bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE EFFECT OF VALSARTAN AND CAPTOPRIL ON LIPID PARAMETERS IN PATIENTS WITH TYPE II DIABETES MELLITUS AND NEPHROPATHY
Authors: Cheung R , Lewanczuk RZ , Rodger NW , Huff MW , Oddou‐Stock P , Botteri F , Pecher E , Muirhead N 
Published: April 2023

SUMMARYThe study compared valsartan 80 mg or 160 mg o.d. with captopril 25 mg t.i.d. or placebo on plasma lipids in normotensive and treated hypertensive patients with type II diabetes and microalbuminuria. One hundred and twenty‐two adult outpatients were randomised to receive either valsartan 80 mg or 160 mg, captopril 25 mg or placebo for 360 days. Changes from baseline to endpoint in plasma lipid parameters were measured. The primary criterion for tolerability was the incidence of adverse events. All treatment groups showed minor changes in lipid parameters. Triglyceride increased by 2.7% (valsartan 160 mg) to 9.1% (placebo). Total cholesterol decreased under valsartan 80 mg, while other groups showed increases of up to 0.031 mmol/l. Decreases in total cholesterol (p=0.018), apolipoprotein B (p=0.042) and apolipoprotein A1 (p=0.025), were significant for the comparison of 80 mg valsartan and captopril. Valsartan 80 mg or 160 mg o.d. does not cause deleterious changes in the diabetic lipid profile and, unlike captopril, is not associated with dry cough.
A DOSE‐DEFINING STUDY OF SUMATRIPTAN SUPPOSITORIES IN THE ACUTE TREATMENT OF MIGRAINE
Authors: Bertin L , Brion N , Färkkilä M , Göbel H , Wessely P 
Published: April 2023

SUMMARYIn this dose‐ranging, randomised, multinational, multicentre, double‐blind, placebo‐controlled, parallel group study, 431 patients treated a single migraine attack with study medication: sumatriptan suppository 6 mg, 12.5 mg, 25 mg, 50 mg, 100 mg, or placebo. Patients were treated in the clinic with a single dose in suppository form. All doses of sumatriptan, except 6 mg, were significantly better than placebo (p<0.004) and achieved similar rates of headache relief within two hours of dosing. The highest response rate was in the 25 mg group (72%) compared with placebo (37%) (p<0.001). Fewer patients required rescue medication in the active groups (1% 100 mg to 13% 6 mg) compared with placebo (17%), and more patients were able to work and function normally two hours after dosing (41%, 100 mg; 20%, placebo). The overall incidence of adverse events was similar in the placebo, 6 mg and 12.5 mg groups (14‐17%) but higher in the 25 mg, 50 mg and 100 mg groups (25%, 32% and 29% respectively). Analysis of plasma sumatriptan levels indicated rapid rectal absorption for all doses (median tmax=1.0 hr). It is concluded that sumatriptan, in doses above 6 mg, is an effective and well tolerated treatment for acute migraine. From this study doses of 12.5 mg and 25 mg sumatriptan were identified as having the best efficacy/safey profile and were evaluated further.
DISSOLUTION OF THROMBUS FORMED DURING DIRECT CORONARY ANGIOPLASTY WITH A SINGLE 10 MG INTRACORONARY BOLUS DOSE OF ABCIXIMAB
Authors: Thuraisingham S , Tan KH 
Published: April 2023

SUMMARYDirect coronary angioplasty with stent implantation is an effective treatment for acute myocardial infarction. The use of adjunctive abciximab, a platelet glycoprotein IIb/IIIa receptor antagonist is expensive. We report on three cases of direct coronary angioplasty complicated by extensive thrombus formation that were successfully treated with attenuated dosing of abciximab via the intracoronary route. All patients presented with acute myocardial infarction complicated by cardiogenic shock or eminent cardiogenic shock. Abciximab was administered after balloon dilatation when extensive thrombus formation was noted and persisted despite repeated inflations. In all three patients a single 10 mg vial of intracoronary abciximab was administered, resulting in complete dissolution of thrombus, allowing successful deployment of stents. Thus, a single 10 mg intracoronary bolus dose of abciximab may be sufficient to achieve high local concentrations of antiplatelet activity. This facilitates thrombus dissolution and allows the safe deployment of a stent to normalise intracoronary rheology.
COMPARISON OF THERAPY WITH SIMVASTATIN 80 MG AND ATORVASTATIN 80 MG IN PATIENTS WITH FAMILIAL HYPERCHOLESTEROLAEMIA
Authors: Wierzbicki AS , Lumb PJ , Chik G , Crook MA 
Published: April 2023

SUMMARYThis study compared the efficacy of simvastatin 80 mg and atorvastatin 80 mg in the treatment of 26 patients with familial hypercholesterolaemia over 12 weeks using an open crossover trial format. Both, similarly, reduced LDL by 47 ± 13% and 43 ± 16% and median triglycerides by 22% and 27% respectively. However, atorvastatin reduced HDL by 2 ± 24% compared with 8 ± 30% increase with simvastatin (p=0.05) affecting the LDL:HDL ratio achieved (4.478 ± 1.56 vs 3.74 ± 0.93, P=0.001). Atorvastatin raised median fibrinogen by 15% compared with a non‐significant 5% increase with simvastatin (p=0.05). Simvastatin reduced lipoprotein (a) by a median 20% compared with baseline (p=0.05) compared with 5% for atorvastatin. Side‐effects, mostly gastrointestinal, were seen in four patients (16%) with atorvastatin compared with one case of myalgia with simvastatin (4%). We conclude both drugs are equally effective in LDL reduction but that simvastatin is superior in raising HDL and causes fewer side‐effects. These results require confirmation in larger studies.
GLYCOPROTEIN IIB/IIIA ANTAGONISTS: DO THEY HAVE A ROLE IN THE MANAGEMENT OF UNSTABLE ANGINA?
Authors: Redwood S , Marber M , Jackson G 
Published: April 2023

SUMMARYPlaque rupture, platelet aggregation and thrombosis have central roles in the pathogenesis of acute coronary syndromes. Despite several trials showing the benefit of aspirin and heparin in patients presenting with unstable angina and acute myocardial infarction, these patients are still at risk. This has prompted the development and evaluation of several new therapeutic agents including low molecular weight heparin, new antiplatelet drugs (e.g. ticlopidine and clopidogrel), direct thrombin inhibitors, and intravenous and oral glycoprotein IIb/IIIa antagonists. The IIb/IIIa receptor is the ‘final common pathway’ involved in platelet aggregation. Thus, whatever the stimulus for platelet activation, subsequent aggregation is mediated by the IIb/IIIa receptor binding fibrinogen. A variety of antibody, peptide and non‐peptide compounds that block the IIb/IIIa receptor have been developed, and several studies have investigated the role of these agents in patients with acute coronary syndromes both within and outside the setting of percutaneous intervention. This article summarises the studies to date using IIb/IIIa antagonists, and discusses their role in patients with non‐ST segment elevation acute coronary syndromes.
LOCAL ANAESTHETIC CIRCUMCISION IN ADULTS
Authors: Sobeh M , Junaid I , Marsh H , Fowler CG 
Published: April 2023

SUMMARYCircumcision is a simple operation often performed under general anaesthesia. In this study, we assessed the suitability of local anaesthesia in 38 adult patients, 79.4% of whom suffered little or no discomfort. Infiltration of local anaesthesia caused moderate pain in 10 patients (29.4%) and severe pain in only one. The circumcision itself caused moderate pain in three patients and severe pain in another three (8.8%); 85% of patients expressed complete satisfaction.
PREGNANCY OUTCOME IN WOMEN WITH TYPE 2 DIABETES MELLITUS NEEDS TO BE ADDRESSED
Authors: Brydon P , Smith T , Proffitt M , Gee H , Holder R , Dunne F 
Published: April 2023

SUMMARYMaternal diabetes mellitus (types 1 and 2) is the most chronic prevalent medical condition affecting the pregnant population and is associated with a less satisfactory pregnancy outcome for both mother and infant when compared with the non‐diabetic population. Most reports have focused on women with type 1 disease, type 2 disease being perceived as a less serious condition. However, type 2 disease is far more common (and is increasing) in some areas of the UK, especially where there is a high proportion of women from the Indian subcontinent. This paper shows that pregnancy complicated by type 2 diabetes mellitus is a high‐risk state, with miscarriage and congenital malformations almost twice that seen in type 1 disease. These adverse outcomes are contributed to by poor attendance for pre‐pregnancy care, later booking for antenatal clinic and poor glycaemic control at booking. Offspring of pregnancies complicated by type 2 diabetes are more likely to be delivered before 37 weeks gestation and be large in size for gestational age. We must dispel the myth, in women of childbearing age and in their healthcare providers, that diabetes treated with diet and/or tablets (type 2) is a less serious problem than type 1 disease.
POST‐TONSILLECTOMY PATIENT CARE IN THE COMMUNITY
Authors: Ghufoor K , Frosh A , Sandhu G , Hamf J 
Published: April 2023

SUMMARYTonsillectomy is a frequently performed surgical procedure. Problems arising in the early postoperative period will have an important impact on community and hospital resources. We determined the type of problems that occur and the way these problems are managed. We monitored 203 patients undergoing routine tonsillectomy by a postoperative telephone survey and contacted their general practitioners, 164 in all. We found 46% of the patients experienced problems post‐discharge which led to early contact with a doctor. Infection was identified in 26% and secondary haemorrhage in 11%. Common symptoms associated with the prescribing of antibiotics were sore throat (74%) and secondary haemorrhage (41%). Each GP saw, on average, 2.4 post‐tonsillectomy patients per annum. The diagnosis of post‐tonsillectomy infection is difficult. This was reflected in the wide variation of clinical features used to diagnose post‐tonsillectomy infection by doctors. The vast majority (95%) of GPs expressed a desire for a framework for treating post‐tonsillectomy complications.
TRANSIENT ISCHAEMIC ATTACKS: EVALUATION AND MANAGEMENT
Authors: Hennessy MJ , Britton TC 
Published: April 2023

SUMMARYTransient ischaemic attacks (TIAs) are temporary focal cerebral or retinal deficits that resolve within 24 hours. Attention should be given to the tempo and localisation of the clinical syndrome, as multiple and hemispheric TIAs are associated with the greatest incidence of early stroke. Evaluation of TIAs depends on the clinical symptoms, physical examination and investigations. Attention should be given to clinical evidence of generalised atherosclerotic disease, as death due to the complications of ischaemic heart disease is the commonest outcome in patients with TIA. Early attention should focus on risk factor modification, with emphasis on the treatment of hypertension and smoking cessation. Antiplatelet therapy should be instituted. Aspirin is the first‐line treatment but, if not tolerated, clopidogrel is effective in preventing vascular complications. Anticoagulants are generally reserved for patients with atrial fibrillation and are associated with a significant reduction of stroke risk. The use of statins is becoming more widespread, with emerging evidence of their efficacy in reducing stroke risk. The risk of stroke is greatest in the weeks following TIA and patients should be referred for carotid duplex ultrasonography. Carotid endarterectomy for symptomatic internal carotid artery high grade stenosis virtually abolishes stroke risk in that vascular territory over subsequent years. TIAs should be regarded as an emergency requiring early diagnosis and prompt referral.
COMPARISON OF TWO DIFFERENT FORMULATIONS OF MEBEVERINE HYDROCHLORIDE IN IRRITABLE BOWEL SYNDROME
Authors: Gilbody JS , Fletcher CP , Hughes IW , Kidman SP 
Published: April 2023

SUMMARYA total of 213 patients were recruited to a multicentre, randomised, double‐blind, double dummy, general practice study lasting eight weeks. The objectives of the study were (i) to demonstrate therapeutic equivalence of mebeverine hydrochloride 200 mg b.i.d. capsules (Colofac®MR) and 135 mg t.i.d. tablets (Colofac®) in the treatment of abdominal pain in irritable bowel syndrome (IBS) and (ii) to evaluate safety and physicians' and patients' assessments of therapeutic response. Patients were randomised at day 0 and assessments performed after four and eight weeks. Primary and secondary efficacy endpoints were number of responders (response being defined as 50% or more improvement in global mean visual analogue scale for abdominal pain); patients' and physicians' global assessment of therapeutic response; and physicians' global impression of patient symptoms. Safety was assessed from adverse event reports and routine laboratory tests. Therapeutic equivalence was proven statistically (difference <18%; p=0.003), with 65/92 (71%) of the 135 mg t.i.d. group and 64/92 (70%) of the 200 mg b.i.d. group classified as responders. The patients' evaluation of response (week 8) was that 75% of 135 mg t.i.d. and 81% of 200 mg b.i.d. improved; the physicians' assessment of therapeutic response (week 8) was that 64% of 135 mg t.i.d. and 70% of 200 mg b.i.d. had no or mild symptoms. In conclusion, Mebeverine hydrochloride 200 mg b.i.d. (Colofac®MR) was shown to be therapeutically equivalent to mebeverine hydrochloride 135 mg t.i.d. (Colofac®) in the treatment of abdominal pain in IBS. Results for the secondary efficacy variables were comparable. No safety concerns were identified.
ZOLMITRIPTAN PROVIDES EFFECTIVE MIGRAINE RELIEF IN ADOLESCENTS
Authors: Linder SL , Dowson AJ 
Published: April 2023

SUMMARYData from a subgroup of adolescents (12–17 years) entered into a one‐year open‐label phase of a large international study were analysed to evaluate response rates and tolerability of zolmitriptan for the acute treatment of migraine. In the open‐label phase of this study, the first two migraine attacks were treated with zolmitriptan 2.5 mg and subsequent attacks with zolmitriptan 2.5 mg or 5 mg, at the patient's discretion, for up to 12 months. Two‐hour headache and pain‐free responses were evaluated and adverse events were recorded. Thirty‐eight adolescents treated 276 migraine attacks of any intensity. The overall headache response at 2 hours was 80% (88% and 70% with zolmitriptan 2.5 mg and 5 mg, respectively), and the pain‐free response was 66% (76% and 52% for zolmitriptan 2.5 mg and 5 mg, respectively). Response rates were independent of whether or not migraine was associated with aura or menses. During prolonged use, patients learned to adjust the dose of zolmitriptan to effectively manage their migraine. Treatment was well tolerated. In conclusion, preliminary data indicate that zolmitriptan is effective in the acute treatment of migraine in adolescents and is well tolerated.
‘ACUTE ABDOMEN’ WITH A RASH
Authors: Lannon DA , Smyth YM , Waldron R 
Published: April 2023

SUMMARYA previously fit and healthy 17‐year‐old male presented with the clinical symptoms and signs of an acute abdomen and with the secondary complaint of a rash. In view of the primary presenting complaint he was admitted to the surgical ward. The patient was initially booked for an emergency exploratory laparotomy, but after reassessment on the ward a clinical diagnosis of meningococcal septicaemia was made. The patient was treated medically with intravenous antibiotics and supportive therapy, and made a complete recovery. Medical causes of abdominal pain, as exemplified here, can be more life threatening than surgical causes and should be considered in all patients.
SYSTEMIC WEBER‐CHRISTIAN DISEASE COMPLICATED BY PARTIAL TRANSVERSE MYELOPATHY
Authors: Larner AJ , Marshall B , Ma RCW , Ball JA 
Published: April 2023

SUMMARYWeber‐Christian disease is an inflammatory disorder of fatty tissue which usually presents with raised red tender nodules in the skin. Although there may be additional systemic upset, there are very few reports of neurological features associated with this condition. We report a patient with biopsy‐confirmed systemic Weber‐Christian disease in whom a transient partial myelopathy, of probable inflammatory origin, was the most prominent feature. Based on recent reports of the effects of immune mediators on neuronal function, a possible pathogenetic explanation for this syndrome is suggested.
THE DOGMA OF IDENTIFYING OCCULT BACTERIAL INFECTIONS IN YOUNG FEBRILE CHILDREN: A SURVEY OF PRIMARY‐CARE PHYSICIANS
Authors: Al‐Zamil FA 
Published: April 2023

SUMMARYManagement of undifferentiated febrile illness in young children continues to be a controversial issue among primary‐care physicians. A self‐administered questionnaire was mailed to 600 randomly selected physicians regarding their management of children with high fever and no focus of infection at various ages: 3 weeks, 7 weeks, 4 months and 20 months. Completed questionnaires were returned by 419 (70%) physicians. Nearly 77% of physicians would hospitalise a 3‐week old infant with fever and 70% would treat these infants empirically with antibiotics. Sixty‐one per cent of physicians would hospitalise a 7‐week‐old infant with fever and 46% would treat empirically with antibiotics. Approximately 80% and 93% of physicians, respectively, would not hospitalise 4‐ and 20‐month‐old infants with high fever and no focus of infection, but 72% and 59%, respectively, would treat such infants with antibiotics. There was considerable variation in the way physicians managed young febrile children with no focus of infection and the clinical approach of some physicians was remarkably different from current knowledge and recommendations.
RELIEF OF SORE THROAT WITH THE ANTI‐INFLAMMATORY THROAT LOZENGE FLURBIPROFEN 8.75 MG: A RANDOMISED, DOUBLE‐BLIND, PLACEBO‐CONTROLLED STUDY OF EFFICACY AND SAFETY
Authors: Watson N , Nimmo WS , Christian J , Charlesworth A , Speight J , Miller K 
Published: April 2023

SUMMARYIn this double‐blind study, 301 patients with subjective and objective signs of sore throat were randomly assigned to flurbiprofen 8.75 mg (n=129), flurbiprofen 12.5 mg (n=43) or placebo (demulcent lozenge without active drug [n=129]). Efficacy was assessed by changes in subjective rating scales primarily after a single dose and also over a 4‐day period. Flurbiprofen 8.75 mg was superior to placebo in a number of efficacy parameters, notably throat soreness. Throat soreness was significantly reduced after 15 minutes (p<0.05), with effects sustained for at least 2 hours (p<0.05). Multiple dosing with flurbiprofen 8.75 mg lozenges continued to provide effective symptomatic relief over the 4‐day treatment period. The small sample size was considered contributory to the variable results obtained with flurbiprofen 12.5 mg lozenges, but overall these were not inconsistent with previous trials. Both treatments were tolerated well. Flurbiprofen 8.75 mg lozenges provide an effective and well tolerated treatment for sore throat.
PROGNOSTIC VALUE OF CT SCAN FEATURES IN ACUTE ISCHAEMIC STROKE AND RELATIONSHIP WITH CLINICAL STROKE SYNDROMES
Authors: Sharma JC , Fletcher S , Vassallo M , Ross I 
Published: April 2023

SUMMARYThe aim of this prospective study was to investigate the value of CT scan in prognosis of acute ischaemic stroke patients as a variable additional to clinical stroke syndromes to develop a simple classification of CT scan features to provide a practical approach to prognosticate and manage such patients. One hundred and eight nine patients admitted with ischaemic stroke were investigated with a CT scan. CT scan features were classified into two groups: large infarct, LI (across more than one lobe) and non‐large infarcts (N‐LI) for all other features. Patients were also studied for clinical syndromes, analysing results for total anterior circulation syndrome (TACS). Outcome was measured as early post stroke Barthel index, acute phase and 3‐month mortality. Patients with LI had features of severe strokes and had a lower Barthel index (p<0.001), lower Glasgow coma score (p<0.001), more association with incontinence (p<0.001), pyrexia (p=0.007) and dysphagia (p<0.001). LI patients required higher level of care in acute wards and had a higher length of stay (p=0.01). Both the LI and TACS individually had a significantly higher mortality (p<0.001) and similar positive predictive value, sensitivity and specificity for 3‐month mortality. While the combined factor of ‘large infarct and TACS’ provided the highest likelihood ratio (3.1) for mortality, the factor of ‘large infarct or TACS’ was the most sensitive (85%) to identify majority of patients at a risk of mortality. N‐LI patients had a better prognosis. Classification of cerebral infarcts into large and non‐large categories identifies patients who require higher level of care in acute wards and have a higher mortality. Combined factor of ‘large infarct and/or TACS’ identifies the majority of patients at risk of 3‐month mortality as compared to either variable taken individually. CT scan features are complimentary to clinical syndromes for managing acute stroke patients.
AXILLARY ARCH AND ITS IMPLICATIONS IN AXILLARY DISSECTION — REVIEW
Authors: Babu ED , Khashaba A 
Published: April 2023

SUMMARYAxillary arch is an anomalous muscular slip of latissimus dorsi muscle occasionally encountered in axillary dissection. A systematic review of medical literature published between 1966 to 1999 was performed regarding its incidence, clinical features and management. Its presence in axillary dissection should be recognised to avoid confusion in staging of lymph nodes and to prevent injury to axillary vessels and brachial plexus.
DIABETES KNOWLEDGE ‐ ARE PATIENTS GETTING THE MESSAGE?
Authors: Ford S , Mai F , Manson A , Rukin N , Dunne F 
Published: April 2023

SUMMARYDiabetes knowledge in a multi‐ethnic population was assessed in 161 insulin treated diabetic patients using a 21‐point multiple choice questionnaire translated into the appropriate languages. Our data showed a significant difference in diabetes knowledge related to ethnicity, being less in Asians and Afro‐Caribbeans groups compared to Caucasians. In all groups there was a negative correlation with age, with older adults achieving lower scores. Gender and duration of disease did not appear to influence knowledge scores. This information has implications for the way in which we deliver our diabetes educational programme to ethnic minority groups and the elderly.
ESOMEPRAZOLE, A NEW PROTON PUMP INHIBITOR: PHARMACOLOGICAL CHARACTERISTICS AND CLINICAL EFFICACY
Authors: Thitiphuree S , Talley NJ 
Published: April 2023

SUMMARYEsomeprazole, the S‐isomer of omeprazole, is the first proton pump inhibitor synthesised as an optical isomer to become available for clinical use. Esomeprazole is optically stable in humans with negligible inversion to the R‐isomer. Esomeprazole has significantly higher oral bioavailability than omeprazole, resulting in greater acid suppression. In clinical studies, 4 weeks' treatment with 40 mg esomeprazole demonstrated greater healing of all grades of erosive oesophagitis, compared with 20 mg omeprazole (76–82% versus 69–71%) and higher rates of symptom resolution (65–68% versus 58–61%) Furthermore, esomeprazole maintained healing rates of up to 90% over 6 months in erosive oesophagitis. Comparisons with other proton pump inhibitors in oesophagitis are, as yet, unavailable. In patients with endoscopy‐negative gastro‐oesophageal reflux disease (GERD), on‐demand therapy with esomeprazole 20 mg has been shown to be very efficacious compared with placebo, and is well tolerated; however, comparisons with other proton pump inhibitors have not been performed. Long‐term use of esomeprazole for up to 12 months in patients with GERD have not raised any significant safety concerns with respect to the development of atrophic gastritis or clinically relevant changes in enterochromaffin‐like cells.