bluuebunny/crossref_metadata_2025_split huggingface dataset:
PATIENT PERSPECTIVE ON ZANAMIVIR IN THE TREATMENT OF INFLUENZA
Authors: Bricaire F , Cohen JM , Jacquet M , Boucot I , Nicolas M ,   JAG Committee
Published: April 2023

SUMMARYPlacebo‐controlled clinical studies have shown zanamivir to be an effective treatment of influenza A and influenza B illness. This survey, conducted in France, was done to evaluate patients' perception of zanamivir in clinical practice. Between January and mid‐April 2000, 271 retail pharmacists gave questionnaires to patients with a prescription for zanamivir to be completed on a voluntary basis. A total of 514 patients returned completed questionnaires, of whom 97 (19%) were considered at high risk of developing influenza complications. Fifty‐one (10%) patients, mainly those over 65 years, were vaccinated against influenza. Fever or feverishness was reported by 93% of patients, and cough, myalgia and headache by 72%. Most (58%) patients consulted their doctor within 24 hours of the onset of symptoms, and 96% within 48 hours. Eighty‐five per cent of patients overall and 82% of high‐risk individuals (82/97) reported being satisfied with their zanamivir treatment. Treatment compliance was high with 75% of patients completing the whole course of treatment. Symptom relief was reported by 45% of patients within 24 hours and by 74% of patients within 48 hours; 66% of patients resumed normal activities within 72 hours. These results suggest that patient satisfaction is high and compliance with zanamivir is highly satisfactory. In addition, the use of zanamivir was reported to be associated with rapid symptom relief and return to normal activity.
NON‐INVASIVE IMAGING METHODS BEFORE FINE‐NEEDLE ASPIRATION IN THE DIAGNOSIS OF CERVICAL MASSES
Authors: Camci C , Sari R , Buyukberber S , Kutlu R , Sevinc A , Çokkeser Y 
Published: April 2023

SUMMARYA carotid body tumour is a vascular tumour usually located at or around the bifurcation of the carotid artery and originating from the tunica adventitia. Carotid body tumours, which are generally non‐functional and asymptomatic, grow slowly, which is why diagnosis can be delayed. Because of the vascular structures, fine‐needle aspiration biopsy may be dangerous and impractical. Efficient and reliable methods of diagnosis, such as colour Doppler ultrasound, magnetic resonance imaging, computerised tomography and arteriography, can be useful. We report on a 58‐year‐old woman with diarrhoea, flushing and a cervical, hard, non‐tender, fixed mass. An unsuccessful diagnostic fine‐needle aspiration biopsy was performed after palpation of the cervical mass. A carotid body tumour was finally diagnosed. We concluded that non‐invasive imaging methods should be evaluated before fine‐needle aspiration in cervical masses. It should also be kept in mind that asymptomatic cervical masses may be related to non‐local symptoms.
SUDDEN PERMANENT HEARING LOSS FOLLOWING ANTERIOR INFERIOR CEREBELLAR ARTERY INFARCTION
Authors: Nagaratnam N , Mak J , Phan TA , Kalouche H 
Published: April 2023

SUMMARYAnterior inferior cerebellar artery infarction with the only sequel being a permanent unilateral hearing loss is described. The damage was confirmed by magnetic resonance imaging. Hearing loss of vascular cause may be more common and permanent than realised, and missed if the other neurological deficits have resolved.
THE CLINICAL BENEFITS OF RIVASTIGMINE MAY REFLECT ITS DUAL INHIBITORY MODE OF ACTION: AN HYPOTHESIS
Authors: Bullock R 
Published: April 2023

SUMMARYRecent health technology assessments have given us the go‐ahead to use Cholinesterase inhibitors, which, in combination with community services, are currently the most appropriate treatment for patients with Alzheimer's disease (AD). Initial research focused upon acetylcholinesterase (AChE)‐selective agents, but it is now thought that dual inhibitors of AChE and butyrylcholinesterase (BuChE) may provide more sustained efficacy over the course of AD and may help to slow disease progression. Rivastigmine is a potent inhibitor of AChE and BuChE and has demonstrated broad benefits across the severity of AD and across the cognitive, functional and behavioural domains of AD. In addition, rivastigmine has shown cognitive and behavioural benefits in patients with dementia with the Lewy body variant of AD. These benefits may reflect the inhibition of both AChE and BuChE, as demonstrated by significant correlations between cognitive improvements and Cholinesterase inhibition in rivastigmine‐treated patients with AD. Rivastigmine shows a clear dose‐response relationship, and physicians should aim to maintain patients on doses of 6 mg/day or higher, to a maximum of 12 mg/day. As with all Cholinesterase inhibitors, rapid forced dose escalation may increase the incidence of typical cholinergic side‐effects, resulting in lower maintenance doses. In a chronic disease such as AD, there is time to implement slow dose escalation and higher final maintenance doses. If used appropriately, the benefits of rivastigmine seen in clinical practice may prove to be even greater than those reported in clinical trials.
CERVICAL SURGICAL EMPHYSEMA: A RARE PRESENTATION OF A SIGMOID COLON RETROPERITONEAL DIVERTICULAR PERFORATION
Authors: Basu S , Corless D 
Published: April 2023

SUMMARYSpontaneous retroperitoneal sigmoid diverticular perforation presenting as subcutaneous cervical emphysema is rare. We describe a case successfully treated by surgery. Patients presenting with subcutaneous emphysema with negative thoracic findings should be scrutinised for signs of retroperitoneal hollow viscus perforation to improve their outcome.
USE OF OPIOID ANALGESICS IN A PATIENT WITH CHRONIC ABDOMINAL PAIN
Authors: Iles S , Catterall JR , Hanks G 
Published: April 2023

SUMMARYPethidine is the most commonly used opioid in hospitals in the UK, but it lacks potency, has a short duration of action and a narrow therapeutic index. These points are illustrated by a case history of a patient prescribed pethidine for chronic abdominal pain. Misplaced fears of the side‐effects of morphine result in its underuse in the management of chronic pain with consequential restriction of patients' functional ability.
EFFECTIVENESS OF QUININE IN TREATING MUSCLE CRAMPS: A DOUBLE‐BLIND, PLACEBO‐CONTROLLED, PARALLEL‐GROUP, MULTICENTRE TRIAL
Authors: Diener HC , Dethlefsen U , Dethlefsen‐Gruber S , Verbeek P 
Published: April 2023

SUMMARYTo determine the efficacy and safety of quinine in treating nocturnal muscle cramps we performed a double‐blind, placebo‐controlled, parallel‐group, multicentre trial in 17 general practice centres in Germany. Ninety‐eight patients aged 18–70 years with more than six muscle cramps in two weeks were enrolled. A two‐week run‐in period without treatment was followed by two weeks of treatment with 400 mg quinine or placebo per day and a wash‐out period of two weeks without treatment. The primary outcome measure was the reduction in the number of muscle cramps between the run‐in and treatment periods. The intensity of cramps, number of nights with cramps, sleep disturbance and intensity of pain were recorded as secondary outcome measures. At baseline the median number of cramps was 12 in two weeks in both groups. The median reduction between the run‐in and therapy phases was eight (95% CI 7–10) versus six (95% CI 3–7) muscle cramps during quinine and placebo treatment; 36 (80%) participants in the quinine group and 26 (53%) in the placebo group had a reduction of at least 50% in the number of muscle cramps. Frequency, intensity and pain at night showed a statistically significant difference in favour of quinine. The improvement was more evident according to physician assessment than patient assessment; this is corroborated by the high placebo response rate. No significant differences were found between the two groups with respect to side‐effects. Short term treatment with 400 mg quinine per day can effectively prevent nocturnal leg cramps in adults without relevant side‐effects.
ANTIMICROBIAL DRUG USE IN DERMATOLOGY IN A TEACHING HOSPITAL IN WESTERN NEPAL
Authors: Sarkar C , Das B , Sripathi H 
Published: April 2023

SUMMARYMedical audit is supposed to oversee, monitor and analyse standards of medical treatment at all levels of the healthcare delivery system. This study was undertaken to monitor the prescribing of antimicrobial drugs for patients seeking treatment in the dermatology outpatient department of the Manipal Teaching Hospital in Nepal. A total of 292 dermatology prescriptions of patients attending the dermatology OPD were collected between July 2000 and June 2001. Prescriptions for antimicrobial agents were separated from the total prescriptions collected, and evaluated. There were more female patients (58.2%) than male (41.8%) in our study; most were in the 21–40 year age group. The commonest cutaneous infections were acne (15.8%) followed by fungal infections (14.8%). Of the 292 prescriptions audited, 149 contained antimicrobial agents, constituting 36% of the total number of drugs prescribed. Of 256 antimicrobials prescribed, 63% were topical and 37% systemic; 5% were generic, 29% were from the essential drug list of Nepal, and 15% were fixed‐dose combinations. Most of the patients received one or two antimicrobials, 50% of which were antibacterials and 40% antifungals. Though the selection of antimicrobial drugs used in dermatology was largely rational, anomalies were observed, and these issues were discussed with clinicians in relation to various aspects of drug use. The results indicate there is scope for improving prescribing habits. A periodic audit of drug prescribing is desirable in rationalising prescribing practice.
IMMUNISATION WITH A PNEUMOCOCCAL 7‐VALENT CONJUGATE VACCINE
Authors: Dagan R 
Published: April 2023

SUMMARYPneumococcal disease causes approximately 1 million deaths a year worldwide in children aged younger than 5 years. Increasing antibiotic‐resistant strains have made management of pneumococcal disease difficult. A pneumococcal 7‐valent conjugate vaccine (PNCRM7) has been shown to prevent invasive disease in young children; it has also demonstrated a modest impact on the prevention of otitis media. This conjugated vaccine provides a consistent immune response in infants and young children and can be administered simultaneously with other childhood vaccines. It is generally well tolerated, with local reactions similar to those observed with other licensed childhood vaccines. The objective of this review is to discuss the clinical efficacy, immunogenicity and safety of PNCRM7.
CLINICAL AND BIOCHEMICAL OUTCOME OF RENAL AMYLOIDOSIS
Authors: Odabas AR , Cetinkaya R , Selcuk Y , Erman Z , Bilen H 
Published: April 2023

SUMMARYAA amyloidosis is a relatively rare disease which complicates chronic inflammatory diseases, chronic infections, familial Mediterranean fever (FMF) and malignant diseases. Although amyloid deposition may be found in many organs, renal involvement dominates the clinical picture. We reviewed 63 patients with AA amyloidosis who presented to our nephrology department between 1995 and 2000. Prognostic markers, detailed history, physical examination and laboratory tests were evaluated. The causes of AA amyloidosis were as follows: FMF 42 (66.6%), pulmonary tuberculosis 9 (14.2%), chronic osteomyelitis 4 (6.3%), bronchiectasia 4 (6.3%), rheumatoid arthritis 1 (1.5%), juvenile idiopathic arthritis 1 (1.5%), inflammatory abdominal aortic aneurysm 1 (1.5 %), unknown aetiology 1 (1.5%). The diagnosis was made on renal biopsies in 63.4% of the patients, while the remaining 36.6% were diagnosed as a result of rectal biopsies. Sixteen patients died. A low serum albumin, high creatinine and high 24‐hour urine albumin excretion were associated with high mortality.
ATRIAL FIBRILLATION CURRENT AND FUTURE TREATMENTS: RADIOFREQUENCY ABLATION AND NOVEL PACING TECHNIQUES
Authors: Baszko A , Rinaldi CA , Simon RDB , Gill JS 
Published: April 2023

SUMMARYAtrial fibrillation (AF) is a common clinical arrhythmia with significant symptomatology and is associated with an increased risk of systemic embolic events. Until recently, the treatment options for AF were essentially pharmacological. Recent developments in the understanding of the mechanisms of AF have resulted in a series of non‐pharmacological treatments becoming available. Such treatments include surgical ‘maze’ procedures and, more recently, the introduction of radiofrequency ablation techniques within the atria to prevent fibrillation. Complex pacing procedures, including multisite and biatrial pacing, have been used to treat AF. Tailoring treatment for individual patients is a complex task and this review will attempt to rationalise the non‐pharmacological treatment paths for individual patients with AF.
GIANT GASTRIC TRICHOBEZOAR
Authors: Baskonus I , Gökalp A , Maralcan G , Sanal I 
Published: April 2023

SUMMARYBezoars are relatively common foreign body lesions of the stomach and intestine. Small bezoars can be treated using non‐surgical methods, but large bezoars usually require open surgery. Occasionally they are giant‐sized and may mimic an intra‐abdominal mass clinically. We present the case of a 24‐year‐old woman with a giant gastric trichobezoar treated by open surgery; treatment methods are discussed.
INSULIN GLARGINE (LANTUS®)
Authors: Owens  , Griffiths S 
Published: April 2023

SUMMARYInsulin glargine (Lantus®) is a long‐acting, human insulin analogue that has been specifically designed to overcome the deficiencies of traditionally available ‘intermediate‐acting’ insulins that are currently used for basal insulin supplementation. In contrast to NPH insulin, subcutaneous insulin glargine injected once daily provides a relatively constant basal level of circulating insulin with no pronounced peak. In patients with type 1 and type 2 diabetes, once‐daily insulin glargine achieves equivalent glycaemic control to NPH insulin given once or twice daily. In patients with type 1 diabetes, it is associated with significantly lower fasting blood glucose (FBG) levels, especially in those patients previously on twice‐daily NPH insulin. Insulin glargine is well tolerated and elicits less hypoglycaemia, especially nocturnal episodes, than NPH insulin, with similar levels of glycaemic control. This benefit is seen in patients with both type 1 and type 2 diabetes, in particular those previously on a once‐daily NPH insulin regimen. Patients with type 1 and type 2 diabetes have also reported higher levels of treatment satisfaction when treated with insulin glargine. Insulin glargine provides the opportunity to achieve target blood glucose levels more effectively and safely compared with NPH insulin, due to the reduced risk of hypoglycaemia, especially nocturnal hypoglycaemia. Insulin treatment needs to be individualised, with the dose of insulin glargine adjusted according to the blood glucose level as part of an aggressive regimen in an attempt to achieve near normoglycaemia without incurring episodes of hypoglycaemia. Insulin glargine should be used in combination with short‐acting insulin analogues in patients with type 1 diabetes. In patients where oral hypoglycaemic agents are failing, insulin glargine can be added. The early introduction of insulin in patients with type 2 diabetes is to be encouraged.
ONE‐AND‐A‐HALF SYNDROME RESULTING FROM SPONTANEOUS VERTEBRAL ARTERY DISSECTION
Authors: Larner AJ , Rudge P 
Published: April 2023

SUMMARYA patient with one‐and‐a‐half syndrome due to brainstem ischaemia is presented. The case emphasises the importance of attempting to establish the aetiology of this syndrome – in this case infarction secondary to spontaneous vertebral artery dissection – when making therapeutic decisions.
ROSIGLITAZONE IN THE MANAGEMENT OF OLDER PATIENTS WITH TYPE 2 DIABETES MELLITUS
Authors: Kreider M , Heise M 
Published: April 2023

SUMMARYThe prevalence of type 2 diabetes increases dramatically with age in all populations. This report describes a post‐hoc analysis of eight rosiglitazone monotherapy studies to characterise the efficacy and safety of rosiglitazone in older patients with type 2 diabetes, using a designation of ≥70 years for elderly. A total of 3127 patients were randomised to rosiglitazone (<70 years: n=2099; ≥70 years: n=427) or placebo (<70 years: n=497; ≥70 years: n=104). In both age groups, rosiglitazone 4 mg/day and 8 mg/day reduced HbA1c and fasting plasma glucose compared with baseline and placebo at week 26 with no difference between age groups. There was no difference between the nature, severity or type of adverse events experienced by older or younger patients. Rosiglitazone improves glycaemic control and is well tolerated in older as well as younger patients with type 2 diabetes.
DERMAL OBJECTIVE PHARMACODYNAMIC PROFILE OF CETIRIZINE AND EPINASTINE: TWO CONTROLLED, RANDOMISED, DOUBLE‐BLIND, CROSSOVER STUDIES
Authors: Leroy T , Van Neste D 
Published: April 2023

SUMMARYTwo double‐blind clinical pharmacology studies were performed in healthy volunteers to compare the dermal pharmacodynamic profile of epinastine with cetirizine, a well‐documented anti‐H1 antagonist, after oral administration at the usual recommended dosage, i.e. 10 mg cetirizine and 20 mg epinastine (versus placebo). Histamine skin challenges (prick test) were evaluated before and at 1, 2, 4, 8 and 24 hr after drug intake by measuring the wheal and flare area (studies 1 and 2) along with laser Doppler monitoring of the microvascular responses (study 2). A decrease in wheal and flare areas was observed following intake of both drugs compared with placebo controls. With the notable exception of 1 hr post dose wheal values, which were consistently smaller after epinastine, cetirizine was superior to epinastine for both wheal and flare at all other times. At the prick test site, treatment with epinastine and cetirizine accentuated the increase in blood flow induced by histamine. This reflects the decrease of the whealing but there was no significant difference between the two active test compounds. At 1 cm from the prick test site, the administration of both active treatments inhibited the increase of blood flow, and cetirizine showed a more potent inhibitory effect from 8 hr post dose. This reflects the reduction of the flare induced after histamine‐receptor activation of the axon reflex. In conclusion, epinastine shows a rapidly greater (within 1 hr post dose on the wheal only) but vanishing effect than cetirizine. At all other time points, cetirizine was generally more effective than epinastine.
16. BREAST CANCER IN OLDER WOMEN
Authors: Bultitude MF , Fentiman IS 
Published: April 2023

SUMMARYElderly women are more likely to have less aggressive tumours, which are oestrogen receptor positive. They are less likely to be offered screening and often given inadequate treatment leading to a higher mortality rate. They should be assessed in the same way as their younger counterparts. Age should not be a consideration, rather life expectancy. Patients' wishes are important but the mainstay of treatment is surgical, including axillary node clearance, with adjuvant tamoxifen as appropriate. Radiotherapy should not be withheld unless there are good reasons to contradict this. In unfit patients, tamoxifen alone is a suitable treatment but tumorectomy under local anaesthetic is preferable. If the tumour is oestrogen receptor negative, surgery and/or radiotherapy will be required.
ETHNICITY AND PERIPHERAL VASCULAR DISEASE
Authors: Makin AJ , Silverman SH , Lip GYH 
Published: April 2023

SUMMARYThere are well‐documented differences in the prevalence of coronary artery disease and carotid disease between Caucasians, Afro‐Caribbeans and Indo‐Asians. Very little data are available on ethnic differences in peripheral vascular disease (PVD). To investigate this further, we surveyed 200 consecutive patients attending the vascular surgery service at a city centre hospital serving a multiethnic patient catchment population. All patients had proven PVD, with an ankle brachial pressure index of less than 0.8. Within this cohort, Afro‐Caribbeans presented more frequently with PVD compared with the proportion of this ethnic group in the local population (p=0.013), with a greater proportion with diabetes mellitus than in the other two ethnic groups. There did not appear to be a significant difference between the ethnic groups in any of the other established risk factors or associations (i.e. treated hypertension, smoking, previous history of ischaemic heart disease, atrial fibrillation, previous history of cerebrovascular accident or transient ischaemic attack) with PVD. As with coronary artery disease and carotid disease, there are ethnic differences in the prevalence of PVD, and the underlying risk factors, between Caucasians, Afro‐Caribbeans and Indo‐Asians. Furthermore, patients of Afro‐Caribbean origin present more frequently with symptomatic PVD than do either Caucasians or Indo‐Asians.
THE NEW ROLE OF PHARMACOTHERAPY FOR WEIGHT REDUCTION IN OBESITY
Authors: Fernstrom MH , Fernstrom JD 
Published: April 2023

SUMMARYObesity is associated with an increased risk for a wide variety of chronic health conditions. Despite this fact, less than half of obese patients are advised by healthcare professionals to lose weight. Creating a viable plan for losing weight and maintaining weight loss is difficult. Lifestyle change is always the cornerstone of treatment, but two new therapeutic agents approved for long‐term use, sibutramine and orlistat, can help maximise success. Increased weight loss can lead to reductions in the risk of obesity‐related co‐morbidities. Sibutramine and orlistat offer new weight reduction opportunities for obese patients.
TOLERABILITY OF IBUPROFEN, ASPIRIN AND PARACETAMOL FOR THE TREATMENT OF COLD AND FLU SYMPTOMS AND SORE THROAT PAIN
Authors: Moore N , Parc J‐M Le , Van Ganse E , Wall R , Schneid H , Cairns R 
Published: April 2023

SUMMARYThis double‐blind randomised study compared the tolerability of ibuprofen (up to 1.2 g daily), aspirin and paracetamol (both up to 3 g daily) for up to seven days, in patients with mild to moderate pain resulting from cold/flu symptoms or sore throat (CF/ST) (n=2815). The main outcome was the rate of significant adverse events (SGAE). Rates of SGAE for ibuprofen, aspirin and paracetamol were respectively 12.0%, 15.7% and 12.3%. Ibuprofen was significantly better tolerated than aspirin (p=0.02) and had comparable tolerability with paracetamol. The latter was also true for total digestive system events and for abdominal pain and dyspepsia. In conclusion, in patients with CF/ST, ibuprofen used at over‐the‐counter doses is as well tolerated as paracetamol and much better tolerated than aspirin.
MATCHING THE STANDARDS OF CLINICAL TRIAL EVIDENCE WITH APPLICATION IN PRACTICE
Authors: Sharpe N 
Published: April 2023

SUMMARYA high standard of proof of efficacy and safety is required in clinical trials. This standard requires careful translation into practice, combining an evidence‐based approach with clinical experience and judgment to maximise patient benefits and minimise harms. The tendency to extend application of new treatments to patient groups other than those for whom reliable data exist should be avoided. Equally, extrapolation of the data to agents of the same class untested for particular indications should not occur. If the considerable potential benefits of modern cardiovascular therapeutics are to be maximised and harms avoided, clinicians should observe these principles carefully as new treatments become accessible and are applied.