bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for diabetic retinopathy in South Africa with 60° retinal colour photography
Authors: JOANNOU J. , KALK W. J. , NTSEPO S. , BERZIN M. , JOFFE B. I. , RAAL F. J. , SACHS E. , VAN DER MERWE M. T. , WING J. R. , MAHOMED I. 
Published: November 2003

Objectives. Comparison of 60° mydriatic retinal photography, in screening for diabetic retinopathy, with diabetes clinic doctors, formal ophthalmological assessment, and with one or two 45° fields. Design. Consecutive subjects screened by clinicians and photography, and selected eyes evaluated by an ophthalmologist. Randomized photographs assessed through one or two 45° fields (by masking the slides), and at 60°. Setting. The first 663 patients attending for routine clinic visits and screened for retinopathy. Main outcome measures. The relative diagnostic sensitivity of screening methods, the utility of screening one eye only, and the costs of photographic screening. Results. Compared to an ophthalmologist’s assessment, retinal photography had a sensitivity of 93% and a specificity of 89% for any retinopathy, and 100 and 75%, respectively, for severe retinopathy. Photography detected 28% more retinopathy (16% severe) than the clinicians. Compared to a 60° field, one 45° field missed 31%, and 2×45° fields 11% of retinopathy. Of 57 patients with retinopathy meeting referral criteria, 31 pairs of eyes had substantially discordant scores. The cost of diagnosis in a patient requiring referral to ophthalmologist was about US$37.00. Conclusions. 60° retinal photography compares well with an ophthalmologists screening, and is better than clinical and one to two 45° field assessments. Both retinae should be screened. This method is cost‐effective in our hands.
Islet cell and glutamic acid decarboxylase antibodies in hyperthyroid patients: at diagnosis and following treatment
Authors: HALLENGREN B. , PAPADOPOULOS K. I. , LANDIN‐OLSSON M. , SUNDKVIST G. , FALORNI A. , LERNMARK Å. 
Published: November 2003

Objectives. To study the frequency of islet cell (ICA) and glutamic acid decarboxylase (GAD‐Ab) antibodies in patients with hyperthyroidism of different types at diagnosis before treatment and in the euthyroid state following treatment. Setting. Department of Endocrinology, Malmö University Hospital, Malmö, Sweden. Subjects and design. Blood samples were collected at diagnosis from 129 hyperthyroid patients, and about 6 months later, from 78 of the patients (euthyroid state). Ninety‐two patients had Graves' disease (69 females and 23 males, median age 49 years, range 17–85 years), and 37 patients had toxic nodular goitre/solitary toxic adenoma (34 females and three males, median age 69 years, range 24–86 years). Interventions. Most patients were treated by radioactive iodine following the first blood sample. Main outcome measures. ICA and GAD‐Ab in serum. Results. At diagnosis of Graves' disease, ICA were detected in two out of 92 (2.2%) patients, two out of 85 (2.4%) without diabetes mellitus and in the euthyroid state in one patient. None of the patients with toxic nodular goitre/solitary toxic adenoma had detectable ICA. At diagnosis of Graves' disease, GAD65‐Ab as well as GAD67‐Ab were detected in 11 out of 85 (13%) patients without diabetes. As many as six out of 11 GAD67‐Ab‐positive patients were GAD65‐Ab negative. In the euthyroid state, GAD65‐Ab were found in six out of 51 (12%) and GAD67‐Ab in eight out of 51 (16%) of the non‐diabetic Graves' disease patients. The frequencies of GAD65‐Ab and GAD67‐Ab in toxic nodular goitre/solitary toxic adenoma, diabetes excluded, were 3 and 0%, respectively, in the hyperthyroid state. Conclusion. The frequency of ICA in patients with hyperthyroidism is not increased as compared to the background population. GAD‐Ab seems to be associated with Graves' disease and not with hyperthyroidism. The presence of GAD67‐Ab in GAD65‐Ab negative sera from patients with Graves' disease indicates autoreactivity against a specific GAD67 epitope.
A new model for classification of disease manifestations in primary Sjögren's syndrome: evaluation in a retrospective long‐term study
Authors: ASMUSSEN KARSTEN , ANDERSEN VAGN , BENDIXEN GUNNAR , SCHIØDT MORTEN , OXHOLM PETER 
Published: November 2003

Objectives. The clinical features of 80 patients with primary Sjögren's syndrome (PSS) were revised in order to evaluate the descriptive and analytical facilities of a newly proposed model for classification of the exocrine and nonexocrine disease manifestations in PSS. Design. Retrospective, long‐term (median 7.5 years follow‐up) observational, clinical study. Setting. Patients were recruited from our Department, which is a tertiary referral centre for PSS patients. Subjects. Eighty patients fulfilling the Copenhagen criteria for keratoconjunctivitis sicca and/or xerostomia and followed between 1972 and 1991 were studied. Results. All patients had ‘surface exocrine disease’ and in 31% this was the only disease manifestation. ‘Internal organ exocrine disease’ was found in 25% of the patients, whilst 2.5% developed ‘monoclonal B lymphocyte disease’ (non‐Hodgkin's lymphoma). 28% displayed ‘inflammatory vascular disease’, 25% ‘noninflammatory vascular disease’, 41% ‘mediator‐induced disease’ and 2.5% ‘autoimmune endocrine disease’ (thyroiditis). In patients with ‘internal organ exocrine disease’ the frequencies of ‘mediator‐induced disease’ (70%; P<0.01) and ‘inflammatory vascular disease’ (50%; P<0.03) were significantly higher than expected by chance. The level of immunoinflammatory activity (assessed by plasma IgG, serum ANA and focus scoring of minor labial salivary gland biopsies) correlated with the extent of clinical disease as assessed by the model. Conclusions. We conclude that this theoretically based model for classification of disease manifestations in PSS contains descriptive and analytic powers which may assist the clinical handling of these patients.
Autoantibodies against adrenal medulla in type 1 and type 2 diabetes mellitus: no evidence for an association with autonomic neuropathy
Authors: HUSEBYE E. S. , WINQVIST O. , SUNDKVIST G. , KÄMPE O. , KARLSSON F. A. 
Published: November 2003

Objective. To examine the role of autoimmunity in the development of autonomic neuropathy in diabetes mellitus. Design. Retrospective cross‐sectional study. Setting. The Department of Medicine, University Hospital, Uppsala, and the Department of Endocrinology, University of Lund, Malmö General Hospital, Malmö, Sweden. Subjects and main outcome measures. We examined 135 patients with type 1 (n=96) or type 2 (n=39) diabetes mellitus. Tests for cardiovascular autonomic functions were performed, and patient sera were analysed for the presence of autoantibodies against the adrenal medulla by indirect immunofluorescence, Western blot and immunoprecipitation techniques. Results. Sera from 13% (12/96) of the type 1 and 20% (8/39) of the type 2 patients showed a positive cytoplasmic immunofluorescence (IF) staining of the adrenal medullary cells, as did 20% (30/151) of sera from healthy controls. Fifty‐eight and 64% of type 1 and type 2 patients, respectively, had cardiovascular autonomic neuropathy, but no correlation between autonomic neuropathy and positive IF against the adrenal medulla was observed, with the exception of significant drops in diastolic blood pressure 8 min after tilt (P<0.005) in type 1 patients. The various IF‐positive sera reacted with several different proteins when analysed with Western blot technique using a total homogenate of the bovine adrenal medulla. These did not correspond to any of the proteins involved in the synthesis or storage of catecholamines which were considered as putative autoantigens. Conclusion. The finding of similar frequencies of immunoglobulins binding to adrenal medulla in both type 1 and 2 diabetic patients as well as in normal controls, argues against a role of anti‐adrenomedullary antibodies in the pathogenesis of autonomic diabetic neuropathy.
Strategies for the prevention of senile (type II) osteoporosis: an update
Authors: BOONEN S. , DEQUEKER J. 
Published: November 2003

Boonen S, Dequeker J (Department of Internal Medicine, Divisions of Geriatric Medicine and Rheumatology, and the Arthritis and Metabolic Bone Disease Research Unit, Katholieke Universiteit, Leuven, Belgium). Strategies for the prevention of senile (type II) osteoporosis: an update (Review). J Intern Med 1996; 239: 383–91.Hip fractures in the elderly represent a global issue, associated with significant morbidity and mortality. Considering the magnitude of the problem, any substantial reduction in the hip fracture burden depends on prevention. In view of the complex pathogenesis of senile (type II) osteoporosis, preventive strategies should focus on the frequency of falling in the elderly as well as on the prevalence of compromised femoral integrity as a consequence of bone loss. Although many risk factors for senile osteoporosis are potentially preventible or reversible with targeted interventions, the beneficial effects of most strategies have not yet been adequately documented, indicating the need for additional long‐term controlled studies.
Outcomes associated with diabetes‐related amputations in the Netherlands and in the state of California, USA
Authors: VAN HOUTUM WILLIAM H. , LAVERY LAWRENCE A. 
Published: November 2003

Objective. The purpose of this study is to compare the incidence, relative risk, in‐hospital mortality and hospital stay of diabetes‐related lower extremity amputations in the state of California and the Netherlands in the year 1991. Research design and methods. We used established data obtained from the Office of Statewide Planning and Development for the state of California and from SIG Health Care Information in the Netherlands to identify all hospitalisations for lower extremity amputations. We used age‐ and sex‐specific prevalence rates of diabetes mellitus from the National Health and Nutrition Examination Survey and the Hispanic Health and Nutrition Examination Survey for the state of California and rates from the Central Bureau of Statistics for the Netherlands. A direct standardisation technique with the 1991 Netherlands population as the standard population was used to calculate age‐adjusted incidence rates. Age was categorised into four different groups; 25–44, 45–64, 65–74 and 75 +. Amputations were defined by four levels; toe, foot, leg and thigh. Results. The age‐adjusted incidence of diabetes‐related lower extremity amputations was significantly higher in the state of California than in the Netherlands (49.9 vs. 36.1 per 10000 diabetics, P< 0.01). The relative risk, comparing the risk in the diabetic with that in the non‐diabetic population, was California 23.7 vs. the Netherlands 19.7. The length of hospital stay was significantly higher in the Netherlands: 40.8 vs. 16.0 (P<0.01). Conclusions. There are some significant differences in the outcomes associated with diabetes‐related lower extremity amputations. Some of these differences may be explained by differences in access to health care.
Inactivated hepatitis A vaccine in healthy Chinese adults
Authors: LO Y. C. , LEE S. S. , WONG K. H. , LIM W. L. 
Published: November 2003

Objectives. To study the safety, tolerability of and immune response to an inactivated hepatitis A vaccine in healthy Chinese adults. Design. Seronegative subjects were randomized to receive formalin‐inactivated, alum‐adjuvanted hepatitis A vaccine (25 units, MSD) at 0, 24 weeks (group I) or 0, 2, 24 weeks (group II). Subjects. Healthy Chinese adults aged 18 years or above were recruited. All subjects were staff of a regional hospital and primary care clinic in Hong Kong. Main outcome measures. Side‐effects, tolerance, seroconversion rate and geometric mean titre (GMT) of the two groups were noted and compared. Results. Thirty‐two and 28 people were recruited into group I and group II, respectively. Antibody against hepatitis A developed in 100% of the recipients 1 month after the last dose of either regimen, with a GMT of around 450 IU L‐1. High antibody levels were maintained at the end of one year. There was no statistically significant difference in the seroconversion rates and GMTs between the two regimens of vaccination. All subjects in group I seroconverted at 24 weeks after one single dose of the vaccine. No adverse effects were reported except for complaints of some mild local and constitutional symptoms. Conclusions. The inactivated hepatitis A vaccine is highly immunogenic, safe and well‐tolerated.
Metformin improves blood lipid pattern in nondiabetic patients with coronary heart disease
Authors: CARLSEN S. M. , ROSSVOLL O. , BJERVE K. S. , FØLLING I. 
Published: November 2003

Objectives. To study whether the addition of metformin further improves the blood lipid pattern in non‐diabetic patients with coronary heart disease already treated with lovastatin, diet and lifestyle advice. Design. An open, prospective, randomized study in a university hospital setting. Subjects. Sixty non‐diabetic male patients previously treated with coronary artery bypass surgery or angioplasty and with serum cholesterol6.0 mmol L‐1 and/or HDL‐cholesterol1.2 mmol L‐1. Interventions. After a 4‐week run‐in period with lovastatin (40 mg day‐1), and diet and lifestyle advice, patients were randomized into two groups, both continuing the run in treatment. One group received metformin up to 2000 mg day‐1; the control group got no additional treatment. Main outcome measures. Fasting serum lipids, glucose and weight were registered at entrance (=week‐4), and at weeks 0, 4 and 12. Changes from week 0 to week 4 and from week 0 to week 12 were compared. Side‐effects of the treatment were also registered. Results. Metformin lowered the LDL/HDL‐cholesterol ratio by 12 and 6% at weeks 4 and 12, respectively, and reduced body weight by 1.8 kg at week 12. There was also a transient lowering effect on LDL‐cholesterol and apolipoprotein B. In the normal weight subgroup of patients (body mass index< 27 kg m‐2), metformin induced a decrease in total cholesterol (‐9%), LDL‐cholesterol (‐12%), LDL/HDL‐cholesterol ratio (‐10%) and apolipoprotein B (‐7%), as compared to the control group. In this subgroup, body weight and fasting glucose were unaffected by metformin. Thus, the lipid lowering effect in normal weight patients was not secondary to changes in body weight or fasting glucose. In overweight patients (body mass index>27 kg m‐2), metformin had no significant effects on blood lipids, but induced a weight loss of ‐3.0 kg and a transient reduction of fasting glucose. No side‐effects were registered apart from those expected from each individual drug. Conclusions. Metformin given for 12 weeks as a supplement to lovastatin, diet and lifestyle advice to non‐diabetic male patients with coronary heart disease further improves the lipid pattern in normal weight patients, and reduces weight in the overweight patients. Because metformin is cheap and other lipid lowering drugs are expensive, the potential of metformin as a lipid lowering agent should be further investigated.
Tetanus – still a topic of present interest: a report of 27 cases from a Belgian referral hospital
Authors: PEETERMANS W. E. , SCHEPENS D. 
Published: November 2003

Objective. To study the clinical presentation, treatment and outcome of tetanus in a European population. Design. A retrospective study. Setting. A large university hospital with a regional as well as a referral service. Subjects. All patients with tetanus from 1983 till 1993. Results. Twenty‐seven patients (13 men, 14 women; mean age 68.5 years) were studied. Seventeen out of 24 wounds (three patients had no history of a recent wound) were described as tetanus‐prone. Ten patients had medical wound care, but none received tetanus immunoglobulins despite the absence of tetanus immunity. All patients had the generalized type of the disease. The classical symptoms of trismus, dysphagia and muscular rigidity were present in all patients. Treatment consisted of wound management, neutralization of tetanus toxin by immunoglobulins, antibiotics, treatment of muscle spasm and instability of the autonomic nervous system, and supportive care. Twenty‐five patients were admitted to the intensive care unit for a mean duration of 25.7 days. Sixteen patients were artificially ventilated for a mean duration of 27.5 days. Three patients died, 11 patients had a complicated course caused by haemodynamic instability and 15 patients had pulmonary complications. Conclusions. Tetanus has not vanished. It remains a difficult‐to‐treat disease with a substantial morbidity and mortality rate. Prevention during wound management of tetanus‐prone wounds was inappropriate in many patients. The elderly population may have the highest risk for tetanus since they may not have had tetanus toxoid immunization or regular booster injections.
High‐technology medicine and the old: the dialysis example
Authors: KJELLSTRAND C. M. 
Published: November 2003

High‐technology medicine, which is often expensive, and most often very useful for old people, whose numbers are rapidly increasing, is presenting huge moral problems for physicians. There are now pressures to make physicians salaried employees rather than professionals, and this will decrease or obliterate their efficiency as advocates for patients. Advocacy is a previously non‐described duty, which is an important ethical principle for physicians, in addition to the four universally recognized principles: beneficence, non‐maleficence, respect for autonomy, and justice.Not‐so‐subtle economic pressure by managed care, government, administrators, and politicians, is already in force. If physicians, by advocating expensive treatment for many, irritate those with economic power, they may violently retaliate.Chronic dialysis illustrates well the dilemma of high‐technology medicine because acceptance numbers are accurate and widely known, most patients are old, the treatment is rationed everywhere by age, and, as patients die if excluded, it can be used to analyse reactions to an ongoing age rationing.Post‐modern bioethics and moral philosophy appears helpless and, in some regards, irrelevant in elucidating and solving the concrete moral conflict posed by high‐technology medicine and the old. Administrators and politicians wish physicians to be society's economic gatekeepers; however, this is incompatible with classical ethical concepts of the profession of physicians. Physicians and their professional organizations had better realize this in order to map out defensive strategies so that physicians, as a profession, do not disappear.
Daytime sleepiness and napping amongst the elderly in relation to somatic health and medical treatment
Authors: ASPLUND R. 
Published: November 2003

Objectives. To investigate daytime sleepiness and napping in relation to age, health and nocturnal sleep. Design. An epidemiological survey by means of a questionnaire. Setting. The counties of Västerbotten and Norrbotten in northern Sweden. Subjects. All 10216 members of the pensioners' association SPF. Main outcome measures. Daytime sleep, daytime sleepiness, health, night sleep, somatic diseases and medication. Results. Daytime sleepiness was 4.9 (3.7–6.4) and 5.1 (4.2–6.1) times more common in men and women, respectively, in poor health than in those in good health. It was also more common in subjects suffering from cardiac diseases, diabetes and musculo‐skeletal diseases, urological symptoms, and diseases with sensory and neurological impairments, compared with symptomless subjects. Stepwise regression analysis showed an increase in daytime sleepiness in men in association with impaired general health (r2=0.067), frequent awakenings (r2 =0.098), higher age (r2=0.109) and difficulty in falling asleep again after nocturnal awakening (r2= 0.115), and in the women, in association with impaired health (r2=0.118), difficulty in falling asleep again (r2=0.149), frequent awakenings (r2=0.160) and higher age (r2=0.171). There was no further increase in r2=either for men or women in relation to use of hypnotics. Conclusion. Age, poor health and different somatic diseases, but not hypnotics, are associated with daytime sleepiness in elderly persons.
Assessment and diagnosis of heart failure
Authors: CLELAND J. G. F. , HABIB F. 
Published: November 2003

Cleland J, Habib F (Medical Research Council (UK) Clinical Research Initiative in Heart Failure, West Medical Building, University of Glasgow, Glasgow, and Royal Post‐Graduate Medical School, Hammersmith Hospital, London, UK). Assessment and diagnosis of heart failure (Minisymposium: Heart failure). J Intern Med 1996;239: 317–25.Diagnosis is the first essential step in the provision of good management of heart failure. Diagnosis of heart failure by clinical means alone may be fairly accurate in advanced heart failure but will only be correct in about 50% of milder cases; little better than guessing. The number of patients with mild heart failure in whom the diagnosis is not even considered is unknown. In at risk groups, such as those who have had a myocardial infarction, symptoms alert the clinician to a possible diagnosis of heart failure which must be confirmed by further investigation. The echocardiogram is the single most useful diagnostic tool for heart failure in widespread use at the present.Once it is established that the patient has heart failure, its cause must be sought out. As the majority of patients with heart failure are elderly, concomitant diseases may complicate management and should be sought out. European Society Guidelines on the Diagnosis of Heart Failure have been published and provide a minimum data set of investigations that should be carried out in all patients.
Prevalence of factor V gene mutation amongst myocardial infarction patients and healthy controls is higher in Sweden than in other countries
Authors: HOLM JOHAN , ZÖLLER BENGT , BERNTORP ERIK , ERHARDT LEIF , DAHLBÄCK BJÖRN 
Published: November 2003

Objective. Haemostatic imbalance may be an aetiological factor in the development of acute coronary syndromes. Inherited resistance to activated protein C (APC) is a common disorder associated with hypercoagulability and lifelong risk of venous thrombosis. APC resistance is due to a single mutation in the gene coding for coagulation factor V (FV:Q506). To test the importance of the FV:Q506 mutation in premature myocardial infarction (MI), its prevalence was investigated in Swedish patients with MI before the age of 50 years. Design, setting and subjects. In a retrospective case‐control study, the FV:Q506 mutation was investigated in 101 survivors of MI (79 men, 22 women) and in 101 healthy sex‐ and age‐matched controls. Main outcome measure. The prevalence of FV:Q506 mutation. Results. The FV:Q506 mutation was found in 18% of patients versus 11% of controls (P=0.16). The mutation was significantly more frequent amongst male patients than amongst controls (23 vs. 10%; P=0.03), the calculated odds ratio being 2.6 (95% CI, 1.1–6.4). Conclusion. The high prevalence of the FV:Q506 mutation found amongst Swedish MI patients, especially amongst men, is noteworthy, and calls for further studies on the outcome of MI in APC‐resistant patients. The prevalence of the FV:Q506 mutation in controls is higher than figures reported from other countries, suggesting that at least 10% of the Swedish population are carriers of a congenital prothrombotic disorder.