bluuebunny/crossref_metadata_2025_split huggingface dataset:
Distribution and prognostic significance of cell cycle proteins in squamous carcinoma of the larynx, hypopharynx and adjacent epithelial hyperplastic lesions
Authors: Volavšek Metka , Bračko Matej , Gale Nina 
Published: March 2003

Alterations of cell cycle proteins contribute to the development and biological behaviour of malignant tumours. We evaluated the distribution and prognostic significance of immunohistochemically detected proteins p53, p21, Rb, and cyclin D1 in 101 laryngeal and hypopharyngeal squamous cell carcinomas (SCC) and adjacent epithelial hyperplastic lesions (EHL). Protein expression was correlated with tumour grade and stage.Varying patterns of protein expression were found in SCC. A significant correlation (p <0.05) was found between Rb expression and tumour grade. Different grades of EHL exhibited randomly distributed p53 and cyclin D1 positive cell clusters with no association to the pattern of their expression in SCC.Our study demonstrated derailment of cell cycle regulation in almost all cases of SCC of the larynx and hypopharynx. However, only cyclin D1 expression had an independent prognostic value for cancer-specific survival. The results also suggest that Rb gene inactivation, although rare, might be more important in the development of SCC than previously thought.
Hearing loss due to mannosidosis and otitis media with effusion. A case report and review of audiological assessments in children with otitis media with effusion
Authors: Ahmmed A. U. , O’Halloran S. M. , Roland N. J. , Starkey M. , Wraith J. E. 
Published: March 2003

A case of a child with mannosidosis and bilateral otitis media with effusion (OME) is reported here along with some discussion of relevant literature to emphasize the need for age appropriate audiometricc assessment before and after insertion of grommets for glue ear (OME).There is a need for multidisciplinary teamwork in the management of children with hearing loss. If OME is treated surgically, age-appropriate hearing assessment is required before and after insertion of grommets. The need for audiological assessments will be relevant even if children had passed the newborn hearing screening test.
Unusual complication of tonsillectomy: taste disturbance and the lingual branch of the glossopharyngeal nerve
Authors: Uzun Cem , Adali Mustafa Kemal , Karasalihoglu Ahmet Rifat 
Published: March 2003

Taste disturbance is an unusual complication of tonsillectomy of which there are very few reports in the literature. The possible causes of this rare complication are: (1) direct or indirect damage to the glossopharyngeal nerve or its lingual branch (LBGN), (2) lack of dietary zinc, and (3) habitual drug intake.We report a 41-year-old man, who complained of taste disturbance following tonsillectomy that was performed for chronic tonsillitis and unilateral (left) tonsillar hypertrophy. During surgery, hypertrophic tonsils were found to be sited deeply into the tonsillar bed, especially at the lower pole of the left tonsil. Pathologic examination following tonsillectomy revealed a keratinous cyst and chronic infection at the left tonsil, and lymphoid hyperplasia and chronic infection at the right tonsil. Although his complaint had been getting better, qualitative examination of his taste function revealed bilateral impairment of the sense of sweet taste on the base of his tongue two months after the surgery, and a taste disturbance of sweet taste on the left side persisted the 10th month after the surgery. His serum zinc value was normal, and he did not take any drug that could affect his sense of taste. Depending on the literature data, possible indirect damage to the LBGN was suspected as the cause of the taste disturbance. This symptom may be reversible within two years after tonsillectomy, but it can also be irreversible. Therefore, tonsillectomy should be performed with minimal trauma to the tonsillar bed, especially when there is an additional pathology extending into the lower pole, and such a patient should be informed of the risk of post-operative taste disturbance after tonsillectomy as being one of the rare complications of this surgery.
Management of lateral cystic swellings of the neck, in the over 40s’ age group
Authors: Andrews P. J. , Giddings C. E. B. , Su A. P. 
Published: March 2003

We present a series of three case reports of patients over the age of 40 with cystic swellings in the lateral neck. Clinically they masqueraded as branchial cysts, but subsequently were diagnosed as being squamous cell carcinoma cystic lymph node metastasis arising from an occult tonsillar primary.Currently there is an absence of national guidelines for the treatment of lateral neck cysts in the over 40s’ age group that subsequently prove to be cystic metastases from occult tonsillar primaries. This disease process is more common than thought, with up to 80 per cent of so-called branchial cysts in the over 40s’ age group being malignant.We recommend that patients over the age of 40 presenting with lateral cystic swellings in the neck should have a high suspicion of malignancy and require a panendoscopy, ipsilateral tonsillectomy and blind biopsies of Waldeyer’s ring. This avoids inadvertent excision of a possible cystic lymph node metastasis. If the panendoscopy histology proves to be benign, then proceed to excision of the cyst with frozen section analysis of it. If this confirms it to be benign then that is all that is necessary; if the frozen section is however positive for carcinoma then the surgeon can proceed at that time to a formal neck dissection and therefore avoid a further procedure. In the event of an occult tonsillar malignancy, excision of the cyst as part of a neck dissection with post-operative radiotherapy is recommended.It is our aim to treat a cystic lymph node metastasis as you would a solid lymph node metastasis.
Prevalence and predictors of HIV-associated weight loss in the era of highly active antiretroviral therapy
Authors: Batterham Marijka J , Garsia Roger , Greenop Philippa 
Published: March 2003

This study was a cross-sectional study of 122 HIV-positive subjects to determine the prevalence and predictors of weight loss in the era of highly active antiretroviral therapy (HAART). Forty per cent reported lipodystrophy, 40% had documented weight loss (mean 6.6 kg). Mean intake 13400 kJ (118% of estimated requirements calculated using the Harris-Benedict equation). One hundred (82%) were taking antiretroviral therapy. Using forward stepwise logistic regression analysis only viral load (VL) was significantly associated with weight loss when intake, CD4 T-cell count, lipodystrophy, and age were entered into the model with VL (log copies/mL). Every one log increase in HIV VL was associated with an odds of weight loss of 1.58 ( P=0.0008). Weight loss is still common in the HAART era. HIV VL was the most significant predictor of weight loss in this sample. Inadequate dietary intake and self-reported lipodystrophy were not related to weight loss in this population.
Investigation of isolated positive syphilis enzyme immunoassay (ICE Murex) results
Authors: Ooi C , Robertson P , Donovan B 
Published: March 2003

This study was conducted to determine the significance of an isolated positive (where all other syphilis serology is negative) syphilis enzyme immunoassay (EIA) test (ICE syphilis: Murex Diagnostics) in a sexual health clinic population. There were significantly greater numbers of isolated positive syphilis EIA tests at Sydney Sexual Health Centre (SSHC) (22/5478) compared to lower risk populations; Southeastern Sydney antenatal clinics (1/11560, P<0.01) and Sydney Children's Hospital (0/3550, P<0.01). We conducted a case control study comparing the cases at SSHC with two control groups drawn from the clinic population. A manual review of the case medical records searched for a history of suggested syphilis. Within the 22 cases, 32% had clinical grounds for suspecting that the EIA test signified syphilis. Men reporting homosexual contact in the past 12 months significantly distinguished cases from controls who tested negative for syphilis (OR=6.06). An isolated positive EIA test should prompt further investigation for syphilis, past or present.
Association of cervical SIL and HIV-1 infection among Zimbabwean women in an HIV/STI prevention study
Authors: Chirenje Z M , Loeb L , Mwale M , Nyamapfeni P , Kamba M , Padian N 
Published: March 2003

A cross-sectional study was conducted on women attending family planning clinics in Harare, Zimbabwe to determine the prevalence of cervical neoplasia among HIV-1 positive women relative to an HIV-1 negative control group. Five hundred and fifty four women were recruited and the prevalence of HIV-1 was 36.8%. Cervical cytology was abnormal in 25.6% of HIV-infected women compared to only 6.7% HIV-1 seronegative women. Cervical neoplasia was significantly associated with HIV infection (χ2=42.4, P<0.001). Cellular changes typical of HPV infection (koilocytocis) were recorded in 6.4% of HIV infected women compared with 1.7% of HIV-1-uninfected women (χ2=8.43, P=0.004). HIV-1-positive women had twice the risk of having abnormal cervical cells than HIV-negative women (relative risk 2.47, odds ratio 10.14, P<0.001). Therefore the introduction of national cervical screening programme in HIV-1 endemic countries like Zimbabwe where the highest burden of pre-malignant lesions is among HIV-1-infected women needs careful planning because these women have other competing health needs including high rates of opportunistic infections.
Significance of sexual route of transmission of hepatitis B and C in Russia
Authors: Mikhailov M I , Gomberg M A , Dolzhanskaya N A , Koubanova A A 
Published: March 2003

It is generally understood that hepatitis B and hepatitis C may be sexually transmitted. During the last decade there was a sharp growth of hepatitis B and C in Russia. In comparison to 1992 the incidence of hepatitis B in Russia rose two-fold and in 1999 there were 43.31 cases per 100,000 of population (in some cities up to 150/100,000 and even more). The incidence of hepatitis C in 1999 (19.31 per 100,000 of population) rose to six times more than in 1994. At the same time there was a dramatic growth in syphilis and other sexually transmitted infections in Russia. The proportion of sexual transmission of hepatitis B virus (HBV) and hepatitis C virus (HCV) compared with other routes of transmission increased. According to the data from Moscow City Centre of Epidemiology during the last two years, up to 40% cases of HCV and HBV were sexually transmitted. The most dramatic growth of registered cases of hepatitis was seen among the sexually active population aged 14-29. Confirmation of the sexual route of transmission of HBV and HCV in teenagers was seen when the results of the study showed various markers of HBV and HCV to be significantly more common among sexually active (n=45) than sexually inactive (n=341) teenagers (13.33% vs. 4.39% for HBsAg; 46.67% vs. 12.61% for HBsAg+anti-HBs+anti-HBc; 9.47% vs. 3.95% for anti-HCV, respectively).
Experience with the new German hepatitis B vaccination strategy since 1995
Authors: Krämer Alexander , Prüfer-Krämer Luise 
Published: March 2003

In Germany general hepatitis B (HB) vaccination for newborns and adolescents was introduced in all federal states following the recommendation of the STIKO (Permanent Vaccination Commission) of 1995. In 1998 serological studies of the German National Health Survey showed that at least 9.8% in the age group of 18 to 19 years had been vaccinated against HBV infection. By 1996 the vaccine doses sold for children rose dramatically and started to reach a plateau of approximately five million per year in 1997. Data from the kassenärztliche Vereinigung of the Oberpfalz region in Bavaria also indicate that the new policy started to be implemented in 1996. At school entry, however, in 1997 only 10% of the children in seven West German states showed serological evidence of HB vaccination coverage. According to observations of virologists, paediatricians and public health experts the current acceptance of the HB vaccination recommendations is 80%–90% in children below the age of six years but only 30% to 40% in adolescents. To achieve high HB vaccination coverage rates in Germany more rapidly a modern surveillance system providing detailed data about vaccination coverage in the different age and population groups is needed. Based on those data additional targeted vaccination strategies for those that can only be contacted by the traditional health care system, such as teenagers and vulnerable groups, should be developed, involving the public health service, local communities and other agencies.
Heterosexual transmission of HIV in Africa: an empiric estimate
Authors: Gisselquist David , Potterat John J 
Published: March 2003

For more than a decade, most experts have assumed that more than 90% of HIV in African adults results from heterosexual transmission. In this exercise, we show how data from studies of risk factors for HIV can be used to estimate the proportion from sexual transmission, and we present our estimates. Calculating two ways from available data, our two point estimates — we do not estimate confidence intervals — are that 25-29% of HIV incidence in African women and 30-35% in men is attributable to sexual transmission; these estimates assume 10% annual epidemic growth. These findings call for reconceptualization of research to more accurately assess routes of HIV transmission.
Confound it: latent lessons from the Mwanza trial of STD treatment to reduce HIV transmission
Authors: Gisselquist David , Potterat John J 
Published: March 2003

In 1995, an international team reported that improved syndromic management of sexually transmitted disease (STD) in Mwanza, Tanzania, had reduced HIV incidence by 38% in intervention compared to control communities. However, the team has not addressed confound: project interventions might have reduced HIV transmission during health care through provision of syringes and benzathine (replacing short acting) penicillin and through interactions with a coeval safe injection initiative. Mwanza's success in lowering HIV incidence is a puzzle, since it was achieved with only minor reductions in observed STD prevalence. Despite incomplete analyses, reports from Mwanza have encouraged expansion of STD treatment. However, should success be attributed to injection safety rather than to decreased STD prevalence — an hypothesis that fits published data — expanded STD treatment without attention to injection safety could, ironically, increase rather than decrease HIV incidence. To control for confound, additional data and analyses from the Mwanza study are warranted.
Sexually transmitted infections and sexual behaviour among commercial sex workers in a rural district of Malawi
Authors: Zachariah R , Spielmann M P , Harries A D , Nkhoma W , Chantulo A , Arendt V 
Published: March 2003

In Thyolo District, Malawi, a study was conducted among commercial sex workers (CSWs) attending mobile clinics in order to; determine the prevalence and pattern of sexually transmitted infections (STIs), describe sexual behaviour among those who have an STI and identify risk factors associated with 'no condom use'. There were 1817 CSWs, of whom 448 (25%) had an STI. Of these, the commonest infections included 237 (53%) cases of abnormal vaginal discharge, 109 (24%) cases of pelvic inflammatory disease and 95 (21%) cases of genital ulcer disease (GUD). Eighty-seven per cent had sex while symptomatic, 17% without condoms. Having unprotected sex was associated with being married, being involved with commercial sex outside a known rest-house or bar, having a GUD, having fewer than two clients/day, alcohol intake and having had no prior medication for STI. The high levels of STIs, particularly GUDs, and unprotected sex underlines the importance of developing targeted interventions for CSWs and their clients.
Thalidomide Dosing in Patients with Relapsed or Refractory Multiple Myeloma
Authors: Thompson Jennifer L , Hansen Lea Ann 
Published: March 2003

OBJECTIVE: To evaluate the literature regarding the dosing of thalidomide in multiple myeloma. DATA SOURCES: A MEDLINE search (1990–February 2003) using the search terms thalidomide and multiple myeloma was performed to identify clinical trials and abstracts. Identified literature was then cross-referenced for further pertinent data. DATA SYNTHESIS: Patients with relapsed or refractory multiple myeloma have few therapeutic options. Thalidomide is a promising agent, although many dose-related issues are still in question. Starting doses studied ranged from 50 to 200 mg/d, usually given at bedtime. Gradual dose escalation up to 800 mg/d has been studied, with some evidence of improved outcome with doses of 400–600 mg/d, while thalidomide appears to be best tolerated at doses ≤400 mg/d. CONCLUSIONS: A reasonable approach for use of thalidomide in multiple myeloma is to initiate therapy at 50–100 mg nightly and escalate every 2 weeks in 50-to 100-mg increments as tolerated. Efforts should be made to titrate the dose to 400–600 mg/d, especially in patients with poor prognostic features. Efficacy should be assessed at approximately 8 weeks and the dose maintained if desired response is achieved.
Increased Vitamin B12 Requirement Associated with Chronic Acid Suppression Therapy
Authors: Force Rex W , Meeker Angela D , Cady Paul S , Culbertson Vaughn L , Force Wendy S , Kelley Craig M 
Published: March 2003

BACKGROUND: Assimilation of vitamin B12 from dietary sources requires gastric acid. By decreasing acid production, the proton pump inhibitors (PPIs) and histamine2 (H2)-blockers may reduce vitamin B12 absorption. OBJECTIVE: To determine whether chronic acid suppression therapy is associated with the initiation of vitamin B12 supplementation, we conducted a retrospective case–control study using a state-wide Medicaid population. METHODS: Case patients were identified as those who initiated vitamin B12 supplementation during the study period. Four control patients were age-and gender-matched to each case. Patients (n = 109 844) with a paid claim between September 27, 1995, and September 27, 1997, were eligible for inclusion. Chronic acid suppression therapy was defined as treatment with H2-blockers or PPIs for ≥10 of the 12 months prior to the first vitamin B12 injection. Comparisons were made between the case and control groups regarding exposure to chronic acid suppression therapy. RESULTS: One hundred twenty-five cases were matched to 500 controls. Twenty-three patients (18.4%) had been exposed to chronic acid suppression therapy compared with 55 (11.0%) of the control group (p = 0.025; OR 1.82; 95% CI 1.08 to 3.09). CONCLUSIONS: Initiation of vitamin B12 supplementation was associated with chronic gastric acid suppression therapy.
Usefulness of Herbal and Dietary Supplement References
Authors: Sweet Burgunda V , Gay Wendy E , Leady Michelle A , Stumpf Janice L 
Published: March 2003

OBJECTIVE: To describe the usefulness of some of the most common tertiary references that healthcare professionals employ to answer requests about herbal and dietary supplements. METHODS: All requests for information on herbal and dietary supplements received by the drug information service between April and September 2000 were evaluated. Each question was independently reviewed by 4 clinicians using a 4-point scale; 14 references were searched for appropriate answers. The percent of responses for each of the possible scores for each reference overall and by category of question was reported to determine the most helpful references for answering the broadest range of questions. RESULTS: Fifty questions regarding herbal and dietary supplements were analyzed. The electronic databases (Natural Medicine Comprehensive Database, Micromedex) and the Internet site (The Natural Pharmacist) were determined to be overall the most helpful references for providing information on herbal and dietary supplements. The Natural Therapeutics Pocket Guide was the most helpful book reference. CONCLUSIONS: These results will facilitate the retrieval of useful information on herbal and dietary supplements and enable healthcare professionals to determine appropriate allocation of resources as they build a drug information library for handling requests about these products.
Orlistat Enhances Warfarin Effect
Authors: MacWalter Ronald S , Fraser Hazel W , Armstrong Katherine M 
Published: March 2003

OBJECTIVE: To report a case of increased international normalized ratio (INR) associated with the addition of orlistat to the drug regimen of a patient receiving warfarin therapy. CASE SUMMARY: A 66-year-old white man with a history of chronic atrial fibrillation (treated with a stable dose of warfarin), hypertension, and diet-controlled type 2 diabetes mellitus was started on orlistat for weight reduction. An increased INR was reported after the introduction of orlistat; there had been no other recent changes to medication or medical conditions. Warfarin was withheld and the dose reduced to allow INR control to be reestablished. According to the Naranjo probability scale, this reaction was probable. DISCUSSION: Control of the INR within therapeutic limits is always a challenge. Dietary intake of vitamin K, intercurrent illness, concomitant medication, herbal remedies, and other factors can interfere with warfarin dosing. Orlistat use may be associated with patient alteration of diet to compensate for adverse effects or other mechanisms by which orlistat alters warfarin control, including direct effect on absorption of vitamin K. CONCLUSIONS: The introduction of chronic dosing of orlistat may reduce the absorption of fat-soluble vitamins, including vitamin K, with the result that a lower dose of warfarin may be required. This may be due in part to change to a lower fat diet with decreased amounts of vitamin K. It may also be due to an effect on vitamin K absorption. Caution should be exercised when these 2 drugs are used concurrently.