefore be paid to details of the clinical history relating to penicillin allergy with a view to decreasing the number of patients labelled ‘penicillin‐allergic‘.
HYPOKALEMIA IN THE ELDERLY: IS IT ALWAYS DIURETIC‐INDUCED?
Authors: Nasar MA , Lyle EM
Published: April 2023

SUMMARY Serum potassium was measured within 24 hours in 156 patients (48 male, 108 female) with an average age of 81.9 years admitted to the unit with acute illness. Of the 156 patients, 88 (56.4%) were taking diuretics (none was on ACE inhibitors); 20 patients (12.8%) were also on digoxin therapy. In all, 24 patients (16%) had hypokalaemia and 3 (2%) hyperkalaemia. Hypokalaemia was seen in patients associated with acute illness. There was no significant difference between the diuretic and non‐diuretic groups. Monitoring of serum potassium is not routinely indicated to detect hypokalaemia in patients on diuretic therapy except in those with severe hepatic or renal impairment or those on digoxin.
CLINICAL FEMINISATION AND SEX HORMONE CONCENTRATIONS IN NIGERIAN MEN WITH CIRRHOSIS WITH AND WITHOUT HEPATOCELLULAR CARCINOMA
Authors: Olubuyide IO
Published: April 2023

SUMMARY The study explored the incidence of clinical feminisation and the sex hormone levels of 18 Nigerian patients with liver cirrhosis (LC) alone and 18 patients with LC and hepatocellular carcinoma (HCC). The incidence (11%) of clinical feminisation in Nigerian patients was lower than values reported from other countries and there was no association between feminising signs and the sex hormone levels of the patients. Plasma oestradiol and sex hormone‐binding globulin (SHBG) levels were significantly higher and testosterone lower in patients with liver diseases than in 18 age‐matched normal controls. Serum concentrations of oestradiol were also found to be significantly higher in patients with LC alone than in those with LC and HCC. A possible promotive role for oestrogens in the development of HCC from the cirrhotic liver is discussed.
UNRECOGNISED ARTERIAL INJURY OF THE FOREARM: A SECONDARY BLEED PRESENTING AS ACUTE COMPARTMENT SYNDROME
Authors: Payne SPK , Eckersley JRT
Published: April 2023

SUMMARY This case describes an arterial injury that remained unrecognised for 3 days, when a sudden secondary bleed caused acute compartment syndrome of the forearm. We have been unable to find another case of compartment syndrome presenting in this manner. The importance of thorough wound exploration is highlighted and the diagnosis and treatment of the syndrome discussed.
RUDIMENTARY SECOND STOMACH AS ADRENAL INCIDENTALOMA
Authors: Stumvoll M , Schmülling R‐M , Brambs H‐J , Wehrmann M , Eggstein M
Published: April 2023

SUMMARY We present the case of an adrenal incidentaloma of considerable size which turned out to be a stomach‐like diverticular mass, probably a malformation arising from the embryonic foregut. We discuss whether results possibly obtained by extensive and costly investigative techniques would have changed the management.
HAEMATOMYELIA FOLLOWING WARFARIN THERAPY
Authors: Liebeschuetz S , Baddeley H , Thomas DJB
Published: April 2023

SUMMARY Perispinal haemorrhage is a rare but serious complication of anticoagulation therapy, and should be considered in patients presenting with sudden pain in the back or neck, with or without neurological signs.
PHARMACOLOGICAL TREATMENT OF BENIGN PROSTATIC HYPERPLASIA
Authors: Pascual J , Woodhouse K
Published: April 2023

SUMMARY Although surgery remains the standard treatment for benign prostatic hyperplasia there has been a rise in the number of available drugs for this condition. The current drug therapies appear to be useful for symptomatic short‐term treatment, particularly for those patients unfit or unwilling to undergo surgical intervention. Further evaluation of the long‐term effects of these treatments and their role in early disease is required, but drug therapy is likely to play a more important part in the management of this condition in the future.
CHOLANGIOCARCINOMA ASSOCIATED WITH HYPERCALCAEMIA AND ASCITES PRESENTING AS SCLEROSING CHOLANGITIS
Authors: D'Costa DF
Published: April 2023

SUMMARY This report tells of a patient presenting with apparent primary sclerosing cholangitis which turned out to be a cholangiocarcinoma. The patient also had ascites and hypercalcaemia, both of which have not been described before in association with cholangiocarcinoma.
A ONE‐YEAR MULTICENTRE STUDY OF SIMVASTATIN IN THE TREATMENT OF HYPERCHOLESTEROLEMIA
Authors:   The UK and Eire Simvastatin Study Group
Published: April 2023

SUMMARY A 1‐year prospective study was conducted in 475 hypercholesterolaemic men and women who received simvastatin monotherapy 10–40 mg daily for 3 months followed by additional lipid‐lowering medication after this period, if necessary, to reach a target of plasma cholesterol <5.3 mmol/l. Of these, 403 subjects completed 1 year of follow‐up. By the end of the 3‐month monotherapy period, the following percentage mean changes were seen (with 95% confidence intervals): total cholesterol (TC) ‐31% (‐30 to ‐32%), low‐density lipoprotein cholesterol ‐39% (‐38 to ‐40%), triglycerides ‐14% (‐11 to ‐17%) and high‐density lipoprotein cholesterol +12% (+11 to +14%). These levels were maintained for the remainder of the study. When subjects with a baseline TC of 6.5–7.8 mmol/l were considered (n=89), 42.7% achieved the target TC levels on simvastatin monotherapy alone. Additional hypolipidaemic medication had no significant impact on plasma lipid and lipoprotein levels. Simvastatin was well tolerated both as monotherapy and in combination.
A MULTICENTRE STUDY TO COMPARE THE THERAPEUTIC EFFICACY OF SUSTAINED‐RELEASE DILTIAZEM AND ENALAPRIL IN THE TREATMENT OF PATIENTS WITH MILD TO MODERATE HYPERTENSION
Authors: Weir RJ , Lee PS , Clegg DS , Hemingray S , Belgrave GP , Walters E
Published: April 2023

SUMMARY A 14‐week study was conducted in order to compare the efficacy and tolerability of a twice‐daily sustained‐release diltiazem preparation (120 or 180 mg) and once‐daily enalapril (10 or 20 mg). Patients not achieving an adequate response after 6 weeks on monotherapy were given a combination therapy of twice‐daily diltiazem 120 mg and once‐daily enalapril 10 mg. Of the 147 patients admitted to the study, 70 received diltiazem and 77 received enalapril; 17 patients subsequently received combination therapy. Blood pressure reductions in patients completing 12 weeks of therapy were (sitting values): diltiazem 120 mg, 10.2/15.2 mmHg; diltiazem 180 mg, 19.1/14.7 mmHg; enalapril 10 mg, 25.7/17.5 mmHg; enalapril 20 mg, 19.6/14.0 mmHg; and combination therapy, 24.6/15.1 mmHg. No significant differences in the incidence level of individual symptoms were seen between the two groups: 34 (49%) in the diltiazem, 37 (48%) in the enalapril group; and, between weeks 6 and 12, 9 (53%) patients taking combination therapy. Two patients withdrew from the enalapril group and 8 from the diltiazem group. No unexpected side‐effects were seen during the study and no deaths occurred in any treatment group. Twice‐daily sustained‐release diltiazem 120 or 180 mg was shown to be an effective antihypertensive agent and equal in efficacy and patient acceptability to once‐daily enalapril 10 or 20 mg. Combination therapy effectively lowered blood pressure in patients in whom monotherapy was ineffective.
FOLLICULAR CARCINOMA OF THYROID PRESENTING AS BACK PAIN LEADING TO A DELAY IN DIAGNOSIS
Authors: Simpson H , Orr DJ , John PJ , Wilson K , Braidwood AS
Published: April 2023

SUMMARY The case is described of a 53‐year‐old man presenting with right‐sided low back and thigh pain. Non‐urgent investigations showed a metastatic lesion in his right hemipelvis arising from a thyroid primary.
AN UNUSUAL PRESENTATION OF GAS GANGRENE COMPLICATED BY PENICILLIN ALLERGY
Authors: Woo P‐L , Eastaway A , Soutar DS
Published: April 2023

SUMMARY A case is reported of non‐clostridial gas gangrene that presented in a similar way to deep venous thrombosis and then developed into septic shock. Management was complicated by penicillin allergy.
SIGMOIDOSCOPY SERVICE IN A DISTRICT GENERAL HOSPITAL: OPEN‐ACCESS VERSUS HOSPITAL‐REFERRED
Authors: Shakil AO , Ellis A , Faizallah R , Cochrane AMG
Published: April 2023

SUMMARY In a retrospective analysis of open‐access versus hospital‐referred flexible sigmoidoscopies, the two groups are compared with reference to the demographic data, presenting symptoms, sigmoidoscopy findings and diagnostic yield. Overall, 1090 patients underwent sigmoidoscopy during 12 months, 544 in the open‐access and 546 in the hospital‐referred group. There was a preponderance of females in both groups, but patients in the hospital‐referred group were older. Diarrhoea was the most common presenting symptom, followed by rectal bleeding. Significantly more patients presented with rectal bleeding with or without diarrhoea and abdominal pain in the open‐access group, while there were more patients with iron deficiency in the hospital‐referred group. The number of patients with colonic carcinoma was similar in the two groups, but significantly more early carcinomas were found in the open‐access group. There were significantly more patients with haemorrhoids in the open‐access group. The positivity rate was similar in the two groups (52% in the open‐access vs 46% in the hospital‐referred group). Of the 24% of patients 40 years or under, none had carcinomas. In this age range the positivity rate was no different in the two groups (32% in the open‐access vs 23% in the hospital‐referred group). The diagnostic yield of open‐access flexible sigmoidoscopy is thus comparable to hospital‐referred sigmoidoscopy, suggesting that it should be freely available to GPs.
DIEULAFOY HAEMORRHAGE IN ASSOCIATION WITH POLYCYTHAEMIA RUBRA VERA
Authors: Lear JT , Atherton MT , Weston P
Published: April 2023

SUMMARY A case is described of massive Dieulafoy haemorrhage associated with polycythaemia rubra vera, an association not previously reported.
THE USE OF LONG‐TERM ACID‐SUPPRESSION THERAPY
Authors: Rubin GP , Contractor B , Bramble MG
Published: April 2023

SUMMARY Drug therapy to suppress gastric acid secretion is commonly used in the management of dyspepsia, many patients taking such therapy over long periods of time. An audit of patients on long‐term (>12 months) acid‐suppression therapy was carried out in the two practices providing primary healthcare to a town in Northeast England. Patients on continuous therapy (>10 months' supply in the previous year) and intermittent therapy (6‐10 months' supply in the previous year) were identified through computerised prescribing records. Their written and computer records were scrutinised to determine diagnosis, duration of therapy, use of NSAIDs and other features. A total of 365 patients were identified (208 men, 157 women): 132 were on intermittent and 233 on continuous therapy. Of the total, 83% were over 45 years and one‐fifth were taking NSAIDs. Of the 310 patients investigated for their dyspepsia, only 250 had a positive diagnosis, of which duodenal ulcer (154) was the most common.
CURRENT ASPECTS IN THE MANAGEMENT OF PNEUMONIA
Authors: Woodhead M
Published: April 2023

SUMMARY Changes are occurring in our approach to the management of patients with pneumonia due to changes in our understanding of the pathogenesis of pneumonia, changes in the causative pathogens, and changes in the investigative techniques and therapies available. This article reviews the management of patients with pneumonia, highlighting some of these areas.
PITUITARY MICROADENOMA IN TURNER'S SYNDROME
Authors: Pejaver RK , Watson AH
Published: April 2023

SUMMARYA case of Turner's syndrome with a pituitary microadenoma is reported. Various implications of the diagnosis are discussed.
PHARMACOLOGICAL THERAPY FOR ACUTE STROKE: THE FUTURE
Authors: Panayiotou BN , Fotherby MD
Published: April 2023

SUMMARY Stroke is a major cause of mortality, morbidity, and resource consumption. To reduce this burden, enormous efforts have focused on the development of drugs to limit brain damage. However, a breakthrough has not yet materialised, and data suggest that even if future drug trials do demonstrate a benefit, the overall impact of such drugs will be relatively limited. The pathophysiology of stroke is too complex to be markedly influenced by interruption of one or two components of the ischaemic cascade; intervention needs to be very soon post‐stroke; and multiple pre‐existing diseases and disabilities in elderly patients diminish their scope for recovery. In contrast, wider application of primary prevention, secondary prevention, and better organisation of services (eg setting up stroke units), could have a far greater effect on public health. Despite considerable enthusiasm for drug therapy in acute stroke, it is likely that the overall potential of such therapy will be disappointing.
HYPERCALCAEMIA IN AN IMMOBILISED PATIENT WITH PNEUMONIA
Authors: Mark S
Published: April 2023

SUMMARY Hypercalcaemia is a serious complication of sepsis and prolonged immobility. Hormonal, humoral and mechanical factors play a complex role in its development. Because hypercalcaemia is associated with a significant increase in morbidity and mortality, early treatment is recommended. Pamidronate is an effective pharmacological agent and should be considered as primary therapy for this syndrome.
APPENDICEAL MASS: INTERVAL APPENDICECTOMY SHOULD NOT BE THE RULE
Authors: Adalla SA
Published: April 2023

SUMMARY Appendicitis is the most common acute abdominal condition in Libya. Delay can result in the presentation of a patient with generalised peritonitis or an appendiceal mass. Clinical diagnosis of an appendix mass was made in 30 patients over three years at the Central Hospital: three required emergency appendicectomy within 48 hours of diagnosis, and another two had an elective appendicectomy for recurrent right iliac fossa pain two and three months after presentation, respectively. The remaining 83%, who were followed up for six months to three years (mean 15.5 months), did not require surgical intervention. An appendiceal mass should no longer be regarded as an indication for interval appendicectomy.
AUDIT OF PATIENT ACCEPTANCE OF NASAL SURGERY AS A DAY CASE PROCEDURE
Authors: Tierney PA , Samuel D , Patel KS , Thomas DM
Published: April 2023

SUMMARY A greater emphasis on day case surgery within the health service is seen as a method of improving efficiency and reducing expenditure. We interviewed 90 consecutive patients undergoing nasal surgery who had been preoperatively assessed as being fit for day case surgery. They were randomised into three groups regarding the duration of postoperative nasal packing. All patients stayed overnight following surgery and were interviewed prior to discharge. Some 52% of the overall sample would be happy to have nasal surgery performed as a day case. If the nasal pack was removed after two hours, this figure rose to 67%. This difference in patient acceptance did not attain statistical significance overall, but there was a significant difference in those undergoing submucosal resection. There was no difference in the age, sex distribution or type of surgery performed between each group. The audit commission quotes patient satisfaction with day case surgery at 80%. Nasal surgery was not examined in their report, but was included as one of a set of procedures suitable for consideration. Although day case nasal surgery may be safe, further research regarding patient acceptance is required.
INSTANT LITHIUM MONITORING: A CLINICAL REVOLUTION IN THE MAKING
Authors: Srinivasan DP , Birch NJ
Published: April 2023

SUMMARY The recent availability of portable ion selective electrodes (ISE) for clinical applications has enabled lithium estimations to be performed instantly and at close proximity to patients. The significance of this is, not in the accuracy of the determination, but in the speed of the feedback provided to doctor and patient, and hence the promotion of compliance. The impact of this on lithium therapy can only be described as a clinical revolution in the making.
FIXED DOSE COMBINATIONS OF ACE INHIBITORS
Authors: Rangoonwala B , Schulz W , Bauer B
Published: April 2023

SUMMARY First‐line antihypertensive monotherapy is effective in reducing blood pressure to within the normal range in approximately 50% of patients. Normalisation in the remaining patients may require a combination of two or more drugs. This review considers the clinical efficacy and tolerability of combinations involving angiotensin‐converting enzyme (ACE) inhibitors. The efficacy of combinations with diuretics or calcium antagonists, as initial therapy or in patients with inadequate responses to monotherapy, has been demonstrated in many trials. With combination therapy, normalisation rates approaching 80% can be achieved using submaximal doses of both components. Therapy with both combinations is well tolerated; with ACE inhibitors reducing the diuretic metabolic effects or counteracting some calcium antagonist‐associated vasodilatory effects. Data on ACE inhibitors with beta‐blockers are limited. When patients respond inadequately to first‐line monotherapy, the increasing availability of drug combinations will allow individual selection of the most appropriate combination, taking account of additional risk factors and concomitant disease.
PREVENTION OF BOTH OSTEOPOROSIS AND CORONARY HEART DISEASE IN PRIMARY CARE
Authors: Waine C
Published: April 2023

SUMMARY This review describes the importance of both osteoporosis and CHD as causes of morbidity and mortality, and emphasises the commonality of risk factors for the development of both conditions. On the basis of this information, an approach to preventing both diseases is outlined — population‐based and personal, as delivered by primary care teams. HRT is seen to have a key role, but the importance of tackling lifestyle issues is also stressed.
MUSICAL HALLUCINATIONS ASSOCIATED WITH RECURRENCE OF A RIGHT OCCIPITAL MENINGIOMA
Authors: Nagaratnam N , Virk S , Brdarevic O
Published: April 2023

SUMMARY The case of an 84‐year‐old woman who experienced musical and visual hallucinations after recurrence of a right occipital meningioma is reported.
TUBERCULOUS PAROTITIS: TWO CASES IN LIBYAN PATIENTS
Authors: Adalla SA , Garmole B
Published: April 2023

SUMMARY Two patients with tuberculous parotitis are described. This condition is rare, and has not previously been recorded in Libya. Unilateral tuberculous parotitis is clinically indistinguishable from a parotid tumour, and imaging techniques may also fail to reveal the true diagnosis. If other features point to tuberculous parotitis, fine needle aspiration allowing bacteriological confirmaton is the most useful investigation.
PRACTICAL MANAGEMENT OF PRIMARY VARICOSE VEINS
Authors: Houghton AD , Panayiotopoulos Y , Taylor PR
Published: April 2023

SUMMARY Varicose veins cause a great deal of morbidity in our population today. Despite the large amount of surgical time spent dealing with the problem, there is still a disappointingly high recurrence rate and many patients are investigated inadequately before surgery. This review considers the assessment of ‘simple’ varicose veins using a combination of tourniquet tests and a hand‐held doppler probe. The place of more sophisticated investigative techniques is also discussed, in particular the value of duplex assessment in localising the variably sited sapheno‐popliteal junction. Routine stripping of the long saphenous vein to the below‐knee level is likely to decrease the recurrence rate of simple, long, saphenous varicose veins.
COMMUNITY‐ACQUIRED LOWER RESPIRATORY TRACT INFECTION: IMPLEMENTATION OF AN ANTIBIOTIC PROTOCOL
Authors: Menown IBA , Archbold JAL , Bamford KB , Bell PM , Callender ME
Published: April 2023

SUMMARY Enthusiastic formulation of clinical guidelines continues to increase but although theoretical difficulties in guideline implementation have been recognised, little attention has been paid to their effectiveness in everyday clinical practice. The introduction of a protocol for empirical treatment of lower respiratory tract infection (PETRI) to an acute medical take‐in unit in Belfast is described. Early involvement of all relevant staff, preparation of user‐friendly flow charts, and imaginative publicity, resulted in an initial implementation rate of 75%. The role of implementation as a significant rate‐limiting step in the audit cycle is emphasised.