bluuebunny/crossref_metadata_2025_split huggingface dataset:
CALCIUM DOBESILATE: PHARMACOLOGICAL PROFILE RELATED TO ITS USE IN DIABETIC RETINOPATHY
Authors: Berthet P , Farine J‐C , Barras J‐P 
Published: April 2023

SUMMARYCalcium dobesilate (Doxium®) is used in the treatment of diabetic retinopathy. Clinical studies show a slowdown of the progression of the disease after long‐term oral treatment. The main action of the drug is related to a reduction of microvascular permeability as measured by different parameters and methods (vitreous fluorophotometry, retinal haemorrhages, skin capillary resistance, blood albumin leakage, blood viscosity) leading to improved visual acuity. The pharmacological activity may be explained in part by the antioxidant properties of calcium dobesilate and its action on endothelium through the synthesis of nitric oxide, increasing the endothelium‐dependent relaxation. The antioxidant effect was demonstrated in different in vitro and in vivo models by decreasing the peritoneal permeability in rats induced by pro‐oxidant substances. Moreover, vascular leakage was also decreased by calcium dobesilate in a reperfusion model in streptozotocin induced diabetic rats after ischaemia of the central artery of the retina. Doxium may also preserve vascular endothelial function by acting directly as antioxidant to protect lipids from peroxidation.
COMBINATION THERAPY WITH BETA‐ADRENERGIC BLOCKADE AND AMLODIPINE AS SECOND LINE TREATMENT IN ESSENTIAL HYPERTENSION
Authors: Mettimano M , Pichetti F , Fazzari L , Migneco A , Specchia L , Spica V Romano , Savi L 
Published: April 2023

SUMMARYIn hypertension both beta‐blockers and calcium antagonists are drugs with proved efficacy. Because only half the patients respond to a single drug, even at full dosage, a second hypotensive agent is frequently required to obtain adequate blood pressure control. The combination of a dihydropyridine calcium antagonist and a beta‐blocker can be justified by their different mechanisms of action. A randomised double blind parallel group study versus placebo was performed, in order to assess the efficacy of atenolol combined with amlodipine in the treatment of stage I‐II essential hypertension not controlled by atenolol alone. Twenty‐four‐hour arterial blood pressure monitoring showed that amlodipine added to atenolol produced a statistically significant reduction of blood pressure values compared with placebo in patients whose blood pressure was not controlled by atenolol alone. Blood pressure circadian rhythm was unchanged. The reduction of side‐effects, obtained by adding a dihydropyridine derivate to a beta‐blocker, confirms the effectiveness of this combination.
BENEFITS OF A STANDARDISED FEEDING REGIMEN DURING A CLINICAL TRIAL IN PRETERM NEONATES
Authors: Patole SK , Kadalraja R , Tuladhar R , Almonte R , Muller R , Whitehall JS 
Published: April 2023

SUMMARYThe feeding regimen was standardised for a trial of erythromycin to reduce the time to reach full feeds (150 ml/kg/day) by 30% in neonates of ≤32 weeks gestation. No significant improvement was noted in the primary outcome (median time: erythromycin 93.5 vs placebo 104 hours, p=0.60). However, necrotising enterocolitis ≥stage II disappeared and the time to full feeds was reduced by over 50% in all neonates during the 18‐month trial, and for more than two years after the trial, when the standardised feeding regimen was adopted as routine policy for feeding neonates of ≤32 weeks (<28 weeks: 13 vs 4.8 days, p<0.05; >28 weeks: 8 vs 3.9 days, p<0.05). This was in contrast to an average of six cases of NEC per year with 45% mortality during the previous five years. The benefits of standardised feeding schedules — improved detection/treatment of signs/symptoms of feed intolerance — are emphasised.
CHRONIC VIRAL HEPATITIS
Authors: Alexander G , Walsh K 
Published: April 2023

SUMMARYBoth hepatitis B and hepatitis C are spread parenterally. Chronic hepatitis C is fast becoming the leading indication for liver transplantation. Most infected patients go on to develop chronic hepatitis, with approximately 20% developing liver cirrhosis or hepatocellular carcinoma after 20 years. Standard treatment now is with a combination of alpha‐interferon and ribavirin, which is successful in up to 40% of patients. A vaccine is still a remote possibility and prevention remains all‐important. Despite having a successful vaccine, chronic hepatitis B remains an important cause of liver cirrhosis and hepatocellular carcinoma. Treatments for active hepatitis include alpha‐interferon and the newer nucleoside analogues such as lamivudine and adefovir. In patients undergoing liver transplantation, recurrence of hepatitis B in the graft can be reduced with a combination of hepatitis B immunoglobulin and these nucleoside analogues.
MYOCARDIAL INFARCTION COMPLICATING HORMONE REPLACEMENT THERAPY IN A YOUNG WOMAN WITH NORMAL CORONARY ARTERIES
Authors: Steiner MK , Clarkson PBM , Lip GYH 
Published: April 2023

SUMMARYWe describe a 30‐year‐old Afro‐Caribbean woman with a history of secondary amenorrhoea, who had been treated with HRT because of a presumed diagnosis of premature ovarian failure, and subsequently presented with an acute infero‐lateral myocardial infarction. Subsequent coronary angiography demonstrated normal coronary arteries.
SCALP PAIN AND HYPERLIPIDAEMIA
Authors: Aravinoan PD , Lloyd‐Mostyn RH 
Published: April 2023

SUMMARYAcute pancreatitis and eruptive xanthomata are the only recognised direct complications of severe hyperthglyceridaemia, although peripheral neuropathy has been described in patients with hyperlipidaemia. We describe a patient with mixed hyperlipidaemia presenting with severe scalp pain and eruptive xanthomata. Both resolved with treatment. We suspect that high triglyceride concentration can affect the function of sensory nerve fibres.
MOXIFLOXACIN VERSUS CEPHALEXIN IN THE TREATMENT OF UNCOMPLICATED SKIN INFECTIONS
Authors: Parish LC , Routh HB , Miskin B , Fidelholtz J , Werschler P , Heyd A , Haverstock D , Church D 
Published: April 2023

SUMMARYThe efficacy and safety of oral moxifloxacin (400 mg once daily, 7 days) versus cephalexin (500 mg three times daily, 7 days) were compared in a prospective, multicentre, randomised, double‐blind trial in 401 adults with uncomplicated skin infections. Clinical outcome was evaluated in 351 patients. Moxifloxacin proved to be as effective as cephalexin both clinically (90% versus 91%, respectively) and bacteriologically in eradicating the most frequently isolated pathogen Staphylococcus aureus (92% and 93%, respectively). Moxifloxacin was more effective than cephalexin in eliminating Streptococcus spp. (90% and 82%, respectively). Drug‐related adverse events were comparable in both treatment groups with the most frequently reported being nausea in the moxifloxacin‐treated patients and headache in the cephalexin‐treated patients. Medication was discontinued due to unwanted reactions in 3% of the moxifloxacin‐ and 4% of the cephalexin‐treated patients. Moxifloxacin, 400 mg once daily for 7 days, is as safe and effective as cephalexin 500 mg three times daily for 7 days in the treatment of uncomplicated skin infections.
CAN PROPHYLACTIC ORAL ERYTHROMYCIN REDUCE TIME TO FULL ENTERAL FEEDS IN PRETERM NEONATES?
Authors: Patole SK , Almonte R , Kadalraja R , Tuladhar R , Muller R , Whitehall JS 
Published: April 2023

SUMMARYEfficacy of oral, prophylactic erythromycin in reducing the time to establish full enteral feeds (150 ml/kg/day) was assessed in neonates <32 weeks, ready for enteral feeds. Seventy‐three consecutive neonates were randomised to receive oral erythromycin ethyl succinate (n=36) or placebo (n=37) in a double‐blind trial until full enteral feeds or 14 days of therapy were reached. A prospectively designed feeding regimen, including plan of action for signs of feed intolerance, was common for all enrolled neonates. The median gestational age, birth weight and postnatal age at start of feeds were 29 versus 30 weeks (p=0.40), 1232 versus 1280 g (p=0.96) and 5 versus 5 days (p=0.84) for erythromycin and placebo group, respectively. Time to achieve full feeds was not significantly different in the two groups. (median times: erythromycin 93.5 versus placebo 104 hours, p=0.60). Erythromycin‐related side‐effects did not occur.
A COMPARISON OF NISOLDIPINE ER AND AMLODIPINE FOR THE TREATMENT OF MILD TO MODERATE HYPERTENSION
Authors: Whitcomb C , Enzmann G , Pershadsingh HA , Johnson R , Ciuryla V , Reisin E 
Published: April 2023

SUMMARYThis multicentre, double‐blind, double‐dummy, randomised trial compared the efficacy and tolerability of nisoldipine extended release (10–40 mg) and amlodipine (2.5–10 mg) in 161 patients. The primary end point was a between‐treatment comparison of change from baseline to week 8 in mean office diastolic blood pressure (DBP). The least squares mean reductions in systolic (S)BP/DBP (± standard error) for nisoldipine and amlodipine were ‐11.7/‐9.3 ± 1.4/0.8 and ‐14.3/‐12.0 ± 1.4/0.8 mmHg, respectively. The DBP treatment difference was 2.7 mmHg (90% confidence interval: 1.1 to 4.3 mmHg; p=0.005). Tolerability profiles were similar between treatments. The drug acquisition cost per mmHg DBP reduction was 40% lower with nisoldipine; an acquisition cost analysis revealed that amlodipine was 80% more expensive than nisoldipine for treating hypertension. In summary, nisoldipine and amlodipine provide clinically equivalent antihypertensive efficacy; however, nisoldipine is more economical than amlodipine.
SKELETAL MUSCLE RELAXANTS: PHARMACODYNAMICS AND PHARMACOKINETICS IN DIFFERENT PATIENT GROUPS
Authors: Booij LHDJ , Vree TB 
Published: April 2023

SUMMARYMuscle relaxants can be safely administered during anaesthesia, providing the basic pharmacodynamic and pharmacokinetic characteristics of the compounds together with the physiological status of the patient are known. In this review the pharmacodynamics and pharmacokinetics of the neuromuscular blocking agents are discussed and related to the physical health or disease state of groups of patients.
PROGRESSIVE HEART BLOCK IN ACTIVE RHEUMATOID ARTHRITIS
Authors: Adhiyaman V , Oke A , Aziz K , White AD 
Published: April 2023

SUMMARYA 68‐year‐old woman presented with active rheumatoid arthritis (RA) and severe extraarticular manifestations. During the course of her treatment, her electrocardiogram (ECG) transformed from normal sinus rhythm to left bundle branch block and finally to complete heart block (CHB). Investigations ruled out an ischaemic event. A permanent pacemaker was inserted due to the symptoms of heart failure and she made an uneventful recovery. CHB in RA is probably a marker of seventy of the disease.
A CASE OF HAEMOPHAGOCYTIC SYNDROME AND KIKUCHI‐FUJIMOTO DISEASE OCCURRING CONCURRENTLY IN A 17‐YEAR‐OLD FEMALE
Authors: Kelly J , Kelleher K , Khan MK , Rassam SMB 
Published: April 2023

SUMMARYAn unusual case in which a young Asian female presenting with fever, lymphadenopathy and cytopaenia was found to have distinct histological features of both haemophagocytic syndrome (HS) and histiocytic necrotising lymphadenitis (Kikuchi‐Fujimoto disease, KFD) is presented. We review the clinical features of each of these rare, but important, diagnoses and propose the hypothesis that they may form part of a disease continuum, rather than representing separate entities.
THE IMPACT OF A STRUCTURED PROGRAMME OF ASTHMA CARE IN GENERAL PRACTICE
Authors: Swanson V , Wright S , Power KG , Duncan B , Morgan J , Turner E , Gordon D 
Published: April 2023

SUMMARYThe impact of a new GP programme of asthma care was examined using: a) a retrospective pre‐ and post‐casenote survey of 400 asthma patients, comparing patients in practices using the health board programme (HBP) and other programmes (OP); and b) a patient satisfaction questionnaire, completed by 532 people on asthma clinic lists in HBP and OP practices. Outcomes assessed were health service use, perceived change in symptoms and asthma self‐management. The casenote survey indicated improved health service use by patients in HBP practices, with fewer patient‐initiated (p<0.05), emergency (p<0.05) and other chest‐related attendances (p<0.01) and increased clinic attendance (p<0.05) post intervention. OP practices also showed reduced patient‐initiated (p<0.01) and increased asthma clinic use (p<0.01). Increased use of management plans (p<0.01) and peak flow diaries (p<0.01) was noted post intervention for HBP practices. Responders to the questionnaire survey perceived that clinic attendance improved asthma symptoms, including severity and control, sleep disturbance and early morning wheeze. People in HBP practices were more likely than those in OP practices to possess a peak flow meter, a diary and a personal management plan (all p<0.01 or above) but were not more likely to use a peak flow diary. Notwithstanding methodological difficulties in the selection of practices, both studies showed trends towards improvement in health service use and asthma self‐management. The HBP was associated with greater improvement in self‐management processes and outcomes, and greater patient satisfaction with asthma care.
LATEX ALLERGY: AN EMERGING PROBLEM IN THEATRES
Authors: Keh C , Soon Y , Wong LS 
Published: April 2023

SUMMARYWith the increasing use of natural rubber products, latex allergy is becoming a major health concern among patients and healthcare workers. The aim of this study was to determine the availability of a latex allergy protocol and essential latex‐free products in theatres. The number of latex allergy complaints among patients and theatre personnel were also studied. Postal questionnaires were sent to theatre managers in 205 hospitals in England, Scotland and Wales, 120 (58.5%) of which were returned. Nearly two‐thirds of the theatres did not have a latex allergy protocol. Overall less than one‐third of theatres in the UK have latex‐free products set aside for use. A total of 505 patients with latex allergy underwent surgery; of these, there were four deaths, 18 major anaphylaxes and 483 minor complaints such as skin rash; 239 theatre personnel reported latex allergic reactions and one had a severe anaphylactic reaction. The number of cases with latex‐related complications might be reduced if all hospitals had a latex allergy protocol and a range of essential latex‐free products.
ORAL ANTIMICROBIAL SUSCEPTIBILITIES OF STREPTOCOCCUS PYOGENES RECENTLY ISOLATED IN FIVE COUNTRIES
Authors: Bandak SI , Turnak  , Allen BS , Bolzon LD , Preston DA 
Published: April 2023

SUMMARYBetween July 1998 and July 1999 1050 clinical isolates of Streptococcus pyogenes were collected from 11 study centres in five countries. Isolates were shipped to a co‐ordinating laboratory for NCCLS specified broth microdilution susceptibility testing for penicillin, cefaclor, azithromycin, clarithromycin, erythromycin and roxithromycin. All 1050 isolates of S. pyogenes tested were susceptible to penicillin (MIC <0.12 ug/ml) and cefaclor (MIC ≤0.25 μg/ml). Azithromycin, clarithromycin and erythromycin resistance rates were 15.9%, 15.4% and 15.8%, respectively. MIC90s for penicillin, cefaclor, azithromycin, clarithromycin, erythromycin, and roxithromycin were 0.015, 0.12, >4, 8, >1 and 16 μg/ml, respectively. Macrolide (erythromycin) resistance rates were highest in study centres in Italy (31.0%) and Spain (26.6%). Lower macrolide resistance rates were identified in study centres in Turkey (4.8%), France (3.8%), and Sweden (3.7%). In conclusion, the isolates of S. pyogenes tested were universally susceptible to β‐lactam antibiotics such as penicillin and cefaclor, while resistance to macrolides was significant and ranged from 3.2% to 31%.
THE EPIDEMIOLOGY OF HYSTERECTOMY AND IRRITABLE BOWEL SYNDROME IN A UK POPULATION
Authors: Kennedy TM , Jones RH 
Published: April 2023

SUMMARYThe prevalence of hysterectomy in the UK general population has not been previously reported. In addition, although it is known that many women with irritable bowel syndrome (IBS) have had a hysterectomy, the relationship between these two conditions has never been quantified. A random community sample of 2238 women aged 20–69 from Teesside was surveyed to determine the prevalence of hysterectomy and of IBS, the relationship between these and the influence of socioeconomic status and consultation behaviour on these variables. We analysed data from 1718 women, 13.6% of whom had a hysterectomy, 22.9% had IBS and neither condition was related to socioeconomic status. More women with IBS reported having had a hysterectomy than did non‐sufferers, odds ratio 1.6 (1.1–2.2), p<0.01; this association was also unaffected by socioeconomic status and was not fully explained by consultation behaviour. This is the first study to determine the prevalence of hysterectomy in a UK general population. The procedure is common and the excess of hysterectomy among women with IBS is considerable. Possible explanations include misdiagnosis of IBS resulting in hysterectomy, IBS symptoms occurring as a result of hysterectomy, a single underlying disorder which produces symptoms in both gastrointestinal and genitourinary tracts, or a combination of these factors.
ARE PREOPERATIVE SERUM GASTRIN LEVELS RELATED TO RESECTABILITY AND SURVIVAL IN GASTRIC CANCER?
Authors: Soran A , Aslar AK , Çöl C 
Published: April 2023

SUMMARYThe aim of this study was to determine the correlation between serum gastrin and resectability in patients with gastric cancer, and to see whether any difference could be demonstrated according to the histologic type and survival. Between 1994 and 1996 records of 34 consecutive patients with gastric carcinoma serum gastrin levels were measured and correlated with age, gender, lymph node positiveness, metastasis, Lauren's classification and survival. The mean serum gastrin level of patients was 98.38 pg/ml (normal range: 25–125 pg/ml). Twenty‐six of 34 patients (76.5%) had normal gastrin levels and eight patients (23.5%) had high gastrin levels. Sixty‐five per cent of patients with normogastrinaemia underwent resection with extended lymphadenectomy, while 38% patients with hypergasthnaemia underwent extended resection. All the hypergastrinaemic patients died within the first year, but in the normogastrinaemic group one, two and five‐year survival rates were 39%, 23% and 4%, respectively. Even though these results are not statistically significantly different in regard to preoperative serum gastrin levels, we conclude that preoperative hypergasthnaemia is associated with unresectability and poor survival in patients with gastric cancer.
AN EPIDEMIOLOGICAL STUDY OF FALLS ON INTEGRATED GENERAL MEDICAL WARDS
Authors: Vassallo M , Azeem T , Pirwani MF , Sharma JC , Allen SC 
Published: April 2023

SUMMARYReducing falls in hospital requires an environmental as well as a patient‐orientated approach. We studied patient and ward characteristics relating to falls in an acute setting. In a prospective open observational study, we examined fall characteristics in two nuclear designed wards (A and B) and a longitudinal ward (C). We recorded 63 falls among 1609 patients. Ward C had the most falls (31vs18/14; p=0.01), fall positive days (29vs15/10; p=0.002) and fallers (27 vs 13/12; p=0.001; OR 2.54, CI‐1.41–4.57). Ward C had a higher cumulative risk of falls (p=0.006) and fall positive days (p=0.003). Choice of ward was a significant independent risk factor for falls (p=0.01) when controlled for age, sex, and diagnostic variation between the wards. Most falls were intrinsic (A 66.7%, B 64.2%, C 61.3%, p=0.45). A significantly higher proportion of falls on ward C occurred by the bed (p=0.04). Significant differences exist between the wards, and fall reduction programmes should identify and compensate for adverse ward‐related factors to increase the effectiveness of patient‐targeted fall risk assessments.
HAEMOGLOBIN SC DISEASE PRESENTING WITH A COMPARTMENT SYNDROME SECONDARY TO A DEEP VEIN THROMBOSIS
Authors: Ivil KD , Mannion SJ 
Published: April 2023

SUMMARYA patient presented with a deep vein thrombosis (DVT), which resulted in a compartment syndrome of both the thigh and the calf. Subsequently, the patient was found to have haemoglobin SC disease. Prompt fasciotomies were performed; however, some muscle and nerve damage was later clinically apparent. This case highlights the value of prompt diagnosis of compartment syndrome and the need for urgent formal fasciotomies. The case also demonstrates the value of seeking an underlying cause for a DVT when none is apparent.
SOLITARY CALCANEAL METASTASIS IN SUPERFICIAL BLADDER CARCINOMA
Authors: Sarlak A , Gündes H , Özkürkçügil C , Özkara S , Gökalp A 
Published: April 2023

SUMMARYWe report a case of a solitary calcaneal metastasis in a patient with superficial bladder carcinoma. The patient underwent transurethral tumour resection twice because of local recurrence. Both histologic examinations revealed a grade 2 PT1 superficial transitional cell carcinoma of the bladder. The metastasis was detected four months after the initial cystoscopy, due to severe leg pain. The lesion was curetted and filled with bone cement. A year later, a below knee amputation was performed because of local recurrence. This case deserves special attention, for two reasons. First, metastatic carcinoma to the bones of the foot is very rare. Although bony metastasis by transitional cell carcinoma of the bladder can be seen, presenting as a symptomatic solitary lesion after superficial bladder carcinoma is extremely unusual. Second, failure to control bladder tumours by local means might be an indication for an early cystectomy, even in tumours with no evidence of muscle invasion, in order to prevent distant metastasis.
A STUDY OF THE EFFICACY AND SAFETY OF IRBESARTAN IN COMBINATION WITH CONVENTIONAL THERAPY, INCLUDING ACE INHIBITORS, IN HEART FAILURE
Authors: Tonkon M , Awan N , Niazi I , Hanley P , Baruch L , Wolf RA , Block AJ ,   Irbesartan Heart Failure Group
Published: April 2023

SUMMARYBecause heart failure therapy with angiotensin‐converting enzyme (ACE) inhibitors may not be optimal, owing to persistent levels of angiotensin II occurring through incomplete blockade and alternate pathways, the benefit of adding irbesartan, an angiotensin receptor antagonist, to conventional therapy, including ACE inhibitors, was examined. In this multicentre, randomised, double‐blind, placebo‐controlled study, 109 patients with heart failure (New York Heart Association functional class II and III) and left ventricular ejection fraction (LVEF) ≤40% received stable doses of ACE inhibitors and diuretics before and throughout the study. Irbesartan was titrated as tolerated to 150 mg once daily in all patients. Exercise tolerance time (ETT), LVEF and clinical status were assessed at baseline and after 12 weeks. Compared with placebo, irbesartan in combination with conventional therapy, including ACE inhibitors, produced favourable trends in ETT and LVEF and was well tolerated in patients with mild to moderate heart failure. (Int J Clin Pract 2000; 54(1): 11‐18)