bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advances in pharmacotherapy of dyslipidemia
Authors: Chinta Harshitha 
Published: August 2024

Abstract:
Dyslipidaemia is a group of disorders of lipoprotein metabolism with consequences of endothelial dysfunction, atherosclerosis and increase in thrombogenecity of blood. Management of dyslipidaemia include diet and lifestyle modifications followed by pharmacotherapy. There are multiple drugs used for the management of dyslipidaemia with statins as most widely used therapeutic class. There are other class of drugs like resins, fibrates, drugs like niacin, ezetimibe being the established drugs in treatment of dyslipidaemia. With identification of mutations in specific genes of the lipoprotein receptors and on observation of adverse effects due to the established treatment modalities available, there is a need for new therapeutic targets to find an alternative treatment. Thus, new agents are approved for the treatment like the microsomal triglyceride transfer protein inhibitors, proprotein convertase substillin/klexin type 9 inhibitors, omega 3 fatty acid ethyl esters, antisense inhibition of Apo B-100 synthesis. Although the available drugs have well defined actions and effects, yet still in some patients either they could not fulfil the desired lipid lowering goals or the patients are intolerant/ non respondent to treatment or there is an imbalance between the risk-benefit profile. Thus, new drugs are being developed, described as pipeline drugs. Some of these are the cholesteryl ester transfer protein inhibitor, ATP citrate lyase inhibitor, antisense oligonucleotide inhibitor of lipoprotein A and Apo C–III, angiopeptin-like-3 inhibitors, AMP kinase activators, cylodextrins, thyroid receptor beta agonists, peroxisome proliferator-activated receptor agonists, acetyl CoA carboxylase inhibitor, diacylglycerol transferase inhibitor, acetyl coenzyme A cholesterol acetyl transferase-1 inhibitors, gene therapy and active immunisations.
A case report on antimuscarinic drug-induced confusion: A cognitive side effect
Authors: Varghese Bindhya Merin , George Ann , James Elizabeth , Reji Rinku Elsa 
Published: August 2024

Abstract:
Oxybutynin and tolterodine are antimuscarinic agents indicated for the treatment of overactive bladder, which is manifested as urinary incontinence, urgency, or frequency. Oxybutynin works by competitively inhibiting acetylcholine at postganglionic muscarinic receptors M1, M2, and M3, causing smooth muscles in the bladder to relax, and tolterodine works by competitively binding to the bladder’s muscarinic M3 receptors, reducing bladder contraction by raising the tone of the internal urethral sphincter and decreasing the tone of the detrusor muscle. Central nervous system’s (CNS) side effects are attributed by the oxybutynin’s anticholinergic actions. There is evidence of several CNS effects associated with anticholinergic medications, including agitation, confusion, disorientation, somnolence, memory loss, and hallucinations. These adverse effects occur in patients during the first few months of treatment or when the dose of oxybutynin is increased. This case report emphasizes the confused behavior of the patient on taking oxybutynin and tolterodine and also the cognitive side effects experienced by the patient.
Bullous fixed drug eruption due to azithromycin: A rare case report
Authors: Jillella Aditya , Zaman Sameer Uz 
Published: August 2024

Abstract:
Fixed drug eruption (FDE) is a common type of cutaneous adverse drug reaction. It is a delayed type of hypersensitivity reaction that occurs and recurs as lesions at the same skin site due to repeated intake of an offending drug. Drugs such as ciprofloxacin, acetaminophen, fluconazole, nimesulide, sulfonamides, tetracyclines, and metronidazole have been reported to cause the bullous form of FDE. FDE due to azithromycin have been reported, but the bullous variant is extremely rare. We present a case of azithromycin-induced bullous FDE in a 32-year-old male. Data were collected through a patient history and clinical examination during consultation. The patient developed a tense bullous lesion on the lower lip after taking azithromycin for an upper respiratory tract infection. This case highlights the importance of recognizing rare adverse reactions to commonly prescribed antibiotics like azithromycin.
Navigating the perils of polypharmacy: A clinical pharmacology case study from elderly patient care
Authors: Samajdar Shambo Samrat , Sarkar Sougata , Venkatraman Shravan , Dey Amit Kumar , Saboo Banshi , Joshi Shashank R. 
Published: August 2024

Abstract:
Polypharmacy is increasingly prevalent among elderly populations due to multimorbidity and the expansion of pharmaceutical options. This case report explores the adverse effects of polypharmacy in an elderly patient, emphasizing the importance of appropriate medication management and the role of clinical pharmacologists. A 78-year-old male with multiple comorbidities was discharged with a complex medication regimen from a hospital in West Bengal. Within 5 days, he experienced severe complications including QT prolongation and a significant fall resulting in a femur fracture. These events were precipitated by the interactions among multiple prescribed medications and a previously unreported use of a fixed-dose combination of paroxetine and clonazepam. The case underscores the dangers of polypharmacy, particularly the risk of adverse drug reactions such as QT prolongation and potential torsades de pointes, exacerbated by drug-drug interactions and electrolyte imbalances. It highlights the necessity of comprehensive medication reconciliation and the critical role of clinical pharmacologists in managing complex medication regimens. This case advocates for the integration of clinical pharmacologists into health-care settings to enhance medication safety and efficacy, particularly in elderly patients with polypharmacy. The involvement of pharmacologically trained professionals can significantly mitigate medication-related risks and improve patient outcomes.
Oncologist-patient conflict regarding imatinib-induced pigmentation: A case report and literature review
Authors: Malik Shivani , Yadav Arun Kumar , Raj Lalit , Singh Renu , Arya Ashok Kumar 
Published: August 2024

Abstract:
The tyrosine kinase inhibitor imatinib mesylate is well known for inhibiting melanocyte growth, which results in hypopigmentation, but here, we present a case report of imatinib-induced hyperpigmentation in a 42-year-old female belonging to a lower-middle socioeconomic status and a resident of a local village. The case report is unique as it provides valuable insights into clinical characteristics, diagnostic challenges, and therapeutic considerations for imatinib-induced hyperpigmentation which may contribute to existing literature on this rare and challenging entity, particularly in chronic myeloid leukemia (CML). The patient presented to the radiotherapy outpatient department 2.5 years ago with chief complaints of a single episode of oral bleeding and abdominal pain for 15 days. Blood investigations revealed a high total leukocyte count, platelet count, and Hb-10.5 suggestive of some myeloproliferative disorder for which the patient was advised bone marrow aspiration biopsy for confirmation. Biopsy findings are consistent with CML. That is how we reached a diagnosis of CML. Imatinib therapy was started with a dose of 400 mg OD orally daily. She was continued on the same dose. As the disease of the patient was partially responding to this dose and the patient still had on-and-off complaints along with abnormal blood parameters, the dose was gradually increased to 600 mg od orally, but after 2 months of this dose, hyperpigmentation on the cheeks gradually appeared which slowly increased to involving whole of the face. Clinical findings revealed brownish hyperpigmented macules involving the forehead, nose, malar, and mandibular areas. There was no significant family history and no history of similar complaints in the past. There was no history of an allergy to any drug. Dermoscopy showed an irregular dark brown pigmentation network in a pseudoreticular pattern, along with hypopigmented areas in between. Based on the clinical findings and dermoscopy results, the patient was diagnosed with imatinib-induced melasma-like pigmentation. Therapeutic intervention was done. The patient was initiated on topical depigmenting agents, sunscreen, and topical corticosteroids to address the hyperpigmentation, coupled with strict photoprotective measures for comprehensive management. The patient is currently under our care, continuing imatinib therapy with us at the same dose as the patient is having a good response to primary disease at this dose and attending regular follow-up appointments at the dermatology clinic showing symptomatic improvement. We conclude that informing the patient about the possibility of this side effect can increase compliance to therapy. Further insight into the mechanisms of the pigmentary alterations caused by this drug is required for better treatment/prevention of this manifestation.
Triple-Negative Breast Carcinoma Subtyping by Immunohistochemistry – Our Experience
Authors: Meena Pangarkar , Mamta Kripalani , Radhika Pagey , Anand Pathak 
Published: August 2024

Abstract

Context:
Breast cancer is currently treated according to the subtype determined by the expression of three immunohistochemical markers, namely, estrogen receptor, progesterone receptor, and human epidermal growth factor 2 neu receptor. If all three markers are negative, the subtype is triple-negative breast carcinoma (TNBC). This subtype is a molecularly heterogeneous group expressing different genetic signatures. The present retrospective observational study has used immunohistochemistry as a practical method to document different subtypes of TNBC.

Materials and Methods:
One hundred cases of TNBC were studied at a tertiary cancer care center, using a panel of five markers – androgen receptor, cytokeratin 5/6, epithelial cadherin, epidermal growth factor receptor, and vimentin.

Statistical Analysis:
Monte Carlo significance test for Chi-square was used for statistical analysis.

Results:
One hundred patients of TNBCs were subtyped into five groups – luminal androgen receptor, basal-like one, basal-like two, mesenchymal stem-like, and unclassified. These subgroups did not differ significantly in clinicopathological characteristics except tumor size.

Conclusion:
TNBC is a molecularly diverse group showing many subtypes. Clinical follow-up of all these cases may reveal differences in the prognosis and survival among the subgroups.
Uncovering the Secret Clues: Using Stool Calprotectin to Improve Low Anterior Resection Syndrome after Surgery
Authors: Al-Kubati Waheeb Radman , Alhajami Faris 
Published: August 2024

Abstract

Background:
A majority of patients who undergo low rectal resection experience a frequent complication of low anterior resection syndrome (LARS). It is characterized by distressing bowel dysfunction such as urgency, frequency, and incontinence. Despite the high prevalence of LARS, its management remains challenging due to the lack of reliable diagnostic and monitoring tools.

Objectives:
This study investigates the relationship between stool calprotectin levels and LARS severity and evaluates the effectiveness of mesalamine treatment.

Design:
This prospective study involved 48 patients with low rectal cancer who had undergone resection with temporary ileostomy. The patients subsequently presented with LARS for over four weeks after ileostomy closure.

Patient and Methods:
LARS diagnosis was based on the LARS score, and stool calprotectin levels were measured at baseline and one month and six months post-ileostomy closure. Patients with elevated calprotectin levels received mesalamine treatment and dietary modifications. Statistical analyses were performed to determine the correlation between calprotectin levels and LARS scores using Pearson correlation analysis, linear regression analysis, paired t-test, and ANOVA.

Main Outcome Measure:
The predictive capacity for stool calprotectin for LARS was the main outcome variable.

Sample Size:
Forty-eight patients who underwent low rectal cancer resection were enrolled.

Results:
Among the study group, 28 were males and 20 were females. The mean age was 50 (9.998) years, 95% confidence interval CI = [17–78]) in both groups. The predictive value of calprotectin levels for LARS severity was high with β = 0.72, P-value < .001, and R² 0.55. The mean (SD) stool calprotectin level was 360 (6.282) mcg/g, which correlated with severe LARS symptoms (mean [SD] LARS score = 35 [2.449]). After six months, 60% of patients showed significant improvement (LARS scores <20), 30% had minor improvement (LARS scores 29–30), and 10% showed no improvement. Correlation analysis revealed a strong positive correlation between calprotectin levels and LARS scores (r = 0.75, P < .001).

Conclusion:
Stool calprotectin is demonstrated to be a promising biomarker for diagnosing and monitoring LARS. The findings highlight the association between LARS and high levels of stool calprotectin. However, the study had limitations of being a single-center study, comprising a small sample size, and not using a randomized clinical trial to evaluate the effectiveness of mesalamine.

Conflicts of Interest:
None.
An Unusual Delayed Complication after Rectal Surgery – 3 Case Reports
Authors: Shetty Dishitha , Hegde Sujai 
Published: August 2024

Abstract
Rectal cancer treatment is challenging and rapidly advancing, and surgical resection is often the keystone treatment and curative modality. Anastomotic complications are the most severe and feared outcomes following rectal cancer surgery considering their associated morbidity and mortality. Delayed complications occurring many years after surgery are rare and less reported. Here, we report three cases of patients with rectal carcinoma who underwent low anterior resection and presented with delayed anastomotic complications. In all three cases, anastomotic complications were found beyond one month: postoperative 1 year, 7 years, and 9 years. Disease recurrence was ruled out in all patients. The patients presented with varied symptoms, namely a delayed presentation with a pelvic abscess along with a rectourethral fistula, a rectocutaneous fistula, and bladder wall necrosis. All of them had received radiation therapy preoperatively. Chronic radiation induces widespread intestinal collagen deposition and fibrosis along with occlusive vasculitis in small arterioles. These effects may develop over several months or years, which results in bowel strictures, ulcerations, and fistulas. Therefore, delayed complications such as anastomotic dehiscence, rectourethral fistulas, and rectocutaneous fistulas appearing after many years of pelvic surgery, especially in patients who received radiation, should be investigated. Therefore, long-term monitoring to identify potential complications is crucial as they are associated with high morbidity and mortality.
Surgery Prolongs Five-Year Survival for Nonmetastatic Colon Neuroendocrine Tumors
Authors: Bangla Venu G. , Panahi Armon , Adler Ava , Divino Celia M. 
Published: August 2024

Abstract

Background:
While treatment guidelines for colon neuroendocrine tumors recommend surgical intervention when feasible, evidence in the literature is limited for patients with nonmetastatic tumors.

Objectives:
This study assessed the efficacy of surgery in terms of five year survival for patients with nonmetastatic colon neuroendocrine tumors.

Design:
This was a retrospective cohort study.

Patient and Methods:
This study used the National Cancer Database (NCDB) which compiles data from 1500 + facilities accredited to the Commission on Cancer. Data from patients with histologically confirmed colon neuroendocrine tumors from 2007 to 2018 were collected. Other inclusion criteria were age more than 18 years, nonmetastatic, nonpalliative care, known surgery status/type, and chemotherapy status. The five year survival rates were assessed using Kaplan–Meier curves and multivariate adjusted Cox proportional hazards regression to analyze the efficacy of surgery for these tumors. In addition, sensitivity analyses were performed to determine the associations in patients with well differentiated and early stage (stage 1) tumors.

Main Outcome Measure:
The main outcome was five year overall survival.

Sample Size:
A total of 3,340 patients met the inclusion criteria from the NCDB.

Results:
The majority of patients received some form of surgery (95.8%), while fewer patients (4.3%) received nonsurgical treatment. Overall, patients were on average 61.5 ± 13.3 years old, female (54.3%), and majority white (77.7%). Five year survival rates were 65.5% for the no surgery group and 79.5% for the surgery group [Kaplan–Meier log rank, P < .0001]. Moreover, multivariate proportional hazards regression showed prolonged five year survival after surgery [adjusted hazards ratio (aHR) (95% confidence interval): 0.39 (0.28–0.54)]. In addition, all sensitivity analyses revealed prolonged survival of patients who underwent surgery.

Conclusion:
To our knowledge, this is the first study to assess survival for nonmetastatic colon neuroendocrine tumors using a national database.

Limitations:
This study was limited by retrospective review, potential selection bias from a registry, and missing data.

Conflicts of Interest:
None.
Norman Sartorius: The Mental Health Crusader Who Simply Won’t Stop
Authors: Basu Debasish 
Published: August 2024

Abstract
Professor N. Sartorius, MD, PhD, FRCPsych, previously the Director of the Mental Health Program of the World Health Organization and President of the World Psychiatric Association and of the European Psychiatric Association, now serves as President of the Association for the Improvement of Mental Health Programs, a nongovernmental organization located in Geneva, Switzerland. Professor Sartorius holds several professorial positions in Europe, the USA, and elsewhere. He has published more than 500 papers in peer-reviewed journals and authored, co-authored, edited, or co-edited more than 120 books. However, more than all these, Professor Sartorius will be remembered by posterity as a relentless crusader for mental health and against stigma toward mental illness. Professor Sartorius has focused his sustained attention on the reduction of the stigma of mental illness, on the comorbidity of mental and physical disorders, and on support to carers of people with mental disorders. He has been particularly interested in the education of young professionals and conducted leadership and professional skills courses in some 60 countries involving more than 3000 psychiatrists early in their careers. In this interview, he briefly but importantly talks about the phases of his life, work, passion, vision, and mission, and leaves important messages for future generations.
The Burden of Caregiving and Quality of Life of Family Caregivers of Bipolar Patients: A Cross-sectional Study
Authors: Mohanty Nitya Gopal , Mahanta Debasish , Mohapatra Debjyoti , Kar Nilamadhab 
Published: August 2024

Abstract

Background:
Caring for patients with severe mental illness could be stressful. Information regarding the burden and quality of life (QOL) of the family caregivers of patients with bipolar affective disorder (BD) is scant from India. It was intended to study the burden and QOL of the caregivers of patients with BD and their association with sociodemographic factors.

Materials and Methods:
It was a cross-sectional study in a tertiary-level psychiatric hospital. Caregivers (n = 60) of patients with BD were assessed using the Family Burden Interview Schedule and World Health Organization QOL-BREF, along with their sociodemographic data.

Results:
Caregivers reported considerable burden in various areas, and a large proportion (71.7%) had higher burden and this group had significantly lower QOL in all domains. Burden and QOL had variations among demographic groups. There was no difference in the burden reported by male and female caregivers, however, the former appeared to have better QOL. Caregivers with the lowest income had considerable burden and poor QOL, besides the caregivers with lower education and from nuclear families.

Conclusions:
Family caregivers of patients with BD experienced considerable burden and had poorer QOL. Caregivers with lower education, the lowest income, and nuclear families had greater challenges. Assessment of caregivers’ needs and provision of appropriate support require prioritization.
Association of angiotensinogen rs699 single nucleotide polymorphism and pre-eclampsia in Lagos, Nigeria: A case-control study
Authors: Fagbayi T.A. , Somade A.O. , Adefemi A.K. , Shonde O.G. 
Published: August 2024

Preeclampsia is a pregnancy disorder that endangers the lives of bpth mother and child. Gene polymorphisms of Angiotensinogen have been shown to be associated with hypertension and since pre-eclampsia is basically hypertension in pregnancy, there might be a genetic correlation. Angiotensinogen rs699 (AGT rs699) polymorphism affects spiral arteries in the uterus and controls blood pressure. Various association studies of SNP for pre-eclampsia have yielded conflicting results. This study investigated the association of AGT rs699 and ascertain the socio-medical factors with pre-eclampsia amongst gestating women in Lagos, Nigeria. Ethical approval and informed consent were obtained from Health Research and Ethical committees. Thirty-eight (38) preeclamptic (P) and 39 normotensive (N) pregnant women from a selected maternity hospital were recruited for this study. Demographic characteristics, medical history, and present medical conditions were assessed using questionnaires. Blood samples were collected and AGT rs699 was genotyped. Descriptive statistics, independent sample t-test, chi-square, and multiple regression analysis were used to analyze the data obtained (p <0.05). The mean age and weight of women with pre-eclampsia were higher in preeclamptic women with no significant difference (P = 32.43 ± 5.76, N = 30.97 ± 4.54, and P =79.04 ± 10.28, N = 76.82 ± 15.35 respectively). Diastolic blood pressure (DBP), Systolic blood pressure (SBP), and Proteinuria were significantly higher in preeclamptic patients. Surprisingly, the incidence of AGT rs699 was significantly higher in 2 normotensive (82%) women than in preeclamptic women (17%) (X =29.150, p = 0.00001). A significant correlation was observed between AGT rs699 and SBP in normotensive patients (r2 = 0.201, p=0.003) and a negative correlation in preeclamptic patients. In contrast, AGT rs699 was negatively related to DBP with no statistical difference in both the normotensive and preeclamptic groups. In addition, no correlation nor significant differences were observed between AGT rs699 and the weights of the preeclampsic and normatensive women. In conclusion, this study revealed a negative significant association between preeclampsia and AGT rs699 among cases and the control population studied.