bluuebunny/crossref_metadata_2025_split huggingface dataset:
WHY DO FAMILY DOCTORS PRESCRIBE ANTIBIOTICS FOR UPPER RESPIRATORY TRACT INFECTION?
Authors: Lam TP , Lam KF 
Published: April 2023

SUMMARYThe prescribing behaviour of family doctors in Hong Kong towards upper respiratory tract infections (URTIs), and the major clinical factors that might affect such behaviour, were studied. Members of the Hong Kong College of Family Physicians were surveyed; 801 completed the questionnaire with an overall response rate of 65%. Purulent nasal discharge, purulent sputum, persistent fever over three days, patients looking unwell, exudates on throat, inflamed eardrums and cervical lymphadenopathy made more than half the respondents ‘likely’ or ‘very likely’ to prescribe antibiotics. Those in private practice and those who graduated in Hong Kong were more likely to prescribe antibiotics, while fellows of the College were less likely to do so. Vocational training and higher qualifications in family medicine/general practice, however, revealed minimal effect. Our results showed that many doctors are still prescribing antibiotics when they encounter URTI patients presenting with clinical factors that have been proven to have no or little benefit from antibiotics.
USE OF NEPHROSTOMY TUBES IN URETERIC OBSTRUCTION FROM INCURABLE MALIGNANCY
Authors: Little B , Ho KJ , Gawley S , Young M 
Published: April 2023

SUMMARYMalignancy may produce ureteric obstruction. This obstruction may be relieved by inserting a nephrostomy tube. All 31 cases of malignant ureteric obstruction from a single institution were retrospectively analysed. The commonest indications for nephrostomy tube insertion were renal failure (87%) and flank pain with hydronephrosis (13%). The mean serum creatinine levels pre and post insertion were 481 and 170 umol/l, representing significant improvement (p<0.01). The complication rate was 13%, relating to tube blockage or dislodgement. Survival of patients was significantly worse if their malignancy was not resectable or suitable for chemotherapy (p=0.01). However, incurable patients still survived for a mean of 232 days, and although 46% of this time was spent as an inpatient, it did not differ significantly from the inpatient rate of curable patients (31%, p=0.1). Nephrostomy tube insertion should be considered for all palliative cases of malignant ureteric obstruction.
BONE METASTASIS AS THE FIRST MANIFESTATION OF LUNG CANCER
Authors: Kagohashi K , Satoh H , Ishikawa H , Ohtsuka M , Sekizawa K 
Published: April 2023

SUMMARYBone metastasis usually occurs late in the course of the disease, but in some patients it is the first manifestation of lung cancer. To evaluate the characteristics of patients with bone metastasis as a first manifestation of lung cancer, the medical records of 1063 patients with lung cancer between 1976 and 2001 were reviewed retrospectively. Twenty‐four (2.3%) lung cancer patients presented symptoms of bone metastasis as a first manifestation; 11 patients had bone metastasis as the only site of spread in lung cancer; 16 had adenocarcinoma; five had a primary lesion <30 mm, and nine had N0‐1 disease. Patients with sole bone metastasis did not have a more favourable survival rate than patients with bone and other systemic metastases (p=0.2938). Whether metastasis is the first manifestation of lung cancer or not, the occurrence of bone metastasis generally means a poor prognosis.
22. DIAGNOSTIC DELAYS IN BREAST CANCER AND IMPACT ON SURVIVAL
Authors: Kothari A , Fentiman IS 
Published: April 2023

SUMMARYThere is always an interval between the first symptoms, time to diagnosis and start of treatment in women with symptomatic breast cancer. Delay may be due to the patient, her general practitioner or a false negative diagnosis in hospital. A systematic overview showed that delays of 3–6 months were clearly associated with increased tumour size, advance in disease stage and poorer long‐term prognosis. Nevertheless, controversy persists regarding the impact of delay on survival. The conflicting results may be due to a difference in sample characteristics, differences in the delay interval studied or variations in the definition of delay. A major drawback of many studies was that the potential confounding effect of lead‐time bias was not taken into account. One of the largest single institution studies, designed to control for the lead‐time bias, confirmed that survival measured from both date of diagnosis and onset of patient's symptoms was worse in women with delays of >12 weeks. Within individual stages, longer delays had no adverse impact on survival. It is important to identify groups of patients at high risk of delay so that strategies can be developed and effectively targeted.
A PROSPECTIVE EVALUATION OF THE MANAGEMENT OF ACUTE PYELONEPHRITIS IN ADULTS REFERRED TO UROLOGISTS
Authors: Gujral S , Bell CR , Dare L , Smith PJB , Persad RA 
Published: April 2023

SUMMARYIn order to assess whether it is appropriate and clinically efficient to admit adults with ‘clinically diagnosed’ acute pyelonephritis (APN) under urologists, as is current practice in many NHS hospitals.a prospective study was undertaken over nine months in an NHS teaching hospital. Thirty‐nine patients with clinical APN were admitted to the urology unit; all were pyrexial and 30 (77%) had typical features of rigor, flank pain and irritative lower urinary tract symptoms. Twenty‐one (54%) had positive urine cultures, 31 (79%) had parenteral antibiotics, while another three (7%) had oral agents initially. The remaining five (14%) were continued on agents initiated by their GPs before admission. Thirty‐three (85%) had imaging procedures with eight significant anomalies being noted. Urgent invasive intervention was required in only four (10%) patients; length of stay varied from one to 25 days. Uncomplicated moderate to severe APN in adults may be treated safely without the need for admission to the urology unit, either in the outpatient setting or on an acute admissions observation ward. Complicated cases requiring intervention can be transferred to the urologist once recommended investigations have been undertaken. This care pathway may help to reduce cancellations of elective urological cases and is likely to be more cost‐effective for the NHS by reducing unnecessary admissions.
SPONTANEOUS RUPTURE OF A NORMAL SPLEEN
Authors: Paulvannan S , Pye JK 
Published: April 2023

SUMMARYA 45‐year‐old woman was admitted with a gangrenous toe. She had a pancreatico‐renal transplant for end‐stage renal disease due to type I insulin dependent diabetes three years previously and had been taking immunosuppressive agents. An epidural catheter was placed to relieve the rest pain. Next day she was found to be hypotensive and tachycardic along with other features of shock. She did not have any clinical symptoms and signs initially. Urgent blood investigations were normal except for Hb of 5.0 g/dl; an ultrasound scan showed free fluid in the peritoneal cavity. Emergency laparotomy after resuscitation confirmed a massive haemoperitoneum secondary to a ruptured spleen. Histology showed loss of areas of the capsule and other areas showing subcapsular haemorrhage with no underlying pathology in the spleen.
OMEGA‐3 FATTY ACIDS: THEIR ROLE IN THE PREVENTION AND TREATMENT OF ATHEROSCLEROSIS RELATED RISK FACTORS AND COMPLICATIONS
Authors: Bhatnagar D , Durrington PN 
Published: April 2023

SUMMARYFatty acids are an important source of energy which can have an influence on serum lipids. Omega‐3 and omega‐6 fatty acids, both polyunsaturated fatty acids, have been advocated as replacement for saturated fat. Omega‐3 fatty acids, derived from fish and certain green plants, lower serum triglycerides, but they have also been shown to have a direct effect on myocardial contractility, blood pressure, platelet function, coagulation factors, cell‐mediated immunity and markers of inflammation. Recently available clinical trial data, including those using the concentrated omega‐3 fatty acid preparation Omacor®, indicate that omega‐3 fatty acids are valuable in preventing sudden death following myocardial infarction. Studies indicate that omega‐3 fatty acids are just as effective as, or have a benefit superior to, statins in secondary prevention. Omacor is also useful in the treatment of hypertriglyceridaemia, both as monotherapy and in combination with statins.
PIMECROLIMUS: A REVIEW OF PRE‐CLINICAL AND CLINICAL DATA
Authors: Graham‐Brown RAC , Grassberger M 
Published: April 2023

SUMMARYPimecrolimus (Elidel®) is a novel cell‐selective inhibitor of inflammatory cytokines that has specifically been developed for the treatment of inflammatory skin diseases due to its favourable skin selective pharmacological profile. Therapeutic efficacy and safety of pimecrolimus cream 1 % has been established in the short‐term treatment and the long‐term management of atopic eczema in clinical studies in adults, children and infants. It rapidly relieves pruritus, and redness and swelling disappear or are only mild in up to 70% of pimecrolimus treated patients during the first three weeks. When applied at the first signs and symptoms of atopic eczema, pimecrolimus has proven to prevent flare progression and to provide superior long‐term disease control compared with a conventional treatment, based on reactive use of corticosteroids. Pimecrolimus cream 1% is well tolerated, even on sensitive areas such as the face and neck. Blood concentrations remain low, even when extensive body areas are treated and no clinically significant systemic effects have been observed during short‐ or long‐term clinical studies with pimecrolimus.
SONOGRAPHIC REPRODUCIBILITY OF A NOVEL APPROACH IN THE ASSESSMENT OF CENTRALISED ACCESS IN END‐STAGE RENAL DISEASE
Authors: Barth JD , Pahl M , Zhang L , Zonjee M , Vazeri N 
Published: April 2023

SUMMARYA reliable and accurate non‐invasive test is needed to help determine grafts and/or fistulae in end‐stage renal disease (ESRD) patients. Sonographic scanning to assess the state of the fistula and AV shunt seems underused. To find out what role B‐mode and Doppler play in the assessment of fistula and shunt, we scanned nine patients with a fistula as central access and nine patients with a graft several times over a period of a month. Diameters were measured before and after the AV shunt and Doppler measurements were made pre, inter and post shunt. We established that B‐mode measurements are reliable in predicting the future and integrity of both fistulae and grafts. Doppler measurements were less consistent and therefore less reliable. The average initial measurement showed a screen of 5.766 mm and a second measurement of 5.890 mm; The coefficient of variation (CV)/reproducibility was 1.58% for first measurement. The average first and second measurements post graft were 6.317 mm and 6.365 mm, respectively. The CV/reproducibility was 0.48%. First and second peak flow measurements averaged 149 m/s and 112 m/s, respectively, resulting in a CV of 14.0%. We conclude that morphological changes may be more reliable than Doppler values, indicating a potentially greater use for B‐mode ultrasound in predicting an open shunt and/or fistula.
EVALUATION OF THE EFFICACY, SAFETY, AND TOLERABILITY OF EZETIMIBE IN PRIMARY HYPERCHOLESTEROLAEMIA: A POOLED ANALYSIS FROM TWO CONTROLLED PHASE III CLINICAL STUDIES
Authors: Knopp RH , Dujovne CA , Le Beaut A , Lipka LJ , Suresh R , Veltri EP 
Published: April 2023

SUMMARYEzetimibe is a novel cholesterol absorption inhibitor that blocks intestinal absorption of dietary and biliary cholesterol. Data from 1719 patients who participated in two multicentre, double‐blind studies of ezetimibe were pooled to evaluate the drug's efficacy and safety in patients with primary hypercholesterolaemia. Following dietary stabilisation, a two‐ to 12‐week washout period, and a four‐week, single‐blind, placebo lead‐in period, patients were randomised to ezetimibe 10 mg or placebo once daily in the morning for 12 consecutive weeks. The primary efficacy endpoint was percent reduction in plasma low‐density lipoprotein (LDL)‐cholesterol from baseline at endpoint. Ezetimibe reduced LDL‐cholesterol by a mean of 18.2% compared with an increase of 0.9% with placebo (p<0.01) and resulted in favourable, statistically significant changes in HDL‐cholesterol, triglycerides and apo B. The response to ezetimibe was consistent across all subgroups analysed. Ezetimibe was well tolerated, with a safety profile similar to placebo. (Int J Clin Pract 2003; 57(5): 363–368)
RESULTS FROM A CARDIOVASCULAR PREVENTION CAMPAIGN IN PERSONS AGED 45–64 YEARS
Authors: Devroey D , De Swaef N , Coigniez P , Vandevoorde J , Kartounian J , Betz W 
Published: April 2023

SUMMARYThe aim of this study was to screen a target population for modifiable cardiovascular risk factors and to find out how treatment goals were achieved in the treated population. All inhabitants aged between 45 and 64 years in the town of Lede in Belgium were invited by the local authorities for a free health check‐up. In total, 629 subjects were screened. Total cholesterol ≥250 mg/dl or triglycerides ≥200 mg/dl was found in 38%, increased fasting glucose (≥110 mg/dl) in 8.6%, diabetes in 2.8%, increased systolic blood pressure (SBP) (≥=140 mmHg) in 22% and increased diastolic blood pressure (DBP) (≥90 mmHg) in 8%. The low‐density lipoprotein cholesterol (LDL‐C) target level of 115 mg/dl was attained in 13% of treated women and 34% of treated men. Target levels for SBP and DBP were attained in 40% and 75% respectively of those treated. Fasting glucose <120 mg/dl was found in 33% of the diabetic participants. (Int J Clin Pract 2003; 57(5): 430–434)
PLATELET AGGREGATION RESPONSE AND ADENOSINE TRIPHOSPHATE SECRETION AFTER ABDOMINAL TOTAL HYSTERECTOMY
Authors: Hayashi M , Kiumi F , Hoshimoto K , Ohkura T 
Published: April 2023

SUMMARYThis study was designed to clarify the quantitative relationship between platelet aggregation and the secretion of adenosine triphosphate (ATP) after surgery. Peripheral blood was collected from 41 patients who underwent abdominal total hysterectomy. Platelet count, volume, aggregation and the amount of secreted ATP were determined using live platelets before, one day after and two weeks after surgery. Platelet aggregation and ATP secretion were investigated using a lumi‐aggregometer. The aggregating reagents used were 5 μM of adenosine diphosphate (ADP) (final concentration) and 5 μg/ml of collagen. Structural alterations of platelets at these time points were also investigated by electron microscopy. Platelet aggregation induced by collagen was significantly lower (p<0.05) one day after surgery. ADP‐induced aggregation two weeks after surgery was more intense than before (p<0.05) and one day after (p<0.05) surgery. The amount of secreted ATP induced by each of ADP and collagen was significantly lower (p<0.05–0.01) one day after surgery and correlation coefficients between platelet aggregation and secretion of ATP showed lower values in both ADP‐ and collagen‐induced aggregation. One day after surgery electron microscopy showed that granule concentrations were markedly reduced in platelets. In conclusion, after consumption of circulating platelets at the site of operation, in addition to being lost by bleeding, the remaining platelets in circulation consist of platelet subpopulations different from those present before surgery, exhibiting low values of correlation coefficients between platelet aggregation and secretion of ATP and low concentrations of granules.
COMPARISON OF FINASTERIDE AND ALPHA‐BLOCKERS AS INDEPENDENT RISK FACTORS FOR ERECTILE DYSFUNCTION
Authors: Sadeghi‐Nejad H , Sherman N , Lue J 
Published: April 2023

SUMMARYThere are insufficient data on the effects of alpha‐blockers and finasteride on erectile function in men who have other risk factors for erectile dysfunction (ED). This study was conducted to compare the relative effects of these medications on ED in men who may be on other medications or have other risk factors for ED. Patients attending urology and primary care clinics were asked to complete an IRB‐approved questionnaire that combined the validated Sexual Health Inventory for Men (SHIM) and a detailed medical history. A total of 123 patients completed the questionnaire. The age range was 28–88 years (mean: 68 years). Eighty‐one per cent of patients had SHIM scores <21, indicating some degree of ED. The average SHIM scores in a population of patients with similar age and risk factors who had been on finasteride or alpha‐blockers indicated the presence of ED but did not reveal a significant difference between the two groups. The scores were no different from an age‐matched group of patients who were not on either medication, demonstrating the relatively greater importance of various other risk factors for ED. There was an inverse linear relationship between the number of ED risk factors and SHIM scores. There does not appear to be a significant difference between alpha‐blockers and finasteride as independent risk factors for ED. Age and other risk factors (heart disease, diabetes, hypertension, smoking, and hypercholesterolaemia) tend to have a much stronger influence on the severity of ED as assessed by SHIM scores.
PHAEOCHROMOCYTOMA PRESENTING AS DILATED CARDIOMYOPATHY
Authors: Attar MN , Moulik PK , Salem GD , Rose EL , Khaleeli AA 
Published: April 2023

SUMMARYPhaeochromocytomas are rare endocrine tumours that secrete excessive amounts of catecholamines and can lead to myocarditis and cardiomyopathy. We report a 63‐year‐old man with long‐standing hypertension and diabetes who presented with dilated cardiomyopathy, which was initially thought to be secondary to ischaemic heart disease. Subsequent coronary angiography was normal. Carvedilol therapy unmasked the characteristic features of phaeochromocytoma. Surgical resection of a right adrenal tumour cured his symptoms, hypertension and diabetes, as well as causing a substantial improvement in cardiac function. Phaeochromocytoma should be considered as a rare cause of dilated cardiomyopathy of uncertain aetiology.
REUSABLE VERSUS DISPOSABLE INSTRUMENTS IN TONSILLECTOMY: A COMPARATIVE STUDY OF OUTCOMES
Authors: Maheshwar A , De M , Browning ST 
Published: April 2023

SUMMARYTonsillectomy, traditionally performed using reusable instruments (RIs), has recently been performed using disposable instruments (DIs), to prevent the theoretical risk of spreading new variant Creutzfeldt‐Jakob disease. Following this, there have been concerns of increased risk of complications, especially haemorrhage. We audited our hospital's complication rates of 100 tonsillectomies performed using R| and 100 using DIs. We analysed the overall complication rates and the postoperative haemorrhage rates. and compared them with the broader groups of RIs versus DIs. We also compared patients who did not have diathermy with those who did have diathermy. The overall complication rate was 6% with RIs and 33% with DIs and the haemorrhage rate was 1% and 12%, respectively. With DIs, these rates were significantly higher in the diathermy subgroup. We believe this is the first study to look at the complications due to DIs.
KOUNIS SYNDROME SECONDARY TO ALLERGIC REACTION FOLLOWING SHELLFISH INGESTION
Authors: Zavras GM , Papadaki PJ , Kokkinis CE , Kalokairinov K , Kouni SN , Batsolaki M , Gouvelou‐Deligianni GV , Koutsojannis CM 
Published: April 2023

SUMMARYTwo cases of allergic angina and allergic myocardial infarction (Kounis syndrome) secondary to shellfish ingestion are described. The patients had pre‐existing quiescent coronary artery disease (type II variant of the syndrome) and the allergic reaction following eating shellfish seemed to have triggered the development of an acute myocardial infarction. The clinical implications are also discussed.
GLUTEAL COMPARTMENT SYNDROME MISDIAGNOSED AS DEEP VEIN THROMBOSIS
Authors: Chua HC , Lim T , Lee HC , Lee SW 
Published: April 2023

SUMMARYGluteal compartment syndrome usually occurs secondary to prolonged immobility and recumbency following alcohol and drug abuse. The resultant pain and swelling in the lower limb may be misdiagnosed as deep vein thrombosis. Once compartment syndrome is diagnosed, urgent decompression fasciotomy is required. The outcome is poor if the diagnosis is missed or delayed. We report such a case.
TREATMENT OF TOXIC EPIDERMAL NECROLYSIS WITH INTRAVENOUS IMMUNOGLOBULIN
Authors: Sidwell RU , Swift S , Yan C‐L , Porter W , Thompson EM , Clark JA , Bunker CB 
Published: April 2023

SUMMARYToxic epidermal necrolysis (TEN) is a rare severe reaction of the skin resulting in full thickness damage to the epidermis. The condition has significant morbidity as a result of dehydration, protein loss, thermoregulatory difficulties, and renal, lung, liver and heart failure. The mortality rate approaches 30%, most commonly from bacterial sepsis. Management of this condition is cessation of the suspected causative agent and supportive care on a burns or intensive care unit. There have been recent reports of treatment using intravenous immunoglobulin (IVIG) therapy, though its efficacy is yet to be established. It has been proposed that IVIG inhibits the Fas‐FasL mediated apoptosis of keratinocytes affected by TEN. We describe a case of extensive drug‐induced TEN in a 33‐year‐old woman who showed rapid improvement with IVIG therapy at a dose of 0.75 g/kg/day given for four consecutive days.
PRIONS AND DISPOSABLE SURGICAL INSTRUMENTS
Authors: Nix P 
Published: April 2023

SUMMARYSingle‐use surgical instruments have been used in the UK's ENT departments. This is in response to guidelines issued by the Department of Health and the British Association of Otolaryngologists and Head and Neck Surgeons, in order to prevent the spread of new variant Creutzfeldt‐Jakob disease (vCJD) in a young population of patients undergoing routine adenotonsillectomy. In one institution we found that the new single‐use instruments were inferior to previous standard kits and that postoperative haemorrhage rates had increased following children's tonsillectomy from 1.7% to 7.8% (p<0.01). Because of the increased reporting of complications following the use of single‐use surgical instruments for adenotonsillectomies, ENT departments in the UK are no longer obliged to use these disposable instruments. This is due to the theoretical risk of prion infection being outweighed by the actual risk to the patient from increased postoperative haemorrhage. (Int J Clin Pract 2003; 57(8): 678–680)
NASOPHARYNGEAL CARRIAGE RATE OF HAEMOPHILUS INFLUENZAE IN CHILDREN AGED 7–12 YEARS IN TURKEY
Authors: Ayyildiz A , Aktas AE , Yazgi H 
Published: April 2023

SUMMARYThis study was undertaken to determine the nasopharyngeal carriage prevalence of Haemophilus spp. in children aged 7–12 years in Erzurum, Turkey. Three hundred randomly selected students from three regions with different socioeconomic properties were included in the study. Nasopharyngeal swabs taken from the students were streaked into selective media for Haemophilus spp. Isolated colonies were identified by macroscopic and microscopic examination and their X and V factor needs determined. Those identified as H. influenzae were serotyped by specific capsule antisera. Haemophilus spp. were recovered from 51 (17.0%), nine (3.0%) of which were H. influenzae type b (Hib), 30 (10.0%) H. influenzae non‐type b, and 12 (4.0%) H. parainfluenzae. Results were evaluated by several risk factors such as age, gender, number of siblings, siblings attending a nursery, family smoking habits and family economic status.