bluuebunny/crossref_metadata_2025 huggingface dataset:
COR TRIATRIATUM: UNUSUAL CAUSE OF TRANSIENT ISCHAEMIC ATTACKS IN A 67‐YEAR‐OLD MAN
Authors: Darbar D , Bridges AB , Roberts R , Pringle TH
Published: April 2023

SUMMARYCor triatriatum is a rare congenital cardiac malformation, and in its most common form is characterised by a membrane that separates the left atrium into a proximal and distal chamber. First manifestation in adulthood has been reported previously, but at 67 years of age this patient is one of the oldest to present for the first time. It was diagnosed after a probable TIA, episodic vertigo and central retinal artery occlusion. The value of echocardiography in patients with neurological disease of presumed embolic origin is demonstrated here.
DIFFUSE HEPATIC HEMANGIOMATOSIS IN THE ELDERLY
Authors: Frangides Ch , Kounis NG , Papadaki PJ , Goudevenos J , Zavras GM
Published: April 2023

SUMMARY The first documented case of massive hepatic haemangiomatosis to present in an elderly patient (who survived to the age of 82).
RECURRENT BILATERAL SHOULDER DISLOCATION RESULTING FROM DYSKINESIA ASSOCIATED WITH DOPAMINERGIC STIMULATION THERAPY
Authors: Sonnenblick M , Nesher G , Dwolatzky T
Published: April 2023

SUMMARY An 80‐year‐old woman with Parkinson's disease developed recurrent bilateral shoulder dislocations. The dislocations occurred during dopaminergic treatment which induced severe dyskinesia. The inability to ensure immobilisation of the limb indicates a conservative approach.
ROUTINE CLINICAL BIOCHEMISTRY TESTS COLLECTED FROM PATIENTS DYING IN HOSPITAL
Authors: Neithercut WD , Chattington P
Published: April 2023

SUMMARY A study conducted of the collection of samples from patients dying in hospital and the results of their analysis found that samples are often collected unnecessarily from patients dying in hospital, and are collected more often from women than from men.
AUDITORY REHABILITATION: NEEDS AND REALITIES ON LONG‐STAY WARDS FOR ELDERLY PEOPLE
Authors: Tolson D , Swan IRC , McIntosh J
Published: April 2023

SUMMARY A survey was made of the problem of age‐related hearing impairment within a sample of National Health Service long‐stay wards for elderly people. Detailed assessment of hearing was completed for 188 residents derived from 15 long‐stay wards, located within nine Scottish hospitals. The sample residents were more than four times as likely to need a hearing aid as their contemporaries in the general population. Of the 131 people considered to be potential hearing aid candidates, 103 (78%) demonstrated a positive attitude towards hearing aid ownership. Medical policies on the study wards were not considered sensitive to the needs of the hearing‐impaired; screening was haphazard and specialist referral problematic.
COMPOUND OPIOID/PARACETAMOL ANALGESICS: MISUSE AND DEPENDENCE
Authors: McBride AJ ,   Mid‐Glamorgan Community Drug & Alcohol Team, Meredith‐Smith P
Published: April 2023

SUMMARY Ten cases of individuals with a history of chronic compound opioid/paracetamol misuse are described. Potentially useful indicators of toxicity are suggested.
MÜNCHAUSEN'S SYNDROME (HIV INFECTION): A TRAP FOR THE UNWARY
Authors: Harry TC , Ong ELC
Published: April 2023

SUMMARY A case of Münchausen's syndrome with AIDS illustrates the need for a high index of caution when dealing with individuals whose histories are inconsistent and suspicious, particularly when they have moved area.
MASSIVE ENDOMETRIAL POLYP AFTER TAMOXIFEN THERAPY
Authors: Divers MJ
Published: April 2023

SUMMARY This case describes the largest tamoxifen‐induced endometrial polyp to date and illustrates the importance of investigating postmenopausal bleeding thoroughly.
AUDIT OF IMPORTED AND DOMESTIC MALARIA CASES AT KUALA LUMPUR HOSPITAL
Authors: Moore CS , Cheong I
Published: April 2023

SUMMARY The clinical, haematological and biochemical profiles of all domestic and imported malaria cases admitted to the Hospital Kuala Lumpur were analysed. The most common malaria types were Plasmodium falciparum (39.5%) and Plasmodium vivax (42%). The most common patient type was men aged 29‐40 years (reflecting the high mobility of this group, many of whom were illegal immigrants). Misdiagnosis on admission was frequently due to the variable clinical presentation of the disease and the difficulties of obtaining an accurate history. Associated haematological abnormalities were common. Chloroquine resistance was diagnosed in four P. falciparum patients and in one P. falciparum/vivax patient. Overall, imported malaria did not seem more severe than domestic. The three patients with cerebral malaria survived. One patient died of acute liver failure. The large influx of illegal immigrants to Malaysia has resulted in a surge in malaria infection; illegal immigrants remain a source of chloroquine resistance.
DOXAZOSIN: A NEW APPROACH TO HYPERTENSION AND BENIGN PROSTATIC HYPERPLASIA
Authors: Pool JL
Published: April 2023

SUMMARY Doxazosin, a selective α1‐adrenoceptor antagonist, is an established first‐line antihypertensive agent that is being introduced for the management of benign prostatic hyperplasia. Hypertension and benign prostatic hyperplasia are linked by the sympathetic nervous system, which has an aetiologic role in both conditions. The α1‐adrenoceptor is a mediator of increased tension, both in vascular and prostatic smooth muscle. Studies have shown that doxazosin, through its balanced action on α1‐adrenoceptor subtypes, reduces blood pressure and improves other risk factors for coronary heart disease, such as lipid profile, insulin sensitivity, left ventricular hypertrophy, platelet aggregation and fibrinolysis. Data are now accumulating to show that doxazosin improves urinary flow rates and symptoms in patients with benign prostatic hyperplasia. These effects have been demonstrated in controlled clinical studies, within weeks, and long term. Since hypertension and benign prostatic hyperplasia are widespread and often undiagnosed in the community, particularly with increasing age, doxazosin may be a particularly appropriate therapy for the considerable number of older men with both conditions.
ANGIOTENSIN II ANTAGONISTS: A NEW CLASS OF ANTIHYPERTENSIVE AGENT
Authors: Waeber B , Brunner HR
Published: April 2023

SUMMARY Losartan is an orally active angiotensin II antangonist that selectively blocks effects mediated by the stimulation of the AT1 subtype of the angiotensin II receptor. This agent, at doses of 50‐150mg/day, is as effective at lowering blood pressure as chronic angiotensin converting enzyme (ACE) inhibitors. Losartan is generally well tolerated and has an incidence of adverse effects very similar, in double‐blind controlled trials, to that of placebo. It does not cause coughing, the most common side‐effect of the ACE inhibitors, most probably because angiotensin II antagonism has no impact on ACE, an enzyme known to process bradykinin and other cough‐inducing peptides. Losartan is a promising antihypertensive agent with the potential to become a first‐line option for the treatment of patients with high blood pressure.
FRONTAL LOBE TUMOURS
Authors: Aitken EM , Luce PJ
Published: April 2023

SUMMARY The diagnosis of frontal lobe tumours can easily be missed. Subtle mood or personality changes may be evident only after questioning of close family, friends or carers. Neurological signs may be absent.
ALLERGIC REACTIONS TO LOCAL GLYCERYL TRINITRATE ADMINISTRATION
Authors: Kounis NG , Zavras GM , Papadaki PJ , Soufras GD , Poulos EA , Goudevenos J , Alangoussis A , Antonakopoulos K , Frangides C , Peristeropoulou SA , Koutsojannis C
Published: April 2023

SUMMARY To assess the exact cause and extent of transdermal glyceryl trinitrate (GTN)‐induced allergic reactions, a study of continuous and intermittent use of GTN patches was conducted in 320 patients with New York Heart Association (NYHA) class II and III angina pectoris. Three commercially available GTN patch systems were used. Twenty‐one patients (6.5%) developed cutaneous reactions. In 17 patients (5.3%), the reactions were confined to the area of application and were characterised as irritant reactions. Four patients (1.2%) developed both localised and remote from the area of application lesions and one patient developed a generalised anaphylactic reaction. The rate of discontinuation of therapy was 3.4%. The irritant skin reactions were mainly due to contaminants and additives. Changing to a different transdermal system reduced the incidence of local reactions — a particularly desirable effect in patients who respond well to GTN therapy.
THE DURATION OF ACTION OF INHALED FORMOTEROL DRY POWDER
Authors: Quebe‐Fehling E , Brambilla R , Bromly CL , Fishwick K , Walters EH , Hendrick DJ
Published: April 2023

SUMMARY The duration of action of formoterol inhaled as a dry powder formulation is compared with placebo and a reference treatment of salbutamol dry powder in patients with bronchial asthma. This single‐centre, double‐blind, cross‐over study recruited 23 outpatients with clinically stable asthma. These patients were treated with 12μg formoterol, 400μg salbutamol or placebo in a randomly allocated sequence, with at least 2 days between treatments. Forced expiratory volume in 1s of expiration (FEV1) was measured at specified time points from 15 min to 15 hours post‐treatment. Formoterol produced significantly higher values of FEV1 at the primary endpoint of 12 hours compared with placebo and salbutamol. No differences between FEV1 values were seen for the active treatments of formoterol and salbutamol for the first 5 hours post‐inhalation. Formoterol was significantly superior to placebo at all time points, whereas salbutamol was significantly superior to placebo for the first 5 hours.This study demonstrates that formoterol, when given as a dry powder inhalation, has a significantly longer duration of acute bronchodilator action than 400μg salbutamol inhaled as a dry powder. The duration of action of formoterol of at least 12 hours seen in this study is at least as long as that reported following administration from a metered dose inhaler (MDI) at the same dose level. The study also demonstrates that 12μg formoterol dry powder is well tolerated by patients.
BONE MINERAL DENSITY IN PREMENOPAUSAL WOMEN WITH OESTROGEN DEFICIENCY AND SYMPTOMATIC CORONARY HEART DISEASE
Authors: Bruck B , Seitz D , Hanke S , Lange K , Schmah W , Haasis R , Hanke H
Published: April 2023

SUMMARY Serum oestrogen deficiency is one of the main causes of osteoporosis in postmenopausal women. In premenopausal women, oestrogen deficiency is rare. In 13 premenopausal women with symptomatic coronary heart disease (CHD) and significantly reduced serum oestrogen levels, bone mineral density, determined by quantitative computed tomography (QCT), was not reduced. In these women, oestrogen deficiency was probably one risk factor for the development of CHD. The level of serum oestrogen that protects women from the development of CHD might be different from the level that protects them from early loss of bone mineral density. Seven of the 13 women had a history of tubal sterilisation. This might be a possible risk factor, causing ovarial dysfunction and oestrogen deficiency.
AN UNUSUAL THYROGLOSSAL CYST CAUSING UPPER AIRWAY OBSTRUCTION
Authors: Strachan D , Wengraf C
Published: April 2023

SUMMARY Rarely does a thryoglossal cyst reach such proportions as to compromise the upper respiratory airway. Such a case is presented and the manner in which it was satisfactorily treated is described.
FENTANYL THERAPY CONTROLS AUTONOMIC HYPERACTIVITY IN TETANUS
Authors: Moughabghab AV , Prevost G , Socolovsky C
Published: April 2023

SUMMARY This report describes the use of fentanyl in severe tetanus after failure of established therapeutic modalities (heavy sedation, neuromuscular blockade and ventilation). Cardiovascular instability accompanying severe tetanus secondary to sympathetic overactivity and raised catecholamine levels is associated with a mortality of over 50%.1 In this clinical situation, a variety of drugs with a primary or secondary action on the cardiovascular system has been used with varying success. The following case of severe generalised tetanus in the adult associated with autonomic hyperactivity, was successfully managed with large doses of intravenous fentanyl.
WHAT FACTORS INFLUENCE GENERAL PRACTITIONERS' COMMENCEMENT OF HORMONE REPLACEMENT IN PERIMENOPAUSAL WOMEN?
Authors: Larcos G
Published: April 2023

SUMMARY The purpose of this study was to determine factors influencing general practitioners' (GPs) commencement of hormone replacement (HRT) in perimenopausal women referred for bone mineral density analysis. GPs who referred 80 untreated healthy perimenopausal women to a Western Sydney teaching hospital for osteoporotic fracture risk assessment were surveyed. All patients underwent dual energy X‐ray absorptiometry of the lumbar spine, femoral neck and distal radius. Subjects were reported as ‘at risk of fracture’ if their bone mineral density was more than two standard deviations below the mean of young adults. Patients had normal (n=55) or reduced (n=4) bone mineral density at all sites; 21 subjects (26%) had regional osteoporosis. HRT was commenced in 35 women. A multivariate logistic model showed that menopausal symptoms (OR 173.9, p<0.001) and reduced bone mineral density at any site (OR 28.3, p<0.001) were highly significant independent factors predicting HRT (R2 0.48). Other clinical features such as low weight, family history and smoking status did not contribute further to GP decision making.
A QUALITY ASSESSMENT SCHEME FOR BLOOD GLUCOSE MONITORING: COMPETITION IMPROVES PERFORMANCE
Authors: Leonard MB , South JP , Johnson D
Published: April 2023

SUMMARY Quality assurance procedures are often ignored or forgotten about by wards involved in the blood glucose monitoring of patients. We have devised a complete quality assurance scheme for checking the ward performance of 38 B‐M Reflolux meters and two B‐M Accutrend meters. Quality control (QC) material, supplied commercially and distributed by the laboratory, is analysed and recorded daily by the wards (internal QC). In addition, a ‘spiked’, whole blood sample is prepared by the laboratory and distributed for analysis to all wards at six‐monthly intervals (external QC). The laboratory also conducts a monthly survey of meter operation (quality assessment) based on a ‘scoring system’ that allows easy identification of poor performers. Poor performers are counselled accordingly and, if poor performance is persistent, their meter is removed. In our experience, the publication and distribution of ward quality assessment scores has increased competion between wards in terms of avoiding low scores, dramatically improved performance, and ultimately led to improved patient care.
MANAGEMENT OF SUBSTANCE MISUSERS ON THE GENERAL HOSPITAL WARD
Authors: Williams H , Salter M , Ghodse AH ,   Drug and Alcohol Liaison Team
Published: April 2023

SUMMARY Since a high prevalence of physical morbidity is associated with substance misuse, drug misusers are frequently admitted to general hospitals. Medical staff often perceive drug misusers as a particularly difficult patient group, feeling that they lack the knowledge and skill to deal with them adequately without specialist support. We review the common physical complications of substance misuse likely to be encountered in a general hospital, and provide comprehensive guidelines for the assessment and management of drug dependence in this setting.
ALLERGEN AVOIDANCE IN THE PRIMARY PREVENTION OF ATOPY
Authors: Tariq SM
Published: April 2023

SUMMARY Atopy development cannot yet be predicted with certainty, and primary prophylaxis has to be directed at every ‘at‐risk’ infant. However, substantial progress has been made in identifying environmental factors associated with allergic disorders. The process of sensitisation to common allergens may begin in utero. The influence of adjuvants, especially passive smoking, is considerable in individuals with established atopic disease. This article examines the role of intervention during pregnancy and the first year of life in the primary prevention of atopy and suggests a number of measures based on the current evidence.
OBSTETRIC FACTITIOUS DISORDER: IS IT MORE COMMON THAN WE THINK?
Authors: Guthrie EA , Lavin JM , Rosimilia A , Tasker M , Osborn MF , Donnai P
Published: April 2023

SUMMARY This case discusses the diagnosis of obstetric factitious disorder in a 27‐year‐old woman with bleeding per vagina. The case illustrates the need for a high index of suspicion in patients with unexplained physical symptoms during pregnancy, and highlights issues related to subsequent child care.
IMMUNOGENICITY AND TOLERABILITY OF A TRIVALENT INFLUENZA SUBUNIT VACCINE (INFLUVAC®) IN HIGH‐RISK CHILDREN AGED 6 MONTHS TO 4 YEARS
Authors: Daubeney P , Taylor CJ , McGaw J , Brown EM , Ghosal S , Keeton BR , Palache B , Kerstens R
Published: April 2023

SUMMARY Fifty‐two children, aged less than 5 years, with chronic lung disease or congenital heart disease were entered into a two‐centre open study to determine the immunogenicity and tolerability of Influvac®, a trivalent influenza sub‐unit vaccine. Seroresponses were determined following two intramuscular vaccinations with 0.25 ml of Influvac, four weeks apart. Any local or systemic reaction was sought. Seroresponses were age and antigen specific, with children older than 9 months showing better seroresponses to all three antigens. Both A/Taiwan and B/Panama strains met all efficacy criteria. A/Shangdong met two of the three criteria: seroconversion and mean geometric titre increase. Local (23%) and systemic (48%) reactions following either of the two vaccinations were minor in nature and resolved within a few days. The vaccine induced a strong antibody response against all three haemagglutinin antigens and was well tolerated. The incidence of local and systemic reactions was comparable with those reported in healthy adults.
DETERMINATION OF PLASMA FIBRONECTIN AND SERUM C‐REACTIVE PROTEIN IN PATIENTS WITH CEREBROVASCULAR EVENTS
Authors: Pen SÇE , Yilmaz G , Yilmaz N , Kocoglu H , Namiduru E , Yüncü M , Gökalp N
Published: April 2023

The relationship between the levels of C‐reactive protein (CRP) and fibronectin (FN) and atherosclerotic diseases such as coronary heart disease has already been studied, but their relationship with cerebrovascular events has not. The aim of this study was to determine the levels of plasma FN and serum CRP in cerebrovascular events, and their relationship with the outcome of the disease. CRP and FN levels were analysed in 133 patients with acute cerebrovascular disease, together with 66 healthy controls. Cerebrovascular event patients were divided into subgroups according to disease severity. FN and CRP levels in patients with cerebrovascular disease were found to be significantly elevated compared with the control group (p<0.001). CRP levels correlated with disease severity, in contrast to FN levels. We conclude that FN is not a clinically useful marker in patients with acute differentiative cerebrovascular events, in contrast to CRP which may be useful in such cases.
BREASTFEEDING DOES NOT POSE ANY ADDITIONAL RISK OF IMMUNOPROPHYLAXIS FAILURE ON INFANTS OF HBV CARRIER MOTHERS
Authors: Wang J‐S , Zhu Q‐R , Wang X‐H
Published: April 2023

Whether babies born to hepatitis B (HB) carrier mothers with HB immunoprophylaxis at birth can be breastfed safely is controversial. A total of 230 such babies were followed up for one year to assess the influence of feeding method on the efficacy of HB immunoprophylaxis. The positive rates of anti‐HBs at different ages are not statistically different between the breastfed group and the bottle‐fed group. At 1 year, the rate was 80.9% in the breastfed group and 73.2% in the bottle‐fed group in infants with HB vaccine alone, and 90.9% in the breastfed group and 90.3% in the bottle‐fed group in infants with HBIG plus HB vaccine. There were no significant differences in the incidence of immunoprophylaxis failure between breastfed and bottle‐fed babies. The results indicated that breastfeeding does not have a negative influence on the response of anti‐HBs and on the failure rates of immunoprophylaxis in the infants born to HB carrier mothers.
21. THE ADJUVANT TREATMENT OF BREAST CANCER
Authors: Kelleher M , Miles D
Published: April 2023

Risk of relapse of breast cancer depends largely on tumour features: size, grade and, particularly, lymph node status. Adjuvant systemic therapies reduce risk of relapse and death, as shown in several meta‐analyses. Relative risk reductions are similar across different prognostic groups but the absolute benefits are greater in those with a worse prognosis. Combination chemotherapy is superior to single agent regimens but longer duration (>6 months) gives no additional benefit compared with six months of therapy. Benefits from adjuvant chemotherapy diminish with the age of the patient. CMF type regimens have been most widely used: anthracyclines can reduce risk of relapse by 12% (an absolute survival benefit of about 3%) but with greater toxicity Early trials of taxoids look promising but benefit was seen only in those with ER‐ tumours. Tamoxifen is the most extensively used endocrine adjuvant therapy, and is associated with a reduction in risk of death of 26% independent of age or menopausal status but only in those with ER+ tumours. Aromatase inhibitors are effective only in postmenopausal women and, although the early results with anastrozole look promising, long‐term efficacy and toxicity studies are presently lacking, so five years of tamoxifen is standard treatment for women with ER+ tumours.
CONGENITAL CORONARY ARTERY FISTULAS IN TURKISH PATIENTS UNDERGOING DIAGNOSTIC CARDIAC ANGIOGRAPHY
Authors: Serçelik A , Mavi A , Ayalp R , Pestamalci T , Gumusburun E , Batiraliev T
Published: April 2023

A coronary artery fistula is a direct communication between a coronary artery and one of the cardiac chambers or vessels around the heart. The present study was undertaken to define the incidence, clinical findings and angiographic characteristics of congenital coronary artery fistula in Turkish adults who underwent diagnostic cardiac angiography. A consecutive series of 11,350 coronary angiography, performed between January 2000 and December 2001, was retrospectively examined for the presence of coronary artery fistulas. The incidence of congenital coronary artery fistulas was 0.08%. All the patients had chest pain during exertion or at rest. All the fistulas were single and most arose from the proximal left anterior descending coronary artery and drained into the pulmonary artery. All the fistulas were small. Surgical treatment was not indicated. A congenital coronary artery fistula in adults is a distinct though rare entity, variable in its incidence and commonly associated with coronary artery obstructive disease. Diagnosis is mostly incidental during routine coronary angiography.
MASSIVE BLEEDING FROM AN ARTERIOVENOUS MALFORMATION IN THE GASTRIC FUNDUS FOLLOWING GASTRIC BIOPSY TREATED BY EMBOLISATION
Authors: Ibrahim AS , Allangawi MH , Al‐Muzrakch AM
Published: April 2023

A 60‐year‐old male was admitted with massive upper gastrointestinal bleeding following a gastric biopsy. Repeat gastroduodenoscopy failed to identify the source. Angiography identified bleeding from an arteriovenous malformation at the fundus of the stomach. This was controlled by embolisation.
PREVALENCE OF PERIPHERAL ARTERY DISEASE IN URBAN HIGH‐RISK MALAYSIAN PATIENTS
Authors: Amudha K , Chee KH , Tan KS , Tan CT , Lang CC
Published: April 2023

Atherosclerosis is a progressive, disseminated condition that affects all the vascular beds. Peripheral arterial disease (PAD), a manifestation of atherosclerosis, measured non‐invasively in the legs by ankle‐brachial index (ABI) is associated with increased cardiovascular morbidity and mortality Though several studies in the western industrialised countries have shown that PAD is widely prevalent in the general older population at risk, not much data are available in the South East Asian developing countries. We have conducted an epidemiological survey on the prevalence of PAD in high‐risk patients at an urban hospital in Malaysia. A total of 301 consecutive patients aged 32–90 years were recruited during their follow‐up clinic visits for established cardiovascular disease, ischaemic stroke or diabetes mellitus ≥5 years. All participants underwent ABI measurement and were subjected to the Edinburgh claudication questionnaire to assess leg symptoms. The prevalence of PAD in our high‐risk population was 23%, of which only 27% were symptomatic with the classical intermittent claudication. All the patients with PAD were diagnosed at the time of the study. PAD was found in 33% of patients with pre‐existent cardiovascular disease, 28% in patients with ischaemic stroke and 24% in diabetic patients. PAD was also highly prevalent among the younger patients. Our study has shown that PAD is highly prevalent among high‐risk Malaysian patients and is not necessarily a disease of older age. Only 27% of these patients were symptomatic. All the subjects with PAD were diagnosed at the time of the study, which would suggest it is an unrecognised and underdiagnosed condition, even in patients with atherosclerotic risk factors.
PSOAS HAEMATOMA AND FEMORAL NEUROPATHY ASSOCIATED WITH ENOXAPARIN THERAPY
Authors: Ho KJ , Gawley SD , Young MRA
Published: April 2023

Haemorrhage into the iliopsoas muscle causing femoral neuropathy is an infrequent complication of haemophilia or anticoagulant therapy. The association of an iliopsoas haematoma with enoxaparin therapy is very rare. We describe a case of femoral neuropathy secondary to psoas haematoma in a patient who was on enoxaparin therapy for suspected non‐Q wave myocardial infarction. There is no clear consensus for the treatment of these haematomas, with both surgical and conservative options advocated. In this case, our patient recovered fully following conservative management.
PEGINTERFERON ALFA‐2A (40KD) (PEGASYS®) FOR THE TREATMENT OF PATIENTS WITH CHRONIC HEPATITIS C
Authors: Ferenci P
Published: April 2023

Compared with conventional interferon alfa, peginterferon alfa‐2a (40KD) has improved pharmacokinetics, provides sustained therapeutic plasma levels, and can be administered once weekly. In randomised, multinational trials, peginterferon alfa‐2a (40KD) 180 μg once weekly was significantly more effective than three times weekly interferon alfa‐2a in patients with chronic hepatitis C, including patients with cirrhosis. Peginterferon alfa‐2a (40KD) and ribavirin 1000/1200 mg/day for 48 weeks produced significantly higher sustained responses than three times weekly interferon alfa‐2b and ribavirin 1000/1200 mg/day in patients with chronic hepatitis C including those with HCV genotype 1, genotypes 2/3 and those with high or low viral loads at baseline. The drug is well tolerated when given alone or in combination with ribavirin. Health‐related quality of life was significantly less impaired during treatment with peginterferon alfa‐2a (40KD) than interferon alfa‐2a in randomised trials. Peginterferon alfa‐2a (40KD) is widely approved for use in patients with chronic hepatitis C. (Int J Clin Pract 2003; 57(7): 610–615)
DUTASTERIDE: A NEW 5‐ALPHA REDUCTASE INHIBITOR FOR MEN WITH LOWER URINARY TRACT SYMPTOMS SECONDARY TO BENIGN PROSTATIC HYPERPLASIA
Authors: Brown CT , Nuttall MC
Published: April 2023

Dutasteride is a new 5‐alpha reductase inhibitor for the treatment of men with moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia. It has been available in the UK since March 2003. It is a competitive inhibitor of both type I and type II isoforms of the 5‐alpha reductase enzyme that converts testosterone to the more potent androgen, dihydrotestosterone. Randomised controlled studies have shown dutasteride to be statistically more effective than placebo in reducing lower urinary tract symptoms and increasing maximum urinary flow rates. This is a consequence of a reduction in serum dihydrotestosterone and hormone dependent prostate volume. Dutasteride has also been shown to decrease the absolute risk of urinary retention and the need for prostate‐related surgery when compared to placebo taken over a 24‐month period. In this review article we discuss the pharmacology and clinical effects of dutasteride, a new dual‐acting 5‐alpha reductase inhibitor.
CLINICOPATHOLOGICAL AND THERAPEUTIC PATTERNS OF IDIOPATHIC PULMONARY FIBROSIS IN KUWAIT: A PROSPECTIVE STUDY
Authors: Khadadah ME , Onadeko BO , Abul AT , Behbehan NA , Cerna M , Cherian JM , Adesina O , Maradni N , Jayakrishnan B
Published: April 2023

Though common, the exact incidence and clinical pattern of idiopathic pulmonary fibrosis (IPF) in Gulf countries are not known. The results of a four‐year prospective study undertaken in two tertiary hospitals in Kuwait are presented. The mean age at diagnosis of the 52 patients studied was 55 40±11 87 years. Thirty‐two (61.5%) patients were male and 22 (42.3%) were smokers. The mean duration of symptoms at diagnosis was 2.1 ±0.92 years. Digital clubbing was found in 34 (65%) patients The mean FVC, TLC and TLCO were 57%, 64.4% and 55% of predicted normal, respectively. The FVC value showed a significant difference between smokers and non‐smokers (p<0.05). HRCT findings were abnormal in all patients. Typical histological and high‐resolution computed tomography findings of usual interstitial pneumonia, desquamative interstitial pneumonia and non‐specific interstitial pneumonia were observed. This study revealed that IPF is prevalent in Kuwait, with patterns showing some similarities to those established elsewhere. The response to treatment was not encouraging, especially in the usual interstitial pneumonia subtype. (Int J Clin Pract 2003; 57(10): 879–884)
TIOTROPIUM BROMIDE: A LONG‐ACTING ANTICHOLINERGIC BRONCHODILATOR FOR THE TREATMENT OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Authors: Joos GF , Brusselle G , Derom E , Pauwels R
Published: April 2023

Prevention and relief of symptoms by regular use of bronchodilators is central to the management of patients with chronic obstructive pulmonary disease (COPD). The bronchodilators in use are β2‐agonists, anticholinergics and theophylline. Since the 1970s the anticholinergic ipratropium bromide has been widely used for the treatment of patients with regular symptoms, but because it has a relatively short duration of action, it needs to be administered four times a day. Tiotropium bromide is a long‐acting anticholinergic suitable for once daily administration. It has been developed as a dry powder inhaler for the treatment of patients with COPD. Large clinical trials with administration of the drug for one year have now been published. Compared with placebo and ipratopium bromide, significant and long‐lasting bronchodilatation was observed, which was maintained over the year. The bronchodilator effect of tiotropium bromide was accompanied by improvements in other health outcomes. A significant decrease in dyspnoea, improvement in health‐related quality of life, and a reduction in the number of COPD exacerbations and hospitalisations were noted. In this review we summarise the clinical development of this compound.
In vitro and in vivo study of the efficacy of a new sebum control essence
Authors: Wei Juan , Ma Xuemei , Chen Min , Pan Sha , Pang Ying
Published: April 2023

Background

People with oily skin often suffer from skin problems such as oily face, blackheads, acne, and enlarged pores. It is necessary to regulate oily skin with skin care products.

Aims

To develop an effective sebum control essence to reduce oiliness of skin.

Methods

The composition of the essence was designed in consideration of different oil control mechanism targets. The skin irritation was assessed in 30 volunteers by a single application close patch test. The efficacy of the essence was evaluated by in vitro experiment, short‐ and long‐term clinical trials with over 60 volunteers.

Results

The results of both in vitro and clinical trials showed that the essence had significant oil control and moisturizing effect, the skin oil content decreased by 21.8% within 8 h and 30.05% after 28 days, which indicated that the essence could achieve rapid and persistent sebum control efficacy. In addition, the essence could relieve the problems of enlarged pores, blackheads and whiteheads in long‐term use.

Conclusions

The essence developed in this study can alleviate the problems of oily skin from many aspects, and achieve an excellent effect in oily skin regulation. It is suitable for a daily application in oily skin regulation.
Newly identified variability of the antigen binding site coding sequences of the equine major histocompatibility complex class I and class II genes
Authors: Plasil Martin , Oppelt Jan , Klumplerova Marie , Bubenikova Jana , Vychodilova Leona , Janova Eva , Stejskalova Karla , Futas Jan , Knoll Ales , Leblond Agnes , Mihalca Andrei D. , Horin Petr
Published: April 2023

The major histocompatibility complex (MHC) with its class I and II genes plays a crucial role in the immune response to pathogens by presenting oligopeptide antigens to various immune response effector cells. In order to counteract the vast variability of infectious agents, MHC class I and II genes usually retain high levels of SNPs mainly concentrated in the exons encoding the antigen binding sites. The aim of the study was to reveal new variability of selected MHC genes with a special focus on MHC class I physical haplotypes. Long‐range NGS to was used to identify exon 2–exon 3 alleles in three genetically distinct horse breeds. A total of 116 allelic variants were found in the MHC class I genes Eqca‐1, Eqca‐2, Eqca‐7 and Eqca‐Ψ, 112 of which were novel. The MHC class II DRA locus was confirmed to comprise five exon 2 alleles, and no new sequences were observed. Additional variability in terms of 15 novel exon 2 alleles was identified in the DQA1 locus. Extensive overall variability across the entire MHC region was confirmed by an analysis of MHC‐linked microsatellite loci. Both diversifying and purifying selection were detected within the MHC class I and II loci analyzed.
Exploring the Emotional Functions of Co‐Speech Hand Gesture in Language and Communication
Authors: Kelly Spencer D. , Ngo Tran Quang‐Anh
Published: April 2023

Research over the past four decades has built a convincing case that co‐speech hand gestures play a powerful role in human cognition . However, this recent focus on the cognitive function of gesture has, to a large extent, overlooked its emotional role—a role that was once central to research on bodily expression. In the present review, we first give a brief summary of the wealth of research demonstrating the cognitive function of co‐speech gestures in language acquisition, learning, and thinking. Building on this foundation, we revisit the emotional function of gesture across a wide range of communicative contexts, from clinical to artistic to educational, and spanning diverse fields, from cognitive neuroscience to linguistics to affective science. Bridging the cognitive and emotional functions of gesture highlights promising avenues of research that have varied practical and theoretical implications for human–machine interactions, therapeutic interventions, language evolution, embodied cognition, and more.
New subgenus and species of Tydaeolinae (Acariformes: Prostigmata: Tydeoidea) from Germany
Authors: Laniecka Izabella , Kaźmierski Andrzej , Magowski Wojciech , Laniecki Ronald
Published: April 2023

Paratriophtydeus (Platytydaeolus) russelli, a new subgenus and species of the subfamily Tydaeolinae, is described from continental sandy habitats in Sandhausen, southwest Germany. It is characterized by uniquely shaped flattened bothridial setae. Some morphologic and anatomic structures are depicted for Tydaeolinae for the first time.
Pathophysiology of reinfection by exogenous HSV-1 is driven by heparanase dysfunction
Authors: Suryawanshi Rahul K. , Patil Chandrashekhar D. , Agelidis Alex , Koganti Raghuram , Yadavalli Tejabhiram , Ames Joshua M. , Borase Hemant , Shukla Deepak
Published: April 2023

Limited knowledge exists on exogenous DNA virus reinfections. Herpes simplex virus-1 (HSV-1), a prototype DNA virus, causes multiple human diseases including vision-threatening eye infections. While reinfection with an exogenous HSV-1 strain is considered plausible, little is known about the underlying mechanisms governing its pathophysiology in a host. Heparanase (HPSE), a host endoglycosidase, when up-regulated by HSV-1 infection dictates local inflammatory response by destabilizing tissue architecture. Here, we demonstrate that HSV-1 reinfection in mice causes notable pathophysiology in wild-type controls compared to the animals lacking HPSE. The endoglycosidase promotes infected cell survival and supports a pro-disease environment. In contrast, lack of HPSE strengthens intrinsic immunity by promoting cytokine expression, inducing necroptosis of infected cells, and decreasing leukocyte infiltration into the cornea. Collectively, we report that immunity from a recent prior infection fails to abolish disease manifestation during HSV-1 reinfection unless HPSE is rendered inactive.
Sediment routing systems to the Atlantic rifted margin of the Guiana Shield
Authors: Rouby Delphine , Loparev Artiom , Chardon Dominique , Bajolet Flora , Dall’Asta Massimo , Paquet Fabien , Fillon Charlotte , Roig Jean-Yves , Ye Jing
Published: April 2023

Sediment routing systems of cratonic domains have not been studied extensively because their relief and erosion rates are very low, although their vast dimensions allowed them to contribute to a significant proportion of the sediments exported to the global ocean. To gain further insights into the behavior of cratonic sediment routing systems at geological time scales, we investigated the Guiana Shield and its Atlantic rifted margin (i.e., the Guiana-Suriname and Foz do Amazonas Basins, northern South America) over the Meso-Cenozoic with an emphasis on paleoenvironment and accumulation histories of the offshore sediments.

We show that the basins of the Guiana Shield rifted margin record (1) periods of very low siliciclastic supply concomitant with the development of carbonate platforms, alternating with (2) phases of higher siliciclastic supply associated with sand-dominated clastic deposits and turbidites. Low siliciclastic supplies reflect either very limited rift-related relief growth and erosion such as during the Central Atlantic rifting in the Late Jurassic or intense lateritic weathering of the cratonic source area during Paleogene–Miocene climate optima. Higher siliciclastic supplies correspond either to (1) periods of rapid rift-related relief growth and erosion such as during the Equatorial Atlantic rifting (Early Cretaceous), (2) periods of drainage reorganization over a steadily eroding cratonic domain (Late Cretaceous), or (3) periods of tapping of sediments stored in the Andean retro-foreland basins via the presentday Orinoco and Amazon Rivers (Plio-Pleistocene).
Online support improved eczema symptoms in children and young people
Authors: Saul Helen , Cassidy Samantha , Imison Candace , Santer Miriam
Published: April 2023

The study

Santer M, Muller I, Becque T. Eczema Care Online behavioural interventions to support self-care for children and young people: two independent, pragmatic, randomised controlled trials.
BMJ
2022;379:e072007.

To read the full NIHR Alert, go to:
https://evidence.nihr.ac.uk/alert/online-support-improved-eczema-symptoms-in-children-and-young-people/
Development of numerical tools using boundary element method based on Taylor series for nonlinear analysis
Authors: Ramzan M. , Ahmad M. O. , Bashir M. N. , Asghar A. , Shehzad S. A.
Published: April 2023

The major theme of this research is to develop the numerical scheme for the computation of nonlinear problems by the implementation of the boundary element method dependent on Taylor’s series. This paper deals with the problem of laminar flow in a semiporous channel in the presence of a transverse magnetic field and the homotopy analysis method (HAM) is employed along with the general boundary element method to compute an approximated solution of the system of nonlinear differential equation governing the problem concerned. A well-known and useful nonlinear differential equation of fluid mechanics [Formula: see text] with the boundary conditions [Formula: see text], [Formula: see text] is referred as an example to show a glimpse into the basic idea of the method and technique used in this paper. It shows the capabilities and wide range of applications of HAM using Taylor series expansion of the derived integral equation. A comparison of HAM with the results calculated previously has been discussed. The solution obtained with HAM in comparison with the numeric solution shows remarkable accuracy. Root mean square formula is computed for the convergence analysis at various values. An increment in the number of elements depicting the convergent results as error is decreased.
The Effect of Dispersal Patterns on Hopf Bifurcations in a Delayed Single Population Model
Authors: Zhang Yuanyuan , Huang Dan , Chen Shanshan
Published: April 2023

In this paper, we consider a delayed single population model with patch structure, and investigate Hopf bifurcations when the dispersal rate or the scaling parameter of the growth rate is small. The effect of dispersal patterns is analyzed. We show that dispersal patterns affect the occurrence of Hopf bifurcations when the scaling parameter of the growth rate is small, and affect the values of Hopf bifurcations when the dispersal rate is small.
Importance of survey demographic questions to foster inclusion in medicine and research and reduce health inequities for LGBTQIA2S+ individuals
Authors: Moreira Jesse D. , Haack Karla , White Vee , Bates Melissa L. , Gopal Deepa M. , Roepke Troy A.
Published: April 2023

A clear, inclusive, and accurate approach to the collection of demographic information in clinical research and medical practice is critical to understanding the healthcare needs of the specific population. Inclusive demography constitutes appropriate and accurate characterization of an individual’s sexual orientation and gender identity (SOGI) data. Appropriate demography fosters sense of inclusion and belonging for those belonging to medically marginalized communities such as the lesbian, gay, bisexual, transgender, queer, intersex, asexual, and Indigenous Two-Spirit (LGBTQIA2S+) communities and improves health outcomes. Acquiring inclusive demographics in healthcare research is needed for the following critical reasons. First, LGBTQIA2S+ individuals experience undue psychological harm when their identities are not appropriately captured in survey data, promoting further alienation of the LGBTQIA2S+ community in medicine and research. Second, LGBTQIA2S+ populations are disproportionately burdened by several major cardiovascular and cardiovascular-associated diseases, including hypertension and diabetes. Failure to include these populations, and accurately characterize their participation, in research leads to failure to identify associations between identities and disease, resulting in worse health outcomes. Furthermore, this lack of precision in current data for sex, gender, and sexual orientation may lead to inaccurate data for all populations, not just the LGBTQIA2S+ community. Finally, there are currently major political and social threats and attacks on the LGBTQIA2S+ community and, in particular, on transgender and gender-diverse individuals. Proper medical inclusion and advocacy for the LGBTQIA2S+ community by the medical community may help protect the community from further undue harm through creating sense of belonging and reductions in marginalization-related health inequities.
Reporting a Case of Solid Pseudopapillary Neoplasm of the Pancreas in a 44-Year-Old Woman with Parallel Analysis of Literature
Authors: Singh Sargun , Zhao Qing , Sachs Teviah E. , Hartshorn Kevan
Published: April 2023

We present a distinctive case of solid pseudopapillary neoplasm as seen in a 44-year-old woman who presented with an abdominal mass but unremarkable labs with no elevation in any of the tumor markers. Her symptomatology ranged from typical symptoms suggestive of malignancy such as weight loss, lethargy, and anorexia to complaints like abdominal pain and jaundice. Prior to presenting at our center, she was given no hope or much in terms of treatment options. She was found to have a substantial mass over the body and tail of pancreas with characteristic and typical gross as well as histological features. Subsequently, she underwent a successful surgery and has found herself in remission since.
HKDC1 Silencing Inhibits Proliferation and Glycolysis of Gastric Cancer Cells
Authors: Yu Chen , Bao Ting-ting , Jin Li , Lu Jian-wei , Feng Ji-feng
Published: April 2023

Gastric cancer (GC) is the third most lethal and fifth most common cancer in the world. In a variety of cancers, the hexokinase domain component 1 (HKDC1) is carcinogenic. This study was to investigate into how HKDC1 contributes to the development and progression of GC. Three different datasets (GSE103236, GSE13861, and GSE55696) were extracted from the Gene Expression Omnibus (GEO) database and then analyzed using the sva package. The R software was used to identify 411 differentially expressed genes (DEGs) in the pooled dataset. We discovered 326 glycolysis-related genes (glyGenes) in the cancer genome atlas-stomach adenocarcinoma (TCGA-STAD) cohort using gene set enrichment analysis set (GSEA). HKDC1 is one of the most prevalent glyGenes in GC tumor tissues and cells, as seen in the Venn diagram. According to the results of the Cell Count Kit-8 assay, the proliferation of AGS and MKN-45 cells decreased when HKDC1 was knocked down. Lack of HKDC1 in cells enhanced oxygen consumption and decreased glycolytic protein expression while suppressing glucose absorption, lactate production, ATP level, and extracellular acidification ratio. As an oncogene in gastric cancer development, HKDC1 influences cell proliferation and glycolysis.
Noise Estimation and Type Identification in Natural Scene and Medical Images using Deep Learning Approaches
Authors: Kavitha G. , Prakash Chetana , Alhomrani Majid , Pradeep N. , Alamri Abdulhakeem S. , Pareek Piyush Kumar , Alhassan Musah
Published: April 2023

The image enhancement for the natural images is the vast field where the quality of the images degrades based on the capturing and processing methods employed by the capturing devices. Based on noise type and estimation of noise, filter need to be adopted for enhancing the quality of the image. In the same manner, the medical field also needs some filtering mechanism to reduce the noise and detection of the disease based on the clarity of the image captured; in accordance with it, the preprocessing steps play a vital role to reduce the burden on the radiologist to make the decision on presence of disease. Based on the estimated noise and its type, the filters are selected to delete the unwanted signals from the image. Hence, identifying noise types and denoising play an important role in image analysis. The proposed framework addresses the noise estimation and filtering process to obtain the enhanced images. This paper estimates and detects the noise types, namely Gaussian, motion artifacts, Poisson, salt-andpepper, and speckle noises. Noise is estimated by using discrete wavelet transformation (DWT). This separates the image into quadruple sub-bands. Noise and HH sub-band are high-frequency components. HH sub-band also has vertical edges. These vertical edges are removed by performing Hadamard operation on downsampled Sobel edge-detected image and HH sub-band. Using HH sub-band after removing vertical edges is considered for estimating the noise. The Rician energy equation is used to estimate the noise. This is given as input for Artificial Neural Network to improve the estimated noise level. For identifying noise type, CNN is used. After removing vertical edges, the HH sub-band is given to the CNN model for classification. The classification accuracy results of identifying noise type are 100% on natural images and 96.3% on medical images.