bluuebunny/crossref_metadata_2025_split huggingface dataset:
ERECTILE DYSFUNCTION: CARDIOVASCULAR RISK AND THE ROLE OF THE CARDIOLOGIST
Authors: Solomon H , Man J , Wierzbicki AS , O'Brien T , Jackson G 
Published: April 2023

SUMMARYErectile dysfunction (ED) shares the same risk factors as coronary artery disease, so the level of occult cardiovascular risk in men with ED was assessed. A total of 174 men presenting with ED underwent cardiac risk stratification according to the Princeton Consensus Guidelines. Thirty per cent were stratified as intermediate/high cardiovascular risk and had ED treatment deferred until further cardiological assessment; 37% had abnormal lipid profiles; 24% had elevated HbA1C/glucose levels; 17% had uncontrolled hypertension; and 6% were suspected of having significant angina. ED is associated with a high incidence of occult cardiovascular disease. We suggest that cardiologists can significantly contribute to the management of ED.
LEFLUNOMIDE
Authors: Cohen SB , Iqbal I 
Published: April 2023

SUMMARYLeflunomide (Arava) was approved for the treatment of rheumatoid arthritis by the regulatory authorities in the US and Europe in 1998. This approval was based on three pivotal randomised clinical trials conducted in the US and Europe. This report will focus on the use of leflunomide in rheumatoid arthritis based on the data from these trials as well information on the efficacy and safety learned from post release clinical experience.
GROWTH CHARTS FOR CHILDREN WITH DOWN'S SYNDROME IN SAUDI ARABIA: BIRTH TO 5 YEARS
Authors: Al Husain M 
Published: April 2023

SUMMARYThe objective was to construct growth charts for Saudi children under 5 years of age with Down's syndrome (DS). A prospective cross‐sectional survey of anthropometrics standards (weight, height, head circumference and weight for height) of Saudi children with DS, excluding those with associated pathology, and a group of normal children seen at King Khalid University Hospital, Riyadh, Saudi Arabia, during 2001 were studied. Both groups were compared to a reference population of American children documented by the National Center for Health Statistics/Center for Disease Control. A total of 785 children with DS and 989 normal children were studied. Growth charts for the different parameters in both sexes at each age were used to estimate seven centiles. The growth pattern for children with DS differed significantly from normal children and was characterised by short stature at most ages. Data indicated a high proportion of underweight children with DS in the first two years of life, but a clear tendency to be overweight by the age of 3 years; 54.5% of children with DS had a head circumference below −2 SD for age and sex. The results of this study accord with others indicating a genetic effect of DS on growth, and support the use of growth charts in conjunction with charts for normal children for assessing growth in DS in Saudi Arabia.
GALANTAMINE: A REVIEW OF ITS USE IN ALZHEIMER'S DISEASE AND VASCULAR DEMENTIA
Authors: Corey J‐Bloom 
Published: April 2023

SUMMARYDementia has the potential to become a major public health concern during this century due to increasing life expectancy and growth in the ageing population. The commonest types of dementia include Alzheimer's disease (AD), vascular dementia (VaD), and dementia with cerebrovascular components. Galantamine is the only acetylcholinesterase inhibitor that exhibits a dual mechanism of action – inhibition of acetylcholinesterase and nicotinic receptor modulation. Clinical studies demonstrate the efficacy and safety of galantamine in patients with AD, VaD, and AD with cerebrovascular components. Galantamine shows beneficial effects on cognition, global function, activities of daily living and behaviour. Adverse events observed with galantamine use are generally mild to moderate in severity, transient and gastrointestinal in nature. The dose of galantamine should be escalated to 16 and 24 mg/day at four‐week intervals to achieve maximal tolerability. Because of its unique mechanism of action, galantamine may have potential benefits over conventional enzyme‐inhibiting agents.
ANAKINRA: THE FIRST INTERLEUKIN‐1 INHIBITOR IN THE TREATMENT OF RHEUMATOID ARTHRITIS
Authors: Kary S , Burmester GR 
Published: April 2023

SUMMARYRheumatoid arthritis is an immunologically mediated inflammation of joints of unknown aetiology and often leads to disability. This inflammatory process may also involve extra‐articular connective tissue. New therapeutic approaches have been made by inhibition of proinflammatory cytokines, lnterleukin‐1 (IL‐1) is regarded as one of the most important mediators in the development of synovialitis. In this article, anakinra (Kineret®), the first direct antagonist to IL‐1, is discussed, in particular the efficacy and safety data from clinical trials. More than 10,000 patients have been treated with anakinra with significant improvement of inflammation and pain; the rate of radiologically visible progressive joint damage was significantly reduced. Among the adverse events, injection site reactions were most frequent, followed by a mild increase in infections. No activation of tuberculosis, as in tumour necrosis factor‐α antagonist administration, has so far been reported.
LEVOSIMENDAN: A NEW DUAL‐ACTION DRUG IN THE TREATMENT OF ACUTE HEART FAILURE
Authors: Mebazaa A , Erhardt L 
Published: April 2023

SUMMARYLevosimendan is a new agent for the treatment of acute heart failure. Levosimendan acts via complementary mechanisms; it enhances contractility by sensitising cardiac myofilaments to calcium and dilates blood vessels by opening ATP‐dependent potassium channels. In contrast to traditional inotropes (β‐agonists or phosphodiesterase inhibitors), levosimendan does not raise myocyte calcium levels and is therefore less likely to elicit arrhythmias or to impair diastolic relaxation. The clinical efficacy of levosimendan is supported by four key clinical studies, including more than 900 patients hospitalised for cardiac decompensation due to acutely worsened chronic heart failure or to heart failure following myocardial infarction. When given as short‐term therapy, levosimendan enhances cardiac output, reduces systemic vascular resistance and lowers pulmonary capillary wedge pressure. At 31 days post‐treatment, mortality rates were halved in decompensated chronic heart failure patients who received levosimendan, compared with those on dobutamine – an advantage sustained at 180 days. Similar survival gains were observed among acute failure patients treated with levosimendan following myocardial infarction. With its substantial haemodynamic and survival benefits, levosimendan is well suited to be part of routine management for patients with acutely decompensated heart failure.
COMPARISON OF ONCE‐DAILY MOMETASONE FUROATE VERSUS ONCE‐DAILY BUDESONIDE IN PATIENTS WITH MODERATE PERSISTENT ASTHMA
Authors: Corren J , Berkowitz R , Murray JJ , Prenner B 
Published: April 2023

SUMMARYWe conducted this study to compare the efficacy and safety of once‐daily mometasone furoate (MF) administered by dry powder inhaler (DPI) with once‐daily budesonide (BUD)‐DPI and placebo in patients with moderate persistent asthma previously using twice‐daily inhaled corticosteroids. A total of 262 patients (≥12 years of age) with moderate persistent asthma were randomised to once‐daily morning treatment with MF‐DPI 440 μg (metered dose), BUD‐DPI 400 μg (metered dose), or placebo in an eight‐week, multicentre, placebo‐controlled, double‐blind, double‐dummy study. The primary efficacy variable was percent change in FEV1 from baseline to endpoint (last evaluable visit). At endpoint, the percent change in FEV1 was significantly greater (p<0.01) following treatment with MF‐DPI 440 μg (8.9%) than with both BUD‐DPI 400 μg (2.1%) and placebo (−3.9%). Secondary efficacy variables, including morning and evening peak expiratory flow rates, albuterol use, percentage of asthma symptom‐free days, and physician‐evaluated response to therapy were also significantly improved at endpoint in the MF‐DPI group compared with both the placebo and BUD‐DPI groups (p<0.05). Both active treatments were well tolerated. In conclusion, once‐daily treatment in the morning with MF‐DPI 440 μg significantly improved pulmonary function and asthma control compared with morning administration of BUD‐DPI 400 μg and placebo.
PATIENTS WITH MIGRAINE PREFER ZOLMITRIPTAN ORALLY DISINTEGRATING TABLET TO SUMATRIPTAN CONVENTIONAL ORAL TABLET
Authors: Dowson AJ , Charlesworth BR 
Published: April 2023

SUMMARYThe Zolmitriptan Evaluation versus Sumatriptan Trial (ZEST) assessed patient preference for 2.5 mg zolmitriptan orally disintegrating tablet (ODT) or 50 mg sumatriptan conventional tablet in 218 patients with significant migraine disability. Significantly more patients preferred zolmitriptan ODT to sumatriptan conventional tablet (60.1% vs 39.9%; p=0.0130). In terms of efficacy, significantly more patients considered zolmitriptan ODT to be an effective migraine treatment than sumatriptan conventional tablet (77% vs 63%; p=0.0063). When asked about specific formulation attributes, significantly more patients selected zolmitriptan ODT as the least disruptive therapy (83.6% vs 16.4%), the easiest to take (85.5% vs 14.5%), the most convenient to take (86.1% vs 13.9%), and the one which enabled them to maintain an active lifestyle (65.5% vs 34.5%), compared with the sumatriptan conventional tablet (all comparisons p<0.001). Zolmitriptan ODT is a convenient and beneficial alternative to conventional tablets and is preferred to sumatriptan conventional tablets by migraineurs.
THE POTENTIAL VALUE OF ERECTILE DYSFUNCTION INQUIRY AND MANAGEMENT
Authors: Sadovsky R , Mulhall JP 
Published: April 2023

SUMMARYErectile dysfunction (ED) is a serious condition that becomes more common as men age. Many older men, however, report satisfactory erectile capacity and enjoy satisfying sexual relationships. Physicians have been slow to discuss ED with patients even in the presence of multiple risk factors. New information provides strong reasons for ED inquiry and management in the primary care physician's office. The presence of ED can reveal as yet undiscovered neurovascular and Psychological disorders including diabetes, hypertension, dyslipidaemia, depression and anxiety as well as early neuromuscular disorders. By inquiring about ED, physicians can better decrease iatrogenic sexual dysfunction caused by certain commonly used medications. The successful management of ED, made much easier by the development of phosphodiesterase type 5 inhibitors, has additional potential benefits including improvement of quality of life for both the patient and his Partner; decreasing the symptoms of depression in depressed men who also have ED; improving relationships, a significant factor related to good health; and enhancing overall patient health. Other potential values for the physician include a better clinician‐patient and increased physician work satisfaction. Primary care physicians need to recognise the value of ED inquiry and management and integrate these activities into practice.
THE IMPACT OF IMPLEMENTING THE OTTAWA ANKLE RULES ON ANKLE RADIOGRAPHY REQUESTS IN A&E
Authors: Gwilym SE , Aslam N , Ribbans WJ , Holloway V 
Published: April 2023

SUMMARYThis audit was set up to quantify the effect of implementing the Ottawa ankle rules in a district general hospital that relies on both medical and nursing radiography requests. Data were collected prospectively on 207 patients who presented with an acute ankle injury between August 2001 and February 2002. The department's activity was recorded before and after a period of teaching on the Ottawa ankle rules. Before teaching, 71% of patients with an acute ankle injury were sent for radiography; teaching reduced this figure to 56% (p<0.05). Auditing the activity of our department enabled us to observe a significant decrease in the number of patients sent for ankle radiography following acute ankle injury. This correlates well with research in other settings. The difficulties of rationalising radiology investigations are discussed.
PLUMMER‐VINSON SYNDROME: A REPORT OF THREE CASES
Authors: Yukselen V , Karaoglu AO , Yasa MH 
Published: April 2023

SUMMARYPlummer‐Vinson syndrome is characterised by dysphagia, anaemia, glossitis and oesophageal web. We report our findings in three patients with membranes in the upper oesophagus. All patients underwent endoscopic dilatation and iron replacement therapy, with good results. We review the literature of this syndrome.
BUDESONIDE/FORMOTEROL ADJUSTABLE MAINTENANCE DOSING REDUCES ASTHMA EXACERBATIONS VERSUS FIXED DOSING
Authors: Ställberg B , Olsson P , Jörgensen LA , Lindarck N , Ekström T 
Published: April 2023

SUMMARYA guided, adjustable‐dosing regimen with budesonide/formoterol was investigated in asthma patients. In a randomised, open, multicentre study, 1034 patients received budesonide/formoterol (Symbicort®, Turbuhaler®,) 80/4.5 μg or 160/4.5 μg (depending on pre‐study inhaled corticosteroid dose) two inhalations twice daily for four weeks, followed by adjustable or fixed maintenance dosing for six months. Patients receiving adjustable dosing stepped down to one inhalation twice daily if symptoms were controlled and could, if symptoms worsened, step up to four inhalations twice daily for one or two weeks according to a self‐guided management plan. The primary efficacy variable was occurrence of exacerbations. Compared with fixed dosing, adjustable dosing was associated with fewer patients experiencing exacerbations (6.2% vs 9.5%, NNT 30, p<0.05), fewer daily inhalations of budesonide/formoterol (2.35 vs 3.95, p<0.001), lower costs (six‐month saving €98, p<0.001) and was similarly well tolerated. Adjustable maintenance dosing with budesonide/formoterol provides more effective asthma control than fixed dosing, and reduces costs.
EFFICACY OF RADIOFREQUENCY VOLUMETRIC TISSUE REDUCTION OF THE SOFT PALATE IN THE TREATMENT OF SNORING
Authors: Fang TJ , Li HY , Shue CW , Lee LA , Wang PC 
Published: April 2023

SUMMARYTraditional surgery for snoring often leads to intolerable postoperative pain. A new surgical treatment radiofrequency volumetric tissue reduction (RVTR) of the soft palate, was carried out and its effect and safety in the management of snoring were evaluated. Thirty‐two patients received a single treatment of RVTR with a mean follow‐up period of 4.5 months. All patients were assessed by a questionnaire using the Snore Outcomes Survey (SOS) and the Epworth Sleepiness Scale (ESS). Postoperative pain, speech and swallowing disturbances were also evaluated. The postoperative scores of SOS and ESS all significantly improved (p<0.05). Postoperative pain, speech and swallowing disturbances were all mild 1–3 days after treatment. With the success of treatment defined as a postoperative snoring index (SI) of <3 or a reduction of the SI by >5 points by the visual analogue scale, the success rate was 81.3% in patients with a respiratory disturbance index (RDI) of <20, and 50% in those with an RDI of >20. We conclude that RVTR of the soft palate is an effective treatment for snoring, resulting in only mild postoperative discomfort. A patient whose RDI was <20 had a higher success rate with a single RVTR treatment.
THERAPEUTIC EFFECTS OF ANGIOTENSIN II INHIBITION OR BLOCKADE ON THE PROGRESSION OF CHRONIC RENAL DISEASE
Authors: Cantarovich F , Rangoonwala B 
Published: April 2023

SUMMARYExperimental and clinical research has supported the use of angiotensin‐converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) in diabetic, hypertensive and proteinuric nephropathies. This review will evaluate the role of angiotensin II in the progression of renal damage in kidney diseases; the diagnostic value of microalbuminuria as an early clinical sign of renal damage and the possibility of preventing its further progression; the clinical results obtained with ACE inhibitors and/or ARBs in diabetic and non‐diabetic nephropathies; and the therapeutic possibilities of ACE inhibitors and ARBs in renal transplantation. Based on available clinical data, ACE inhibitors can be considered to be the gold standard in reducing and/or preventing albuminuria, and thereby decreasing the percentage of patients who will progress to end‐stage renal disease and death. Renal transplantation and chronic allograft nephropathy appear to be a promising field for the use of ACE inhibitors and ARBs.
UNINTENTIONAL RECHALLENGE RESULTING IN A CAUSATIVE RELATIONSHIP BETWEEN KETOCONAZOLE AND ACUTE LIVER INJURY
Authors: Chien R‐N , Sheen I‐S , Liaw Y‐F 
Published: April 2023

SUMMARYWe present the case of a female patient in whom acute overt hepatitis developed after 60 days of ketoconazole administration (200 mg/day). A prompt renewed hepatic injury 48 hours after an unintentional rechallenge 30 months later provided definitive evidence for a causative relationship between ketoconazole and acute liver injury. Histological examination revealed acute hepatitis with bridging hepatic necrosis. Clinicians should be aware of this cause and effect relationship between ketoconazole and acute liver injury, which can result in prompt severe acute liver injury after rechallenge.
SARCOMAS OF THE BREAST
Authors: Alabassi A , Fentiman IS 
Published: April 2023

SUMMARYBreast sarcomas are rare lesions that can be derived from any of the mammary stromal cells. A phyllodes tumour may resemble a rapidly growing fibroadenoma but in an older age group. Behaviour ranges from benign to frankly malignant and cannot always be predicted from the histological appearance. For all the sarcomas spread is haematogenous rather than lymphatic and treatment is based on wide surgical clearance without axillary surgery. Angiosarcoma is a rare consequence of skin irradiation as part of breast conservation therapy. Fibrosarcomas have a tendency to relapse locally unless wide surgical margins have been achieved. Radiotherapy is not of value but chemotherapy can be used to palliate women with metastatic disease.
GUILLAIN‐BARRE SYNDROME ASSOCIATED WITH ACUTE NEUROBRUCELLOSIS
Authors: Namiduru M , Karaoglan I , Yilmaz M 
Published: April 2023

SUMMARYWe report the case of a 14‐year‐old girl with Guillain‐Barré syndrome associated with brucellosis due to Brucella melitensis. The diagnosis was established by the isolation of B. melitensis from her blood and by the determination of high levels of Brucella aglutinins in her sera and cerebrospinal fluid. A combination of rifampin, co‐trimoxazole and physical therapy resulted in complete healing within 30 days. Antibrucellar treatment continued for 12 weeks. This case report suggests that brucellosis should be kept in mind in the aetiology of Guillain‐Barré syndrome in the endemic areas for brucellosis, and bacteriological and serological tests for brucellosis should be performed.
Obstetrical outcomes of pregnant women 50 years and older compared to those aged 45–49 years: A systematic review and meta‐analysis
Authors: Sugai Shunya , Sekizuka Tomoyuki , Haino Kazufumi , Nonaka Taro , Sekine Masayuki , Yoshihara Kosuke , Nishijima Koji 
Published: April 2023

AbstractAimIn this review, We compared clinical characteristics of pregnant women aged 50 and older with those aged 45–49. Pregnant women ≥45 years are strongly associated with pregnancy‐related complications, such as cesarean section rate, gestational hypertension, gestational diabetes mellitus, and preterm birth. Although pregnant women ≥50 years are considered more high‐risk, differences in pregnancy outcomes between those over 45 and 50 years of age are unclear.MethodsOur source strategy included using PubMed, the Cochrane Central Register of Controlled Trials, and Web of Science databases to include studies published between January 1, 2010 and September 30, 2022. The study population was pregnant women 50 years and older; the control group was pregnant women aged 45–49 years. Primary outcomes were cesarean section, gestational hypertension, gestational diabetes mellitus, and preterm birth. The secondary outcomes were small‐for‐gestational age, 5‐min Apgar score < 7, neonatal intensive care unit admission (as neonatal outcomes), nulliparity, assisted reproductive technology (ART), and multifetal pregnancy (as maternal backgrounds).ResultsThe incidence of cesarean section, gestational hypertension, and preterm delivery was significantly higher in those 50 years and older; however, significant differences disappeared when pooled analyses were limited to singleton pregnancies. ART was significantly more likely to be used for conception of pregnant women ≥50 years. Infants of women ≥50 years were more likely to be admitted to NICUs.ConclusionsThe differences in outcomes between the two groups are obviously influenced by multiple pregnancies, therefore, reproductive medicine specialists should aim for singleton pregnancies in ART.
Fracture strength of anterior cantilever resin‐bonded fixed partial dentures fabricated from high translucency zirconia with different intaglio surface treatments
Authors: Al‐Wahadni Ahed , Dkmak Mhd Salim Fissal , Almohammed Saleh , Hatamleh Muhanad M. , Tabanjah Abedelmalek 
Published: April 2023

AbstractPurposeTo compare the fracture resistance and failure modes of anterior cantilever resin‐bonded fixed partial dentures (RBFPDs) fabricated from high translucency zirconia with different intaglio surface treatments.Materials and methodsSound‐extracted canines (N = 50) were randomly divided into five groups (n = 10) to be restored with high translucency zirconia RBFBDs of different intaglio surface treatments. The RBFPD was designed using exocad software and fabricated using a CAM milling machine. The RBFPDs were treated differently: abrasion with 50 µm alumina particles (Group 1); abrasion with 30 µm silica‐coated alumina particles (Group 2); abrasion with silica‐coated alumina particles (30 µm) and silane application (Group 3); abrasion with silica‐coated alumina particles (30 µm) and 10‐methacryloyloxydecyl dihydrogen phosphate (10‐MDP) primer application (Group 4); abrasion with silica‐coated alumina particles (30 µm) and silane, and 10‐MDP primer application. All RBFPDs were cemented using dual‐cured resin cement. The RBFPDs underwent 6000 thermal cycles with distilled water at 5/55°C for 2 min per cycle and then mechanical cyclic loading with 1200,000 cycles of 50 N at a 1.7 Hz frequency at an angle of 135° to the abutment's long axis. Then, RBFPDs were loaded to fracture using a universal testing machine at 1 mm/min. Maximum fracture forces and failure modes were recorded. Fractured specimens and uncemented specimens were examined using a scanning electron microscope. Data was analyzed using ANOVA and Games–Howell post hoc tests at p < 0.05.ResultsMean fracture load results showed a statistically significant difference between the research groups (p < 0.0001) and it ranged from 69.78 to 584 N. Group 4 exhibited the highest fracture load mean (p < 0.0001) which was significantly different from all other groups. Group 2 recorded a significantly higher fracture load mean than Group 3 (p = 0.029). Three modes of failure were observed: prosthesis debonding, prosthesis fracture, and abutment fracture.ConclusionsAbrasion of zirconia surface with 30 µm silica‐coated alumina particles and application of 10‐MDP primer yielded the highest mean fracture loads of monolithic high translucency zirconia RBFPD. The mode of fracture of the RBFPDs was influenced by the type of surface treatments.