bluuebunny/crossref_metadata_2025 huggingface dataset:
BATMAN-TCM 2.0: an enhanced integrative database for known and predicted interactions between traditional Chinese medicine ingredients and target proteins
Authors: Kong Xiangren , Liu Chao , Zhang Zuzhen , Cheng Meiqi , Mei Zhijun , Li Xiangdong , Liu Peng , Diao Lihong , Ma Yajie , Jiang Peng , Kong Xiangya , Nie Shiyan , Guo Yingzi , Wang Ze , Zhang Xinlei , Wang Yan , Tang Liujun , Guo Shuzhen , Liu Zhongyang , Li Dong
Published: October 2023

Traditional Chinese medicine (TCM) is increasingly recognized and utilized worldwide. However, the complex ingredients of TCM and their interactions with the human body make elucidating molecular mechanisms challenging, which greatly hinders the modernization of TCM. In 2016, we developed BATMAN-TCM 1.0, which is an integrated database of TCM ingredient–target protein interaction (TTI) for pharmacology research. Here, to address the growing need for a higher coverage TTI dataset, and using omics data to screen active TCM ingredients or herbs for complex disease treatment, we updated BATMAN-TCM to version 2.0 (http://bionet.ncpsb.org.cn/batman-tcm/). Using the same protocol as version 1.0, we collected 17 068 known TTIs by manual curation (with a 62.3-fold increase), and predicted ∼2.3 million high-confidence TTIs. In addition, we incorporated three new features into the updated version: (i) it enables simultaneous exploration of the target of TCM ingredient for pharmacology research and TCM ingredients binding to target proteins for drug discovery; (ii) it has significantly expanded TTI coverage; and (iii) the website was redesigned for better user experience and higher speed. We believe that BATMAN-TCM 2.0, as a discovery repository, will contribute to the study of TCM molecular mechanisms and the development of new drugs for complex diseases.
PhageScope: a well-annotated bacteriophage database with automatic analyses and visualizations
Authors: Wang Ruo Han , Yang Shuo , Liu Zhixuan , Zhang Yuanzheng , Wang Xueying , Xu Zixin , Wang Jianping , Li Shuai Cheng
Published: October 2023

Bacteriophages are viruses that infect bacteria or archaea. Understanding the diverse and intricate genomic architectures of phages is essential to study microbial ecosystems and develop phage therapy strategies. However, the existing phage databases are short of meticulous annotations. To this end, we propose PhageScope (https://phagescope.deepomics.org), an online phage database with comprehensive annotations. PhageScope harbors a collection of 873 718 phage sequences from various sources. Applying fifteen state-of-the-art tools to perform systematic annotations and analyses, PhageScope provides annotations on genome completeness, host range, lifestyle information, taxonomy classification, nine types of structural and functional genetic elements, and three types of comparative genomic studies for curated phages. Additionally, PhageScope incorporates automatic analyses and visualizations for curated and customized phages, serving as an efficient platform for phage study.
MENINGIOMA-05 ONE HUNDRED SKULL BASE MENINGIOMAS OPERATED AT BLACK LION SPECIALIZED HOSPITAL, ADDISABABA, ETHIOPIA
Authors: Laeke Tsegazeab , Sahlu Abat , Tirsit Abenezer , Lund-Johansen Morten
Published: October 2023

INTRODUCTION

Since the start of the neurosurgery training program in Ethiopia, the specialty has significantly grown both in terms of service provision and quality of surgeries. Locally trained neurosurgeons are now able to operate on complex skull base tumors. Our study used a retrospective design of an in-hospital series of skull base meningiomas with short-term follow-up.

METHODS

A total of 100 patients (mean age, 40.2 years;80% women) had undergone surgery for skull base meningiomas from 2016 to 2017. Their symptoms included headache in 90%, impairment of vision in 47%, gait impairment in 25%, cognitive dysfunction in 29%, and seizures in 18%. Of the 100 tumors, 44% had a diameter >50 mm. Microsurgery was performed using the Hudson drill, Gigli saw, and conventional microsurgical instruments.

RESULTS

A total of 59 complications in 39 patients occurred. Eleven patients had died within 3 months postoperatively. The cranial infection rate was 14%. The rate of Simpson grade I and II was 63%. We present the 3 -12 month outcomes for 84 of the 100 patients. Of the 16 remaining patients, 4 were lost to follow-up (mean, 6.7 months) and 12 had died. Headache was noted in 65 of 74 patients preoperatively and in 20 during follow-up. Overall,33 patients reported better vision, 48 reported similar vision, and 3 patients reported worse vision. Finally, 20 patients had gait difficulties preoperatively and 9 reported impaired gait during follow-up.

CONCLUSION

A young faculty of locally trained neurosurgeons in a low income country, Ethiopia, were able to do large skull base meningiomas. The patients had presented at a young age with severe disabilities due to advanced disease. Surgery led to symptom improvement in a large proportion of patients. The outcome of patients was promising; however, there should still be improvement on the resource limitations faced.
OTHER-01 INTERNATIONAL CLASSIFICATION, BRAIN TUMOURS AND CARE: ACCOUNTING FOR THE DIAGNOSTIC POTENTIAL OF SUB-SAHARAN AFRICA
Authors: Llewellyn Henry
Published: October 2023

International cancer classification is fundamental to oncology. It structures diagnostic routines, research programmes, treatment pathways, and grounds for correspondence and comparison across settings. It is vital to cancer epidemiology, which influences national and global health investment and policy. However, the process of classification is not straightforward and often poorly understood. Importantly, classification is not simply a matter of discerning biological difference. It also demands ethical and political choices, which have major social consequences around the world. These choices are made largely by classification experts in elite settings in high-income countries and overseen by the WHO's International Agency for Research on Cancer. Decision-making is therefore rooted in particular frameworks and assumptions about technical capabilities for diagnosis, which might not be appropriate to the situations of practitioners (and patients) in low- and middle-income countries, who often face the challenges of severely limited resources and compromised healthcare infrastructures. These issues have been made starkly apparent in the field of neuro-oncology in recent years. A key concern is the progressive integration of new molecular genetic and epigenetic biomarkers in brain and CNS tumour diagnosis. Although such markers have been welcomed by many as a powerful way to distinguish between brain tumour subtypes, others caution that parts of the world without access to molecular pathology—including many parts of Africa—will be “left behind”. This presentation will introduce a new 5-year social science research project about brain tumour classification and care in Sub-Saharan Africa. The project aims to: 1) document the various “on-the-ground realities” of brain tumour diagnosis and care in Sub-Saharan Africa, and 2) examine how the diagnostic contexts of low- and middle-income countries are considered by brain tumour classifiers. The presentation will reflect on the role that the social sciences might play in the process of cancer classification, which is, arguably, thoroughly social.
OTHER-12
Authors: Cheruiyot Davies , Maina Benson M , Komen Ahmed , Mogere Edwin , Cheserem Beverly
Published: October 2023

Glomus jugulare tumours are rare but present a treatment challenge due to their anatomy, endocrine and cardiovascular effects. Their care requires a multidisciplinary approach. We present the case of a 62year-old female patient who presented with 4-year history of tinnitus, hearing loss and hypertension. Over a period of 2 weeks she decompensated with bulbar dysfunction and rapid cardiovascular instability. MRI demonstrated a 88 cc right jugulotympanicum para-ganglioma with intracranial, extra-axial extension and encasement of cranial nerves VI to XII, and marked mass effect on the brainstem with compression and left displacement of the medulla. The patient also had hydrocephalus. Clinically she had limited physiological reserve. She underwent partial embolization to reduce the hyperdynamic circulation, a total dose of 54Gy in 30 fractions using IMRT technique and ventriculoperitoneal shunt insertion. She had a prolonged critical care stay .However, she progressively improved over a period of six months with the brainstem oedema resolving. Currently, the patient is living independently with normal cardiovascular status. This case demonstrates the benefit of combining endovascular intervention and radiation therapy in the management of glomus tumours.”
Scope
Authors: Jelliffe Derrick B , Jelliffe E F Patrice , Zerfas Alfred , Neumann Charlotte G
Published: October 2023

Nutrition has to be considered as an applied science with methods of assessment and any action taken as a result guided (but not dominated) by metabolic minutiae and mathematical precision. In particular, methods of classifying malnutrition have to be useful for assisting communities using primary health care services—the majority of the world.
Assessment from health statistics (‘indirect assessment’)
Authors: Jelliffe Derrick B , Jelliffe E F Patrice , Zerfas Alfred , Neumann Charlotte G
Published: October 2023

Malnutrition influences morbidity and mortality rates for various infections (such as tuberculosis), as well as maternal, young child, and perinatal mortality rates, life expectancy, and other health statistics as a result of the combined effects of inadequate nutrition and infections. A variety of vital and health statistics have, therefore, been considered as being in part (and in part only) indirect indicators of the nutritional status of the community.
Methods of data collection
Authors: Jelliffe Derrick B , Jelliffe E F Patrice , Zerfas Alfred , Neumann Charlotte G
Published: October 2023

The information needed for community nutritional assessment can be obtained by many methods through numerous channels, either singly or preferably in combination. These can be considered in the following overlapping categories—existing services, surveys, and surveillance. As noted many times, information from each is imperfect, but can best be used together to give a more complete picture and to complement deficiencies in all data.
Epilepsy
Authors: Bannister Sir Roger
Published: October 2023

What is epilepsy? Hughlings Jackson described it as ‘an occasional, and excessive and a disorderly discharge of nerve tissue’. This description could only be. a speculation until Berger in 1929 discovered a method of recording the electrical rhythms of the brain known as electroencephalography. This showed. that different varieties of epileptic attack are associated with abnormal electrical rhythms recorded from the surface of the head, and differing in their characteristics and localization, and led to the description of epilepsy as a cerebral dysrhythmia. This was a great step forward, but it still. leaves some questions un ans: wered, for we do not yet unqerstand the physiological relationship between the· dysrbythmia and the. epileptic attack or the nature of the physicochemical disturbance which causes the dysrhythmia.
Ancillary investigations
Authors: Bannister Sir Roger
Published: October 2023

Over the calvarium the skull X-rays may show osteolytic lesions possibly due to myeloma, fibrous dysplasia, or Paget’s disease. Hyperostosis may occur in acromegaly or a meningioma (Fig. 8.1 ). Calcification within the brain substance may be due to an oligodendroglioma, craniopharyngioma, or meningioma or, rarely, a chronic abscess, tuberculoma, or toxoplasmosis. In hypoparathyroidism there may be calcification of the basal ganglia. Sometimes within the substance of the brain the pattern of the calcified arteriovenous malformation may be seen or an angioma associated with the Sturge-Weber syndrome.
Meningitis
Authors: Bannister Sir Roger
Published: October 2023

Meningitis is one of the few acute emergencies of clinical neurology in which a clinician must move promptly from diagnosis to treatment in order to avoid delay which may quite literally make a critical difference between full recovery and chronic disability or death. By acute meningitis is meant acute leptomeningitis, that is, an infection of the pia mater and arachnoid, which inevitably involves the subarachnoid space and the cerebrospinal fluid. There are three principal ways in which the meninges may become infected.
CFS and psychiatric disorders
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

We have previously looked at the epidemiology of fatigue (Chapter 2) and the epidemiological evidence for an association between fatigue and psychological distress (Chapter 4). We now turn to fatigue syndromes and their possible associa tions with discrete psychiatric disorders. Later chapters will consider the role of broader social, cultural, and psychological factors, with specific reference to the aetiology of disability.
Assessment of the chronically fatigued patient
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

We now tum our attention to clinical management. We begin with the patient for whom the diagnosis of chronic fatigue syndrome is being considered. Two types of presentation may raise this possibility. One is the patient who complains of severe fatigue or exhaustion. The other is the patient who arrives already equipped with a diagnosis (whether by a doctor or self-made) of chronic fatigue syndrome (CFS), chronic fatigue and immune dysfunction syndrome (CFIDS), or myalgic encephalomyelitis (ME). It is important to note that although these groups of patients overlap, they are not identical.
Treatment of the patient with CFS
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

The management of the patient with CFS is in many ways the culmination of this book. Treatment of the individual patient is based on the findings of the assessment outlined in Chapter 16, the knowledge of the efficacy of treatments reviewed in Chapter 17, and on an awareness of the biological, psychological, and social issues discussed in the other chapters. We hope that this penultimate chapter will add to those that have gone before, by providing the reader with additional guidance on the practical administration of treatment.
Evidence For Reduced Fecundity In Female Smokers
Authors: Baird Donna Day
Published: October 2023

Cigarette smoking has been linked with several adverse reproductive outcomes (Rosenberg 1987). The most consistently reported effect is reduction in birth weight (reviewed by Hogue and Sappenfield 1987). The question of whether smoking adversely affects a woman's ability to become pregnant has received less attention. Data on smoking and fertility are available from several epidemiological studies, but only one of these was designed specifically to address this question. In a 1986 review article on the subject, Stillman et al. (1986) claimed that: ‘this literature clearly demonstrates a reduction in fecundity of women who smoke.’ Yet, in the accompanying editorial, Wentz (1986) stated: ‘There are few good hard data that show that smoking impairs fertility. Published data are weighted in the direction of showing no deleterious effect on fertility in the woman.’ Clearly a controversy existed. Additional reports published after 1986 do not resolve this controversy.
Ectopic Pregnancy And Smoking: Confounding Or Causality?
Authors: Campbell Oona
Published: October 2023

Renewed interest in ectopic pregnancy began in the mid-1970s with observations of a marked increase in the rate of ectopic pregnancies (Beral 1975; Rubin et al. 1983). Around the same time, awareness of the reproductive consequences of smoking was growing and, by the early 1980s, reports of an association between smoking and ectopic pregnancy emerged. The question posed in the title of this chapter-whether the association between ectopic pregnancy and smoking is a causal one or whether it is due to confounding by unmeasured variables-is one that frequently arises in relation to smoking. The argument for confounding runs as follows: smoking is a 'lifestyle' variable, an exposure associated with systematic differences, not just in smoking behaviour but in overall characteristics and 'lifestyle' of the smoker (Pederson and Stavraky 1987). Associations observed between smoking and adverse outcomes may be attributable to this 'lifestyle' rather than to smoking per se. A well known example where consensus has not been reached is the controversy over the role of smoking and potential confounding by sexual and reproductive behaviour in the aetiology of cervical cancer (Winkelstein et al. 1984; Clarke et al. 1985). In different circumstances, Yerushalmy (1971, 1972) and Hickey and colleagues (1978) argue that low birth weight is caused by attributes of the smoker rather than by smoking itself. Hickey et al. (1978) go further and claim that both smoking and low birth weight are ‘symptoms of deficient maternal bioenergetic systems’.
Exposure To Passive Cigarette Smoking And Child Development: An Updated Critical Review
Authors: Rush David
Published: October 2023

While maternal cigarette smoking during pregnancy is closely related to the growth and survival of the fetus (Rush and Kass 1972), the nature and extent of effects on later development of the child are not clearly understood. In an attempt to clarify current knowledge, this review (an update of Rush and Callahan 1989) describes the design and some of the strengths and weaknesses of each of the studies known, and then summarizes, across studies, relationships with somatic, cognitive, and behavioural development.
Prevention Of Smoking In Pregnancy: Results Of Intervention
Authors: MacArthur Christine , Knox George
Published: October 2023

Smoking during pregnancy has been shown repeatedly to be associated with adverse outcomes of pregnancy, in particular with reduced birth weight and corresponding higher rates of perinatal mortality (Butler et al. 1972; Surgeon General 1980). The early findings all came from observational studies comparing smokers with non-smokers and ex-smokers. These groups, however, might be different in ways other than their smoking and it was not certain that the associations were causal. Only a randomized intervention, demonstrating that increased birth weight results directly from persuading pregnant smokers to reduce their smoking, would allow a firm inference that the association was causal (Butler et al. 1972); and at the same time indicate the pragmatic value of the intervention.
Ankylosing spondylitis
Authors: Rigby Alan S
Published: October 2023

As a remarkable and, it would seem, peculiar condition, we might now draw anention, in passing, to a form of morbidity ln which there supervenes, progressively and without pain, a complete ankylosis of the entire spine and of both ilio-femoral joints, in such a manner that the head, the trunk and the thighs become fused to one another and completely rigid, while other joints preserve their normal mobility. It goes without saying that, as a result of this fusion, very peculiar alterations in posture and gait develop.
Systemic lupus erythematosus*
Authors: Silman Alan J , Hochberg Marc C
Published: October 2023

Systemic lupus erythematosus (SLE) is a multisystem disorder characterized by an abundance of immunologic abnormalities including loss of self-tolerance, polyclonal B-lymphocyte activation and the production of auto-antibodies to a variety of cellular constituents. The clinical features of SLE are well described and include, in descending order of frequency, constitutional symptoms (malaise, fever, and weight loss), skin and mucous membrane involvement, arthritis and/or arthralgia, pleurisy and/or pericarditis, renal involvement, central nervous system involvement, Raynaud’s phenomenon, peripheral vasculitis, and inflammatory myositis.
Plastic Surgery
Authors: McNeil M
Published: October 2023

Plastic surgery encompasses a wide variety of . surgical procedures in patients of all ages. The workload varies from the removal of lumps and bumps under local infiltration to major reconstructive work requiring microvascular flaps.
Introduction to chronobiology
Authors: Reilly T , Atkinson G , Waterhouse J
Published: October 2023

Evolution has resulted in humans being anatomically, physiologically, and behaviourally adjusted to their environment. Thus, they show adaptation to an upright posture, they control their body temperature in spite of large swings in ambient temperature, and they control the composition of their plasma in spite of the dehydrating effects of the atmosphere and taking in food and drink discontinuously. Ecologically, humans have responded to environmental demands, whether these be due to gravity, temperature or dehydration. Another influence - that of time - is equally important, and humans, like all other living organisms, have also responded to the changes produced by time in their bodies.
Sleep and exercise
Authors: Reilly T , Atkinson G , Waterhouse J
Published: October 2023

One of the more fundamental human circadian rhythms is the sleep wakefulness cycle. While asleep, the organism is virtually unresponsive to external stimuli; this is in sharp contrast with a state of extreme alertness. In this sense, the states associated with the sleep-wakefulness cycle constitute a continuum from deep sleep to high excitement. The biphasic rhythm in human lives is in most cases matched to the light and dark cycles in the environment caused by the rotation of the earth around its long axis.
Time-zone transitions
Authors: Reilly T , Atkinson G , Waterhouse J
Published: October 2023

Since the Earth is spinning on its axis, for anybody standing on the Earth’s surface, the sun rises in the east and sets in the west, and is at its highest point in the sky at noon by local time. However, these events must occur in the UK after they have taken place in countries to the east and before they have taken place in countries to the west. In order to resolve this problem, the world has been divided into 24 time-zones centred around Greenwich and separated by lines of longitude 15° apart. These time-zones determine the relationship between Greenwich Mean Time (GMT) and local time, those to the east of the UK being advanced and those to the west being delayed.
Ventilator management
Authors: Frca C Ferguson
Published: October 2023

A 38-year-old female patient who had taken an overdose of tricyclic antidepressants presented with tachyarrythmias and convulsions having been transferred intubated from another hospital.
Endocarditis
Authors: Mrcp J B Salmon
Published: October 2023

A 25-year-old man was admitted with a pyrexial illness and confusion. Temperature was 39.5°C; GCS 13; he had a severe digital v sculitis and evidence of mild aortic regurgitation: There were no focal neurological abnormalities and no meningism. Heart rate was 105/min with a normal pulse character and BP was 135/80 mmHg. He had a: soft ejection systolic murmur and a short early diastolic murmur of grade 2/4 intensity. A CT brain scan was normal and an echocardiogram showed mild aortic regurgitation with no evidence of vegetations. Blood, urine, and cerebrospinal fluid cultures all yielded a heavy, pure growth of a penicillin-sensitive Staphylococcus aureus. A search for obvious sources of infection was negative and there was no history of drug abuse. He was treated with benzylpenicillin, flucloxacillin, and gentamicin but deteriorated acutely 48 hours later. He became hypotensive, breathless, and hypoxaemic such that he required intubation and ventilation.
Sepsis
Authors: Frca C J Hinds Frcp
Published: October 2023

A 56-year-old man with chronic nephrolithiasis and recurrent urinary tract infections underwent nephrolithotomy. A few hours after returning to the ward he was reviewed by the surgical registrar who noted that he was febrile (38°C), tachycardic (100/min), and tachypnoeic (30 breaths/min), with a poor urine output. The patient also appeared to be confused. Blood and urine were sent for microscopy, culture, and sensitivities, and antibiotics (gentamicin and ampicillin) were given intravenously. Two hours later the patient became hypotensive and was referred to the intensive care team.
Guillain-Barré syndrome
Authors: Frca N Hirsch
Published: October 2023

A 70 kg, 55.:year-old man was admitted to A&E with a 24-hour history of increasing shortness of breath and difficulty in swallowing, One week previously he suffered an upper respiratory tract infection, followed by pain and paraesthesiae in both feet and weakness in both legs, making it difficult for him to walk without help.
Diabetic ketoacidosis
Authors: Md R Woolfson Mrcp
Published: October 2023

A 35-year-old nurse with no previous medical history was admitted from home with a 3-day history of vomiting and diarrhoea, abdominal pain, and progressive confusion. On admission, he was apyrexial and unkempt with signs of urinary incontinence. Examination revealed a respiratory rate of 35/min; pulse 120/min; BP 80/40 mmAgjugular venous pressure not seen. His extremities were cyanosed and cool to touch. Abdominal examination revealed moderate epigastric tenderness without guarding or rebound’.but bowel sounds were absent. On catheterization, the bladder was empty.
Introduction
Authors: Lader Malcolm , Herrington Reginald
Published: October 2023

Psychopharmacology is both an old and a new subject. Old, because mankind has resorted to mmd-altering drug for the whole of recorded history and probably for thousands of year before that. New, because the study of mind-altering drugs using modern scientific methods essentially dates from around 1950, culminating in the discovery of the modern drugs used in psychiatry. Only the tcchnolog1cal revolution separates neolithic man finding out that fermented wild grapes intoxicated him from the synthesizer of and experimenter with LSD, Albert Hoffmann. The unknown Sterne Age man who first discovered the analgesic and psychotropic effect of the opium poppy ranks with the chemists, pharmacologists and dimcians who developed chlorpromazine, imipramme, lithium, and the bcnzodiazcpines and discovered their therapeutic effects.
Behavioural studies in animals and humans
Authors: Lader Malcolm , Herrington Reginald
Published: October 2023

As well as providing techniques for use in the development of new drugs and other therapies, psychopharmacology has used those techniques to derive a large body of knowledge concerning the effects of drugs. This chapter will focus on the former and outline behavioural methods used in the assessment of psychotropic drugs in animals and humans.
Paediatric resuscitation
Authors: Skinner David V , Vincent Richard
Published: October 2023

Paediatric resuscitation follows the same essential principles as adult resuscitation. The difference is that paediatric resuscitation events occur over a wide range of size and weight, varying from the small baby, at 2.5 kg, to the average teenager, at 70 kg. With this wide range, it is obvious that the paediatric resuscitator must have knowledge of and confidence in the methods appropriate to the size of child. This chapter will deal mainly with the small infant weighing between 5 and 10 kg. Patients at the other end of the range can be dealt with as small adults. It will not deal with resuscitation of the newborn, as this is a specialist, planned recovery event occurring in the delivery room. Suggested further reading on resuscitation of the newborn is given at the end of the chapter.
Poisoning
Authors: Morton Rosemary J , Phillips Barbara M
Published: October 2023

Suspected poisoning in children results in about 40 000 attendances at A & E departments per year in England and Wales. Less than half these children are admitted to hospital for treatment or observation.

Deaths are uncommon; there are usually less than 10 per year in England and Wales. The most common fatal poisons in children are the tricyclic antidepressants (TCAs).

The most frequently ingested drugs are analgesics (particularly paracetamol), anxiolytics, cough medicines, oral contraceptives, and dietary drugs such as vitamins. The most frequently ingested household products are bleaches, detergents, disinfectants, and petroleum distillates.

There has been a fall in the incidence of admissions for analgesic poisonings since the introduction of child-resistant containers for these drugs in the mid-1970s.
Child abuse
Authors: Morton Rosemary J , Phillips Barbara M
Published: October 2023

1 If abuse is suspected, ask for a senior paediatric opinion.

2 Particularly consider the possibility of abuse when examining injured babies of less than one year of age.

3 In a child with suspected sexual abuse, genital examination constitutes further abuse and should be undertaken by one experienced doctor only unless life-threatening bleeding requires immediate aid.

The management of suspected child abuse should be directed to the following:

• treat the child’s injuries, including the psychological ones

• cooperate with others to ensure the child’s safety.
Neonatal problems
Authors: Morton Rosemary J , Phillips Barbara M
Published: October 2023

Occasionally an asphyxiated baby, newly born in an ambulance or at home, may be brought to the A & E department for resuscitation. A baby who il’l born quickly and unexpectedly and is asphyxiated is very likely to be a preterm baby. Staff in the A & E department should be able to resuscitate such an infant before transferring him to the special care baby unit or neonatal intensive care unit.
Menstruation, surgery, and women
Authors: Voda Ann M , Mansfield Phyllis Kernoff , Root Jan L
Published: October 2023

And did we find regularity in the menstrual cycle? Anything but! Variation so clearly characterized every history that we wondered how the word regular had come to be applied; not only that, but so firmly entrenched. As biometricians, we were prone to define a term like regular in a strictly mathematical sense, as straight lines of circled onset dates, which never appeared on the cards as we studied them individually, and in great numbers each new year. Surely, if we were persistent enough in assembling data, we could convince those who were apt to regard the menstrual cycle as ‘regular’ as the superlative of falsehood. (from Alan E. Treloar’s diary ∼1930s)
Definition and epidemiology of menorrhagia
Authors: Coulter Angela
Published: October 2023

Menorrhagia is ‘excessive’ menstrual blood loss or, in lay terms, heavy periods. The widely accepted clinical definition is a blood loss of 80 ml or more per period. This cut-off point was derived from a community study of menstrual blood loss conducted in Gothenberg, Sweden, in the 1960s, in which 80 ml represented the 90th centile of the distribution (Hallberg et al. 1966). These researchers found that the incidence of anaemia was significantly increased in women with blood losses over 60 ml and they recommended that a blood loss greater than 80 ml should be regarded as pathological. However, this apparently clear-cut definition masks a tangle of scientific debate and clinical uncertainty.
The pathophysiology of menorrhagia
Authors: Smith Stephen K
Published: October 2023

Menorrhagia is the subjective complaint of heavy periods. Its cause in the vast majority of cases is unknown. As one of the commonest referrals for gynaecological consultation (Bradlow et al. 1992) this statement may appear surprising. Yet when one considers the burden of proof needed to identify the cause of such a complex disease and when one views the highly pragmatic means used in the past to deal with the problem it is perhaps less surprising. However, a new urgency to this conundrum is now with us. Regular menstruation is the consequence of the use of wide spread fertility regulation and thus in the past has only been a problem of the developed world, about 20 per cent of the total population of women of reproductive age. However, with the spread of effective fertility regulation worldwide and the global reduction of family size, the rest of the world’s population will for the first time experience regular menstruation.
Pathophysiology and medical treatment of uterine fibroids
Authors: Vollenhoven Beverley J , Healy David L
Published: October 2023

Uterine leiomyomas are the commonest solid tumours in women. They are tumours of the smooth muscle of the uterus, but they also contain varying amounts of fibrous tissue. They are said to occur in 20–25 per cent of females over the age of 30 years. However, the figure is probably an underestimate and they are more likely to occur in about 50 per cent of women (Thompson and Rock 1992).
Oligomenorrhoea and polycystic ovary syndrome
Authors: Franks Stephen
Published: October 2023

Oligomenorrhoea is conventionally defined as an intermenstrual interval of greater than 42 days and is usually indicative of anovulation. Although the focus of this chapter is on oligomenorrhoea, it should be noted that its causes and management are very similar to those of secondary amenorrhoea or irregular menses which are also manifestations of anovulation. Anovulatory menses carries the implication that the ovary is producing oestrogen concentrations which are in the mid-follicular phase range but that progesterone secretion will be deficient. A series of anovulatory menses may, however, be interspersed by the occasional ovulatory cycle, a phenomenon which is relevant when considering the management of patients with oligomenorrhoea, as will be discussed later.
Pre-menstrual syndrome: aetiology and clinical management
Authors: Joshi Changulanda Medappa , Govind Abha , O’Brien P M Shaughn
Published: October 2023

Since the first documentation of pre-menstrual syndrome (PMS) by Frank in 1931, numerous treatment methods have been advocated. The syndrome has no known aetiology and an uncertain and variable course. None the less a psychoneuroendocrine mechanism triggered by the normal endocrine events of the ovarian cycle seems the most plausible explanation. No single intervention will uniformly eradicate symptoms in all patients presenting with PMS. Logical approaches to treatment would therefore include modulations or elimination of the ovarian cycle or correction of a neurotransmitter metabolic abnormality. Women with PMS present with heterogeneous symptoms; therefore management approaches must be designed on an individual basis.
Administrative and organizational aspects
Authors: Beattie B L , Bucks R S , Matthews J
Published: October 2023

As the number of elderly people increases, so does the demand for services aimed at diagnosing and managing cognitive impairment, especially dementia. There is a stronger imperative than ever to study changing cognitive and functional ability in order to improve understanding, treatment, and quality of life. Though a small number of memory teams see patients who do not have dementing disorders (e.g. epilepsy, head injury, or amnesia; see Kopelman and Crawford 1996), most concentrate on older patients. For convenience this chapter focuses on patients with dementia, although the general principles apply whichever group is being served.
The role of the speech and language therapist
Authors: Stevens Susan , Ripich Danielle
Published: October 2023

Communication, defined as the sharing or imparting of information, is integral to the process of building and maintaining relationships. It can be verbal or non-verbal, and is often a combination of the two. Effective communication depends on shared language and semantic (knowledge) memory, adequate physical skills, and a common code of behaviour, including body language and gestures. Language as a cognitive function underpins many other aspects of cognition, including memory. Any breakdown in language is likely to affect both other cognitive skills and the ability to test those skills.
Research potential
Authors: Gauthier S , Byrne J , Byrne L
Published: October 2023

Research into Alzheimer’s disease has greatly advanced in the past decade (High, 1993). This has resulted in improvements in understanding the disease process, patient care, and in diagnosis. Indeed, it is now estimated that misdiagnosis of probable Alzheimer’s disease is less than 10 percent (Katzman and Jackson, 1991). The need to use humans as research participants in Alzheimer’s disease is greater than in many other areas of research because there is no successful animal model of Alzheimer’s disease, although the transgenic mouse model may change this. Therefore, unlike other diseases where valid animal models exist, the prospect of effective diagnosis and treatment will be greatly reduced if research using human subjects is not undertaken. If it is accepted, therefore, that there is a scientific and ethical imperative to undertake research into Alzheimer’s disease and related disorders (Kapp, 1994), then the question of how best to conduct such research is raised.
Other dementias
Authors: Pryse-Phillips William , Wahlund Lars-Olof
Published: October 2023

Cognition is the action or faculty of knowing—knowledge—implying consciousness. The complex faculty is taken to include orientation, attention, memory, language functions, gnosis, visual perception, comprehension, abstraction, reasoning, constructional praxis, judgement, and new learning. Definitions of dementia emphasize memory loss, the presence of other cognitive disturbances, a progressive course, and the presence of diffuse brain disease. Thus the DSM-IIIR criteria for probable Alzheimer’s disease require the presence of dementia; deficits in two or more areas of cognition; progression; normal consciousness; and the absence of other diagnosable pathologies. The diagnosis is supported by progressive deterioration of specific cognitive skills; impaired Activities of Daily Living and inappropriate behaviour; positive family history; normal cerebrospinal fluid; normal electro-encephalography (EEG) or non-specific changes only; and CT evidence of cerebral atrophy. But to require the absence of other pathologies begs the question as to the diagnosis and makes the diagnosis of Alzheimer’s disease one of exclusion. In this chapter, we will survey briefly those conditions which fulfil many of the criteria for Alzheimer’s disease but exhibit physical signs or other clinical features which disallow that diagnosis. As there are so many of them, those occurring less frequently are included in an appendix at the end of this chapter.
Therapeutic intervention in dementia
Authors: Forette Fran<;oise , Rockwood Kenneth
Published: October 2023

We are on the threshold of a new era in the treatment of dementia, in that pharmacological therapy is becoming available for palliation of cognitive symptoms. Until now, only the depressive symptoms, often seen in the early stages of dementia, and behaviour problems, more characteristically seen in the later stages, have been amenable to pharmacological treatment. This chapter will review standard methods of treatment of such problems and will also outline the current possibilities for the treatment of cognitive symptoms. In addition, it will discuss prescription of such medications in the setting of a multidisciplinary memory disability team.
Management of common problems
Authors: O’Neill D , Carr D
Published: October 2023

In this chapter we will discuss class-specific management (i.e. for dementia of any cause), assuming that dementia-specific treatment (i.e. cholinesterase inhibitors for Alzheimer’s disease, or blood pressure control and smoking cessation for vascular dementia) will be initiated. The evidence-based literature in dementia is heavily biased towards i) the aetiopathology of the dementias, ii) their accurate diagnosis, and iii) pharmacological interventions, particularly those aimed at the cholinergic system. While these are issues of great importance, there is a relative lack of formal evaluation of the assessment and management of problems by dementia services as well as the efficacy and appropriateness of commonly used strategies for intervention. There are also differences between memory disorders teams as to the emphasis and structure of management strategies for those patients and caregivers who consult them. It is important that existing strategies should be evaluated and where shown to be effective should be incorporated into routine service provision. A lack of controlled studies should not prevent the use of common-sense strategies but should spur on research programmes on their efficacy, a need recognized by the European Union (O’Neill, in press) and the National Institute on Aging in the United States.
Glass injuries
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

There is often more damage beneath a glass laceration than is clinically suspected. All glass is radio-opaque in soft tissue views. All deep glass lacerations should be carefully explored. Late presenting deeply situated small glass fragments may be treated expectantly in the asymptomatic patient.
Amputations (replants)-total and subtotal
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Treat Life-Threatening Injuries First. Avoid delay (‘toxins’ are released from anoxic muscle). Avoid damage to the amputation stump and the part. Refer all cases and let the transplant team discuss with the patient the feasibility/wisdom of replanting.
Metacarpal shaft/base fractures
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

May occur from a punch or a direct blow to the hand. Patients are often very economical with the truth when describing the mechanism of injury.
Swollen PIP joint (volar plate injury)
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Irreversible volar plate contracture (bent finger) can develop late (up to 3 months). Follow up all these injuries at least once. Thereafter, tell the patient to return if the finger starts to bend and will not straighten completely. Then refer to hand surgeon or therapist.
Bite wounds
Authors: Wilson G R , Nee P A , Watson J S , Harrison R K
Published: October 2023

Do not miss the tooth injury to the MPJ of the little finger. It is a common injury and if neglected may lead to complete destruction of the joint.
What happens next?
Authors: Ismach Madeline
Published: October 2023

Professionals interact with children and their families in different ways according to the nature of their contact and responsibilities. The key to making a positive and informed contribution to the safety of children is to have an understanding of the child protection system and be clear about your professional role. There are many reasons why GPs may give the identification of child abuse or neglect rather less attention than other medical responsibilities. Nevertheless guidance to GPs from the Department of Health indicates that GPs are a vital part of the professional childcare network and that there is a clear expectation of cooperation with child protection procedures. (See also Chapter 6c.)
Complications of long-term dialysis: cellular immunity, infection, and neoplasia
Authors: Khan Izhar H , Catto Graeme R D
Published: October 2023

The treatment of end-stage renal disease (ESRD) with dialysis has evolved greatly since the pioneering days of Wilhelm Kolf’s experiments with the artificial kidney during the Second World War. Then, and in the early days of renal replacement therapy, dialysis was a novel treatment which sustained life in patients who would otherwise have succumbed to uremia. During the 1970s in the United States of America, and in the past two decades in the United Kingdom and Europe, improvements in the technological aspects of dialysis and the ability to offer this treatment to patients with a variety of renal diseases, irrespective of age or of the presence of comorbidity, have resulted in a great increase in the number of patients receiving dialysis therapy. In the USA 200 patients per million of the population start dialysis each year (USRDS Report, 1991). However, in the UK around 80 patients per million of the population commence dialysis each year (Feest et al., 1990), but this number is likely to rise as the incidence of ESRD is much higher than the number of patients treated (Khan et al., 1994). A greater proportion of patients now also receives a renal transplant and many patients currently receiving renal replacement therapy in Western countries have a functioning renal graft. Nevertheless, a significant proportion of patients with ESRD are kept alive with dialysis. Some patients are less likely to receive a renal transplant because of increased preformed antibodies as a result of previous unsuccessful grafts or transfusions. Furthermore, in some countries ethical and religious objections to cadaveric transplants have led to a much higher proportion of ESRD patients on dialysis. An increasing number of older patients now starting dialysis are also not considered for transplantation. There are many patients who are likely to remain on dialysis for years and be at risk of long-term complications.
Aluminum, silicon, and strontium accumulation/ intoxication as a complication of long-term dialysis
Authors: D’Haese Patrick C , Broe Marc E De
Published: October 2023

A number of considerations indicate that trace elements may accumulate in dialysis patients. This is due to:the patients’ uremic state;the dialysis treatment during which these constituents may be transferred to the patient;the diet; and the administration of pharmaceutical preparations which may contain high con¬ centrations of a number of trace metals (Alfrey, 1989; Salusky eta/., 1991; D’Haese eta/., 1990a).
Drugs used in cardiac anaesthesia
Authors: Hwang Dr Nian Chih , Sinclair Dr Michael
Published: October 2023

The drugs that are used during cardiac anaesthesia include premedicants, drugs for inducing and maintaining general anaesthesia, antibiotics, vasoactive and cardio-active drugs, drugs that affect the clotting system, drugs for cerebral and renal protection, and insulin for the control of blood sugar. As patients with heart disease undergoing cardiac surgery are very fearful and apprehensive, with inevitable cardiovascular sequelae, the purpose of premedication is to allay anxiety, to provide analgesia for painful events prior to induction, and to give some degree of amnesia. Either an oral benzodiazepine (diazepam, lorazepam, midazolam, or temazepam) or an intramuscular injection of an opiate (morphine or papavaretum) can be used to achieve sedation. Opiates have the additional benefit of providing preoperative analgesia. An anticholinergic agent (hyoscine bromide or atropine) or a tranquillizer (droperidol) is usually administered with the opiate as an antiemetic and amnesic agent. Premedicants are often administered parenterally to avoid uncertain uptake or first-pass metabolism when given orally (however, they still have to be absorbed from the intramuscular site).
Guidelines for coronary artery bypass grafting
Authors: Hwang Dr Nian Chih , Sinclair Dr Michael
Published: October 2023

Previously, only patients with three-vessel coronary artery disease were scheduled for coronary artery bypass grafting. Today, patients with left anterior descending artery stenosis alone can undergo a left internal mammary artery graft with or without the use of cardiopulmonary bypass. These patients may benefit from a degree of myocardial depression since they have a hyperdynamic response to surgical stimuli. Generally, patients with an ejection fraction of more than 40 per cent do not require inotropic support when separating from cardiopulmonary bypass, provided that the heart rate is maintained at more than 90 beats/min.