bluuebunny/crossref_metadata_2025 huggingface dataset:
THE VALUE OF MG7 ANTIGEN IN PREDICTING CANCEROUS CHANGE IN DYSPLASTIC GASTRIC MUCOSA
Authors: Liu J , Hu JL , Zhang XY , Qiao TD , Chen XT , Wu KC , Ding J , Fan DM
Published: April 2023

The aim of this study was to ascertain whether MG7Ag is a useful predictor of evolution of gastric dysplasia to carcinoma. A total of 1090 patients with confirmed dysplasia were stained immunohistochemically with MG7 monoclonal antibody by the ABC method. A prospective follow‐up study was undertaken on 19 patients with MG7Ag positive staining and 16 with MG7 negative staining over a period of 10–78 months. The expression of MG7Ag was also compared in another two groups by conducting retrospective studies. One group showed an evolution into gastric cancer over 2–4 years, the other did not. Quantitative analysis of MG7Ag expression was carried out on the last two groups. The receiver operating characteristic curve and Youden index were used to assess the best critical value for MG7Ag. MG7Ag was found positive in 456/1090 cases (41.8%) with dysplasia. Prospective follow‐up of 35 patients showed that 6/19 patients with MG7Ag positive staining developed gastric cancer, but there were no carcinomatous changes in 16 patients with MG7 negative staining. The results of MG7Ag expression in 72 cases with retrospective follow‐up showed there were 24 with positive immunostaining among 34 cancerous cases (70.6%), and only 7 in 38 non‐cancerous cases (18.4%) (p<0.01). Image analysis showed that an average MG7Ag density index ‡0.19 could be regarded as the critical value for high risk of gastric mucosa with dysplasia evolving to cancer. Positive MG7Ag expression in gastric mucosa of patients with dysplasia, especially in cases with a density index ‡0.19, was an indicator of high risk of malignant change.
GASTROGRAFIN ADMINISTRATION IN THE TREATMENT OF POSTOPERATIVE DELAYED GASTRIC EMPTYING
Authors: Karavias DD , Tepetes K , Vagenas K , Panagopoulos K , Agelopoulou H , Androulakis J
Published: April 2023

Five cases of delayed gastric emptying (DGE) are reported. Three patients had pancreatic head carcinoma and underwent a Whipple operation during which truncal vagotomy and gastrectomy were performed. The remaining two patients underwent vagotomy and gastrectomy because of benign peptic ulcer. In one of the pancreatectomy cases, the pylorus was at first preserved, but after DGE developed, a gastrectomy was carried out, which did not result in any improvement. The duration of DGE was 16–72 days, during which time the patients were under total parenteral or enteral nutrition. There were no other major complications. The patients received prokinetic agents (metoclopramide, erythromycin) but without any improvement. Finally, all patients were treated with Gastrografin, 40 ml every two hours, via a nasogastric tube. In all cases, gastric motility was restored within 20–36 hours.
INCREASED FREQUENCY OF HCV BUT NOT HBV INFECTION IN TYPE 2 DIABETIC PATIENTS IN TURKEY
Authors: Okan V , Araz M , Aktaran S , Karsligil T , Meram I , Bayraktaroglu Z , Demirci F
Published: April 2023

The aim of this study was to investigate the prevalence of hepatitis B and hepatitis C virus infections in type 2 diabetic patients in Gaziantep, Turkey. Six hundred and ninety‐two type 2 diabetic patients and 1014 healthy blood donors were included in the study. No significant difference was found between type 2 diabetic patients and the control group for seropositivity of HBsAg (5.3% vs 5.1%, p>0.05). In contrast, anti‐HCV was significantly more frequent in type 2 diabetic patients (7.5% vs 0.1%, p>0.0001). We found no significant difference for HBsAg seropositivity between type 2 diabetic patients with a disease duration of 12 months or less, but anti‐HCV seropositivity was significantly more frequent in diabetic patients with a longer disease duration (p<0.05). We suggest that HCV infection is not a trigger factor for type 2 diabetes mellitus but is frequently associated with it.
11. BREAST CANCER IN YOUNG WOMEN
Authors: Kothari AS , Fentiman IS
Published: April 2023

Women under the age of 35 years comprise only 5% of cases of breast cancer but because of the unexpected nature of the diagnosis this may be associated with delay. In the clinic, the diagnosis may not be immediate because of the low sensitivity of the components of triple diagnosis. The disease tends to be more aggressive with a higher incidence of poorly differentiated (grade III) carcinomas and more hormone insensitive (ER/PR negative) tumours. Additionally, the tumours are often rapidly proliferating and express abnormal p53. Women under 35 have an increased risk of local failure following breast cancer therapy, but this does not affect their cancer‐specific survival. Young women treated with cyclophosphamide, methotrexate and fluorouracil chemotherapy have a greater risk of relapse and death than older premenopausal patients, especially if their tumours express oestrogen receptors, so endocrine treatment should also be offered under these circumstances.
‘WHY DON'T YOU DO AS I TELL YOU?’ COMPLIANCE AND ANTIHYPERTENSIVE REGIMENS
Authors: Hansson L
Published: April 2023

Although hypertension is recognised as one of the major health hazards in the developed world, compliance with antihypertensive regimens is still undesirably low This brings important costs, both to patients in increased morbidity and mortality, and to society in hospitalisations and lost productivity. This review surveys possible reasons for non‐compliance with treatments generally and antihypertensive medications specifically It also looks at how insights into reasons for non‐compliance can help us design more effective treatments, and discusses current and emerging medications in the context of compliance. As one of the reasons for low compliance is thought to be the impact of a drug on the patient's lifestyle, recently developed agents such as angiotensin II‐receptor blockers may be expected to have less effect on patients' daily lives than earlier treatments, which brings hope for increased compliance with these regimens.
MALIGNANT BY NAME OR MALIGNANT BY NATURE: A CASE OF WEGENER'S GRANULOMATOSIS DIAGNOSED AS ADENOCARCINOMA OF UNKNOWN PRIMARY
Authors: Virik K , Karapetis C , Harper P
Published: April 2023

Most malignancies are characterised by malignant behaviour at some point in the disease trajectory. However, non‐malignant diseases may exhibit malignant behaviour. A diagnosis of malignancy based on fine needle aspiration cytology (FNAC) can be misleading. We report a case of Wegener's granulomatosis initially diagnosed by FNAC as adenocarcinoma of unknown primary. The limitations of FNAC, the disparate prognoses of the two diagnoses despite a compatible clinical picture and the need for clinical vigilance in monitoring a disease course are highlighted.
DISCLOSURE OF CANCER DIAGNOSIS AND PROGNOSIS BY PHYSICIANS IN KUWAIT
Authors: Qasem AA , Ashour TH , Al‐Abdulrazzaq HK , Ismail ZA
Published: April 2023

To analyse preferences for disclosure of cancer diagnosis and prognosis among physicians practising in Kuwait, a cross‐sectional survey was conducted in public hospitals in both urban and suburban parts of the country, which included physicians likely to encounter adult cancer patients in their practice. A total of 217 physicians participated, 67% indicating they preferred full and complete disclosure of cancer diagnosis to patients. However, 79% of those would withhold the truth if the patient s family requested them to do so. Preference for concealment was more common among physicians who had experienced cancer directly with a friend or a family member, or who were in medical as opposed to surgical specialties. The belief that patients in Kuwait did not want to hear the truth about cancer diagnosis or prognosis was also significantly associated with concealment preference. Changes in public norms and expectations should be monitored, because they seem to play a major role in physicians preference for disclosure of cancer diagnosis and prognosis.
DELIBERATE SELF‐POISONING WITH RODENTICIDE: A DIAGNOSTIC DILEMMA
Authors: Walker J , Beach FXM
Published: April 2023

A 71‐year‐old man presented with a recurrent bleeding diathesis requiring frequent blood transfusions, vitamin K and fresh frozen plasma. Extensive investigations revealed vitamin K deficiency. After repeated interviews the patient admitted to deliberately ingesting rat poison. Superwarfarins are an uncommon cause of deranged clotting and specialised tests are available to identify them. They can cause prolonged coagulation abnormalities and may require treatment with oral vitamin K for several months after just a single dose.
TWO CASES OF SUBMUCOSAL HAEMATOMA OF THE OESOPHAGUS AND MALLORY‐WEISS TEAR
Authors: Ganeshram KN , Harrisson P
Published: April 2023

Submucosal haematoma of the oesophagus is an uncommon condition which may be under‐recognised. Presentation may be with chest pain, dysphagia or haematemesis. Endoscopy, CT scan, barium meal or a combination of these modalities makes the diagnosis. Most patients make a full recovery.
SURVEILLANCE STUDY OF BACTERAEMIC EPISODES IN FEBRILE NEUTROPENIC CHILDREN
Authors: Ariffin H , Navaratnam P , Lin HP
Published: April 2023

We prospectively studied the type, frequency and outcome of infections in 513 patients with 762 consecutive episodes of febrile neutropenia (FN) over a five‐year period between 1995 and 1999 in a single paediatric oncology unit. The findings were then compared with a similar study carried out in our unit between 1990 and 1994. The types of bacterial isolates and sensitivity patterns were also studied to identify trends and to gauge the suitability of antibiotics chosen for empirical therapy. Bacteraemia was documented in 35.4% of FN episodes, although 70% of patients did not have an obvious site of sepsis. The majority of isolates (61.9%) were Gram‐negative bacteria, a consistent finding throughout the study period. Resistance to ceftazidime, amikacin and imipenem among Gram‐negative bacteria was 26.3%, 21.2% and 0.7%, respectively. Methicillin resistance among Gram‐positive bacteria was 26.3%, while no vancomycin‐resistant bacteria were encountered. There were 36 sepsis‐related deaths. Factors associated with a fatal outome were prolonged capillary refill time, hypotension, fever above 39°C and pneumonia. Rapid neutrophil recovery was associated with a good prognosis. A change to our current choice of empirical antibiotics for FN, comprising ceftazidime/ceftriaxone and amikacin appears necessary because of the relatively high resistance rates found.
14. BREAST CANCER PREVENTION
Authors: Salih AK , Fentiman IS
Published: April 2023

Increased risk of breast cancer may result from potentially modifiable causes such as endogenous hormone levels, obesity, HRT, and non‐lactation, or non‐modifiable factors including genetic susceptibility and increasing age. The Gail model, based on known factors, may be useful for estimating lifetime risk in some individuals, but those risk factors that are easier to modify may have a limited impact on the totality of breast cancer. Tamoxifen prevention still remains contentious, with a significant reduction in risk of breast cancer in women given tamoxifen in the NSABP P1 study but no effect in the Italian and Royal Marsden trials. Raloxifene, tested in the MORE trial, reduced the incidence of breast cancer by 65% but this was restricted to oestrogen receptor positive tumours. Lifestyle factors such as diet, obesity, exercise and age at first full term pregnancy and number of pregnancies have a mild to moderate impact on risk, so may have little effect on the incidence of breast cancer. Reduction of alcohol intake could lead to a modest reduction in the risk of breast cancer but possibly adversely affect other diseases. Fat reduction and GnRH analogue reduce mammographic density but have not yet been shown to affect risk. For women with BRCA1/2 mutation, options include unproven surveillance and prophylactic mastectomy with an unquantified risk reduction. Interesting new candidates for chemoprevention include aromatase inhibitors, new generation SERMs, demethylating agents, non‐selective COX inhibitors, tyrosine kinase inhibitors and polyamine synthetic inhibitors.
CLINICAL MANAGEMENT OF CHILDHOOD OSTEOPOROSIS
Authors: Chan YY , Bishop NJ
Published: April 2023

A current working definition of osteoporosis in children is ‘fragility fractures in association with low bone mass’. This review illustrates the determinants of bone mass and fracture risk. We elucidate the pathophysiology and causes of osteoporosis in various childhood disorders, with a particular focus on the commonest iatrogenic problem, glucocorticoid‐induced osteoporosis. We discuss clinical evaluation, investigation and multidisciplinary management including lifestyle advice, diet, physiotherapy and occupational therapy, drug treatments and monitoring for children with osteoporosis. We also emphasise the important concepts of bone mass assessment and interpretation in children.
CURRENT CONCEPTS IN VENOUS THROMBOEMBOLISM AND MAJOR LOWER LIMB ORTHOPAEDIC SURGERY
Authors: McCahill JP , Carrington RWJ , Skinner JA
Published: April 2023

Venous thromboembolism remains a major cause of morbidity and mortality among patients undergoing major orthopaedic surgery. With improved surgical techniques, the use of heparin‐based thromboprophylactic agents has allowed significant advances in the prevention of thrombosis during the past 30 years. With an aging population and the growing burden of degenerative joint disease, the management of this preventable disease remains at the forefront of surgical care. Despite the use of the supposedly most effective antithrombotic agents (low‐molecular‐weight heparins), recent studies have highlighted considerable prevalence of thrombosis, especially among hip fracture patients. New prevention strategies include a greater use of existing therapies, combining chemical and mechanical methods, extending the duration of prophylaxis and, most importantly, developing more effective agents with improved benefit to risk ratios.
FULVESTRANT: A REVIEW OF ITS DEVELOPMENT, PRE‐CLINICAL AND CLINICAL DATA
Authors: Wardley AM
Published: April 2023

Hormone therapy is the most important systemic treatment of hormone receptor‐positive breast cancer at all stages. Selective oestrogen receptor modulators (SERMs), such as tamoxifen, the mainstay of hormone receptor positive breast cancer manipulation for many years, are limited by their agonist actions. Oestrogen‐like activity of these drugs may stimulate cancer growth such as in the endometrium and is a mechanism of resistance in breast cancer. Fulvestrant, the first of a new class of drugs, an oestrogen receptor down regulator, may have advantages over tamoxifen in the treatment of oestrogen‐dependent disease. The pre‐clinical development and early clinical data of fulvestrant are reviewed. Fulvestrant was as effective as the aromatase inhibitor anastrazole in second‐line advanced breast cancer. The phase III trial of fulvestrant versus tamoxifen, as first‐line treatment for metastatic breast cancer, has completed accrual and is maturing. Fulvestrant has useful activity against breast cancer as well as a favourable side‐effect profile and is likely to represent a useful addition to the fight against hormone dependent breast cancer. Its place will be better defined by ongoing clinical trials.
INCREASED SERUM FERRITIN LEVELS IN ACTIVE BEHÇET'S DISEASE
Authors: Odabas AR , Karakuzu A , Cetinkaya R , Selcuk Y , Keles S , Bilen H
Published: April 2023

There is no routine test to evaluate the activity of Behçet's disease (BD). Ferritin as a serum predictor of iron storage is an important acute phase reactant. In this study, we assessed serum ferritin levels in patients with active BD and compared them with those of patients with inactive BD. We aimed to show the relationship between ferritin and BD. The patients with BD were subdivided into two groups according to disease activity: active (24 patients; 18 men and 6 women, average age 36.5 ± 4.9 [28–45] years), and inactive (20 patients; 16 men and 4 women, average age 37.2 ± 5.2 [30–49] years). Twenty healthy volunteers (15 men and 5 women; average age 38.2 ± 4.6 [30–47] years) served as controls. Patients with active BD had significantly higher serum ferritin levels (p=0.0001) than the inactive and control groups. Ferritin levels in patients with inactive BD did not differ significantly from healthy control subjects (p=0.687). We concluded that in patients with active BD, serum ferritin levels are increased and do not reflect serum iron levels.
MYELOFIBROSIS: RESPONSE TO BUSULFAN AFTER HYDROXYUREA FAILURE
Authors: Naqvi T , Baumann MA
Published: April 2023

We report a case of myelofibrosis with myeloid metaplasia (MMM) that responded dramatically to oral busulfan treatment after failure of hydroxyurea. Although busulfan treatment of this disease has fallen out of favour due to the favourable toxicity profile of hydroxyurea and reports of efficacy of interferon‐α, our observation suggests there may still be a role for busulfan treatment of MMM in the setting of hydroxyurea or interferon failure or intolerance.
SUBMANDIBULAR CASTLEMAN'S DISEASE
Authors: Chan SC , Ng SH , Lee KF , Hao SP , Cheung YC , Wan YL
Published: April 2023

Castleman's disease is a rare benign lymphoid tumour of unknown aetiology, which usually appears as a solitary mediastinal mass. We report an unusual case of Castleman's disease, an asymptomatic submandibular mass in the lower jaw, and we discuss the computed tomography appearance.
CHRONIC RENAL FAILURE IN A PATIENT WITH SOTOS SYNDROME DUE TO AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE
Authors: Cefle K , Yildiz A , Palanduz S , Ozturk S , Ozbey N , Kylyçaslan I , Çolakoglu S , Balci C
Published: April 2023

Sotos syndrome is characterised by accelerated growth, acromegalic appearance, mental retardation and social maladjustment. Most cases are sporadic, but familial cases have also been reported. We report a case of Sotos syndrome presenting with chronic renal failure due to autosomal dominant polycystic kidney disease (ADPKD). Ultrasonographic examination of the patient, his father and other family members revealed polycystic kidneys. Renal failure was present only in the Sotos case, who also had considerably larger cysts than other family members. We suggest that the underlying mechanism responsible from the somatic overgrowth in Sotos syndrome may also be linked with the development of larger cysts and earlier onset of renal failure in ADPKD. Although Sotos syndrome has been associated with urological abnormalities, chronic renal failure is very rare. To our knowledge, Sotos syndrome associated with ADPKD has not been reported before.
GIANT MYELOLIPOMA OF THE RIGHT ADRENAL GLAND
Authors: Zografos GN , Korkous D , Georgoutsos P , Antypa F , Ageli C , Fragia K , Vachliotis P , Papastratis G
Published: April 2023

Adrenal myelolipoma is an unusual, benign and hormonally inactive tumour composed of mature adipose and haematopoietic tissue. In the past, these tumours were accidentally discovered at autopsy. Today, they are found much more frequently and incidentally, mainly because of the widespread use of ultrasonography, computed tomography and magnetic reasonance imaging. Adrenal myelolipoma is usually unilateral and asymptomatic. The case of a 52‐year‐old female patient, surgically treated for a symptomatic giant myelolipoma of the right adrenal gland, is reported, together with a review of the literature.
STROKE PREVENTION: MISSED OPPORTUNITIES?
Authors: Gupta A , Thomas P
Published: April 2023

Identification and modification of risk factors can prevent strokes. Certain previously unidentified risk factors for stroke can become apparent following admission with acute stroke. The aim of the study was to investigate the prior capture, identification and management of modifiable risk factors for stroke in patients admitted to a hospital following acute stroke. One hundred consecutive stroke patients admitted to a UK hospital were prospectively assessed for modifiable risk factors. The extent of pre‐admission risk factor management was also determined. Pre‐admission risk factors identified and effectively managed were hypertension in non‐diabetics (28%), hypertension in diabetics (7%), previous cerebrovascular event (100%), diabetes (29%), smoking (50% counselled), atrial fibrillation (81%), hypercholesterolaemia (100%), excess alcohol (22% counselled) and obesity (52% counselled). Twenty‐five new modifiable risk factors were identified following incident stroke. In conclusion, a significant number of patients admitted with acute stroke have their risk factors poorly identified and controlled in the community. Despite the trial evidence available, an evidence‐practice gap exists and many stroke prevention opportunities are being missed.
NON‐INVASIVE CARDIAC ASSESSMENT IN β‐THALASSAEMIA MAJOR
Authors: Ong M‐L , Hatle LK , Lai V‐M , Bosco J
Published: April 2023

Iron deposition in the heart occurs in β‐thalassaemia major and contributes to cardiac dysfunction. Eighteen patients with β‐thalassaemia major were assessed clinically and had non‐invasive investigations. They were young (15.5 ± 3.6 years). Two patients had clinical heart failure. Doppler echocardiography demonstrated higher transmitral peak flow velocity in early and late diastole compared with controls (e: p<0.05, a: p<0.01). Transtricuspid peak late diastolic flow velocity was higher in patients (p<0.005). Isovolumic relaxation time was shortened (p<0.001). Pulmonary venous flow velocity was higher in diastole than systole (S: 0.51 ± 0.11 m/s, D: 0.62 ± 0.08 m/s). Reversal of pulmonary venous flow during atrial systole was seen in eight patients. These diastolic filling abnormalities did not significantly change with blood transfusion. Left ventricular ejection fraction was normal in patients. Two patients had cardiomegaly on chest X‐ray. In β‐thalassaemia with iron overload, there is a restrictive pattern of diastolic dysfunction. This is not altered by recent blood transfusion. Left ventricular function remains relatively intact.
THE CHOICE OF ANTIBIOTIC IN OPEN FRACTURES IN A TEACHING HOSPITAL IN A DEVELOPING COUNTRY
Authors: Alonge TO , Salawu SA , Adebisi AT , Fashina AN
Published: April 2023

Open fracture wounds may be contaminated, and the use of an appropriate antibiotic in the early stages of management reduces the risk of osteomyelitis developing. Environmental factors influence both the type of micro‐organisms that are isolated from these wounds and the antibiotics that are chosen to manage the wounds. Before this study, the choice of antibiotic in the management of open fractures in our hospital was based on tradition and ‘best guess' antibiotics. In a prospective study of 52 open fractures seen in the accident and emergency unit of University College Hospital, Ibadan, between January and June 2000, the positive bacterial culture yield was more than 70%. Staphylococcus aureus was the commonest microbial isolate, accounting for 37.5% of total isolates. The antibiotic sensitivity pattern revealed high efficacies for pefloxacin, ciprofloxacin and ceftriaxone against the isolated micro‐organisms. In comparative costs, these antibiotics are cheaper than the combination of the ‘best guess' antibiotics that were used previously. On the strength of this finding, we have suggested a change in the antibiotic policy of the hospital with regard to the antibiotic regimen to be used to complement the surgical management of open fractures.
THE HUMAN AND ECONOMIC COSTS OF UNDERTREATMENT WITH STATINS
Authors: Durrington P
Published: April 2023

Several guidelines for the prevention and management of coronary heart disease (CHD) have been published. These generally recommend lipid‐lowering therapy in patients with and without established CHD on the basis of their low‐density lipoprotein cholesterol (LDL‐C) levels and, for cases without established CHD, their risk‐factor profile. Statins are the preferred lipid‐lowering agent for the prevention of CHD because of overwhelming clinical trial evidence that they can significantly reduce the occurrence of CHD mortality and morbidity. Despite the guidelines, only approximately one‐third of eligible patients receive lipid‐lowering therapy in clinical practice – even for secondary prevention of CHD – and many treated patients fail to achieve their target LDL‐C levels. This underuse must affect patients' clinical outcome and quality of life and has economic consequences for society. Reasons for the underuse may include physicians' and patients' attitudes and knowledge, and the perceptions of physicians and healthcare purchasers about economic factors. Health economic evaluations have confirmed that secondary prevention with statins is cost‐effective, and that primary prevention is also reasonably cost‐effective, depending on the absolute CHD risks in targeted individuals. Newer statins with greater efficacy in reducing LDL‐C levels may allow patients to reach target levels more quickly and without the need for dose titration, thus improving clinical outcomes and being more cost‐effective in the long term. This proposition should be tested in future clinical trials.
MISSED DIAGNOSIS OF VITAMIN B12 DEFICIENCY PRESENTING WITH PARAESTHETIC SYMPTOMS
Authors: Larner AJ
Published: April 2023

Paraesthesia is a common presenting complaint in vitamin B12 deficiency. Since this condition is partially reversible with repletion, this is a diagnosis not to be missed. Two cases in which the diagnosis was initially overlooked are presented, emphasising that the paraesthesia associated with vitamin B12 deficiency may be central (myelopathic) or peripheral (neuropathic) in origin.
STATIN THERAPY: RATIONALE FOR A NEW AGENT, ROSUVASTATIN
Authors: Korlipara K
Published: April 2023

Cardiovascular disease (CVD) remains a major cause of death in industrialised societies, and elevated serum lipids are a significant, highly prevalent and undertreated risk factor for this condition. The 3‐hydroxy‐3‐methylglutaryl‐coenzyme A (HMG‐CoA) reductase inhibitors (statins) have revolutionised the treatment of hyperlipidaemia, and results from large‐scale, long‐term clinical trials have shown that the substantial reductions in low‐density lipoprotein cholesterol (LDL‐C) achieved with these drugs are associated with dramatic decreases in cardiovascular risk. Results from recent comparative clinical trials that have included a new drug in this class, rosuvastatin (Crestor®), have demonstrated that it is significantly superior to atorvastatin, pravastatin and simvastatin in reducing total cholesterol, LDL‐C and apolipoprotein B (Apo B). It is also significantly more effective than atorvastatin in increasing high‐density lipoprotein cholesterol (HDL‐C) and apolipoprotein A‐I (Apo A‐I). Rosuvastatin was also superior to all these agents in helping patients meet European Atherosclerosis Society (EAS) and National Cholesterol Education Programme (NCEP) goals for LDL‐C. The results of an increasing number of studies indicate that statins have a wide range of pleiotropic properties that almost certainly contribute to their ability to decrease cardiovascular risk and may also make them valuable for treatment of other diseases. These actions include plaque stabilisation, improvement of endothelial function, inhibition of smooth muscle cell proliferation and migration, reduction of expression of adhesion molecules, prevention of cholesterol esterification and accumulation, reduction of secretion of matrix metalloproteinases by macrophages, reduction of platelet activity, reduction of formation of thrombogenic factors, chemoprotection and induction of bone morphogenic protein‐2 (BMP‐2). Further exploration of these actions will provide key information about class effects and properties of specific members of this highly useful group of drugs.
LEUPRORELIN ACETATE IN PROSTATE CANCER: A EUROPEAN UPDATE
Authors: Persad R
Published: April 2023

This review provides an update on leuprorelin acetate, the world's most widely prescribed depot luteinising hormone‐releasing hormone analogue. Leuprorelin acetate has been in clinical use in the palliative treatment of prostate cancer for more than 20 years, but advances continue to be made in terms of convenience and flexibility of administration, and in the incorporation of leuprorelin acetate into novel treatment regimens. The drug is administered in the form of a depot injection containing leuprorelin acetate microspheres, and is at least as effective in suppressing testosterone secretion as orchiectomy. In patients with prostate cancer, serum testosterone levels are reduced to castrate levels (≤50 ng/dl) within 2–3 weeks of the first one‐month depot injection of 3.75 mg or three‐month depot injection of 11.25 mg. Both the one‐month and three‐month formulations are effective in delaying tumour progression and alleviating symptoms of locally advanced and metastatic prostate cancer. Tolerability is generally good, with side‐effects reflecting effective testosterone suppression. Recent studies have investigated the place of leuprorelin acetate as part of continuous or intermittent maximal androgen blockade (MAB) and in neoadjuvant therapy (i.e. to reduce the size of the prostate and downsize the tumour before radiotherapy). Additional formulations and presentations are in development, including a six‐month injection, with the aim of adding to the clinical flexibility and patient acceptability of this important palliative treatment for prostate cancer.
ANAL CANAL AMPUTATION AND NECROSIS OF THE ANAL SPHINCHTER DUE TO ELECTRIC CURRENT INJURY
Authors: Yildirgan MI , Basoglu M , Balik AA , Aydinli B
Published: April 2023

The pathophysiology of electrical burns differs from thermal and chemical burns and electrical injuries which are associated with significant morbidity and mortality. We report on a patient who suffered anal canal amputation and necrosis of the anal sphinchter as a result an electric current injury.
EFFECTS OF SOMATOSTATIN, OCTREOTIDE AND PITRESSIN PLUS NITROGLYCERINE ON SYSTEMIC AND PORTAL HAEMODYNAMICS IN THE CONTROL OF ACUTE VARICEAL BLEEDING
Authors: Zhang HB , Wong BCY , Zhou XM , Guo XG , Zhao SJ , Wang JH , Wu KC , Ding J , Lam SK , Fan DM
Published: April 2023

To examine the haemodynamic effects of somatostatin (SS) and octreotide (OC) versus pitressin plus nitroglycerine (PN) in the control of variceal bleeding, 224 patients with acute oesophageal and gastric variceal haemorrhage were randomly divided into three groups and treated with SS, OC and PN; they also had their Doppler ultrasound parameters measured before, during and after treatment. The success rates of bleeding control in the SS (80.9%, 86.8% and 89.7%, p<0.001) and OC (75.3%, 80.8% and 84.9%, p<0.01) groups were significantly higher than in the PN group (51.8%, 59.0% and 65.1%) at 24, 48 and 72 hours respectively, and the average duration of SS (12.7 + 6.8 h) and OC (13.8 + 8.0 h) was significantly lower than that of PN (24.6 + 15.4 h, p<0.001). Side‐effects of SS (7.4%) and OC (8.2%) were less than those of PN (41.0%, p<0.001 and p<0.01). The diameter of portal vein (PVD), velocity of portal vein (PVV), volume of portal blood flow (PVF) and hepatic artery pulsatility index (HA‐PI) in all three groups decreased significantly during initial treatment, but recovered when treatment was stopped. Heart rate and cardiac output decreased significantly in patients treated with SS and OC; mean arterial pressure was unchanged. However, heart rate and mean arterial pressure increased, and cardiac output decreased, with PN. Somatostatin and octreotide were more effective than pitressin plus nitroglycerine in patients with acute variceal haemorrhage, with fewer side‐effects, and may decrease PVF and portal vein pressure through reduction of cardiac output and dilatation of the visceral blood vessels.
PHARMACOLOGY OF PHOSPHODIESTERASE‐5 INHIBITORS
Authors: Corbin JD , Francis SH
Published: April 2023

The clinical properties (efficacy and safety profile) of a medicine are related not only to its mode of action, but also to its selectivity for its target (usually a receptor or enzyme) and are also influenced by its pharmacokinetic properties (absorption, distribution, metabolism and elimination). The growing number of phosphodiesterase inhibitors that are selective for phosphodiesterase‐5 (PDE5) represent a promising new class of compounds that are useful for the treatment of erectile dysfunction and perhaps other disorders. Some of the basic pharmacodynamic and pharmacokinetic parameters that describe drug action are discussed with regard to the new PDE5 inhibitors. Central topics reviewed are the concentration that produces a given in vitro response, or potency (IC50), maximum plasma concentration (Cmax), time to Cmax (Tmax), half‐life (t½), area under the curve (AUC), bioavailability, onset and duration of action, and the balance to achieve optimum safety and efficacy. To illustrate these concepts, a group of inhibitors with varying selectivities and potencies for PDE5 (theophylline, IBMX, zaprinast, sildenafil, tadalafil and vardenafil) are discussed. Each drug has its own set of unique pharmacological characteristics based on its specific molecular structure, enzyme inhibition profile and pharmacokinetic properties. Each PDE5 inhibitor has a distinct selectivity that contributes to its safety profile. As with all new drugs, and especially those in a new class, careful evaluation will be necessary to ensure the optimal use of the PDE5 inhibitors.
UPPER AIRWAY OBSTRUCTION AND ACUTE LUNG INJURY ASSOCIATED WITH COCAINE ABUSE
Authors: Raza S Ali , Krugar M , Houghton J
Published: April 2023

We describe the case of a 14‐year‐old boy who developed airway obstruction due to acute upper respiratory tract infection. Following emergency tracheostomy, he developed pulmonary oedema and required ventilation. The postoperative course was complicated by the development of adult respiratory distress syndrome, characterised by marked respiratory distress, diffuse pulmonary infiltrates on chest radiography, reduced pulmonary compliance and marked increase in alveolar‐arterial oxygen difference. He also developed persistent high‐grade pyrexia, renal failure and cardiac instability. A social history of substance abuse (crack cocaine, amphetamines, alcohol and cigarettes) was obtained three weeks post‐admission and is thought to have made a significant contribution to the severity of his disease.
RANDOMISED TRIAL OF THE EFFECT OF ORLISTAT ON BODY WEIGHT AND CARDIOVASCULAR DISEASE RISK PROFILE IN OBESE PATIENTS: UK MULTIMORBIDITY STUDY
Authors: Broom I , Wilding J , Stott P , Myers N ,   UK Multimorhidity Study Group
Published: April 2023

The potential effect of orlistat on cardiovascular co‐morbidities may have been previously underestimated. This study assesses the efficacy of orlistat therapy for weight loss and cardiovascular risk factor reduction in obese patients with cardiovascular risk. This was a 54‐week, double‐blind, randomised, placebo‐controlled, parallel group study with 531 patients being randomised. Mean weight loss was significantly greater with orlistat than with placebo (5.8% vs 2.3%; p<0.0001). Orlistat was also associated with significantly greater improvements than placebo in diastolic BP (‐5.5 vs ‐3.1 mmHg; p<0.01), systolic blood pressure (‐6.0 vs ‐2.3 mmHg; p<0.01), oral glucose tolerance test (‐0.37 vs +0.09 mmol/l; p<0.05), fasting glucose (‐0.19 vs +0.06 mmol/l; p<0.05), total cholesterol (‐1.31% vs +3.78%; p<0.0001), LDL‐cholesterol (‐7.09% vs ‐0.55%; p<0.0001) and waist circumference (‐5.99 vs ‐2.60 cm; p<0.0001). Orlistat was well tolerated. Orlistat weight loss is associated with improvements in cardiovascular co‐morbidities, and hence cardiovascular risk.
THE EFFECTS OF ACUTE PHASE PROTEINS ON SERUM ALBUMIN, TRANSFERRIN AND HAEMOGLOBIN IN HAEMODIALYSIS PATIENTS
Authors: Kalender B , Mutlu B , Ersöz M , Kalkan A , Yilmaz A
Published: April 2023

In the present study, the effects of C‐reactive protein (CRP) and ferritin on serum albumin, transferrin and haemoglobin (Hb) were assessed to investigate the relationship between inflammation, hypoalbuminaemia and anaemia in haemodialysis patients. A total of 117 patients who were followed at three haemodialysis units in Kocaeli were enrolled. The mean age was 47.83 ± 16.85 years. The median time on dialysis was 26 (minimum 1, maximum 209) months. Serum CRR albumin and ferritin concentrations were measured in our laboratory and transferrin, urea reduction ratio (URR) and KW were calculated. There was significant inverse correlation between serum CRP level and albumin (p<0.001), serum CRP and Hb (p<0.001), and serum transferrin and ferritin (p<0.05). There was significant positive correlation between serum albumin and Hb (p<0.001), serum CRP and ferritin (p<0.05), and transferrin and URR (p<0.05). Our findings suggest that inflammation is a contributor in the development of hypoalbuminaemia and anaemia in haemodialysis patients as well as malnutrition and inadequate dialysis.
GALANTAMINE PROVIDES BROAD BENEFITS IN PATIENTS WITH ‘ADVANCED MODERATE’ ALZHEIMER'S DISEASE (MMSE ≤12) FOR UP TO SIX MONTHS
Authors: Wilkinson DG , Hock C , Farlow M , Van Baelen B , Schwalen S
Published: April 2023

We investigated whether galantamine (Reminyl®), a cholinergic agent with a dual mode of action for the treatment of mild to moderate Alzheimer's disease (AD), would benefit patients with more advanced illness. We performed a post hoc analysis on pooled data from four pivotal studies in patients with ‘advanced moderate’ AD: baseline Mini‐Mental State Evaluation (MMSE) scores ≤12 (range 10–12; mean MMSE score 11) or Alzheimer's Disease Assessment Scale‐cognitive subscale (ADAS‐cog) scores >30 (range 31–69; mean ADAS‐cog score 39). Over 5–6 months, cognitive abilities were improved with galantamine versus placebo (p<0.001; mean treatment difference 6.5 points). At 6 months, galantamine benefited functional abilities (p<0.001 vs placebo). The first quartile of galantamine patients improved over baseline by 10.5 ADAS‐cog points. Cognitive and functional abilities were maintained around baseline; behavioural symptoms were delayed. Over 6 months, galantamine provided a broad spectrum of benefits to patients with ‘advanced moderate’ AD.
ATYPICAL ANTIPSYCHOTICS: EXPERIENCE AND USE IN THE ELDERLY
Authors: Bullock R , Saharan A
Published: April 2023

The use of antipsychotics is common in the elderly. Typical antipsychotics are not without risk, especially in tardive dyskinesia, which, when balanced against relatively low efficacy, make their use debatable. Atypical antipsychotics have much less in the way of side‐effects and are much less likely to induce tardive dyskinesia. However, there is much less in the published literature about the efficacy of these drugs in the elderly and how best to use them in primary psychosis, Parkinson's disease and the behavioural and psychological symptoms of dementia. This review attempts to summarise the current literature and make some tentative recommendations for each of the commonest atypicals, based on the current evidence.
THE EFFECT OF DOXAZOSIN ON SEXUAL FUNCTION IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA, HYPERTENSION, OR BOTH
Authors: Flack JM
Published: April 2023

The prevalence of both benign prostatic hyperplasia (BPH) and hypertension increases with advancing age. These conditions coexist in almost 25% of men aged 60 years and older. The use of transurethral prostatectomy, a common surgical therapy for BPH, alleviates symptoms but results in erectile dysfunction (ED) in up to 35% of patients. Pharmacological intervention for BPH, including androgen‐suppressing agents, has resulted in an increased incidence of sexual adverse experiences compared with the incidence observed in patients receiving placebo. Patients with hypertension also frequently experience problems with sexual function; in addition, antihypertensive medications used to treat this disease may increase problems with sexual function. ED is an age‐related phenomenon, with estimated prevalence rates of 39% among men 40 years old and 67% among those 70 years old. Doxazosin, an α1‐adrenoceptor antagonist indicated for the treatment of patients with BPH and/or hypertension, is not associated with the occurrence of ED compared with other antihypertensive treatments.
POST‐STROKE DEPRESSION
Authors: Gupta A , Pansari K , Shetty H
Published: April 2023

Stroke is considered mainly as a physical disability, and stroke‐related depression is under‐recognised Cognitive, language and functional impairment complicates the recognition of post‐stroke depression. The pathophysiology of post‐stroke depression is poorly understood, but several risk factors have been identified. Depression following stroke can impede recovery and rehabilitation and is associated with higher mortality. Randomised trials show that antidepressants, especially selective serotonin uptake inhibitors, are effective in the treatment of this condition. Despite the evidence available, a large number of patients remain undertreated. Early identification and treatment can reduce the functional impairment and mortality related to post‐stroke depression.
RECOMBINANT HUMAN ACTIVATED PROTEIN C (XIGRIS®)
Authors: Levi M , De Jonge E , Van Der Poll T
Published: April 2023

An impaired function of the protein C pathway plays a central role in the pathogenesis of sepsis. Administration of human recombinant activated protein C (Xigris®) may restore the dysfunctional anticoagulant mechanism and prevent amplification and propagation of thrombin generation and formation of microvascular thrombosis but may simultaneously modulate the systemic pro‐inflammatory response. Experimental studies indicated that the administration of activated protein C could block the derangement of coagulation, inhibit inflammatory effects and preserve organ function. Randomised controlled clinical studies in patients with severe sepsis confirmed these beneficial effects and demonstrated that administration of recombinant human activated protein C resulted in a reduction of mortality in patients with severe sepsis.
BERNARD‐SOULIER SYNDROME IN A TURKISH FAMILY
Authors: Okan V , Araz M , Camci C , Aktaran S , Sahin A , Buyukberber S , Bakir K , Cakmak EA
Published: April 2023

This report describes the first Turkish family to be diagnosed with Bernard‐Soulier syndrome. The family consists of nine members (two parents, three sons and four daughters). The parents were first cousins. The index case, a 22 year‐old‐man, had a history of haemorrhagic diathesis with thrombocytopenia, giant platelets in the peripheral blood smear and a prolonged bleeding time. Refractory idiopathic thrombocytopenic purpura had been diagnosed elsewhere and a splenectomy had been performed six months previously. Ristocetin agglutination of platelets was defective and flow cytometry analysis of platelet membrane glycoprotein showed markedly reduced expression of glycoprotein lb (2.1%). Bernard‐Soulier syndrome was diagnosed. Increased mean platelet volume was found in both parents, one son and three daughters. The other son and daughter were normal.
PRESCRIBING PATTERNS IN MEDICAL OUTPATIENTS
Authors: Shankar P Ravi , Partha P , Nagesh S
Published: April 2023

A drug utilisation review was carried out in the medical outpatient department of the Manipal teaching hospital, a tertiary care hospital in Pokhara, western Nepal, to determine the prescribing frequency of commonly used drugs. An attempt was made to relate prescription data to age and sex of the patients. A total of 530 prescriptions were analysed, and the mean ± SD drugs per prescription was 2.15 ± 1.71; 67.4% of the drugs were prescribed by brand name and only 39.56% of the drugs prescribed were from the WHO essential drug list. The average cost of drugs per prescription was US$2.75 ± 2.21. The frequency of prescribing of antiulcer drugs, antibiotics, antiasthma drugs, antihypertensives and analgesics was 24.15% (n=128), 23.96% (n=127), 20.56% (n=109), 19.81% (n=105) and 15.09% (n=80), respectively. This study revealed considerable scope for educating prescribers to improve their prescribing practice.
A NEW SURGICAL TREATMENT OF AN ACUTE DISLOCATION OF THE PROXIMAL TIBIOFIBULAR JOINT
Authors: Rajkumar P , Schmitgen GF
Published: April 2023

Acute dislocation of the proximal tibiofibular joint is rare, and although most dislocations are treated by closed reduction, open reduction and internal fixation is sometimes required. We present the case of an injury to a professional football player where open reduction and internal fixation with bioabsorbable pins was performed.
RECTAL SALAMI
Authors: Shah J , Majed A , Rosin D
Published: April 2023

We present the case of a 63‐year‐old man who had inserted a salami into his anal canal for sexual stimulation – the commonest reason for inserting foreign bodies – and who subsequently required a laparotomy for its removal. This common surgical problem requires a thorough medical history, an examination and the use of radiographs for management. Current techniques for removal of such objects are discussed.
THERAPEUTIC APPROACH IN INSULIN RESISTANCE WITH ACANTHOSIS NIGRICANS
Authors: Tankova T , Koev D , Dakovska L , Kirilov G
Published: April 2023

The aim of the present study was to evaluate the effect of metformin in very obese subjects with acanthosis nigricans. Five patients (two obese children, mean age 14.4 ± 0.6 yr, mean BMI 35.2 ±1.9 kg/m2 and normal glucose tolerance, and three newly diagnosed obese type 2 diabetic patients, mean age 37.7 ± 3.2 yr, mean BMI 37.7 ± 2.9kg/m2) were enrolled in the study. Insulin secretion was measured during oral glucose tolerance (OGT) and intravenous glucose tolerance (IVGT) tests. Insulin resistance was assessed by the homoeostasis model assessment (HOMA) index. All the patients were treated with metformin at a mean daily dose of 2.23 ± 0.45 g. Six months after initiation of therapy we found a significant reduction in AUC for insulin secretion during OGTT (p<0.05), due to reduction in both basal and stimulated insulin secretion (p<0.05). Body weight was reduced by mean 4.7 ± 1.9% and body fat mass by 8.95 ± 3.7%. We have demonstrated a significant decrease of 36.3% in insulin resistance (p<0.01). Our results demonstrate that metformin reduces hyperinsulinaemia, body weight and fat mass and improves insulin sensitivity in patients with insulin resistance and acanthosis nigricans.
ASSESSMENT, DIAGNOSIS AND MANAGEMENT OF LOWER URINARY TRACT SYMPTOMS IN MEN
Authors: Brown CT , Das G
Published: April 2023

Lower urinary tract symptoms are very common and the approach to assessment and management has changed dramatically over the past few years. Previously referred to as prostatism, benign prostatic hyperplasia and bladder outflow obstruction, it is now recognised that in most men symptoms are due to a combination of benign prostatic enlargement and age‐related bladder dysfunction. Most men require only simple tests for a diagnosis, with the more complex investigations reserved for when the diagnosis is not clear. Symptom bothersomeness and effect on quality of life are the critical factors when deciding how to treat a man. A cascade of treatments exists, including conservative management, medical therapy and surgery. A man moves up the cascade when the present management strategy fails to control symptoms. Traditional surgical techniques such as transurethral resection of the prostate are still appropriate for some men, although with improved medical treatments available the number of men undergoing surgery is declining.
GENETIC HAEMOCHROMATOSIS
Authors: Rosalk SB
Published: April 2023

Genetic haemochromatosis is an autosomal recessive inherited disorder of iron metabolism due to mutation of the HFE gene. In homozygotes (1 in 300 of the UK population), this results in excessive iron absorption from the gut and its deposition in major body organs. This may give rise to fatigue, arthritis, cardiac failure, diabetes mellitus, hepatic cirrhosis or skin pigmentation, occurring predominantly in males over 50 years of age. Identification uses measurement of serum iron, iron‐binding capacity (or transferrin) and ferritin, together with initial or confirmatory genetic DNA studies.