bluuebunny/crossref_metadata_2025_split huggingface dataset:
PATTERN OF BACTERIAL FLORA IN LOCAL GENITAL SKIN AND SURGICAL WOUNDS IN CHILDREN UNDERGOING HYPOSPADIAS REPAIR: A PRELIMINARY STUDY
Authors: Ratan SK , Sen A , Ratan J 
Published: April 2023

SUMMARYTo evaluate the pattern of bacterial flora in children undergoing hypospadias repair, the following swabs were sent for 60 consecutive subjects: perimeatal swabs at admission and immediately before surgical scrub, and intraoperative and postoperative wound swabs (after the first change of operative dressing). A pure or predominant growth of organism that was not part of the local flora was labelled ‘infection’. The peak incidence of infection (53%) was detected in swabs taken at admission. This decreased to 30% in immediately preoperative skin swabs, following local preparations. Coliforms and Staphylococcus aureus were the most commonly grown pathogens and were sensitive to cephalosporin and aminoglycoside. Proximity to the anus, poor personal hygiene in our study subjects (who were of low socioeconomic status) and the high temperature and humidity in our geographic region probably led to the high incidence of infection. The authors feel that the results of preoperative perimeatal swabs could help dictate antibiotic therapy in patients awaiting hypospadias repair.
SILDENAFIL FOR PRIMARY PULMONARY HYPERTENSION: SHORT AND LONG‐TERM SYMPTOMATIC BENEFIT
Authors: Jackson G , Chambers J 
Published: April 2023

SUMMARYWe report two cases of primary pulmonary hypertension (PPH) who benefited from oral sildenafil therapy. Both demonstrated a substantial improvement in exercise ability, which has been sustained at 3 and 6 months. Sildenafil acting as a phosphodiesterase 5 inhibitor may have an important role to play in the management of PPH and we believe further study to be of importance.
VIAGRA ON THE INTERNET: UNSAFE SEXUAL PRACTICE
Authors: Solomon H , Man J , Gill J , Jackson G 
Published: April 2023

SUMMARYThe vast majority of men who experience some form of erectile dysfunction (ED) do not seek medical advice, mainly due to embarrassment and social stigma. They often prefer to seek unorthodox and covert methods of treatment. Unprescribed medication for ED is dangerous because of the strong association between ED and coronary heart disease. Published guidelines already exist for the management of patients presenting with sexual dysfunction and cardiovascular risks. In this case report we highlight that ED itself is a risk factor for occult CHD and illustrate the need for careful medical assessment and adherence to published guidelines for the management of ED.
ANGIOTENSIN CONVERTING ENZYME GENE POLYMORPHISM AND GLOMERULAR FILTRATION RATE CHANGES IN TYPE 2 DIABETIC PATIENTS
Authors: Araz M , Okan V , Celen Z , Aynacioglu S 
Published: April 2023

SUMMARYIt has been suggested that an insertion/deletion (I/D) polymorphism in intron 16 of the angiotensin‐converting enzyme (ACE) gene may be associated with diabetic nephropathy. The aim of this study was to investigate whether an association exists between ACE I/D polymorphism and glomerular filtration rate (GFR) in type 2 diabetes mellitus. A total of 128 type 2 diabetic patients were included in the study with the following ACE genotype distribution: DD 40, ID 58, II 30. I/D polymorphism was determined by polymerase chain reaction (PCR). Mean GFR was not statistically different according to ACE genotype (DD: 89.9 ± 28.1 ml/min, ID: 99.5 ± 25.1 ml/min, II: 96.6 ± 19.6 ml/min). There was no significant difference in genotype distribution in normo‐, micro‐ and macroalbuminuric patients (DD:ID:II [%], normo‐ 35:46:19, micro‐28:55:17, macro‐ 31:55:14). ACE I/D polymorphism does not seem to be associated with GFR in type 2 diabetic patients.
COMPARISON OF MOMETASONE FUROATE ADMINISTERED BY METERED DOSE INHALER WITH BECLOMETHASONE DIPROPIONATE
Authors: Chervinsky P , Nelson HS , Bernstein DI , Rerkowitz RA , Siegel SC 
Published: April 2023

SUMMARYThis study compared the efficacy and safety of mometasone furoate (MF) administered by metered dose inhaler (MDI) 56, 200 or 500 μg b.i.d., with beclomethasone dipropionate (BDP) 168 μg b.i.d. and placebo. Adult patients (n=395), with moderate persistent asthma (FEV1 50–90% of predicted normal), previously maintained on inhaled corticosteroids, were enrolled at 16 centres in a four‐week, randomised, double‐blind, double‐dummy, multicentre, dose‐ranging trial. At endpoint, FEV1 was significantly improved (p<0.01) with MF‐MDI 56, 200 and 500 μg b.i.d., as well as with BDP (6%, 13%, 14% and 4%, respectively), compared with placebo (‐12%). Mean change in FVC, FEF25–75%, and a.m. and p.m. peak expiratory flow rate (PEFR) were also significantly improved for all active treatment groups at endpoint compared with placebo. Asthma symptoms and quality of life (SF‐36) related to physical functioning improved with active treatments relative to placebo. All doses of MF‐MDI were well tolerated. Treatment with MF‐MDI 200 μg b.i.d. was superior to BDP MDI 168 μg b.i.d. or MF‐MDI 56 μg b.i.d., with no additional benefit derived from a higher MF‐MDI 500 μg b.i.d. dose. MF‐MDI was well tolerated, with superior efficacy compared with BDP MDI in these patients with moderate persistent asthma.
BUDESONIDE/FORMOTEROL (SYMBICORT®) IS WELL TOLERATED AND EFFECTIVE IN PATIENTS WITH MODERATE PERSISTENT ASTHMA
Authors: Rosenhall L , Heinig JH , Lindqvist A , Leegaard J , Ståhl E , Bergqvist PBF 
Published: April 2023

SUMMARYThe aim of this study was to compare the safety and efficacy of budesonide/formoterol 160/4.5 μg, two inhalations twice daily, with that of the mono‐products administered at the same daily doses via separate inhalers. A total of 586 patients (mean age 45 years) was included in this six‐month, open, randomised, multicentre study. Patients received either budesonide/formoterol (n=390) or budesonide plus formoterol (n=190). Safety was assessed by adverse events, vital signs and laboratory values. Efficacy was evaluated using spirometry tests, the Mini Asthma Quality of Life Questionnaire and the Asthma Control Questionnaire. Both treatments were well tolerated, with no differences in safety parameters between the groups. Mean FEV1 increased by 5–6% over baseline in both groups. There was no significant difference in the change from baseline between the groups using the disease‐specific questionnaires. Asthma exacerbations occurred with low frequency in both groups. Withdrawal rates were also comparable between the groups (p=0.085). Budesonide/formoterol in a single inhaler was as effective and as well tolerated as budesonide plus formoterol via separate inhalers.
A MULTINATIONAL, RANDOMISED, 12‐WEEK, COMPARATIVE STUDY OF DONEPEZIL AND RIVASTIGMINE IN PATIENTS WITH MILD TO MODERATE ALZHEIMER'S DISEASE
Authors: Wilkinson DG , Passmore AP , Bullock R , Hopker SW , Smith R , Potocnik FCV , Maud CM , Engelbrecht I , Hock C , Ieni JR , Bahra RS 
Published: April 2023

SUMMARYThis 12‐week, multinational study compared the tolerability and cognitive effects of donepezil (up to 10 mg once daily) and rivastigmine (up to 6 mg twice daily) in 111 patients with mild to moderate Alzheimer's disease. Both medications were administered open label according to recommended dosing regimens from the respective product labelling available during the conduct of the study. More patients in the donepezil group (89.3%) completed the study compared with the rivastigmine group (69.1%; p=0.009), and 10.7% of the donepezil group and 21.8% of the rivastigmine group discontinued due to adverse events (AEs); 87.5% of donepezil‐treated patients and 47.3% of rivastigmine‐treated patients remained on the maximum approved dose of each drug at the last study visit. Both groups showed comparable improvements on the ADAS‐cog administered by raters blind to study medication at weeks 4 and 12. Thus, using the recommended dosing schedules, donepezil was better tolerated with fewer discontinuations due to AEs, and both agents improved cognition to a similar extent.
TREATMENT OF PARKINSON'S DISEASE AND RESTLESS LEGS SYNDROME WITH CABERGOLINE, A LONG‐ACTING DOPAMINE AGONIST
Authors: Porter M‐C , Appiah‐Kubi LS , Chaudhuri KR 
Published: April 2023

SUMMARYDopamine agonists have diverse chemical and physical properties that can directly stimulate the dopamine receptors, unlike levodopa which undergoes presynaptic breakdown to dopamine before dopaminergic effects in Parkinson's disease (PD). Cabergoline, a dopamine agonist effective given once daily, is being used as treatment for PD. In theory, therapy with cabergoline provides striatal intrasynaptic dopamine replacement of PD in a physiological manner because of its long half‐life and the resultant sustained rather than pulsatile dopaminergic stimulation. Several placebo‐controlled trials using cabergoline as adjunctive therapy in PD have shown that cabergoline significantly reduces ‘off’ time, improves motor function and reduces levodopa requirement. Cabergoline has also been used as monotherapy in PD and has been shown to be as effective as other dopamine agonists in improving motor function and to be superior to levodopa in reducing dyskinesias over a five‐year period. Work from our group and others have also demonstrated the efficacy of cabergoline in PD patients with nocturnal disabilities and those with restless legs syndrome (RLS). More recently we have reported that cabergoline is a well‐tolerated dopamine agonist in both young and elderly patients and has an acceptable side‐effect profile.
FRACTURED LATERAL EPICONDYLE WITH ASSOCIATED ELBOW DISLOCATION
Authors: Murnaghan JM , Thompson NS , Taylor TC , Cosgrove AP , Ballard J 
Published: April 2023

SUMMARYWe describe a case series involving a very unusual injury in children, i.e. a Milch 1 fracture of the lateral condyle with an associated dislocation of the elbow. This fracture configuration is normally stable as the intact capitellotrochlear groove serves as a lateral buttress for the coronoid‐olecranon ridge of the ulna. In this series, however, each patient had an associated dislocation. These injuries usually present as a clinical dislocation and if the elbow is manipulated before radiographic imaging, the fracture line can be difficult to see on the post‐reduction films. We recommend that all patients with a dislocated elbow should have elbow stability assessed under general anaesthesia, because a missed lateral condylar injury can lead to abnormalities in carrying angle, epiphyseolysis or an unstable elbow.
EFFICACY OF LASER PALATOPLASTY: FOUR‐YEAR RESULTS
Authors: Maheshwar AA , Gomez KG , Obilanade M , Evans RA 
Published: April 2023

SUMMARYThere are few reports on the long‐term results of laser‐assisted uvulopalatoplasty (LAUP), with some casting doubt about its long‐term efficacy. We report satisfactory results in patients with more than four years' follow‐up. We conducted a retrospective study of patients who underwent LAUP at the Princess of Wales Hospital over a period of five years. Thirty‐three patients underwent LAUP as a day case procedure. They had had a mean follow‐up period of four years and five months. Twenty‐eight of these were asked details of their pre‐ and postoperative levels of snoring regarding frequency, volume and disturbance to their partners. There was a 50% reduction in frequency of snoring, a 51.85% reduction in volume and a 53.7% reduction in disturbance to their partners. All these figures are statistically significant (p<0.001). Overall, 60.8% of the patients felt the surgery was successful and had reduced their snoring to acceptable levels. We conclude that LAUP is an effective treatment for snoring, even in the long term.
REVERSIBLE HYPERTENSION IN A YOUNG FEMALE: URETERIC OBSTRUCTION DUE TO ENDOMETRIOSIS
Authors: Aldington S , Gujral S , Sibley GNA 
Published: April 2023

SUMMARYWe present the case of a young female who, upon investigation for hypertension, was found to have a ureteric stricture secondary to endometriosis. After excision of the stricture and an end‐to‐end ureteric anastomosis the patient's blood pressure returned to normal. This case highlights the need to investigate fully hypertension in young people and to consider the possibility of endometriosis in any female who presents with obstructive uropathy.
THE ROLE OF BOTULINUM TOXIN A IN THE MANAGEMENT OF LOWER LIMB SPASTICITY IN PATIENTS WITH CEREBRAL PALSY
Authors: Dursun N , Dursun E , Alican D 
Published: April 2023

SUMMARYThis study aimed to determine the effects of botulinum toxin‐A (btA) on spasticity in children with cerebral palsy (CP). Thirty‐five children with spastic CP were evaluated. The injection group consisted of 25 patients who were injected with btA and received conventional physical therapy The control group consisted of 10 patients who were treated with conventional physical therapy only In the injection group, btA was applied to the lower extremity spastic muscles at a total dose of 8–10 lU/kg. Spasticity was measured by the Ashworth scale. Gait function was evaluated by clinical gait assessment in all patients and temporal distance factors in 16 patients. All the parameters were recorded before treatment, after three days and after one month of therapy. Following injection of btA, significant improvement in all parameters was observed. No statistically significant progression was noted in the control group except clinical gait analysis scores. Comparing the three‐day and one‐month measurements of spasticity of the two groups, statistically significant results were obtained in favour of the injection group in all parameters except for clinical gait analysis scores. The findings of this study showed btA injection to be an effective treatment for reducing spasticity and improving gait function in patients with spastic CP
AGT AND AT1R GENE POLYMORPHISM IN HYPERTENSIVE HEART DISEASE
Authors: Mettimano M , Romano‐Spica V , Ianni A , Specchia ML , Migneco A , Savi L 
Published: April 2023

SUMMARYLeft ventricular hypertrophy in patients with hypertension is a main clinical prognostic entity. The aim of this study was to evaluate the association between mutations at genes of the renin‐angiotensin system (RAS) and the development of left ventricular hypertrophy. Genetic polymorphism in angiotensinogen (AGT) and angiotensin ll‐type 1 receptor (AT1R) genes was examined in a group of well‐selected essential hypertensive Caucasians with left ventricular involvement (n=40) and a group of healthy unrelated Caucasians (n=150). Cardiac morphology and function were assessed by M‐mode echocardiography. Molecular variants were analysed by amplified fragment length polymorphism. We observed a statistically significant difference both for AGT and AT1R genotype distribution in patients with left ventricular hypertrophy compared with controls (p<0.05). A 0.49 and 0.225 frequency was detected among cases for T and C mutant alleles at AGT and AT1R genes. Mutations in RAS genes are involved in the pathophysiology of target‐organ damage in essential hypertension. Evaluation of molecular factors conferring a risk of developing heart involvement may lead to better identification of patient subgroups and more effective control of the clinical course.
15. IMAGE‐GUIDED BREAST BIOPSY
Authors: Ralleigh G , Michell MJ 
Published: April 2023

SUMMARYThe introduction of mammographic screening has led to an increased number of impalpable in situ and invasive breast cancers. Image‐guided percutaneous biopsy in these patients has advantages over surgical biopsy, primarily cost savings and reducing the number of operations required for definitive treatment. Image‐guided breast biopsy is also useful in palpable lesions. Image‐guided biopsy should be used in conjunction with full clinical and imaging work‐up as part of the triple assessment protocol. Techniques available include fine needle aspiration, automated needle‐gun core and vacuum assisted large core biopsy. Lesions visible on ultrasound are preferentially biopsied using ultrasound guidance, while those seen only mammographically are biopsied using stereotactic guidance. Major complications are rare following image‐guided biopsy. In most cases further management can be decided based on the biopsy result. If there is discordance between clinical and imaging features and the biopsy result, image‐guided percutaneous biopsy should be repeated or surgical biopsy may be required.
FONDAPARINUX (ARIXTRA®): A NEW ANTICOAGULANT
Authors: Giangrande PLF 
Published: April 2023

SUMMARYFondaparinux is a promising new antithrombotic agent. This pentasaccharide selectively and specifically inhibits coagulation factor Xa, and requires antithrombin as co‐factor. It is entirely synthetic, in contrast to conventional heparin and low molecular heparins which are derived from animal tissues. Fondaparinux exhibits a high bioavailability and is convenient to use as it only needs to be given once daily by subcutaneous injection. Peak plasma levels are achieved within two hours of dosing and the plasma half‐life of fondaparinux is approximately 17 hours. There is no specific antidote for fondaparinux: it is not neutralised by protamine sulphate. Fondaparinux shows no cross‐reactivity with antibodies associated with heparin‐induced thrombocytopenia. Several randomised, double‐blind studies have demonstrated superiority with respect to a low molecular weight heparin (enoxaparin) in preventing venous thromboembolism in the setting of orthopaedic surgery. The results of clinical trials of fondaparinux in the treatment of deep vein thrombosis and acute coronary syndrome are also presented.
SLOW DECOMPRESSION OF THE BLADDER USING AN INTRAVENOUS GIVING SET
Authors: Perry A , Maharaj D , Ramdass MJ , Naraynsingh V 
Published: April 2023

SUMMARYRapid decompression of the bladder has been associated with complications such as diuresis, hyperkalaemia, haematuria and hypotension. Although these complications are easily managed and rarely clinically significant, clinicians still practise slow decompression using a ‘clamping’ technique. Slow decompression using a giving set provides a more convenient and less time‐consuming way of achieving this goal.
HORNER'S SYNDROME FOLLOWING EXCISION OF A VAGAL PARAGANGLIONOMA
Authors: Clements DM , Hedges AR , Tudor GR 
Published: April 2023

SUMMARYWe report a case of excision of a vagal paraganglionoma resulting in Horner's syndrome. The case was initially misdiagnosed as a carotid body tumour and demonstrates the need for adequate preoperative imaging and patient counselling for likely complications of surgery.
KNOWLEDGE OF STROKE SYMPTOMS AND RISK FACTORS AMONG AT‐RISK ELDERLY PATIENTS IN THE UK
Authors: Gupta A , Thomas P 
Published: April 2023

SUMMARYAssessing patient knowledge can help healthcare providers in planning measures directed at prevention, early identification and referral of patients. An incorrect understanding of stroke symptoms may delay patients seeking emergency help, thus missing the benefits of acute stroke treatments. Insufficient knowledge about stroke risk factors may affect risk factor control. We conducted a questionnaire‐based interview among elderly patients at risk of stroke and assessed their baseline knowledge of stroke symptoms and risk factors. A large proportion were found to have an improper understanding of stroke symptoms and risk factors. Stress was considered the commonest risk factor for stroke. Most patients did not consider themselves to be at further risk of stroke. Further education is needed as part of stroke prevention strategies to remove misconceptions. Improved recognition of stroke symptoms when they occur will help when seeking emergency medical help.
PUBLIC PERCEPTIONS OF CARDIOVASCULAR RISK IN FIVE EUROPEAN COUNTRIES: THE REACT SURVEY
Authors: Erhardt L , Hobbs FDR 
Published: April 2023

SUMMARYLittle is known of the attitudes and behaviours of the general public with regard to their general and personal risk factors for coronary heart disease (CHD), particularly in relation to cholesterol. This study attempted to determine patient perceptions of general population and personal risks regarding cardiovascular disease. Face‐to‐face interviews were conducted with 5104 members of the public in five countries (France, Germany, Italy, Sweden and the UK). Main results showed only 45% of the public correctly identified CHD as the leading cause of death in their country, and only 51% were aware that high cholesterol increases CHD risk. The presence of cardiovascular disease or risk factors in respondents did not appear to alter perceptions of risk compared with the public who had no existing disease. Of the different nationalities interviewed, the Swedes and the Germans appeared to be most aware of CHD risk factors. Awareness and knowledge of LDL‐C and HDL‐C were very poor in all countries except Italy. Half of the general public (50%) reported they had never discussed their cholesterol levels with a physician and only 33% knew what their target level was. Despite this, the most common source of information on CHD and cholesterol was the physician (60%). Only 9% of the total sample reported that they were currently taking medication for high cholesterol, compared with 20% for hypertension. In summary the general public in several European countries has major lack of awareness of the risks of CHD. This gap in knowledge is particularly marked over the risks of high cholesterol. Significant public health education is required.
PERCUTANEOUS TRANSLUMINAL RENAL ARTERY ANGIOPLASTY: WHO BENEFITS MOST?
Authors: Ziakka S , Belli A‐M , Kong TK , Macgregor GA , Missouris CG 
Published: April 2023

SUMMARYWe set out to assess the long‐term benefits of renal percutaneous transluminal angioplasty (PTA) in 107 consecutive hypertensive patients with atheromatous renal artery stenosis. During 12‐month follow‐up, blood pressure fell to normal levels in 10 (8.8%) patients and improved in 76 (67.3%); renal function improved or remained stable in 74% of patients. In patients with atheromatous disease, renal angioplasty was most successful in those with stenosis in a single functioning kidney, and in nine patients who presented with symptoms and signs of heart failure, in the absence of overt ischaemic or valvular heart disease. In the latter group, renal PTA resulted in a large loss of sodium and water, resolution of the ‘apparent’ heart failure, and a marked improvement in blood pressure and renal function. It is suggested that all hypertensive patients with haemodynamically significant renal artery stenosis (and/or mild to moderate impairment in renal function), should be considered for renal PTA. Patients with atheromatous stenosis in a single functioning kidney, and those who present with signs of sodium and water retention, are likely to benefit most.
COMBINED SPINAL AND EPIDURAL ANAESTHESIA IN ELDERLY PATIENTS
Authors: Tahtaci N , Neyal M 
Published: April 2023

SUMMARYThe study was designed to investigate the effects of simultaneously combined spinal‐epidural anaesthesia in elderly patients and to evaluate the problems encountered during and after performing spinal block following epidural blockade. Nineteen ASA grade III elderly patients (mean age 75.8 years) were included in the study. The first 10 patients (group 1) were given 0.5% hyperbaric bupivacaine 2 ml (10 mg) and fentanyl 0.25 ml (12.5 μg) intrathecally. The remaining nine patients (group 2) received 0.5% hyperbaric bupivacaine 1 ml (5 mg) intrathecally; following the spinal block fixation (about 15 min), fentanyl 1 ml (50μg) in saline 10 ml was injected into the epidural catheter. The highest sensory block was achieved at T6 and T9 in groups 1 and 2, respectively. None of the patients experienced respiratory depression, sedation, vomiting, shivering or headache. In conclusion, simultaneous combination of subarachnoid and epidural blockade may provide sufficient anaesthesia with fewer complications.