bluuebunny/crossref_metadata_2025_split huggingface dataset:
GROWTH HORMONE THERAPY FOR ADULT GROWTH HORMONE DEFICIENCY
Authors: Shalet SM 
Published: April 2023

SUMMARYGrowth hormone deficiency in adult life is associated with a number of adverse biological changes which include osteopenia, reduced exercise capacity, altered body composition, deleterious alterations in the lipid profile and insulin status, and reduced quality of life. Most of these changes can be reversed by growth hormone replacement therapy, but in an era of health rationing, such therapy is unlikely to be offered to every growth hormone deficient adult. Therefore we have proposed a strategy aimed at delineating which adults with growth hormone deficiency might benefit most from growth hormone therapy.
A COMPARISON OF RISK FACTORS FOR MALIGNANT MELANOMA, SQUAMOUS CELL CARCINOMA AND BASAL CELL CARCINOMA IN THE UK
Authors: Lear JT , Tan BB , Smith AG , Jones PW , Heagerty AH , Strange RC , Fryer AA 
Published: April 2023

SUMMARYCutaneous malignant melanoma (MM), squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) exhibit markedly different natural histories, but few studies have compared risk factors in individuals from a single population. Using logistic regression analysis in case and control groups, we assessed the association of individual characteristics with MM (n=240) and SCC (n=184). We also compared differences in risk factors (eye/hair colour, skin type, smoking history, occupation, social class, tumour site) between MM/BCC and SCC/BCC. MM patients were more likely to have red/blonde hair and blue/green eyes than controls, and those with SCC more likely to have red/blonde hair, blue/green eyes, outdoor occupation, skin type 1 and to have smoked more. There were few differences in individual characteristics between the skin cancer groups, illustrating their non‐specific nature. Tumour site, however, showed marked differences: MM patients were more likely to have a tumour on the trunk or limbs than BCC patients, while patients with SCC were more likely to have a tumour on the limbs. Reasons for this variation are unclear. The relatively weak effect of individual factors supports the view of a multifactorial disease and suggests that interactions between UV exposure and genetic predisposition may be more significant determinants of risk.
A SURVEY OF PATIENT RESPONSE TO PREOPERATIVE SURGICAL ASSESSMENT
Authors: Offiah CJ , Grimley RP 
Published: April 2023

SUMMARYAn anonymous questionnaire‐based study was devised to examine the role of preoperative assessment of patients by pre‐registration surgical house officers. One hundred and eight patients awaiting elective surgery were entered into the study. The main outcome measures were the proportion of patients who felt they had received a satisfactory explanation concerning the risks and benefits of their intended operation at a preoperative assessment clinic (PAC). Of the patients who believed that details of their operations had been explained to them, more than one‐quarter cited the PAC as the source. More than 25% of patients who stated that the benefits of their operation had been explained cited the PAC as the source; 45% of patients who believed the risks of their surgery had been provided felt the PAC had been the only source of this explanation. It was concluded that preoperative assessment clinics are an efficient and effective means of providing patients with valuable information about their operation.
A RETROSPECTIVE SURVEY OF DIAGNOSIS AND MANAGEMENT OF PATIENTS PRESENTING WITH CHRONIC COUGH TO A GENERAL CHEST CLINIC
Authors: McGarvey LPA , Heaney LG , MacMahon J 
Published: April 2023

SUMMARYRespiratory physicians often encounter patients with chronic cough. The evaluation and outcome of such patients by centres with established diagnostic protocols has been well described. By contrast, little is known about patients referred to general respiratory clinics where no such protocol exists. We describe the findings of a retrospective survey of all new patient referrals with chronic cough to a general respiratory clinic over a 12‐month period. A diagnosis of asthma or chronic airflow obstruction was made in 43% of patients. Gastro‐oesophageal reflux and postnasal drip syndrome, together accounting for over 60% of diagnoses in specialist clinics, were infrequently identified in our study (4% and 2% respectively). At follow‐up, 43% of patients reported persistent symptoms, contrasting the excellent treatment response reported by specialist clinics. In general respiratory clinics where a specific diagnostic protocol is not in place, these differences in diagnosis and outcome may be due to inadequate investigation or may reflect a different patient population.
BLOOD PRESSURE MEASUREMENT AND ANTIHYPERTENSIVE THERAPY IN ACUTE STROKE
Authors: Panayiotou BN , Lloyd M , Fotherby MD , Crome P 
Published: April 2023

SUMMARYInappropriate management of high blood pressure in acute stroke can adversely affect outcome. We examined blood pressure evaluation and antihypertensive therapy during the first week post‐stroke in 40 patients at a district general hospital with no stroke unit. In the first 24 hours, median frequency of blood pressure recording was 3 (range 1‐12). After day 1, 11 (28%) had no blood pressure readings for one or two consecutive days. The side of measurement was not recorded in any patient. None of the 22 hypertensives (55%) had a bilateral measurement to exclude interarm inequality, and only 3 (7%) of all patients had postural readings to exclude orthostatic hypotension. Fourteen (35%) received antihypertensive therapy without meeting recommended indications; some even had low blood pressure. As most stroke patients are managed in general medical wards rather than stroke units, a greater awareness of these important aspects of blood pressure evaluation and therapy are needed among medical and nursing staff.
OSTEOPOROSIS IN MEN
Authors: Anderson FH 
Published: April 2023

SUMMARYOsteoporosis in men is a common cause of morbidity, mortality and health care expenditure throughout the Western world. Most cases are secondary to disease or to drug therapy, but in 30‐45% of affected individuals no cause can be identified. Research into the factors underlying ‘idiopathic’ male osteoporosis is limited, but is gradually moving more patients into the ‘secondary’ category. Recently, attention has focused on interactions between sex hormones and bone: there is evidence that male bone requires both androgens and oestrogens for normal health. Many conditions predispose to osteoporosis in men: hypogonadism, alcohol abuse and the use of corticosteroids are the most frequently identified factors. Osteoporosis following organ transplantation attracts interest despite its relative rarity. Treatment for osteoporotic men is poorly researched and remains largely unsupported by experimental evidence, although clinical experience suggests a useful role for bisphosphonates, testosterone and perhaps fluorides. Symptom control and explanation remain the most important therapeutic interventions.
CENTRALLY ACTING ANTIHYPERTENSIVES: NOT OBSOLETE AFTER ALL
Authors: Schachter M 
Published: April 2023

SUMMARYCentrally acting antihypertensive drugs, or sympatholytics, have a long history of efficacy, including some of the earliest major clinical trials, but they are now little used in the UK and elsewhere. This has been due to the introduction of new drugs with better tolerability than the centrally acting agents. In the case of clonidine there was also concern about rebound hypertension. However, at least some hypertensives may benefit from a centrally acting drug and a new class of agents, the imidazoline agonists, has recently been developed. One of these, moxonidine, is available in the UK. Clinical studies so far suggest that its efficacy is comparable to currently used drugs and that adverse effects are less severe than with earlier sympatholytics. Rebound hypertension has not been described, so this may lead to a revival in interest in these drugs as antihypertensive agents.
A DIFFICULT CASE OF PYREXIA
Authors: McIlmoyle J , Johnston GD 
Published: April 2023

SUMMARYWe present a case of non‐specific vasculitis presenting as a pyrexia of unknown origin to illustrate the diagnostic difficulty which can arise with this condition. The diagnostic event was central retinal artery occlusion and the disease was also associated with pyoderma gangrenosum. History, examination, investigations and management are discussed.
A CASE OF INTRAHEPATIC CHOLESTASIS DUE TO AMYLOIDOSIS
Authors: McDonald P , Usbourne C , Playfer JR 
Published: April 2023

SUMMARYAmyloidosis commonly involves the liver but clinical features of liver disease are rare. We report a case of cholestasis and hepatic failure in an 85‐year‐old man due to primary amyloidosis. This has not been reported previously in anyone of this advanced age. We discuss the clinical features of hepatic amyloidosis and the importance of making a diagnosis.
SEPTIC SACROILIITIS: AN UNUSUAL CAUSATIVE ORGANISM IN A RARE CONDITION
Authors: O'Brien CM , Darley ESR , Kelly AJ , Nelson IW 
Published: April 2023

SUMMARYStreptococcus pneumoniae is a relatively uncommon cause of septic arthritis,1 and Infection of the sacroiliac joint by this organism has been rarely described. We present such a case.
ONCE‐DAILY BUDESONIDE: 400 μg ONCE DAILY IS AS EFFECTIVE AS 200 μg TWICE DAILY IN CONTROLLING CHILDHOOD ASTHMA
Authors: Campbell LM , Bodalia B , Gogbashian CA , Gunn SD , Humphreys PJ , Powell JP ,   PETITE research group
Published: April 2023

SUMMARYOne hundred and sixty seven children on 0‐200 μg/day of inhaled steroid with asthma symptoms and sub‐optimal peak flow values (less than 90% of that predicted for their height) were randomly allocated either 400 μg once daily (nocte with placebo o.m.) or 200 μg twice daily of budesonide Turbohaler® for 8 weeks. Bronchodilator usage and symptoms were reduced in both groups at 4 and 8 weeks compared with baseline. There was a significant increase within both groups in morning and evening PEF after 4 and 8 weeks. The increase in evening PEF after 8 weeks was greater in the once‐daily group than in the twice‐daily group but there were no other significant differences between the groups (morning: +24.6 l/min vs 15.2 l/min, p=0.059; evening: +19.7 l/min vs +8.3 l/min; p=0.013). Budesonide Turbohaler® 400 μg once daily is therefore as effective as 200 μg twice daily in achieving asthma control in children.
PULMONARY TUBERCULOSIS AND ITS THERAPY DO NOT SIGNIFICANTLY AFFECT THYROID FUNCTION TESTS
Authors: Ilias I , Tselebis A , Boufas A , Panoutsopoulos G , Filippou N , Christakopoulou J 
Published: April 2023

SUMMARYBasal thyrotropin, total thyroxine, total tri‐iodothyronine and free tri‐iodothyronine were measured in 30 HIV‐negative patients with focal pulmonary tuberculosis upon starting and after one and two weeks of isoniazid, rifampicin and pyrazinamide therapy. Rapid and statistically significant elevations in free tri‐iodothyronine and total tri‐iodothyronine were noted after the first and second week of treatment respectively. For most patients, however, hormone levels remained within normal limits throughout the study. Overall, the effects of pulmonary tuberculosis and of its therapy on the thyroid function parameters examined, in otherwise healthy individuals, appear to be minimal.
INCIDENCE AND PROGNOSTIC IMPLICATIONS OF FALLS ASSOCIATED WITH ACUTE MEDICAL ILLNESS: A MEDICAL INPATIENT STUDY
Authors: Vassallo M , Sharma JC 
Published: April 2023

SUMMARYFalls are associated with a wide range of acute medical illness across all ages. They have prognostic implications, and screening for falls on admission can help identify those patients who are likely to have an adverse hospital outcome and may benefit from more intense levels of care.
GROWTH AND METABOLIC RESPONSES IN PRETERM INFANTS FED FORTIFIED HUMAN MILK OR A PRETERM FORMULA
Authors: Warner JT , Linton HR , Dunstan FDJ , Cartlidge PET 
Published: April 2023

SUMMARYPreterm infants fed human milk have been shown to grow poorly and develop mineral deficiencies that may lead to osteopenia. This study has investigated the efficacy of a human milk fortifier made up of glucose polymers, a mixture of bovine milk protein fractions and free amino acids, minerals and vitamins designed to improve these nutritional deficiencies. Growth and bone mineral deficiencies were compared in 38 preterm infants fed fortified mother's milk and 21 preterm infants fed a preterm formula until they reached 1800 g; all had a birthweight below 1600 g. Weight gain was similar in each group with a mean (SD) increase of 19.6 (3.5) g/kg/day in the fortified group and 19.9 (4.1) g/kg/day in the preterm formula group. There were also no significant differences in linear growth, head circumference, skin fold thickness or mid‐arm circumference. Serum phosphate, alkaline phosphatase and plasma urea concentrations were similar and there was no clinical evidence of osteopenia. These results indicate that the growth and metabolic disadvantages associated with feeding human milk to preterm infants are ameliorated by the addition of a milk fortifier that increases the calorific, protein and mineral content of breast milk.
THE EFFICACY AND SAFETY OF MIBEFRADIL IN SUBGROUPS OF PATIENTS WITH CHRONIC STABLE ANGINA PECTORIS
Authors: Charlon V , Kobrin I 
Published: April 2023

SUMMARYThe pool of controlled clinical studies on mibefradil, a new selective T‐type calcium channel blocker, for the treatment of chronic stable angina pectoris was analysed to determine the effects in subgroups of patients defined by age, gender, body weight and common co‐existing conditions. Total exercise tolerance test duration increased similarly in all subgroups, both at 50 mg (range 8.9‐17.3%; n=383) and 100 mg mibefradil (range 23.6‐30.8%; n=235). The increases in time to onset of angina and 1 mm ST‐segment depression were similarly comparable. Safety and tolerability was similar to placebo for subgroups at 50 mg, but the incidence of adverse events was slightly higher in females, older, and lower weight patients at the 100 mg dose, particularly in reported leg oedema (7.9% in femalesvs1.0% in males and 5.1% in oldervs0% in younger patients). Mibefradil proved a safe, well tolerated, and effective antianginal agent that can be used regardless of demographic factors or of frequent coexisting clinical conditions.
HYPOMAGNESAEMIA IN POSTOPERATIVE PATIENTS: AN IMPORTANT CONTRIBUTING FACTOR IN POSTOPERATIVE MORTALITY
Authors: Siddiqui MN , Zafar H , Alvi R , Ahmed M 
Published: April 2023

SUMMARYMagnesium is the second most abundant intracellular cation and the fourth most abundant cation in the body. Clinical manifestations of hypomagnesaemia include neuromuscular, neurological, psychiatric and cardiac arrhythmias including torsade de pointes resulting in sudden death. Incidence of hypomagnesaemia in hospitalised patients is common and there is a lack of clinical awareness. Clinicians should become familiar with the common conditions and therapeutics that are risk factors for underlying hypomagnesaemia and become familiar with magnesium replacement regimens. Two patients who suffered fatal complications in whom hypomagnesaemia was an important contributing factor are presented. Hypokalaemia and hypocalcaemia are common in severe magnesium deficiency and require concurrent monitoring and correcting.
VOLVULUS OF THE RIGHT COLON IN PREGNANCY
Authors: Lopez Carral JM , Esen UI , Chandrashekar MV , Rogers IM , Olajide F 
Published: April 2023

SUMMARYIntestinal obstruction in pregnancy is rare, volvulus being the commonest precipitating factor. It is a difficult diagnosis to make, because its symptoms mimic various pregnancy symptoms, but it commonly occurs in the third trimester or puerperium. A high index of suspicion is needed, and investigations for intestinal obstruction should be performed, especially when abdominal pain and vomiting persist. Careful evaluation of the abdominal cavity is also essential where a caesarean section is performed, particularly if there are unusual findings.
SHORT‐COURSE CEFUROXIME AXETIL THERAPY IN THE TREATMENT OF ACUTE EXACERBATIONS OF CHRONIC BRONCHITIS
Authors: Langan C , Clecner B , Cazzola CM , Brambilla C , Holmes CY , Staley H 
Published: April 2023

SUMMARYThe efficacy and safety of a five‐day course of cefuroxime axetil (250 mg b.d.) and a seven‐day course of clarithromycin (250 mg b.d.) were compared in a large double‐blind, randomised, multinational study involving 684 patients with acute exacerbations of chronic bronchitis. In an intent‐to‐treat analysis, the post‐treatment clinical responses to each treatment were comparable (82%) and rates at follow‐up were similar: 64% on cefuroxime axetil and 61% on clarithromycin. Pre‐treatment pathogens were isolated from a total of 192 patients, Haemophilus influenzae being the most common. Overall pathogen eradication rates were similar for both treatments. Both treatments were well tolerated. In conclusion, a five‐day course of cefuroxime axetil is clinically equivalent to a seven‐day course of clarithromycin in the treatment of acute exacerbations of chronic bronchitis, and may have potential socioeconomic benefits.
TUBERCULOUS MENINGITIS: A CLINICAL AND LABORATORY STUDY OF 20 PATIENTS IN QATAR
Authors: Alsoub H 
Published: April 2023

SUMMARYTwenty cases of tuberculous meningitis were diagnosed at the Hamad Medical Corporation between 1990 and 1995. Most of the patients (90%) were expatriates. The most common presenting features were fever, headache, neck stiffness and altered mental status. Five patients were in stage 1 disease at the time of presentation, 11 in stage 2, and four in stage 3. Examination of cerebrospinal fluid showed at least one abnormal finding in all patients, and culture grew Mycobacterium tuberculosis in 50%. A positive tuberculin skin test in 50% of patients, abnormal chest X‐ray in 35%, abnormal CT scan or MRI showing tuberculoma or hydrocephalus in 55%, and positive sputum culture for M. tuberculosis in 15% helped establish the diagnosis. All the patients were treated with antituberculous drugs and steroids. Seventeen (85%) survived, three with severe neurological sequelae; three (15%) died. Poor outcome was associated with advanced stage of disease at presentation and high CSF protein. Tuberculous meningitis continues to be an important disease in Qatar, especially in expatriates, and should be considered in the differential diagnosis in any patient presenting with fever and change in sensorium.
AN INFORMAL ASSESSMENT OF NUTRITIONAL STATUS IN ACUTE STROKE FOR USE IN AN INTERNATIONAL MULTICENTRE TRIAL OF FEEDING REGIMENS
Authors: Mead GE , Donaldson L , North P , Dennis  
Published: April 2023

SUMMARYPatients with acute stroke may become malnourished because of feeding difficulties, so dietary supplementation may improve outcome. We investigated the validity and reliability of an ‘eyeball’ assessment of nutritional status for use in an international trial of different feeding following acute stroke. One hundred and one inpatients (mean age 75 years), of whom 40 had suffered an acute stroke, were independently observed by two medical students, a doctor and a nurse, and categorised as underweight, normal weight or overweight. Body mass index (BMI) was calculated using height and weight. Sensitivity of the informal assessment for correctly classifying the patient as underweight (BMI <20 kg/m2), normal (20‐30 kg/m2) and overweight (BMI >30 kg/m2) ranged from 64% to 100% and specificity from 71% to 100%. Interobserver agreement between different pairs of observers was moderate to good. An ‘eyeball’ assessment of nutritional status is valid and reliable enough for use in a multicentre trial of feeding regimens following acute stroke.
DEVELOPING A STRATEGY FOR THE PREVENTION OF HIP FRACTURES IN THE ELDERLY DUE TO OSTEOPOROSIS: THE APPLICATION OF ECONOMICS TO THE FINDINGS FROM A CLINICAL TRIAL
Authors: Phillips CJ , Moore RA 
Published: April 2023

SUMMARYThe occurrence of a fracture is the most obvious manifestation of osteoporosis. Preventive measures can reduce the risk of such events. The cost of preventing fractures depends on the cost and effectiveness of the intervention and the cost associated with treating the fractures. This paper aims to develop a framework for commissioners to evaluate new technologies by integrating the evidence on effectiveness with the costs likely to be incurred in providing interventions and the probable benefits generated. The explicit aim is to show how the effectiveness of an intervention designed to prevent hip fractures in the elderly, combined with an analysis of its potential economic impact, can provide an indication of how quality improvements in health‐care provision and cost savings may be generated.
ISOLATED NASOPHARYNGEAL HODGKIN'S DISEASE PRESENTING AS NASAL OBSTRUCTION
Authors: Malis D‐D , Moffat D , McGarry GW 
Published: April 2023

SUMMARYLymphomas are the second most frequent malignancy affecting the head and neck. Within head and neck lymphomas, Hodgkin's disease accounts for only 10‐35% of all cases; 70‐80% of Hodgkin's disease of the head and neck involves nodal tissue, with extranodal Hodgkin's disease being most often found in the tissues of Waldeyer's ring. Extranodal Hodgkin's disease of the head and neck that does not involve Waldeyer's ring is extremely rare. We report a case of isolated extranodal Hodgkin's disease of the nasopharynx who presented to the rhinology clinic with symptoms of nasal obstruction. This unusual site, the possible reasons for its rarity and the investigations and management are discussed with reference to the literature.
LATENT TETANY ASSOCIATED WITH THE HYPOKALAEMIA OF CONN'S SYNDROME
Authors: Davies JS , Aguirre G , Cassidy DM , Griffiths BE 
Published: April 2023

SUMMARYWe describe the case of an asymptomatic patient with primary hyperaldosteronism, who was diagnosed fortuitously following the demonstration of a positive Trousseau's sign during routine blood pressure assessment. Further investigations revealed that the carpal spasm was due solely to the associated profound hypokalaemia.
A SURVEY OF HOSPITAL MORBIDITY, MORTALITY AND QUALITY OF LIFE FOLLOWING CORONARY ARTERY BYPASS SURGERY IN A UK INDO‐ASIAN POPULATION
Authors: Goldsmith IRA , Lip GYH , Kumar PP , Patel RL 
Published: April 2023

SUMMARYTo survey the in‐hospital morbidity, mortality, length of stay in the intensive therapy unit (ITU) and hospital and quality of life in patients of Indo‐Asian origin following coronary artery bypass (CABG) surgery, 345 consecutive patients (mean age 58 years; SD 8.9; range 32‐88 years) undergoing primary, isolated CABG were studied. Non‐elective CABG was undertaken in 41% of patients. The left anterior descending artery (LAD) was grafted in 89%, although in 30% of these the internal mammary artery (IMA) was not used. Following CABG, the hospital morbidity and mortality was within the expected range, although there was a trend towards higher in‐hospital mortality in the Parsonnet low risk group of patients. The length of ITU and hospital stay was not prolonged. Using the SF‐36 questionnaire in postoperative patients, low quality of life scores were obtained for six of the eight modalities tested including physical functioning, bodily pain and general health perception. The low quality of life scores and IMA usage in Indo‐Asians needs to be addressed.