bluuebunny/crossref_metadata_2025_split huggingface dataset:
LOW DENSITY LIPOPROTEIN CHOLESTEROL LOWERING: ARE THE TREATMENT GUIDELINES STILL APPROPRIATE?
Authors: Deslypere J‐P 
Published: April 2023

SUMMARYThe availability of treatment guidelines has revolutionised our approach to detection, evaluation and treatment of dyslipidaemias in adults. Such guidelines focus on lowering low‐density lipoprotein‐cholesterol (LDL‐C), the primary risk factor for coronary heart disease, and provide physicians with specific goals to be attained by dietary and, if necessary, pharmacological therapy. However, the guidelines were published in 1993, which means that the pivotal findings from large intervention trials with statins were not included. This has led to calls for the guidelines to be amended to take into account the findings of these studies and other evolving issues such as the pathogenesis of the acute coronary event and the contribution of low HDL‐C and other lipid parameters. More importantly, the mostly epidemiological basis of the guidelines has instilled the concept that the lower the LDL‐C level after lipid‐lowering intervention the better the result in terms of prevention of coronary events. Available data now refute this assumption. Indeed, maximal therapeutic benefit is already obtained with a decrease in LDL‐C level of 20‐30%, irrespective of baseline levels or LDL‐C levels on treatment and, until now, there have been no data to suggest that decreases in LDL‐C of >30% give any additional benefit to patients in terms of improving their long‐term outcome. The concept of absolute LDL‐C treatment goals therefore needs to be revisited. A more appropriate goal of lipid‐lowering therapy with statins is to ensure LDL‐C levels are reduced by 20‐30%, with statin dosages as used in the intervention trials. Furthermore, there are insufficient data to advise that LDL‐C levels should be lowered to 2.6 mmol/l. This issue will be resolved only when the results of the appropriate intervention trials are published. (Int J Clin Pract 2000; 54(5): 307‐313)
HYPERMOBILITY ‐ NOT A CIRCUS ACT
Authors: Grahame R 
Published: April 2023

SUMMARYJoint hypermobility results from genetic variations in connective tissue matrix proteins resulting in stretchier tissues. For many it is an asset that confers greater facility for physical prowess. Others, less fortunate, fall prey to the associated effects of tissue fragility. The most frequently encountered constellation of traumatic and overuse injuries is termed the (benign joint) hypermobility syndrome (BJHS). This condition, poorly understood, frequently overlooked, misdiagnosed and inappropriately treated, is the cause of much needless suffering and anguish. Accumulating evidence suggests that BJHS represents a forme fruste of an heritable disorder of connective alongside Marfan syndrome, Ehlers‐Danlos syndrome and osteogenesis imperfecta, with which it shares many overlapping features, but from which it can be phenotypically distinguished on the basis of clinical features and prognosis. The responsible gene defects have yet to be elucidated. (Int J Clin Pract 2000; 54(5): 314‐315)
ANAPHYLAXIS AND ANAPHYLACTOID REACTIONS
Authors: Murrant T , Bihari D 
Published: April 2023

SUMMARYThe clinical syndrome of anaphylaxis and anaphylactoid reactions is quite variable, making diagnosis difficult at times. Early recognition by patient or physician is imperative to appropriate management. Recurrences may be life‐threatening if the initial diagnosis is incorrect, as patients do not avoid the offending allergen. Release of inflammatory mediators from mast cells and basophils are responsible for the symptoms and signs in both anaphylactic and anaphylactoid reactions. They differ only in the initial cause of the activation of the mast cell or basophil. Management, regardless of the cause, involves rapid treatment. Intravenous fluids and adrenalin (preferably intravenous if appropriate) usually produce a response in more than 90% of patients. Prevention strategies including pharmacological prophylaxis should not be undervalued, because recurrences can easily be avoided. Follow‐up with an allergist/immunologist is essential.(Int J Clin Pract2000;54(5):322‐328)
REFRACTORY BACILLUS CEREUS INFECTION IN A NEONATE
Authors: Tuladhar R , Patole SK , Koh TH , Norton R , Whitehall JS 
Published: April 2023

SUMMARYBacillus cereus is a Gram‐positive aerobic or facultatively anaerobic spore‐forming rod, which usually causes food poisoning. Its recognition as a pathogen in neonates has increased over the past two decades. The clinical course of a neonate (gestation 24 weeks) with B. cereus infection refractory to therapy is described. Death occurred after withdrawal of support following persistently positive blood and bone marrow cultures despite therapy with vancomycin, gentamicin, imipenum, clindamycin, ciprofloxacillin, immunoglobulin and granulocyte colony stimulating factor over a period of 49 days. No obvious focus of sepsis was identified. Contamination from the environment into the hospital and clinics occurs because of the ubiquitous presence of B. cereus. Combination therapy with vancomycin and gentamycin is appropriate for meningitis/severe systemic infections related to most bacillus species. The significance of repeated isolation of B. cereus in neonates with compromised host defences is emphasised. (Int J Clin Pract 2000; 54(5): 345‐347)
CEFTRIAXONE‐PMMA BEADS – A SLOW RELEASE PREPARATION?
Authors: Alonge TO , Fashina AN 
Published: April 2023

SUMMARYThe use of various drug delivery systems to achieve high levels of the desired antibiotic(s) at the site of infection has become commonplace in orthopaedic and trauma units the world over. One of these techniques uses the implantation of antibiotic‐impregnated beads at operation sites. Commercial antibiotic beads such as the gentamicin bead are available but expensive, especially for patients in developing countries. We have shown that ceftriaxone‐polymethylmethacrylate beads can be produced locally and at low cost in a resource‐poor environment. We have also shown that such beads elute the antibiotic (ceftriaxone) effectively in vitro, achieving similar or better activity when measured by zones of inhibition against various bacteria species compared with standard antibiotic discs. This technique offers a cost‐effective method of treating chronic bone infections in resource‐poor settings. (Int J Clin Pract 2000; 54(6): 353‐355)
ADVANCES IN NON‐OPERATIVE THERAPY IN PANCREATIC CANCER
Authors: Ammer R BR , Buckels J , Bramhall S 
Published: April 2023

SUMMARYPancreatic cancer is the fifth leading cause of cancer death in the western world. The majority of patients present with advanced disease and only a few have resectable disease at presentation. This paper reviews current evidence supporting the use of conventional chemotherapy and radiotherapy in advanced disease; it goes on to review the rationale and how these data have influenced the use of radiochemotherapy in the adjuvant setting. Unpublished data from the largest adjuvant study of chemoradiotherapy in pancreatic cancer are also presented. The role of neoadjuvant therapy is discussed and how trials using this approach are evolving in pancreatic cancer. The paper finishes by reviewing the use of marimastat, a novel agent that has been extensively studied in patients with pancreatic cancer. Pancreatic cancer remains a challenge to clinicians, but increases in sub‐specialisation and a renewed interest in the disease has made the future for patients more encouraging than at any time in the past. (Int J Clin Pract 2000; 54(6): 373‐381)
REVIEW OF OXALIPLATIN: AN ACTIVE PLATINUM AGENT IN COLORECTAL CANCER
Authors: Cassidy J 
Published: April 2023

SUMMARYOxaliplatin is a novel platinum analogue which has wide spectrum anti‐cancer activity in in vitro systems. It has distinct biochemical, pharmacological and cytotoxic properties which are different from those of cisplatin and carboplatin. Importantly, it appears to have distinct mechanisms of resistance such that traditionally platinum insensitive tumour types may be susceptible to oxaliplatin. Most notable in this regard is the activity of this agent which has been demonstrated in colorectal cancer. This review concentrates on this aspect of oxaliplatin. Oxaliplatin has modest activity as a single agent in advanced colorectal cancer compared with other novel agents in this disease. However, there appears to be a powerful synergy between oxaliplatin and 5‐fluorouracil. Thus, when given together, response rates of over 50% are consistently observed. The combination has now been extensively tested in this disease and has recently led to the regulatory approval for marketing of oxaliplatin in this condition. (Int J Clin Pract 2000; 54(6): 399‐402)
PERGOLIDE‐INDUCED RETROPERITONEAL FIBROSIS
Authors: Mondal BK , Suri S 
Published: April 2023

SUMMARYRetroperitoneal fibrosis is a rare complication of pergolide therapy. This complication can be easily missed, so it is essential to have a high index of suspicion. We describe a case of well controlled Parkinson's disease who presented with shortness of breath and oedema. (Int J Clin Pract 2000; 54(6): 403)
CHRONIC ISOLATED VERTIGO
Authors: Chan LL , Tan E‐K , Tan K‐P 
Published: April 2023

SUMMARYVertigo can be the first manifestation of vertebrobasilar ischaemia or brainstem and cerebellar stroke. Chronic isolated vertigo may pose a diagnostic dilemma. We report the case of a patient who presented with chronic isolated vertigo, and highlight the clinical use of magnetic resonance imaging and angiography in his management. (Int J Clin Pract 2000; 54(6): 407‐408)
VERAPAMIL SR AND TRANDOLAPRIL COMBINATION THERAPY IS SAFE AND EFFECTIVE IN HYPERTENSIVE PATIENTS WITH METABOLIC DISORDERS
Authors: Aksöyek S , Özer N , Aytemir K , Kes S ,   Turkish Multicentre Verapamil and Trandolapril Study Group
Published: April 2023

SUMMARYVerapamil SR (180 mg) plus Trandolapril (2 mg) is a potent antihypertensive combination but the efficacy and safety of this treatment has not been studied fully in hypertensive patients with metabolic disorders. We enrolled 298 patients with mild to moderate hypertension who had at least one of the following disorders: diabetes mellitus, hypercholesterolaemia or mild renal failure. The sitting systolic pressure and diastolic blood pressures were significantly decreased after 12 weeks of treatment. Blood pressure was inadequately controlled in only 24 patients (8.8%). Progressive decreases in blood glucose, total cholesterol, low‐density lipoprotein and triglyceride levels were observed during the study. There was no significant change in blood urea nitrogen, creatinine and transaminase levels (p>0.05). There was a significant decrease in microalbuminuria levels. There was no significant change in glycosylated haemoglobin levels in diabetic patients. Verapamil SR plus trandolapril is an effective drug combination in the treatment of hypertension. It may be used safely in patients with diabetes mellitus, hyperlipidaemia and mild renal failure.
IDENTIFYING PRIORITY PATIENTS FOR CORONARY ANGIOGRAPHY
Authors: Azeem T , Vassallo M , Smith E , Martin MA 
Published: April 2023

SUMMARYWe conducted an open observational study with blinded endpoint evaluation to validate the use of the Duke treadmill score in identifying patients likely to require coronary intervention. We studied 101 consecutive patients referred for coronary angiography from a cardiology clinic. All patients had a Bruce protocol exercise test. A 70% stenosis was regarded as significant. Patients were referred for percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafting (CABG) surgery, if indicated. The Duke score was calculated as follows: exercise time (min) – (5 × ST segment deviation [mm]) – (4 × angina index [text]). Patients were classified into low, medium and high risk. The patients at high risk are more likely to have a significant stenosis (53/58 vs 30/43: p=0.01 [OR 4.59 95% CI 1.34–16.6]) and require CABG or PTCA (47/58 vs 16/43: p<0.001 [OR 7.21 95% CI 2.69–19.8]) than those at medium/low risk. Multiple logistic regression analysis, including ST segment depression, exercise time and symptoms shows that the score independently predicts a significant stenosis (p=0.002) and the need for coronary intervention (p=0.001). Introducing the score can help to identify those patients who need priority investigation.
CONSIDERATIONS FOR DRUG THERAPY IN HYPERTENSION
Authors: McNally P 
Published: April 2023

SUMMARYBoth the Joint National Committee and the British Hypertension Society recommend b‐blockers and diuretics as first‐line therapy in the treatment of uncomplicated hypertension. As a result, many clinicians will also prescribe these drugs in the treatment of patients with hypertension and coexistent disease (unless they are specifically contraindicated), even though they may not always be the most beneficial choice. This review aims to examine factors that should be taken into consideration when choosing appropriate antihypertensive therapy. Particular attention is given to treatment options in two special patient groups, the elderly and patients with co‐morbid diabetes, as these groups have an increased risk of developing cardiovascular complications. In response to the increasing evidence base from large‐scale trials, the article concludes that cardiovascular risk factors, coexisting disease, concomitant medication and age should all be taken into account when choosing antihypertensive therapy.
CONSENSUS FOR THE PHARMACOLOGICAL MANAGEMENT OF INSOMNIA IN THE NEW MILLENNIUM
Authors: Roth T , Hajak G , Üstün TB 
Published: April 2023

SUMMARYInsomnia, a common symptom throughout the world, is characterised by difficulty initiating or maintaining sleep or non‐restorative sleep and is associated with significant morbidity. A comprehensive medical and sleep history and physical examination are necessary before treating patients with insomnia; the presence of co‐morbidities, including medical and psychiatric disorders, or the possible use of substances that may contribute to sleeplessness should be thoroughly investigated. Non‐pharmacological approaches include correction of sleep hygiene as well as behavioural treatments. Pharmacotherapy includes benzodiazepine‐receptor agonists, which are the drugs of choice for this disorder. They can be subdivided into classic benzodiazepines and non‐benzodiazepines. Although many agents in these classes have been prescribed, potential shortcomings include residual sedation, rebound insomnia, and psychomotor and memory impairment. Novel pharmacological strategies that address limitations of the traditional treatment approach, combined with proven modes of behavioural therapy, offer the most successful results in the management of insomnia. These advances provide the opportunity to establish these current recommendations for the optimal management of insomnia. This report from the XXII Collegium Internationale Neuro‐Psychopharmacologicum Consensus Workshop outlines recommendations to serve as the foundation for developing a therapeutic plan for each patient.
LINEZOLID
Authors: French G 
Published: April 2023

SUMMARYMultiple antibiotic resistance is increasing worldwide in Gram‐positive bacteria, especially in hospitals. Problem organisms include multiply resistant strains of pneumococci,Staphylococcus aureusand enterococci; for many of these the glycopeptide vancomycin has become the treatment of last resort. This situation has been made worse by the emergence of vancomycin‐resistant enterococci and vancomycin‐intermediateS. aureus.Fortunately, several compounds active against resistant Gram‐positive bacteria are in active development. One of these is linezolid, the first of the oxazolidinones, a new class of antibacterial. Linezolid is a synthetic agent which is active against all the clinically important Gram‐positive bacteria, including multiply resistant strains. It has good pharmacokinetics, with equal bioavailability by both oral and intravenous routes and no need for dose adjustment in patients with renal impairment. The drug has a good safety profile and clinical trials have given excellent results in a variety of skin and soft tissue, respiratory and bloodstream infections. Linezolid is a promising drug, which, together with prudent antibiotic use and the prevention and control of hospital infection, will help in the battle against multiply antibiotic resistant Gram‐positive bacteria.
A CASE OF VOLUMINOUS DIARRHOEA WITH HYPOKALAEMIC ACIDOSIS
Authors: Abdelgabar A , Owen A , Starczewski A , Subashchandran R 
Published: April 2023

SUMMARYWe describe a patient presenting with voluminous diarrhoea, hypokalaemic acidosis and hypercalcaemia who was found to have a vasoactive intestinal polypeptide‐producing tumour. His diarrhoea was initially mild and intermittent requiring no medical attention.
GLOSSAL PALPATION OF THE EUSTACHIAN TUBE CUSHION: AN UNUSUAL CAUSE OF GLOBUS SENSATION
Authors: Motamed M , Murty GE 
Published: April 2023

SUMMARYGlobus sensation, the sensation of a lump in the throat, is a common symptom which, in its chronic form, accounts for 4% of first‐patient visits to ENT clinics. We describe a rare cause of globus sensation and stress the importance of thorough investigation to exclude any possible organic causes.
CARDIOGENIC SHOCK FOLLOWING A SINGLE THERAPEUTIC ORAL DOSE OF VERAPAMIL
Authors: Stajer D , Bervar M , Horvat M 
Published: April 2023

SUMMARYCardiogenic shock and apnoea appeared in a 78‐year‐old woman with a history of biventricular heart failure, following ingestion of a single 80 mg verapamil tablet. She was resuscitated with artificial ventilation, dobutamine, norepinephrine and calcium gluconate. Toxicological analysis revealed unexpectedly high plasma verapamil concentration, which was attributed to the patient's liver failure. In patients with advanced heart failure a single oral therapeutic dose of verapamil may have a severe toxic effect.
THE OLD BUT RELIABLE DIGITALIS: PERSISTENT CONCERNS AND EXPANDED INDICATIONS
Authors: Abarquez RF 
Published: April 2023

SUMMARYDigitalis has been an old but reliable drug for 240 years. Concerns regarding its clinical indications and benefits still exist in the absence of a reduction in all‐cause mortality. While intravenous digitalis is used without question in cases of atrial fibrillation, it is still controversial in sinus rhythm, despite the Digitalis Investigation Group (DIG) study showing a significant reduction in death and the need for hospitalisation for congestive heart failure in both diastolic and systolic dysfunction. The influence of digitalis in acute myocardial infarction, coronary artery disease and sudden cardiac death remains speculative. In cases of uncomplicated hypertension, it appears to prevent the onset of left ventricular dysfunction and myocardial infarction. Thus, digitalis can be a cost‐effective agent with added benefits.
THREE‐YEAR UPDATE OF SILDENAFIL CITRATE (VIAGRA®) EFFICACY AND SAFETY
Authors: Sadovsky R , Miller T , Moskowitz M , Hackett G 
Published: April 2023

SUMMARYIn the three years since its launch, sildenafil citrate (Viagra®), an oral agent for the treatment of erectile dysfunction (ED), has been prescribed to more than 10 million patients worldwide and has been further evaluated in clinical studies in diverse patient populations. Significant improvements in erectile function have been demonstrated in double‐blind, placebo‐controlled trials in patients with ED and underlying diabetes, cardiovascular disease, minor depression, spinal cord injury and multiple sclerosis. Promising results have also been reported for patients with treated prostate cancer, end‐stage renal failure, Parkinson's disease, and spina bifida and in multiple organ transplant recipients. Accounts of sildenafil use in clinical practice and postmarketing data reflect clinical trial findings of effectiveness in a broad spectrum of ED aetiologies and overall good tolerability. As in the clinical trials, most adverse events associated with sildenafil use have been transient, mild or moderate effects that rarely lead to treatment discontinuation.
SIMILAR EFFICACY FOLLOWING FOUR WEEKS TREATMENT OF ASTHMATICS WITH FORMOTEROL 12 μG B.D. DELIVERED BY TWO DIFFERENT DRY POWDER INHALERS: DIFFERENCES IN INHALER HANDLING
Authors: Eliraz A , Ramirez‐Rivera A , Ferranti P , Holzer R , Garcí JM Ignacio , Turcotte C , Rapatz G , Pfister P , Overend T , Kottakis J 
Published: April 2023

SUMMARYThis randomised, multicentre, parallel‐group study compared the clinical efficacy and ease of handling of two dry powder inhalers delivering the long‐acting β2‐agonist formoterol. After run‐in, 200 asthmatics on treatment with inhaled corticosteroids and still presenting with suboptimal asthma control were randomised to receive 12 μg formoterol twice daily via either the Aerolizer inhaler (Foradil® Aerolizer™) or the Turbuhaler inhaler (Oxis® Turbuhaler®) for four weeks. Study variables included the mean morning pre‐medication peak expiratory flow (PEF) during the last seven days of treatment and the correct inhaler handling according to inhaler‐specific checklists. The mean difference in the effect on morning pre‐medication PEF was 13.86 l/min in favour of formoterol via the Aerolizer inhaler (90% confidence interval 2.50, 25.21) in the intent‐to‐treat population. Eighty‐six per cent of the patients under treatment with formoterol via the Turbuhaler inhaler performed correctly all the essential inhalation manoeuvres, whereas 98% of those on the Aerolizer inhaler did so. These results strongly suggest similar clinical efficacy with twice daily treatment of formoterol 12 μg metered dose delivered either by the Aerolizer, or the Turbuhaler device. They also suggest that handling the Aerolizer is easier than that of the Turbuhaler.
EFFICACY AND SAFETY OF SILDENAFIL CITRATE FOR THE TREATMENT OF ERECTILE DYSFUNCTION IN MEN WITH CARDIOVASCULAR DISEASE
Authors: Olsson AM , Persson C‐A 
Published: April 2023

SUMMARYMen with cardiovascular disease (CVD) are more likely to have erectile dysfunction (ED) than the general population, as both conditions share risk factors and some drugs used to treat CVD may induce ED as a side‐effect. This study was undertaken to assess the efficacy and safety of sildenafil citrate for the treatment of ED in men with CVD who were receiving treatment with β‐blockers and/or angiotensin‐converting enzyme inhibitors and/or calcium‐channel blockers, but not nitrates. Treatment with sildenafil was associated with significant increases in the mean end‐of‐treatment scores for the questions from the International Index of Erectile Function that assess the ability to achieve and maintain erections (p=0.0001). Furthermore, 71% of patients taking sildenafil reported improved erections compared with 24% taking placebo (p=0.0001). This study also showed that sildenafil was well tolerated in patients with CVD and ED. Besides flushing, no treatment‐related cardiovascular adverse events were noted for sildenafil.
PHOSPHODIESTERASE 5 INHIBITION: EFFECTS ON THE CORONARY VASCULATURE
Authors: Jackson G 
Published: April 2023

SUMMARYAs a potent and selective inhibitor of cyclic guanosine monophosphate‐specific phosphodiesterase 5 (PDE5), sildenafil citrate (Viagra®) is safe and effective in men with erectile dysfunction (ED) of diverse aetiologies, including patients with common cardiovascular diseases who are not receiving organic nitrates or nitrate donor drugs. In retrospective analyses of extensive clinical trials, sildenafil treatment for ED was not associated with any increase in cardiac risk. In haemodynamic studies, sildenafil produced small decreases in systemic and pulmonary blood pressure but caused no adverse cardiovascular effects in specific populations of men with coronary heart disease. Sildenafil also caused no significant changes in coronary blood flow but had a positive effect on coronary flow reserve in men with severe coronary artery disease. Together with findings from other studies, these data suggest that PDE5 may play an important role in the regulation of coronary blood flow in the healthy and diseased heart.