bluuebunny/crossref_metadata_2025 huggingface dataset:
Relative importance of meso‐ and microhabitat features in the within‐reach spatial distribution of size‐structured fish assemblages in small streams
Authors: Maroda Ágnes , Sály Péter
Published: April 2023

This study aimed to explore the relative importance of mesohabitat and microhabitat features, as well as the spatial and within‐day temporal covariates, on the body size‐related within‐reach spatial distribution of stream‐dwelling fishes in a highland‐type and a sub‐mountainous‐type stream in Central Europe. During daytime, point abundance sampling was applied to catch the fish, and environmental data were recorded at the sampling points (microhabitat features) and along the transects that crossed the sampling points (mesohabitat features). Variance partitioning revealed similar patterns in the size‐classified fish data for the two streams. Microhabitat features had a greater explained variance than mesohabitat features. The majority of the mesohabitat influence emerged as variance shared with the microhabitat influence. The pure spatially explained variance proportion was lower than the variance explained purely by the environmental features (meso and micro together), and no temporally explained variance was found. Many species showed body size‐related environmental associations. The results suggest that the different‐scale habitat features act in a hierarchical way on the within‐reach fish distribution. Meso‐scale features may determine a great proportion of the micro‐scale habitat variability and micro‐scale conditions may directly affect how fish select places to stay as a function of both species identity and body size. The restoration of meso‐scale environmental diversity can effectively contribute to the protection of size‐structured populations in sub‐mountainous and highland streams.
miRNA implication in the pathogenesis and the outcome of Tunisian endemic pemphigus foliaceus
Authors: Khabou Boudour , Fakhfakh Raouia , Tahri Safa , Bahloul Emna , Hadj Kacem Hassen , Belmabrouk Sabrine , Hachicha Hend , Sellami Khadija , Turki Hamida , Masmoudi Hatem , Abida Olfa
Published: April 2023

Pemphigus foliaceus (PF) is a bullous autoimmune skin disease diagnosed through sera and skin analyses. PF severity is associated with maintained anti‐Dsg1 sera levels and its prognosis is unpredictable. MicroRNA (miRNA), dynamic regulators of immune function, have been identified as potential biomarkers for some autoimmune diseases. This study aimed to assess the miRNA expression of miR‐17‐5p, miR‐21‐5p, miR‐146a‐5p, miR‐155‐5p and miR‐338‐3p using quantitative real‐time PCR in peripheral blood mononuclear cells (PBMC) and lesional skin samples from untreated and treated PF patients (both remittent and chronic) over 3 months. Overall, miRNA expression was significantly higher in PBMC than in biopsy samples. Blood miR‐21 expression was increased in untreated patients compared to controls and had a diagnostic value with an AUC of 0.78. After 6 weeks, it decreased significantly, similar to anti‐Dsg1 antibodies and the PDAI score. In addition, a positive correlation was observed between cutaneous miR‐21 expression and the disease activity score. Conversely, cutaneous expressions of miR‐17, miR‐146a and miR‐155 were significantly higher in treated chronic patients compared to remittent ones. The cutaneous level of miR‐155 positively correlated with pemphigus activity, making it a potential predictive marker for patients' clinical stratification with an AUC of 0.86.These findings suggest that blood miR‐21 and cutaneous miR‐155 can be used as supplemental markers for PF diagnosis and activity, respectively in addition to classical parameters.
Phosphatidic acid: from biophysical properties to diverse functions
Authors: Zhou Hejiang , Huo Yanwu , Yang Na , Wei Taotao
Published: April 2023

Phosphatidic acid (PA), the simplest phospholipid, acts as a key metabolic intermediate and second messenger that impacts diverse cellular and physiological processes across species ranging from microbes to plants and mammals. The cellular levels of PA dynamically change in response to stimuli, and multiple enzymatic reactions can mediate its production and degradation. PA acts as a signalling molecule and regulates various cellular processes via its effects on membrane tethering, enzymatic activities of target proteins, and vesicular trafficking. Because of its unique physicochemical properties compared to other phospholipids, PA has emerged as a class of new lipid mediators influencing membrane structure, dynamics, and protein interactions. This review summarizes the biosynthesis, dynamics, and cellular functions and properties of PA.
Plant influences on soil microbial carbon pump efficiency
Authors: Feng Xiaojuan , Wang Simin
Published: April 2023

Microbe‐mediated carbon transformation plays an important role in soil carbon sequestration, which is considered to be one of the key strategies to achieve carbon neutrality in the long term. Assessing the efficiency of microbial necromass accumulation relative to plant carbon input or microbial respiration will help to identify ways to promote soil carbon sequestration from an ecosystem perspective.
Contrasting ecosystem vegetation response in global drylands under drying and wetting conditions
Authors: Abel Christin , Abdi Abdulhakim M. , Tagesson Torbern , Horion Stephanie , Fensholt Rasmus
Published: April 2023

Increasing aridity is one major consequence of ongoing global climate change and is expected to cause widespread changes in key ecosystem attributes, functions, and dynamics. This is especially the case in naturally vulnerable ecosystems, such as drylands. While we have an overall understanding of past aridity trends, the linkage between temporal dynamics in aridity and dryland ecosystem responses remain largely unknown. Here, we examined recent trends in aridity over the past two decades within global drylands as a basis for exploring the response of ecosystem state variables associated with land and atmosphere processes (e.g., vegetation cover, vegetation functioning, soil water availability, land cover, burned area, and vapor‐pressure deficit) to these trends. We identified five clusters, characterizing spatiotemporal patterns in aridity between 2000 and 2020. Overall, we observe that 44.5% of all areas are getting dryer, 31.6% getting wetter, and 23.8% have no trends in aridity. Our results show strongest correlations between trends in ecosystem state variables and aridity in clusters with increasing aridity, which matches expectations of systemic acclimatization of the ecosystem to a reduction in water availability/water stress. Trends in vegetation (expressed by leaf area index [LAI]) are affected differently by potential driving factors (e.g., environmental, and climatic factors, soil properties, and population density) in areas experiencing water‐related stress as compared to areas not exposed to water‐related stress. Canopy height for example, has a positive impact on trends in LAI when the system is stressed but does not impact the trends in non‐stressed systems. Conversely, opposite relationships were found for soil parameters such as root‐zone water storage capacity and organic carbon density. How potential driving factors impact dryland vegetation differently depending on water‐related stress (or no stress) is important, for example within management strategies to maintain and restore dryland vegetation.
Explaining transgender policy change: Policy momentum in Canada and Australia
Authors: McMahon Nicole
Published: April 2023

Western democracies are experiencing a widespread shift towards greater recognition of transgender rights in public policy, yet the timing of change differs across states. To explain this variation, I present a novel theoretical framework called “policy momentum.” Unlike existing work on policy diffusion, which typically emphasizes domestic or international processes, I theorize how the combined pressure from each level creates the conditions for policy change to occur. Empirically, I contrast the creation of national human rights policies to protect transgender individuals in Canada (2017) and Australia (2013). Using process‐tracing and within‐case analyses, and drawing on elite interviews, primary documents, and Hansard records, I demonstrate the decisive interaction of subnational legislative changes with an emerging global norm to produce transgender policy change. This paper thus contributes to our understanding of LGBTQ+ public policy while also providing a framework for explaining the conditions for cross‐national policy change more broadly.
Association between vascular access type and depression in hemodialysis patients
Authors: Çora Ahmet Rıfkı , Çelik Ersin
Published: April 2023

Introduction

Hemodialysis is the most common treatment used for end‐stage kidney disease (ESKD) patients and an arteriovenous fistula (AV) fistula is the preferred vascular access. The goal of our study was to investigate potential associations between vascular access type and depression.

Methods

This was a cross‐sectional survey of 180 patients receiving maintenance hemodialysis. The Beck Depression Inventory was used to assess degree of depression. Demographic factors, treatment details, and laboratory values were obtained from the hospital medical record.

Findings

Fifty‐two percent (n = 93) of the patients were being dialyzed using an AV fistula and 48% (n = 87) via a tunneled cuffed catheter. No significant differences were found between access type use in terms of gender (p = 0.266), presence of diabetes, hypertension, or peripheral artery disease (p = 0.409, p = 0.323, p = 0.317; respectively). The prevalence of Beck Depression Inventory scores greater than 14 (marking presence of depression) was significantly higher in the patients being dialyzed with a tunneled cuffed catheters (61%) compared to patients dialyzed with an AV fistula (36%) (p = 0.001).

Discussion

We found statistically higher depression scores among patients receiving hemodialysis with a tunneled cuffed catheter.
Dots and spots: A retrospective review of T2‐hyperintense white matter lesions in pediatric patients with and without headache
Authors: Ackley Elizabeth , Asamoah Philip , Mirsky David , White Christina , Maloney John , Stence Nicholas , Silveira Lori , Yonker Marcy , Neuberger Ilana
Published: April 2023

Objective

We aimed to determine if T2‐weighted hyperintense white matter lesions (WMLs) on brain magnetic resonance imaging (MRI) occur more frequently in pediatric patients with migraine and other primary headache disorders compared to the general pediatric population.

Background

Small foci of T2 hyperintensity in the white matter are frequently identified on brain MRI during the workup of pediatric headache. Such lesions have been reported to be more common among adults with migraine versus adults without migraine; however, this association has not been well established in the pediatric population.

Methods

We performed a retrospective cross‐sectional single‐center study of electronic medical records and radiologic studies, examining pediatric patients from 3 to 18 years old who underwent brain MRI between 2016 and 2021. Patients with existing intracranial disease or abnormalities were excluded. Patients with reports of headache were categorized. Imaging was reviewed to determine the number and location of WMLs. Headache‐associated disability scores (Pediatric Migraine Disability Assessment) were noted, when available.

Results

Brain MRI of 248 patients with a diagnosis of headache (144 with migraine, 42 with non‐migraine primary headache, and 62 with headache that could not be further classified) and 490 controls were reviewed. WMLs were encountered commonly among all study participants, with a prevalence of 40.5% (17/42) to 54.1% (265/490). There was no statistically significant difference comparing the number of lesions between each of the headache groups and the control group: migraine group versus control group median [interquartile range (IQR)], 0 [0–3] versus 1 [0–4], incidence rate ratio [95% confidence interval (CI)], 0.99 [0.69–1.44], p = 0.989, non‐migraine headache group versus control group median [IQR], 0 [0–3] versus 1 [0–4], 0.71 [0.46–1.31], p = 0.156, headache not otherwise specified group versus control group median [IQR], 0 [0–4] versus 1 [0–4], 0.77 [0.45–1.31], p = 0.291. There was no significant correlation between headache‐associated disability and the number of WMLs (0.07 [−0.30 to 0.17], rho [95% CI]).

Conclusion

T2 hyperintense WMLs are common within the pediatric population and are not encountered more frequently in pediatric patients with migraine or other primary headache disorders. Thus, such lesions are presumably incidental and unlikely related to headache history.
Effects of performance management systems–strategy alignment on lecturers' engagement with knowledge transfer: A perspective from Spain
Authors: Barrachina‐Palanca Mercedes , Gonzalez‐Sanchez Maria Beatriz , Gutiérrez‐López Cristina
Published: April 2023

Growing competition among higher education institutions (HEIs) explains their increasing interest in reinforcing strategies by incorporating knowledge transfer (KT) objectives into their strategic plans. However, this strategic formulation must be aligned with the implementation of performance management systems (PMSs) to properly achieve KT objectives. Thus, the aim of this paper is to examine whether aligning PMSs with KT strategic objectives improves KT performance while misalignment worsens it. To that end, PMSs are measured with respect to planning; cybernetic control; policies and procedures and reward and compensation elements. KT is specified as R&D contracts, extended patents, patents and licences. With a sample of 3812 Spanish university lecturers, we test the theoretical positive and negative effects of PMS–KT strategy alignment and misalignment on KT performance respectively. The results show not only that this alignment is effective for KT strategy implementation but also that misalignment has unintended effects on the achievement of long‐term KT objectives. Therefore, lecturers' behaviour is influenced by how closely KT strategy and PMSs are aligned. The findings are useful for managers and academics to develop PMSs that effectively contribute to the achievement of universities' strategic goals.
Effect of laser power on microstructure and tribological performance of WC−10Co4Cr coating
Authors: Zhicheng Liu , Jiangzheng Shi , Chuang He , Fan Wang , Dejun Kong
Published: April 2023

In order to enhance wear resistance of cold work molds, WC−10Co4Cr coating was fabricated on Cr12MoV steel by laser cladding. The morphologies, chemical compositions, and phases of obtained coatings were analyzed using a scanning electron microscopy (SEM), energy disperse spectroscopy, and X−ray diffraction, respectively. The effect of laser power on the tribological performance was analyzed using a ball−on−plate friction machine, and the wear mechanism was also discussed. The results show that the WC−10Co4Cr coating is composed of WC and Co6W6C phases, and the average hardness of coating cross−sections fabricated at the laser power of 1200, 1500, and 1800 W was 1296, 1375, and 1262 HV0.5, respectively, in which that fabricated at the laser power of 1500 W is the highest among the three kinds of coatings. The average coefficients of friction of coatings fabricated at the laser power of 1200, 1500, and 1800 W are 0.61, 0.52, and 0.59, respectively; and the corresponding wear rates are 64.38, 35.38, and 123.92 μm3•N−1•mm−1, respectively, showing that the coating fabricated at the laser power of 1500 W has best friction reduction and wear resistance. The wear mechanism of WC−10Co4Cr coating is fatigue wear and abrasive wear, which is contributed to the increase of hard WC mass fraction.
Exploring the displacement induced changes in social convoys and support for older women in displacement (OWD) in Abuja, Nigeria
Authors: Ekoh Prince Chiagozie , Chukwuemeka Ejimakaraonye
Published: April 2023

The world is witnessing a dramatic increase in displaced persons in Africa, Asia, South America, and, most recently, Europe. Within this population of violence‐induced displacement are older women, a group that is mostly unseen because research and relief initiatives primarily target younger women and children. This study aimed to explore the changes in the convoys and support for older women in displacement (OWD). Qualitative data were collected from nine OWD using art‐based convoys of concentric circles and interviews. The collected data were analysed in themes, and findings revealed that while there has been intervention from formal organisations to fill the displacement‐induced support gap, supports are still limited, sporadic, not focused on the peculiar needs of OWD, not guided by any framework, and mainly material in design. The study concluded by recommending sustainable support to help OWD become empowered to cope effectively without aid.
Aleukaemic granulocytic sarcoma
Authors: Ifrah N , Saint‐Andre J P , Rousselet M C , Chretten M F , Fondimare A , Boasson M
Published: April 2023

A case of aleukaemic granulocytic sarcoma with bone and lymph node involvement is reported in a young man. It was initially misdiagnosed as an eosinophilic granuloma. Death occurred 13 months later with evidence of leukaemia arising a few days before the end‐stage of the disease. A review of the literature shows that these rare tumours are difficult to identify and to treat.
Comparative evaluation of cefotaxime and cephamandole in the prevention of post‐operative infective complications following emergency abdominal surgery
Authors: Ridley P D , Sagar S
Published: April 2023

In previous published work we described 57 patients undergoing emergency abdominal surgery, prospectively randomised to receive either cefotaxime or cephamandole as a single‐antibiotic, three‐dose, peri‐operative prophylaxis against post‐operative infective complications. This earlier work suggested that cefotaxime might be more effective than cephamandole in preventing wound sepsis in emergency abdominal surgery.

We describe here our findings in a further 63 patients undergoing emergency abdominal surgery who were similarly allocated into either a cefotaxime or cephamandole antibiotic group. Infective complications occurred in 12/32 (37 percent) of the cefotaxime group and 15/31 (48 per cent) of the cephamandole group. Wound infections occurred in 5/32 (16 per cent) of the cefotaxime group and 9/31 (29 per cent) of the cephamandole group. The organisms cultured and their sensitivities are discussed in detail.

The total of 120 patients studied in the two series showed wound infection to occur in 13 per cent of the 62 patients receiving cefotaxime and 30 percent of the 58 patients receiving cephamandole. This difference reaches statistical significance (p<0.05). Possible mechanisms to explain this finding are discussed.

Again we found the regime of 4 g of cefotaxime given peri‐operatively to be a simple, safe and effective single agent as prophylaxis for emergency abdominal surgery
Abdominal tuberculosis
Authors: Aston N O , De Costa A M
Published: April 2023

Over a four‐year period, 28 patients with abdominal tuberculosis were seen, of whom 24 were immigrants and 22 under 45 years. Emergency surgery was carried out in 10 patients; another 14 had elective laparotomy. The diagnosis was suspected pre‐operatively in 75 per cent of those having elective surgery and 10 per cent of those having emergency laparotomy. Perforated ileal strictures were found in 30 per cent of those with acute symptoms. Half of those with chronic disease had hyperplastic ileocaecal disease and half tuberculous peritonitis. Positive histology was obtained in 23 patients, but culture was positive in only four. The only death was of an elderly white man with a perforated ileal stricture. The four patients treated without surgery showed a rapid symptomatic response to antituberculous drugs.
Gastrointestinal malignancies as a complication of chronic myeloid leukaemia
Authors: Slade R , Thomas W E G
Published: April 2023

A 70‐year‐old patient is presented who, after chemotherapy for chronic myeloid leukaemia, developed two separate gastrointestinal malignancies. His family history indicated a strong family tendency towards neoplasia, and it is speculated that this predisposition may have been potentiated by the chemotherapy or the leukaemic process itself. It is stressed that, in such cases of multiple malignancy, each condition should be treated on its own merits.
Multicentre, double‐blind comparison of terfenadine and cetirizine in patients with seasonal allergic rhinitis
Authors: Backhouse C I , Renton R , Fidler C , Rosenberg R M
Published: April 2023

This double‐blind, multicentre study was designed to compare the efficacy and tolerability of terfenadine 120 mg with cetirizine 10 mg, each taken once daily, in the treatment of seasonal allergic rhinitis. Two hundred and eighty‐five patients were recruited to the study by nine general practice centres in the south of England during the 1989 hay‐fever season.

Symptom severity was assessed daily by the patient and before and after the one‐week treatment period by the investigator. At the second clinic visit both patient and investigator assessed the overall response to treatment.

The two treatment groups were well matched for all demographic variables and baseline symptom scores. Improvement in all seven symptoms (nasal congestion, sneezing, rhinorrhoea, itching nose, itching eyes, watery eyes and red eyes) and overall response to treatment were similar in both treatment groups. Adverse events were mainly of mild to moderate severity and were reported by 14 patients on terfenadine and 21 patients treated with cetirizine (p=0.317).

This study confirmed terfenadine's role as the treatment of choice in hayfever. A single 120 mg dose in the morning effectively reduced symptoms by 43 to 70 per cent of baseline values, with an acceptably low incidence of side effects. Cetirizine at a single dose of 10 mg displayed equal efficacy in controlling hayfever symptoms but, in common with other studies, had a significantly greater incidence of drowsiness (p=0.046).
A multicentre, long‐term evaluation of the safety and efficacy of ibuprofen syrup in children with juvenile chronic arthritis
Authors: Steans A , Manners P J , Robinson I G
Published: April 2023

The safety, efficacy and acceptability of ibuprofen syrup were assessed in a multicentre controlled open study in children with juvenile chronic arthritis. Forty‐six children aged 18 months to 13 years (mean 6.8 years) were studied. Dosage commenced at 10 mg/kg/day and increased to a maximum of 40 mg/kg/day depending on condition and individual disease control. Follow‐up assessments of disease severity, active joint count and any side effects were made at each clinic visit, usually monthly or as often as deemed necessary by the physician.

Thirty‐nine children completed the minimum eight weeks treatment period, with average duration of treatment being eight months. Seven children did not complete the minimum required treatment period, of which four were lost to follow‐up or non‐compliant, two had suspected adverse reactions, and one had a taste complaint and nausea. Adverse reactions were predominantly gastrointestinal, but only one was severe enough for discontinuation from the study before the end of the protocol period. Two children had minimal benefit from treatment and were changed to other medication, 10 went into remission during the study period and four were lost to follow‐up. Twenty‐three children continued on ibuprofen syrup or tablets after the study period.

This study demonstrates that ibuprofen is a well tolerated anti‐inflammatory agent for children with juvenile chronic arthritis, and that the syrup form is particularly useful for small children who may not be able to swallow tablets.
The body‐worn alarm in the treatment of childhood enuresis
Authors: Butler R J , Forsythe W I , Robertson J
Published: April 2023

Two studies examined the effectiveness of the body‐worn alarm in out‐patient treatment of childhood nocturnal enuresis. The first involved 40 children, previously untreated by conditioning methods, treated with either the body‐worn alarm or the traditional pad and bell alarm. The second study compared the body‐worn alarm with modified dry‐bed training with 48 children previously resistant to treatment.

Results of both studies indicated the body‐worn alarm was as effective as other methods in terms of the proportion of children successfully treated and was superior with respect to rapidity of response and consumer appeal. Such findings indicate that the body‐worn alarm could become the treatment of choice for nocturnal enuresis.
Disseminated intravascular coagulation and bacterial infections in the elderly
Authors: Anandadas J A , Banerjee A K
Published: April 2023

Anticoagulant screening tests (prothrombin time, thrombin time, kaolin‐cephalin time and serum fibrinogen levels), platelet count and estimation of fibrinogen degradation products were carried out on 34 elderly patients with proven bacterial infections, 42 elderly patients with suspected bacterial infections and in 20 controls, to investigate the existence of a sub‐clinical form of disseminated intravascular coagulation.

The prothrombin time was significantly prolonged in bacterial infections of the elderly and subclinical intravascular coagulation was not found to be a feature. The screening tests did not show any correlation with the outcome of the disease or the presence of septicaemia.
Comparison of the efficacy and long‐term tolerability of a combination of atenolol and nifedipine with atenolol alone in the treatment of hypertension
Authors: Mayhew S
Published: April 2023

This randomised, double‐blind crossover study in 30 hypertensive patients has demonstrated that the fixed combination of atenolol (50 mg) and nifedipine retard (20 mg) once daily lowered blood pressure to a significantly greater extent than atenolol (50 mg once daily) alone. In a follow‐up six‐month open tolerance study there was no evidence of tachyphylaxis, and treatment with the fixed combination was well tolerated. In selected hypertensive patients use of this fixed formulation may result in improved blood pressure control and benefit patient compliance.
Displaced boxers' fractures: a simple and effective method of external splintage
Authors: Maitra Asit , Sen Basav
Published: April 2023

Forty patients with fractures of the fifth metacarpal neck (boxers' fractures) having a volar angulation of 30° or more were treated by closed reduction and external immobilisation. A combination of malleable aluminium alloy splint and plaster of Paris cast was used. The results show a significant improvement in fracture angulation after reduction and at follow‐up (3/5 weeks) using this form of external splintage. There were no complications. Our results compare favourably with those of other recently published series. We advocate the use of this method of treatment for these fractures with significant volar angulation.
SCABIES IN AN AIDS HOSPICE UNIT
Authors: Moss V A , Salisbury J
Published: April 2023

SUMMARY Scabies may cause severe problems in immunocompromised persons. Three case histories are presented which illustrate these problems in people with advanced AIDS.
AN AUDIT OF RECTAL EXAMINATION ON GENERAL/GERIATRIC WARDS IN A DISTRICT GENERAL HOSPITAL
Authors: Abel K , Stewart K , Rai G S
Published: April 2023

SUMMARY A study of 187 in‐patients on designated medical/geriatric wards revealed that rectal examination was performed as part of physical examination in only 25% of patients. In the elderly (118 patients) it was performed in 36%. A prospective analysis of 100 elderly patients, in whom digital rectal examination was performed, revealed that 46 patients had significant findings. In only 33 of these were there any gastrointestinal or genitourinary symptoms or signs. As a result of these findings it is recommended that digital rectal examination be considered mandatory in the elderly admitted into hospital.
PERSISTENT NORMAL ANION GAP ACIDOSIS IN THE RECOVERY PHASE OF DIABETIC KETOACIDOSIS
Authors: Sinclair A J , Bouloux P‐M G , Sanders P G , Gale E A M
Published: April 2023

SUMMARY Diabetic ketoacidosis is associated with an increased anion gap but its recovery phase may be complicated by hyperchloraemic acidosis with a normal anion gap. We report a case where this complication developed. There was a delayed return to normal acid‐balance, possibly aggravated by adminstration of hyperchloraemic fluids, and the true diagnosis was overlooked. Measurement of the anion gap remains an important part of the assessment of diabetic acid‐base disturbances.
GASTRIC RETENTION OF SWALLOWED COINS AFTER PYLOROMYOTOMY
Authors: Stringer M D , Kiely E M , Drake D P
Published: April 2023

SUMMARY Swallowed coins are a frequent problem in paediatric practice. The majority that reach the stomach will pass unimpeded through the gastrointestinal tract. Prolonged gastric retention of a swallowed penny is reported in three children who had previously undergone pyloromyotomy for infantile hypertrophic pyloric stenosis. The coins were removed after laparotomy in two patients and endoscopically in the third. This abnormal retention may reflect a long‐term disturbance of pyloric function after pyloromyotomy.
WHICH ANTIBIOTIC FOR SURGICAL NOSOCOMIAL INFECTION?
Authors: Chapman S T , Walsh T H
Published: April 2023

Nosocomial infection means hospital‐acquired infection. In this article we discuss treatment of nosocomial infections which relate to, or arise as a consequence of, general surgical procedures. Most such infections become apparent during the patient's stay in hospital, but some patients with nosocomial infection first present to their general practitioners after discharge and this group should not be overlooked.
PARADOXICAL EMBOLI IN ELDERLY PATIENTS
Authors: Vella M , McNabb R , Lewis R , Sulke N , Poston R , Lugon M
Published: April 2023

We report two elderly patients who each had a patent foramen ovale (PFO) and were considered to have had paradoxical emboli. In one patient the PFO was detected by contrast two‐dimensional echocardiography, whereas in the other it was demonstrated at post‐mortem examination. This is an unusual but treatable condition, particularly difficult to diagnose in older people and probably occurring more frequently than is generally suspected.1
RECURRENT ENDOMETRIAL ADENOCARCINOMA PRESENTING AS AN UMBILICAL METASTASIS (SISTER MARY JOSEPH'S NODULE)
Authors: Patel K S , Watkins R M
Published: April 2023

A case of recurrent endometrial adenocarcinoma metastatic to the umbilicus is reported. The possible modes of spread, management and prognosis of this rare manifestation of visceral malignancy are discussed.
RUPTURED ABDOMINAL AORTIC ANEURYSM PRESENTING WITH ACUTE URINARY RETENTION
Authors: Scott HJ , Bearn PE , Scott RAP
Published: April 2023

Ruptured abdominal aortic aneurysm classically presents with abdominal pain radiating to the back, a pulsatile abdominal mass and circulatory collapse. However, other symptoms may be the only presenting complaint. We report the case of a patient who presented with a history of acute retention of urine relieved by catheterisation, but who then developed clinical features more typical of abdominal aortic aneurysm rupture.
POLYARTERITIS NODOSA PRESENTING WITH HYPERTENSIVE ENCEPHALOPATHY
Authors: Vora J , Cooper J , Thomas J P
Published: April 2023

Polyarteritis nodosa (PAN) is a rare cause of malignant hypertension.1 As far as we are aware, hypertensive encephalopathy has not been described in the literature as a presenting feature of PAN.
ACUTE GASTROENTERITIS: EFFECT ON NUTRITIONAL STATUS
Authors: Cunningham R , Parry C M , Harries A D , Beeching N J
Published: April 2023

Anthropometric measurements were performed on admission and at four weeks post discharge on 25 adults referred to hospital with acute gastroenteritis. There was a significant change in weight (P <0.001) and mid‐arm circumference (P <0.05), but no change in skinfold thickness, arm muscle area or arm fat area. The results suggest that weight change during acute gastroenteritis is more a consequence of dehydration than of malnutrition.
PATIENT SATISFACTION IN AN URBAN ACCIDENT AND EMERGENCY DEPARTMENT
Authors: Maitra A , Chikhani C
Published: April 2023

The aim of this study was to assess patients' opinions about their experience of attending an urban Accident and Emergency department. They were given a questionnaire designed to demonstrate any shortcomings in the delivery of care which required corrective actions. Just over half (50.8%) the patients responded, 411 (95%) of whom recorded satisfaction with the outcome of their visit (P = 0.0001). There was significant correlation between patient satisfaction and waiting time to see the doctor (P = 0.003), the doctor's explanation about management (P = 0.02), and total time spent in the department (P = 0.01). A total of 120 patients (27.8%) did not receive any explanation from the nurse about what was going to happen, and 267 (61.6%) received no information about possible delay. These factors did not significantly influence patients' satisfaction with the outcome, but they need to be addressed as they will obviously lead to an improved service.
FINE NEEDLE ASPIRATION CYTOLOGY OF PALPABLE BREAST LESIONS
Authors: De Freitas R , Hamed H , Fentiman I
Published: April 2023

Fine needle aspiration cytology is a safe diagnostic technique for breast cancer and can identify certain benign lesions, which can be excised without affecting surrounding tissue. The combination of experienced operator and cytologist can yield high sensitivity and specificity, together with important prognostic information.
THE USE OF SUMATRIPTAN IN THE TREATMENT OF MIGRAINE
Authors: Gross M
Published: April 2023

SUMMARY Sumatriptan is a selective agonist of 5‐hydroxytryptamine receptors, recommended for the acute treatment of migraine. The 5‐HT1 receptor subtype is found in the cranial vasculature of many species including humans, and causes vasoconstriction of these vessels. Sumatriptan as a highly potent 5‐HT1 agonist selectively constricts large intracranial blood vessels and also blocks neurogenic inflammation. Those treating patients with severe or inconveniently timed attacks will find sumatriptan the drug of choice.
INTESTINAL MALABSORPTION PRESENTING WITH NIGHT BLINDNESS
Authors: Hasan M , Finucane P
Published: April 2023

SUMMARY Night blindness from vitamin A deficiency was observed in a patient with intestinal malabsorption, which in turn was attributable to duodenal diverticulosis and bacterial growth. Monthly supplementation with vitamin A and correction of bacterial overgrowth with tetracycline resulted in a normalisation of plasma retinol levels and resolution of the night blindness.
TOPICAL TREATMENT OF ACUTE SPRAINS
Authors: Frahm E , Elsasser U , Kämmereit A
Published: April 2023

SUMMARY In a randomised, placebo‐controlled, double‐blind study with parallel group comparison, the efficacy and tolerability of topical treatment with a mucopolysaccharide polysulphate/salicylic acid cream was investigated in 156 patients with acute sprains of the knee or ankle joint. There was a more rapid reduction in pain on movement (the main parameter) in the active drug group compared with the placebo group. On day 9 after randomisation the difference was highly significant. There were no adverse events in the active drug group.
Helicobacter pylori: ENOUGH TO GIVE ANYONE AN ULCER!
Authors: Levine TS , Price AB
Published: April 2023

SUMMARY Since the early 1980s, research into gastritis and peptic ulcer disease has been dominated by Helicobacter pylori. This is a small, Gram‐negative spiral bacterium which inhabits the mucus layer that coats the gastric mucosa. Colonisation of the human stomach by this bacterium is worldwide and, in certain continents, virtually ubiquitous. While histological gastritis is always the result, H. pylori‐positive individuals are characteristically asymptomatic. Transmission is thought to be via the faecal‐oral route and infection, usually acquired in childhood, will persist unless treatment supervenes. H. pylori is the main causative agent of peptic ulceration, but its role in non‐ulcer dyspepsia is less clearcut. Recently epidemiological, histological and experimental data have been described linking H. pylori to gastric neoplasia — in particular adenocarcinoma and MALT lymphoma. A variety of treatment modalities exists for the eradication of this bacterium, and for adults the recommended drug therapy is a combination course of tetracycline, bismuth and metronidazole. Currently the new combination of omeprazole and amoxycillin is suggested as second‐line treatment after failed triple therapy.
THE ACUTE PORPHYRIAS
Authors: Lip G Y H , McColl K E L , Moore M R
Published: April 2023

The porphyrias are a heterogeneous group of rare inborn errors of metabolism caused by inherited enzyme defects in the haem biosynthetic pathway, resulting in overproduction of porphyrins. The porphyrias can be distinguished biochemically but may be difficult to differentiate clinically. Considerable advances have been made in the understanding of the enzymology and molecular biology of the porphyrias. The acute attack of porphyria may be a life‐threatening condition, and an understanding of its many precipitating factors, clinical features and management is of importance in a disease with a significant mortality.
PLASMA VISCOSITY AND THE DIAGNOSIS OF GIANT CELL ARTERITIS
Authors: Orrell R W , Johnson M H
Published: April 2023

The level of plasma viscosity associated with the diagnosis of giant cell arteritis, and its use as a replacement for the erythrocyte sedimentation rate (ESR) is examined, by reviewing the records of 59 patients undergoing temporal artery biopsy. All patients with positive temporal artery biopsy had plasma viscosity above the upper limit of normal (1.72 mPa.s), range 1.88 to 2.28. There was a large group of patients with a possible diagnosis, supported by a raised plasma viscosity, who in the absence of a positive biopsy were not felt to have clinical disease requiring steroid treatment. The role of plasma viscosity appears to be similar to that of the ESR in the diagnosis of giant cell arteritis.
INAPPROPRIATE OUT‐PATIENT REFERRALS INCREASING?
Authors: Nunez D A
Published: April 2023

A study was undertaken to determine if inappropriate general practitioner out‐patient referrals have increased. Out‐patients referred to an otolaryngology unit in north‐east England were analysed. Patient, diagnosis, waiting time and outcome of consultation details of new attenders for a two‐month period in 1981 and 1989 were compared. New out‐patient attenders without evidence of otolaryngological disease, who required no treatment, investigation or follow‐up, were defined as inappropriate referrals.

A total of 2200 new attendances were studied, 819 in 1981 and 1381 in 1989. In all, 125 referrals (15%; 95% confidence interval, 12–18%) in 1981 and 180 patients (13%; 11–15%) in 1989 were inappropriate. There was no increase in the proportion of inappropriate referrals.
RHINOCEREBRAL MUCORMYCOSIS DIABETES MELLITUS AND ADRENOGENITAL SYNDROME
Authors: Weinberg J R , Smith A , Langley K , Gwavava N J
Published: April 2023

A case of rhinocerebral mucormycosis in a diabetic is described. The case is unusual as the mucormycosis developed in the absence of ketoacidosis and because the patient had concomitant adrenogenital syndrome.
COMPARING THE EFFICACY OF CISAPRIDE AND RANITIDINE IN OESOPHAGITIS: A DOUBLE‐BLIND, PARALLEL GROUP STUDY IN GENERAL PRACTICE
Authors: Dakkak M , Jones BP , Scott MGB , Tooley PJH , Bennett JR
Published: April 2023

SUMMARYPatients with endoscopically confirmed oesophagitis (n=49) were treated for 8 weeks with either cisapride (10 mg four times a day) or ranitidine (150 mg twice a day) in a double‐blind study in general practice. Mean overall symptom scores fell from 10.8 to 4.5 in the cisapride group and from 9.9 to 4.4 in the ranitidine group over the course of the study. The proportion of patients reporting improvements in individual symptoms in the two treatment groups (cisapride and ranitidine respectively) were: heartburn, 66% and 55%; acid regurgitation, 53% and 47%; epigastric pain, 60% and 52%; satiety, 57% and 47%; bloating, 69% and 71%; belching, 65% and 72%; nausea, 62% and 85%; vomiting, 77% and 66%; poor appetite, 50% and 75%. Improvement in the endoscopic grade of oesophagitis was observed in 66% of patients receiving cisapride and 63% of those receiving ranitidine. It was concluded that cisapride is as effective as ranitidine in relieving the symptoms of oesophagitis and in healing oesophageal erosions.
A PHARMACOLOGICAL ALTERNATIVE FOR TREATMENT OF HAEMORRHAGE FROM A HIATUS HERNIA GASTRIC ULCER
Authors: Talbot D , Attard R
Published: April 2023

SUMMARY Haematemesis in the elderly patient is a life‐threatening condition. When the degree of blood loss is severe enough to warrant intervention by surgery or endoscopic means, the risk is even greater. We describe such a case, where treatment was further complicated as the bleeding point was in a hiatus hernia. The bleeding was successfully controlled by non‐invasive means using an infusion of a somatostatin analogue.
PAROXETINE AND HYPONATRAEMIA
Authors: Chua TP , Vong SK
Published: April 2023

SUMMARY This case illustrates the need to be aware of potential hyponatraemia in patients taking paroxetine and other selective serotonin reuptake inhibitors.
SEVERE HYPONATREMIA IN A QUADRIPLEGIC
Authors: Gibbs CJ , Lee HA
Published: April 2023

SUMMARY A young quadriplegic patient developed convulsions and brain damage due to severe hyponatremia. Potential causes of severe hyponatraemia in quadriplegics include excessive water intake (because of the low threshold for vasopressin release) and asymptomatic renal tract infection causing sodium loss. Mild hyponatraemia, occurring in up to 10% of quadriplegics, is due to a reset osmostat.
NON‐HODGKINS LYMPHOMA PRESENTING WITH EVIDENCE OF RIGHT VENTRICULAR OUTFLOW TRACT OBSTRUCTION
Authors: Burn S , Barnes PC
Published: April 2023

SUMMARY Anterior mediastinal tumours have been reported that initially presented with signs suggestive of cardiac disease. The widespread availability of two‐dimensional echocardiography has demonstrated that, in the majority of cases, right ventricular compression is the major cardiac complication of such masses. We report two cases of mediastinal lymphoma that presented with chest pain and signs of right ventricular outflow obstruction.
HEREDITARY COPROPORPHYRIA
Authors: Downey DC
Published: April 2023

SUMMARY Hereditary coproporphyria is a rarely diagnosed disease and is one of the acute porphyrias. The classic mental, neurological and abdominal symptoms are often observed, but there appear to be atypical clinical features and laboratory findings that may lead to underdiagnosis. In an oral stomatology practice, a group of patients having oral conditions with unknown pathophysiology and multiple systemic complaints were evaluated for porphyrin abnormalities. Blood enzymes, urine and stool porphyrin panels were usually run. A large number of the patients had the clinical symptomatology and porphyrin abnormalities classically found in hereditary coproporphyria.
SQUAMOUS CARCINOMA OF THE RECTUM
Authors: Fazzi U , Anderson JR
Published: April 2023

SUMMARY A case of squamous carcinoma of the rectum in a 50‐year‐old woman is reported, which was treated by excisional surgery and then radiotherapy. The patient is alive and well, with no evidence of tumour recurrence 6 years later. The aetiology and treatment of this uncommon tumour is discussed.
ANISAKIASIS (‘HERRING WORM DISEASE‘) AS A CAUSE OF ACUTE ABDOMINAL CRISIS
Authors: Kark AE , McAlpine JC
Published: April 2023

SUMMARY A hazard associated with eating raw fish is presented. The larval nematode Anisakis marina (‘herring worm‘) is a recognised public health problem in Japan, and cases have been reported in the UK. The intestinal burrowing of the larval form causes acute abdominal symptoms clinically resembling acute appendicitis. Operation is required; no antiparasitic agent is available.
PREPARING THE MALE URETHRA FOR TRANSURETHRAL PROCEDURES
Authors: Underwood MA , Fishwick KT , Hoy RA , Croton RC
Published: April 2023

SUMMARY The antiseptic and analgesic effectiveness of different preparations of lignocaine gel used prior to flexible cystoscopy were studied in patients recruited over a 12‐month period. This random study involved 106 patients in four groups. There appeared to be no difference in bacterial colonisation of the urethra between the groups. Urethral analgesia was improved when higher volumes of gel were used. It was concluded that high‐volume gel preparations (>20 ml) with no antiseptic provided optimal conditions for flexible cystoscopy.
COMPLIANCE WITH PRESCRIBED MEDICINES IN GENERAL MEDICAL AND SURGICAL WARDS
Authors: McMlllan TW , Hamley J , Pullar T
Published: April 2023

SUMMARY A total of 6833 doses of medication were prescribed to 753 hospital inpatients in general wards over a 24‐hour period (excluding medicines prescribed on an as‐required basis and medicines prescribed for the first time during the 24‐hour period). Of these, 574 (8.4%) doses were omitted, representing at least one omitted dose in 242 (32.1%) patients. Many of the omitted doses were of symptomatic treatments and in 43% of instances omission was deemed, retrospectively, to have been beneficial. Some omissions, however, were of a potentially life‐threatening nature. The most common reasons for omission were that the patient refused the drug or that the nurse thought the drug unnecessary, the patient was on ‘nil by mouth’ or was too ill or unable to take the medicine. Thus, omission of prescribed medicines in general wards is common, often of little consequence or even beneficial, but of a potentially serious nature.
UNDISCLOSED SELF‐MEDICATION — A CLINICAL PITFALL
Authors: Davies P , Fattah H , Clee MD
Published: April 2023

SUMMARY Over‐the‐counter medication may produce side‐effects or precipitate hospital admission. Our patient's self‐medication, initially not admitted, led to much mental and physical morbidity.
DOES THE METHOD OF TRANSLUMINAL CORONARY REVASCULARISATION INFLUENCE RE‐STENOSIS? BALLOON ANGIOPLASTY, ATHERECTOMY AND STENTS COMPARED
Authors: Foley DP , Keane D , Serruys PW
Published: April 2023

SUMMARY Luminal renarrowing after successful coronary angioplasty is now recognised as a continuously distributed process which is determined largely by the extent of luminal increase achieved at angioplasty. In this study an alternative analytical approach is applied to determine whether luminal renarrowing following coronary intervention is related to the mechanism of luminal increase (ie by balloon, by atherectomy, by a self‐expanding stainless steel mesh stent, or by a balloon‐expandable tantalum coil stent). The results confirm the known proportional relationship between luminal renarrowing during follow‐up and luminal improvement at intervention, regardless of the device used. However, significant differences were observed between the devices, which may reflect device‐specific characteristics of the hyperplastic response to vessel injury and may have clinical implications.
HAEMANGIOLYMPHANGIOMA: THORACIC PRESENTATION OF A RARE VASCULAR NEOPLASM
Authors: Stebbing JF , Sayer RE
Published: April 2023

SUMMARY A case of haemangiolymphangiorna, a rare hybrid vascular tumour not previously reported in the mediastinum. The pathology and surgical management are discussed.
POLYCYTHAEMIA RUBRA VERA PRESENTING WITH DEPRESSION: RECOGNISING THE SYNDROME ABULIA
Authors: Fones C , Tsoi WF
Published: April 2023

SUMMARY A patient with polycythaemia rubra vera is described, presenting primarily with symptoms attributed to depression. While in the ward she developed a stroke, confirmed on CT scan of the head. Venesection alone produced marked improvement in her neurological and psychiatric symptoms. The clinical picture corresponds most accurately to the neurological syndrome of abulia, which is an important differential diagnosis of depression with psychomotor retardation. The pathophysiology of impaired cerebral blood flow causing neuropsychiatrie symptoms in polycythaemia is discussed.