bluuebunny/crossref_metadata_2025_split huggingface dataset:
SPLENIC TUBERCULOSIS: AN UNUSUAL SONOGRAPHIC PRESENTATION
Authors: Chandra S , Srivastava DN , Gandhi D 
Published: April 2023

SUMMARYTuberculosis (TB) of the spleen is rare, especially in the immunocompetent. Recently there has been an increase in the incidence of splenic TB, primarily attributable to the raging HIV epidemic. Almost all cases of splenic TB present as multiple hypoechoic foci (<2 cm) on ultrasonography. We present a case of a large solitary splenic tuberculoma in a middle‐aged, non‐immunosuppressed female, an employee at the local TB hospital. To the best of our knowledge, only two such cases have been described on ultrasound before. We suggest that, regardless of immune status, splenic TB should be considered as a diagnostic possibility when dealing with the solitary nodules of the spleen, especially when there is a history of exposure to or evidence of tuberculous foci elsewhere in the body.
A COMPARISON OF THE EFFECTS OF TWO MODIFIED RELEASE PREPARATIONS OF NIFEDIPINE – NIFEDIPINE RETARD 10 MG TWICE DAILY AND NIFEDIPINE GITS 20 MG ONCE DAILY – IN THE TREATMENT OF MILD TO MODERATE HYPERTENSION
Authors: Kirby BJ , Kitchin NRE 
Published: April 2023

SUMMARYA multicentre, randomised, double‐blind, cross‐over comparison of nifedipine GITS 20 mg once daily and nifedipine retard 10 mg twice daily in 49 patients with mild to moderate hypertension was conducted. Both treatments resulted in clinically significant trough blood pressure reductions (nifedipine GITS ‐10.1/‐8.9 mmHg, nifedipine retard ‐7.5/‐8.2 mmHg). The study demonstrated that nifedipine GITS was ‘at least equivalent’ to nifedipine retard in the reduction of trough diastolic blood pressure (one‐sided lower 95% confidence limit, ‐1.2 mmHg). The overall incidence of adverse events (nifedipine GITS 25.5%, nifedipine retard 34.0%), as well as the incidences of headache (nifedipine GITS 8.5%, nifedipine retard 12.8%) and peripheral oedema (nifedipine GITS 2.1%, nifedipine retard 8.5%), was higher with nifedipine retard compared to nifedipine GITS. Nifedipine GITS 20 mg once daily is ‘at least equivalent’ to nifedipine retard 10 mg twice daily in patients with mild to moderate hypertension, as well as being better tolerated.
A COMPARISON OF NIMESULIDE BETA CYCLODEXTRIN AND NIMESULIDE IN POSTOPERATIVE DENTAL PAIN
Authors: Scolari G , Lazzarin F , Fornaseri C , Carbone V , Rengo S , Amato M , Cicciù D , Braione D , Argentino S , Morgantini A , Bassetti C , Tramèr M , Monza GC 
Published: April 2023

SUMMARYThe aim of this study was to assess the efficacy and tolerability of single doses of nimesulide beta cyclodextrin compared with nimesulide in patients with dental pain following surgical procedures. This was a randomised, double‐blind, between‐patient, multicentre study involving 148 outpatients suffering from moderate to severe pain, who received single doses of either 400 mg nimesulide beta cyclodextrin or 100 mg nimesulide. The principal criterion for efficacy was pain intensity assessed on a visual analogue scale (VAS) 15 minutes after drug intake. Pain intensity was further evaluated 30, 45, 90, 120, 180, 240 and 360 minutes after dosing. Pain relief was evaluated at the same time points by means of a categorical scale. The time point of first pain relief, the use of rescue medication and the global evaluation of efficacy were also recorded. The reduction in pain intensity was significantly more pronounced in the nimesulide beta cyclodextrin group at 15, 30, 45 and 60 minutes (p<0.01). Pain relief was significantly greater (p<0.05) and more rapid with nimesulide beta cyclodextrin. In the patient overall assessment of efficacy, nimesulide beta cyclodextrin and nimesulide were rated excellent or good by 95% and 92% respectively; only one patient in the nimesulide beta cyclodextrin group needed rescue medication. Both study drugs were effective and well tolerated in the treatment of acute dental pain, with nimesulide beta cyclodextrin showing a faster onset of analgesic action.
A RANDOMISED, DOUBLE‐BLIND STUDY OF ITRACONAZOLE VERSUS PLACEBO IN THE TREATMENT AND PREVENTION OF ORAL OR OESOPHAGEAL CANDIDOSIS IN PATIENTS WITH HIV INFECTION
Authors: Smith D , Midgley J , Gazzard B 
Published: April 2023

SUMMARYHIV‐infected patients presenting with oral or oesophageal candidosis were randomised to four weeks treatment with itraconazole 200 mg, followed by itraconazole or matching placebo for a prophylaxis phase of 24 weeks. Clinical and mycological evidence of candidosis infection was assessed on a four‐weekly basis. Seventy patients were enrolled, of whom 50 completed 28 days of itraconazole therapy; 74% (37 patients) were clinically cured and 40% were also mycologically cured. Fifteen patients were withdrawn for a variety of reasons including non‐compliance, adverse events and the use of excluded medications. Forty‐four patients were enrolled in the prophylactic phase. There were significantly more relapses of candidosis, and time to candidosis was significantly shorter in the placebo group than in the itraconazole treated group (p=0.0001). Itraconazole 200 mg daily is effective and well tolerated for the treatment and prevention of oral and oesophageal candidosis in HIV‐infected patients.
ERECTILE DYSFUNCTION AND CARDIOVASCULAR DISEASE
Authors: Jackson G 
Published: April 2023

SUMMARYPatients with cardiovascular disease are at increased risk of developing erectile dysfunction (ED). This may be a consequence of atherosclerosis of the penile arteries, a reduced cardiac output, or a side‐effect of drugs used to reduce cardiovascular risk factors (particularly β‐blockers, thiazide diuretics and, occasionally, lipid‐lowering drugs). ED is a distressing condition, which often diminishes the patient's self‐esteem, with the potential for damage to his psychological health and his relationship with his partner and family. When treating ED, the underlying aetiology should be established by careful examination and consideration of medical history and concurrent medication. Until recently, pharmacological treatment options involved intracavernous injections (alprostadil or moxisylyte) or intraurethral alprostadil. These treatments are often inconvenient and not well accepted by the patient. The recent introduction of oral sildenafil promises to revolutionise the treatment of ED. In double‐blind, placebo‐controlled trials in patients with ED, sildenafil improved erectile function and quality of life and was well tolerated. ED is a clinically important complication of cardiovascular disease and should be asked about and treated accordingly. It is important that effective treatments, including sildenafil, should be available for treating patients with cardiovascular disease and ED.
TREATMENT GUIDELINES FOR HYPERCHOLESTEROLAEMIA: TIME TO CONSIDER SOLUBLE FIBRE
Authors: MacMahon M 
Published: April 2023

SUMMARYLowering raised serum cholesterol levels is firmly established as an effective intervention for reducing the mortality and morbidity due to coronary heart disease (CHD). Recent European and British guidelines for the management of hypercholesterolaemia recommend dietary modification as first‐line therapy. However, dietary measures alone do not significantly reduce cholesterol levels. There is ample evidence that soluble fibre, such as ispaghula, lowers cholesterol and could therefore potentially reduce the risk of CHD. As CHD management costs spiral upwards, prescribing lipid‐lowering drugs for all indicated patients is not sustainable within current NHS resources. It is suggested that treatment guidelines be revised to include a soluble fibre product, such as ispaghula, as an adjunct to diet for patients where diet alone has failed and where lifelong therapy with lipid‐lowering drugs is inappropriate.
THE MANAGEMENT OF YOUNG DYSPEPTIC PATIENTS IN THE ERA OF HELICOBACTER PYLORI
Authors: Phull PS , Jacyna  
Published: April 2023

SUMMARYThe management of young dyspeptic patients remains controversial in the modern Helicobacter pylori era. The use of non‐invasive screening for H. pylori in one proposed strategy has demonstrated a substantial reduction in the endoscopy workload by excluding H. pylori negative patients under the age of 45 years with uncomplicated dyspepsia. An alternative screening strategy proposes a ‘test and treat’ approach, with H. pylori positive patients proceeding directly to an empirical course of eradication therapy. Ednoscopy would be reserved for patients who failed to respond symptomatically or who were H. pylori negative on intial screening. At present there are few data available from clinical studies of putting the ‘test and treat’ policy into practice. Although there is likely to be a role for screening young dyspeptic patients for H. pylori in primary care, subsequent management requires well‐planned studies in order to assess the benefits of any particular strategy.
AN UNUSUAL CAUSE OF FALLS IN AN ELDERLY PATIENT
Authors: Hussain A , Qadiri  , Rees PJ , O'Brien MD , Lewis RR 
Published: April 2023

SUMMARYFalls are common in the elderly, often causing considerable morbidity and mortality. Prevention is therefore important and is based on determining the cause. We present an elderly patient who had multiple falls during the day due to recurrent daytime sleep episodes, an entity we believe has not previously been reported.
UPDATE ON SOME ASPECTS OF THE USE OF EPIDURAL ANALGESIA IN LABOUR
Authors: Okojie P , Cook P 
Published: April 2023

SUMMARYThe aim of the study was to investigate the effect of epidural analgesia on blood pressure, duration of the second stage and mode of delivery. In a prospective controlled study carried out in a district general hospital, 122 parturients made up the study population; 81 had epidural blocks and 41 had other forms of analgesia during labour. Data were collated using questionnaires within 48 hours of delivery: 58/81 (71.6%) of those who chose epidural were Primigravidae compared with 14/41 (34%) in the non‐epidural group (p<0.001). During labour, minimum diastolic blood pressure was significantly lower in the epidural group: 65.8 versus 72.4 mmHg (p=0.003). Mean duration of the second stage of labour was significantly longer in the epidural group: 108.3 versus 41.6 minutes (p<0.0001); 28/81 (34.6%) of the epidural group had operative vaginal deliveries compared with 6/41 (14.6%) of the non‐epidural group (p=0.0004). Epidural analgesia provides an effective form of pain relief in labour, which has a particularly strong appeal to Primigravidae. It has a hypotensive effect which can be put to beneficial effect in hypertensive disease of pregnancy, but is significantly associated with a lengthened second stage of labour, resulting in an increased operative vaginal delivery rate.
123I‐METAIODOBENZYLGUANIDINE SCANS IN PHAEOCHROMOCYTOMA DIAGNOSIS: CURRENT CLINICAL PRACTICE AND RELATIONSHIP TO BIOCHEMICAL SCREENING
Authors: Tormey WP , Keeling F , Lee MJ 
Published: April 2023

SUMMARYThe use in practice of 123I‐metaiodobenzylguanidine (MIBG) scans in phaeochromocytoma diagnosis in a teaching hospital over an eight‐year period is reported. MIBG scans were performed in 43 patients and the clinical context is reviewed and reported in 42 of these. A paraganglioma and five phaeochromocytomas were found in the MIBG series. There were no false negative MIBG scans. CT was performed in 61.9%, abdominal ultrasound in 45.3% and MRI in 7.1% of the patients. Urinary catecholamines and metanephrines are considered the best screening tests for phaeochromocytoma and false positive biochemistry values were associated with MIBG scans in 35% of the cases. Despite published limitations on its sensitivity, MIBG scans were the only modality used in 21.4%; 25% of the scans were performed for clinical reasons when the biochemical screen was within the reference range. MIBG is superior to CT and MRI for the localisation of suspected recurrence after surgery and is also useful for the detection of extra adrenal tumours and metastases.
CHRONIC INFECTIONS AND CORONARY HEART DISEASE
Authors: Smith D , Gupta S , Kaski JC 
Published: April 2023

SUMMARYThe rapidly changing patterns of coronary heart disease (CHD) prevalence and presentation fail to be explained by conventional cardiovascular risk factors alone. An infectious basis to atherosclerosis may, at least in part, be contributing to the variable rates of prevalence of CHD in different parts of the world. The evidence for such an association appears to be strongest for Chlamydia pneumoniae. Results of recent anti‐chlamydia antibiotic intervention pilot studies have renewed interest in the role of C. pneumoniae, and corroborated the evidence from sero‐epidemiological, pathological and animal‐model studies. The results of larger, on‐going, purpose‐designed intervention studies should help to increase our understanding of the role of infection in atherogenesis and potentially lead to a novel and effective treatment strategy for patients with CHD – broad spectrum antibiotics.
CLINICAL COURSE OF A PITUITARY MACROADENOMA IN THE FIRST TRIMESTER OF PREGNANCY: PROBABLE LYMPHOCYTIC HYPOPHYSITIS
Authors: Ôzbey N , Kahraman H , Yilmaz L , Orhan Y , Sencer E , Molvalilar S 
Published: April 2023

SUMMARYRecent findings revealed that the clinical features of lymphocytic hypophysitis are more complicated than previously thought. It is rarely described in the first trimester of pregnancy and signs of meningeal irritation are infrequently reported. In this study, a pregnant woman in her first trimester of pregnancy with clinical and radiological characteristics of a pituitary macroadenoma is described. The patient's pituitary profile revealed a relatively low prolactin for her stage of pregnancy. Unusual findings were neck stiffness associated with headache, nausea and vomiting. She was treated conservatively. Spontaneous complete resolution of the pituitary mass in the postpartum period led us to conclude that the correct diagnosis should be hypophysitis. Hypophysitis should be considered in the differential diagnosis of a pituitary mass presenting in early stages of pregnancy with symptoms mimicking hyperemesis gravidarum and/or meningeal irritation.
HAEMANGIOPERICYTOMA OF THE ADULT MALE BREAST
Authors: Talwar S , Prasad N , Gandhi S , Prasad P 
Published: April 2023

SUMMARYHaemangiopericytoma is an uncommon, usually benign, soft tissue tumour which has been rarely reported to occur in the female breast. Haemangiopericytoma of the adult male breast has been reported only once before. We report another such case.
A PROSPECTIVE AUDIT OF HOSPITAL‐ACQUIRED DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM
Authors: Wright G , Elliott K , Wilkie C , Cuschieri RJ , Bittiner B , Hughes KB 
Published: April 2023

SUMMARYThe incidence of symptomatic deep vein thrombosis and pulmonary embolism acquired in hospital was studied, and the effectiveness of current thromboprophylaxis was assessed in an open study of 8648 admissions to the Doncaster Royal Infirmary between April and July 1994. On admission, all patients were assessed for their likely risk of thromboembolic problems according to THRIFT criteria. Treatment, prophylaxis, complications and outcome were recorded on discharge. A high risk sub‐group was followed up for up to 42 days after discharge. The overall rate of clinically apparent hospital‐acquired thromboembolic complications was 0.4% (n=35). The rate of clinically apparent thromboembolic disease in the high risk group was 2.1% (n=17). The incidence of thromboembolic problems appeared not to be reduced by prophylaxis apparently even when stratified by risk group. These findings suggest that thromboembolic complications may be less common than would be expected from published literature. Thromboprophylaxis as currently practised within our institution does not seem to affect the incidence of deep vein thrombosis or pulmonary embolism, and these results would appear to argue against a ‘blanket’ policy for pharmacological thromboprophylaxis.
AN ASSESSMENT OF THE EFFICACY OF ATORVASTATIN IN TREATING PATIENTS WITH DYSLIPIDAEMIA TO TARGET LDL‐CHOLESTEROL GOALS: THE ATORVASTATIN MATRIX STUDY
Authors: McVey D , Patel H , Eminton Z , Maton S 
Published: April 2023

SUMMARYA total of 531 patients from 57 hospital centres across the UK, who had previously been treated with lipid‐lowering agents in combination or alone, in whom the degree of cholesterol reduction was insufficient to achieve European Atherosclerosis Society target levels, were treated with atorvastatin over a 12‐week period. The dose of atorvastatin (10, 20 or 80 mg/day) was determined by assignment of risk based on entry level cholesterol levels and the presence of other established CHD risk factors. Atorvastatin was successful in achieving target LDL‐cholesterol levels in 86% of mild risk patients, 88% of moderate risk patients and 52% of high risk patients. Compliance with atorvastatin was 96% and treatment was well tolerated. This study demonstrates that atorvastatin is effective in achieving target lipid levels in a large proportion of patients and that the dose required can be predicted by an assessment of the patient's risk profile.
UNSTABLE ANGINA: A REVIEW AND PRACTICAL GUIDE TO MANAGEMENT
Authors: Mishra B , Jackson G 
Published: April 2023

SUMMARYThe syndrome of increasing angina leading to myocardial infarction was first recognised in the 1930s and the term unstable angina coined in 1971 by Fowler.1 Since then the importance of acute coronary syndromes as a presentation of ischaemic heart disease has been fully recognised. Recently several new pharmacological agents have been developed for the treatment of these syndromes. We aim to review the current treatments available for unstable angina and give a practical guide to its management.
NUTRITIONAL FACTORS IN OSTEOPOROSIS
Authors: Swaminathan R 
Published: April 2023

SUMMARYNutritional factors are important but correctable factors in the pathogenesis of osteoporosis. The rate of bone loss in the elderly can be reduced and the peak bone mass in the young can possibly be increased by dietary manipulation, thereby reducing the risk of fracture. Dietary manipulation likely to be of benefit are increased calcium intake, increased vitamin D intake, moderate reduction in intake of salt protein, caffeine and phosphate and increased intake of potassium and magnesium. The possible mechanisms by which these dietary factors influence bone metabolism are discussed.
NARATRIPTAN
Authors: Salonen R 
Published: April 2023

SUMMARYThe new 5‐HT1B/1D agonist naratriptan, introduced in many countries in 1997 and 1998 for the acute treatment of migraine, was designed to complement the sumatriptan portfolio of offerings (including the injection, the tablets, the nasal spray, and in some countries, the suppository) by offering patients excellent tolerability and a sustained duration of action. Clinical studies on naratriptan, including more than 4000 patients treating more than 15,000 migraine attacks, show that naratriptan tablets 2.5 mg are distinguished from other 5‐HT1B/1D agonists for migraine on the basis of their excellent tolerability profile, which does not differ from that of placebo. In addition to its tolerability, naratriptan tablets 2.5 mg possess a long duration of action with a low incidence of headache recurrence (17‐28% in phase II and III clinical trials). With its tolerability profile and long duration of action, naratriptan tablets 2.5 mg may be particularly appropriate as a single‐dose alternative to NSAIDs and analgesics, which often are not effective in migraine but are used because of tolerability considerations.
RATIONAL PRESCRIBING: PRACTICE AUDIT AND DRUG SWITCH IN DYSPEPSIA MANAGEMENT
Authors: Dott AG , Johnson L 
Published: April 2023

SUMMARYGrowing demands on limited healthcare resources and budgets have led to an increased focus on the costs associated with the purchase of drugs. Consequently, approaches to treatment for various disease states are now dictated not only by issues such as best medical benefits, but also by the cost of the drug that is used. As such, drug‐switching strategies have become increasingly common practice where, although the clinical benefits offered by the various medications for a specific condition may be similar, the cost differentials are notable. Application of this switch procedure has recently been assessed in the context of the management of acid‐related gastrointestinal disorders and has demonstrated that switching patients to therapy with the proton pump inhibitor lansoprazole from H2‐receptor antagonists or other proton pump inhibitors not only offers therapeutic advantages but also has important financial implications in general practice with regard to cost savings.
PIVMECILLINAM FOR THE TREATMENT OF ACUTE UNCOMPLICATED URINARY INFECTION
Authors: Nicolle LE 
Published: April 2023

SUMMARYPivmecillinam is a beta‐lactam antimicrobial marketed almost two decades ago. It has been used widely for the treatment of acute cystitis in selected areas of the world, particularly in Scandinavia. With increasing resistance of community Escherichia coli isolates to trimethoprim and trimethoprim/sulphamethoxazole, as previously observed for ampicillin and sulphonamides, reassessment of empiric antimicrobial regimens for acute uncomplicated urinary infection is necessary. Thus, it is timely to revisit the role of pivmecillinam for the treatment of acute cystitis. Clinical studies document the efficacy of this antimicrobial with short course therapy for acute cystitis, and clinical practice in countries where it has been used for many years confirms its efficacy and tolerability. If this agent were more widely used for empiric treatment for acute cystitis, use of antimicrobials such as the quinolones might be avoided. Further trials to define the comparative efficacy of pivmecillinam with other antimicrobials, and further studies of community resistance in E. coli isolates to this agent are needed.
PARKINSON'S DISEASE SURGERY: ADVANCES AND FUTURE STRATEGIES
Authors: Tan E‐K 
Published: April 2023

SUMMARYThe recent resurgence of surgical treatment of Parkinson's disease has generated enormous interest in the scientific community and with the general public. Both ablation (pallidotomy, thalamotomy), deep brain stimulation (thalamus, pallidum, subthalamus), and neural transplantation (human, porcine) have been demonstrated to be effective for specific subsets of Parkinson's disease patients. Future studies need to define better the ideal target sites and lesion volume of ablation and stimulation procedures, and optimising graft survival in neural transplantation. Numerous potential surgical interventions are currently being evaluated.
IV. THE ORIGINAL SIN OF MADNESS ‐ OR HOW PSYCHIATRISTS CAN STIGMATISE THEIR PATIENTS
Authors: Allison‐Bolger VY 
Published: April 2023

SUMMARYA stigma is a mark of infamy or disgrace. People who are stigmatised are subject to abuse and social exclusion. Negative attitudes towards people with mental illness are attributed to stigma. In the literature, stigma is regarded as something that is attached to a person ‐ like a badge or label. This is undermined by two facts. Firstly, it is the person who is regarded as disgraceful, not the illness or diagnosis, and secondly, the diagnosis of mental illness is itself evaluative. Mental illness is by definition bad, so to be diagnosed as mentally ill is to be defined as bad (or somehow wrong). The stigmatisation of the mentally ill will not stop until this negative evaluation is removed from diagnosis.