bluuebunny/crossref_metadata_2025_split huggingface dataset:
CORONARY ARTERY DISEASE IN PATIENTS WITH RENAL FAILURE
Authors: Goldsmith DJA , Covic A 
Published: April 2023

SUMMARYCardiovascular disease is prevalent in patients with advanced renal failure or on dialysis treatment, and after renal transplantation. The risk factors for the cardiovascular problems are a mixture of conventional and novel ones. Inflammation and oxidation may be especially important in the acceleration of atherosclerosis in chronic renal failure. This article discusses these factors and gathers together the evidence for cardiovascular intervention and treatment in a group of patients whose overall mortality is high.
ALEXIA WITHOUT AGRAPHIA: A CENTURY LATER
Authors: Imtiaz KE , Nirodi G , Khaleeli AA 
Published: April 2023

SUMMARYA case of alexia without agraphia is presented. It is a rare but classic disconnection syndrome, first described by Dejerine in 1892. Recent advances in modern neuroimaging techniques such as FLAIR MRI can now localise in vivo the site of origin of the syndrome, especially when computerised axial tomogram of the brain is normal.
DICE 2: A FURTHER INVESTIGATION OF THE EFFECTS OF CHANCE IN LIFE, DEATH AND SUBGROUP ANALYSES
Authors: Clarke M , Halsey J 
Published: April 2023

SUMMARYIn an investigation into how chance might influence the distribution of deaths in a randomised trial and the time of those deaths, and to highlight the possible dangers of subgroup analyses, 100 randomised controlled trials were simulated and 50 subgroup pairs were simulated for some of these trials. Each of 580 control patients from a colorectal cancer trial was randomly coded to simulate allocation to treatment or control, the main outcome measure being time to death. Not surprisingly, most of the 100 trials gave non‐significant results. Four were conventionally significant with logrank 2p‐values of less than 0.05. The most extreme result was associated with a logrank 2p‐value of 0.003, showing an absolute reduction in four‐year mortality of 40% (SD 15) for patients allocated to treatment. One of the simulated prognostic factors for this trial (subgroup 13) showed that mortality for one type of patient was non‐significantly slightly increased by treatment, whereas treatment reduced four‐year mortality by 64% (SD 16) among the other patients in the trial (2p=0.00006). Similar, extreme results were found for a trial of borderline statistical significance overall. Chance can influence the overall results of any randomised controlled trial, regardless of how well it is conducted, and can play an even more powerful role in the results of subgroup analyses. This should be borne in mind both by trialists when reporting their results and by readers and reviewers of those reports.
AETIOLOGY AND TREATMENT OF HYPERHOMOCYSTEINAEMIA CAUSING ISCHAEMIC STROKE
Authors: Sarkar PK , Lambert LA 
Published: April 2023

SUMMARYRecent studies have shown that hyperhomocysteinaemia is a common, independent and easily modifiable risk factor for atherosclerotic and thromboembolic diseases such as cerebrovascular disease, coronary artery disease and venous thrombosis. The vascular risk rises continuously across the spectrum of elevated plasma homocysteine concentrations. It is at least as important as cholesterol, lipoprotein abnormalities and hypertension and should be part of risk assessment, especially those at high risk. Moderately elevated plasma homocysteine concentration is readily correctable by folic acid, betaine, or vitamin B12 supplementation. It seems logical to assume that a reduction in homocysteine concentration will reduce the risk of ischaemic stroke, but there are as yet no published data to prove this. This review will discuss the aetiology and possible treatment of hyperhomocysteinaemia causing ischaemic stroke.
C‐REACTIVE PROTEIN
Authors: Rosalki SB 
Published: April 2023

SUMMARYC‐reactive protein (CRP) is a protein whose concentration in serum is increased in response to inflammatory stimuli. Increased levels serve to identify organic disease, monitor disease activity and assist differential diagnosis. High values are observed early in bacterial infections, active rheumatoid disease, Crohn's disease, acute myocardial infarction and after major trauma. In patients with ischaemic chest pain, a raised CRP value on hospital admission is associated with an adverse prognosis. In apparently healthy individuals, a raised CRP value indicates an increased risk of developing atherosclerotic vascular disease, but also increased benefit from aspirin prophylaxis and treatment of hyperlipidaemia.
A STUDY OF THE APPROPRIATENESS OF ANTIBIOTIC USE IN THE MEDICAL WARDS OF A TERTIARY TEACHING HOSPITAL IN MALAYSIA
Authors: Hooi PY , Yong CM , Cheong I 
Published: April 2023

SUMMARYA prospective study was conducted to determine the proportion of patients who received an antibiotic within 12 hours of admission to the medical wards. During the four‐week study, 234 patients were admitted to medical wards from casualty; 68 patients (29%) received an antibiotic. The survey indicated that antibiotics were inappropriate in 22–65% of those treated. This study also shows that as many as 67% of patients who received intravenous antibiotics could have been equally well treated with oral preparations.
MOXIFLOXACIN VERSUS AMOXYCILLIN CLAVULANATE IN THE TREATMENT OF ACUTE MAXILLARY SINUSITIS: A PRIMARY CARE EXPERIENCE
Authors: Rakkar S , Roberts K , Towe BE , Elores SM , Heyd A , Warner J 
Published: April 2023

SUMMARYIn this prospective, multicentre, randomised, non‐blinded phase III clinical trial, 475 adult patients with acute sinusitis received a 10‐day oral regimen of either moxifloxacin (400 mg once daily) or amoxycillin clavulanate (875 mg twice daily). The primary measure of efficacy was clinical resolution. Secondary outcome measures included clinical relapse at follow‐up and evaluation of patient reported outcomes. Of 471 adults comprising the intent‐to‐treat population (234 moxifloxacin, 237 amoxycillin/clavulanate), moxifloxacin treatment was statistically equivalent to amoxycillin/clavulanate at the test‐of‐cure visit (85% vs 82%; 95% CI ‐6%, 13%). Analysis of the efficacy evaluable population, confirmed statistical equivalence (86% vs 84 %; 95% CI ‐7%, 13%). Of note, by day 3 of treatment, significantly more moxifloxacin‐treated patients (n=47; 24%), than amoxycillin/clavulanate‐treated patients (n=28; 14%), reported feeling better (p<0.02). Frequency of drug‐related adverse events were similar between groups: nausea (11% moxifloxacin, 5% amoxycillin/clavulanate) and diarrhoea (3% moxifloxacin, 10% amoxycillin clavulanate). In conclusion, once‐daily moxifloxacin is as effective and safe as twice‐daily amoxycillin/clavulanate in the treatment of acute sinusitis. Moxifloxacin is associated with more rapid symptomatic relief.
SEVERE BRADYARRHYTHMIA IN A PATIENT WITH ALZHEIMER'S DISEASE AND A PATIENT WITH CEREBRAL ISCHAEMIA, BOTH INDUCED BY ACUTE DISTENSION OF THE BLADDER
Authors: Koch HJ , Szecsey A , Raschka C 
Published: April 2023

SUMMARYTwo case reports are presented of bradycardia in two elderly patients, which was resistant to atropine but which resolved immediately the acute bladder distension was treated. Generally, a sympathetic cardiac response is expected, and this paradoxical response may be due not only to lesions of the reflex loop involving both the vagal and the sympathetic nerves, but also to endocrinological factors. As acute urinary distension is not uncommon on geriatric wards, bradyarrhythmia due to bladder distension should be considered in elderly patients.
XELODA® IN COLORECTAL CANCER
Authors: Cassidy J 
Published: April 2023

SUMMARYXeloda® (capecitabine) is a rationally designed, oral pro‐drug of 5‐fluorouracil (5‐FU). It is rapidly and almost completely absorbed in the upper gastrointestinal tract. It is then catabolised in a three‐enzyme system, the last step being catalysed by thymidine phosphorylase, which is upregulated in many human cancers. Clinical pharmacology studies have confirmed that this preferential activation actually occurs in human colorectal cancer. Phase I and II trials were performed in colorectal cancer to define the optimal dose and schedule of capecitabine. In two large scale phase III studies this agent has been shown to be at least as effective as a standard regimen of bolus 5‐FU and leucovorin (Mayo regimen). Response was superior in the capecitabine arms of these studies with equivalence of progression‐free and overall survival. In addition the oral regimen was associated with significantly less toxicity. It seems likely that this agent will replace intravenous 5‐FU in the therapy of colorectal cancer and possibly in other cancers.
TREATMENT OF INSOMNIA WITH ZALEPLON, A NOVEL SLEEP MEDICATION
Authors: Doghramji PP 
Published: April 2023

SUMMARYInsomnia is a highly prevalent sleep problem that often results in poor daily functioning of the affected patient. Unfortunately, sedative hypnotic agents prescribed in the past often resulted in residual sedation, as well as impairment of cognitive and psychomotor performance, throughout the day after use. Newer agents with relatively rapid elimination require administration regularly each night before bedtime if symptoms of insomnia are to be prevented and next‐day sedation is to be avoided. The availability of zaleplon challenges these standards of practice. The rapid elimination of zaleplon, combined with its unique receptor binding affinity, permits 10 mg of zaleplon to be taken at bedtime or later in the night with minimal concern for next‐day residual effects. Clinical studies of zaleplon also identified the low risk of withdrawal syndrome or rebound insomnia after the discontinuation of nightly use. If used only on the nights when symptoms actually occur, the occurrence of such problems with zaleplon will be minimal.
A HARD THYROID MASS DUE TO PLASMA CELL GRANULOMA
Authors: Chong JSW Li Voon , Burrows CT , Cave‐Bigley D , Macfarlane IA 
Published: April 2023

SUMMARYPlasma cell granuloma involving the thyroid is very rare. A 29‐year‐old man with type 1 diabetes mellitus presented with a one‐week history of fever, sore throat, neck tenderness and dysphagia. Antibiotics were given but over the next two weeks a hard 8 cm mass in the left lobe of the thyroid developed. Fine needle aspiration was not diagnostic and surgical exploration revealed an inflammatory process arising from the left lobe of the thyroid involving the left sternothyroid muscle and parapharyngeal spaces. Histology of multiple biopsies showed plasma cell granuloma. Immunoperoxidase staining demonstrated the presence of IgG, IgM and IgA with predominance of IgG. The residual mass resolved and was impalpable after four weeks. Plasma cell granuloma should be suspected when there is a rapidly developing hard thyroid mass. Open biopsy/removal and histological confirmation are mandatory and residual disease may resolve within weeks.
LYMPHANGIOMA PRESENTING AS A NECK MASS IN THE ADULT
Authors: Moxo C De Casso , Lewis NJ Eynon , Rapado F 
Published: April 2023

SUMMARYLymphangiomas are uncommon congenital lesions of the lymphatic system which usually present in childhood. We report a case of adult lymphangioma, localised in the neck, and discuss the presentation, diagnosis and management of this tumour.
UNSTABLE ANGINA FOLLOWING ACUTE MI IN A PATIENT WITH BILATERAL CORONARY ARTERY FISTULAE: AN UNUSUAL PRESENTATION OF CORONARY STEAL?
Authors: Chin B , Spencer CGC , Lip GYH 
Published: April 2023

SUMMARYWe report a 57‐year‐old woman with acute myocardial infarction and cardiac arrest who subsequently developed unstable angina. The possibility of a coronary steal syndrome contributing to her unstable angina arises in view of the presence of bilateral coronary artery fistulae between two atherosclerotic coronary arteries and the main pulmonary artery.
AVASCULAR NECROSIS OF BONE: THE HIDDEN RISK OF GLUCOCORTICOIDS USED AS ANTIEMETICS IN CANCER CHEMOTHERAPY
Authors: Virik K , Karapetis C , Droufakou S , Harper P 
Published: April 2023

SUMMARYThe role of antiemetics is invaluable in allowing cancer patients to complete otherwise potentially intolerable chemotherapy. Corticosteroids have an established place in the prevention and treatment of nausea and vomiting due to emetogenic cytotoxic agents. Avascular necrosis of bone is a recognised complication of glucocorticoid treatment – the risk of this increasing with higher doses and longer duration of use. This report details a case of bilateral avascular necrosis of the femoral heads in a patient receiving ‘standard’ doses of dexamethasone as part of the antiemetic regimen used in cisplatin‐based combination chemotherapy.
THE PREVALENCE OF PRE‐ECLAMPSIA AND OBSTETRIC OUTCOME IN PREGNANCIES OF NORMOTENSIVE AND HYPERTENSIVE WOMEN ATTENDING A HOSPITAL SPECIALIST CLINIC
Authors: Lydakis C , Beevers M , Beevers DG , Lip GYH 
Published: April 2023

SUMMARYTo study the prevalence of pre‐eclampsia (PE) and other obstetric outcomes (growth restriction and fetal mortality) in pregnancies of normotensive and hypertensive women attending an antenatal hypertension clinic, we studied a cohort of 372 pregnancies from 267 women. The prevalence of PE in the groups of pregnancies of normotensive and chronic hypertensive women was 11.9% (19/159 cases) and 16.0% (34/213 cases) respectively (χ2=1.2, p=0.27). There were no significant differences in respect of ethnicity, being primi‐ or multigravida and smoking status or age. Treatment with antihypertensive drugs during pregnancy did not decrease the prevalence of PE. In pregnancies with hypertensive complications (with or without PE) there was a trend towards higher rates of pre‐term delivery (<37 weeks), caesarean section, small for gestational age babies, stillbirth and lower baby birth weight and ponderal index values. Pregnancies in women with uncomplicated hypertension had an increased risk for emergency caesarean section, pre‐term delivery (<37 weeks), birth weight <2500 g and stillbirth (relative risks [with confidence intervals] 2.5 [1.9–3.2], 2.3 [1.8–2.9], 3.1 [2.5–3.7] and 5.5 [2.6–11.9] respectively) compared with the general hospital obstetric population. After classification according to the type of hypertensive syndrome, a progressively higher risk for fetal growth restriction and adverse perinatal outcome was shown in the hypertensive and pre‐eclamptic groups. In chronic hypertension, this was irrespective of superimposed pre‐eclampsia or antihypertensive therapy. The high prevalence of PE in chronic hypertensive women (16.0%) was not statistically significant to that of normotensive women (11.9%), reflecting the referral selection of ‘high risk’ normotensive women to our clinic.
THE TOXIC OIL SYNDROME: 20 YEARS ON
Authors: Diggle GE 
Published: April 2023

SUMMARYWith hindsight, it is easy to criticise the standards of food regulation of two decades ago. Nevertheless, when the Spanish toxic oil syndrome (TOS) appeared in 1981, there were many who asked why aniline was permitted as an official adulterant for imported French rape seed oil, and why such adulterated oils were often illegally refined in Spain and marketed without difficulty. This review brings up to date a comprehensive survey of the ensuing research published in 1995 and concentrates on recent significant findings. These include the identification of the refinery that produced the toxic oil, and the detection of oil contaminants with possible aetiological significance. Possible chemical links have been found between oil contaminants and those detected in L‐tryptophan implicated in the eosinophilia‐myalgia syndrome (EMS). There is good evidence that the initial pathogenetic mechanism is immunological. On metabolic evidence, it is suggested that not one, but a group of, toxic agents was responsible for TOS.
RESEARCH INTO COMPLEMENTARY/ALTERNATIVE MEDICINE: AN ATTEMPT TO DISPEL THE MYTHS
Authors: Ernst E 
Published: April 2023

SUMMARYThe high level of popularity of complementary/alternative medicine (CAM) renders rigorous research into its efficacy and safety an important task. A House of Lords select committee called for more CAM research and for the establishment of UK centres of excellence to carry it out. In view of the otherwise dire funding situation, this would be a necessary step. This initiative should be complemented by CAM professional bodies setting up their own research budgets. Any central body overseeing CAM research has to be seen to be rigorous and impartial. Strong opinions which often dominate CAM can be a hindrance to good research. Evidence‐based CAM should no longer remain a contradiction in terms.
SUPERFICIAL RADIAL NEUROPATHY FOLLOWING VENEPUNCTURE
Authors: Sheu J‐J , Yuan R‐Y 
Published: April 2023

SUMMARYA 42‐year‐old female suffered excruciating pain and paraesthesia on venepuncture of the cephalic vein in her left wrist. The left superficial radial nerve was injured. A flexed wrist during venepuncture renders the superficial radial nerve immobile and vulnerable to being punctured by the needle. To reduce the risk of nerve injury during venepuncture, the phlebotomist should choose a large and visible vein and insert the needle at a 5–15° angle with the skin. The wrist should be selected only if the veins in the antecubital area are deemed unsuitable. The feeling of an electric shock along the distribution of the nerve, or rupture of the vein during venepuncture, should alert the phlebotomist to the possibility of nerve injury and the procedure should be stopped immediately.
AGE OF SEIZURE ONSET IN ADULTS WITH DOWN'S SYNDROME
Authors: Puri BK , Ho KW , Singh I 
Published: April 2023

SUMMARYIn a cohort of 68 adults (35 males and 33 females) with Down's syndrome aged 29–83 years, a history of seizures was found in 26.5%. The overall mean age of onset of seizures was 37 years, males (22 years) being significantly younger than females (51 years). The age of onset was bimodally distributed, with the first peak occurring in the first two decades, and a late‐onset peak occurring in the fifth and sixth decades. A strong association between Alzheimer's disease and seizures was confirmed. Of those with a history of seizures, those aged over 45 years were significantly more likely to develop Alzheimer's disease than those younger than 45. It is suggested that late‐onset epilepsy in Down's syndrome is associated with Alzheimer's disease, while early‐onset epilepsy is associated with an absence of dementia.
STANDARD CARDIAC REHABILITATION IS LESS EFFECTIVE FOR DIABETICS
Authors: Suresh V , Harrison RA , Houghton P , Naqvi N 
Published: April 2023

SUMMARYTo assess clinical outcomes and lifestyle modifications in diabetic patients attending a standard cardiac rehabilitation programme following myocardial infarction (MI), a retrospective longitudinal study was undertaken in a district general hospital in the north west of England. A total of 1804 patients attended the cardiac rehabilitation programme over 10 years, of whom 223 (12.4%) had diabetes mellitus. Drugs were underprescribed in all patients, aspirin and beta‐blockers especially in diabetics (75.3% vs 90.3%, p<0.0001; 38.6% vs 60.8%, p<0.0001). Smoking cessation was poor in diabetics (54.2% vs 69.1%, p<0.003) and diabetics were less likely to attend at least one session of physiotherapy (26.9% vs 58.6%, p<0.0001). Diabetics had higher mortality at one year (15.7% vs 5.6%; p<0.0001), mostly associated with cardiovascular disease (13.4% vs 5.4%, p<0.0001). Standard cardiac rehabilitation programmes appear to be less effective for patients with diabetes mellitus. We suggest that patients presenting with an existing chronic condition need specialised programmes of rehabilitation to integrate the care of that condition with their recent MI. Aggressive drug therapy following acute MI should also be prescribed in all patients when not contraindicated by other evidence.
PRIMARY BRAIN TUMOURS: A REVIEW OF RESEARCH AND MANAGEMENT
Authors: Turini M , Redaelli A 
Published: April 2023

SUMMARYThe brain is an incredibly complex organ that contains some 10 billion working cells. Brain tumours can arise from the brain itself, the meninges, the nerves at the base of the brain, or even from outside the brain. The frequency of brain tumours directly reflects the relative proportion of each cell type present at the site of the initial tumour. Symptoms produced by a brain tumour often mimic the symptoms of other diseases and vice versa. Because symptoms can develop gradually, and can be subtle, there may well be a long delay between symptom onset and diagnosis. Treatment of brain tumour depends on the type and stage of the disease, and the patient's age and overall state of health. Treatment options fall into three categories: surgery, radiotherapy and chemotherapy. Biological therapy is also being studied in clinical trials. Primary brain tumours occur in all age groups, but are significantly more frequent in children and adolescents under 15 years old and the elderly. For every person diagnosed with a brain tumour (over 100,000 people annually in the US), an average of 22 years of life expectancy is lost. The estimated annual cost, direct and indirect, of the disease in the US is $104 billion.
THALAMIC TUMOUR PRESENTING AS FRONTAL LOBE DYSFUNCTION
Authors: Nagaratnam N , Ting A , Jolley D 
Published: April 2023

SUMMARYA 64‐year‐old man presented with a change in personality and behaviour but with no neurological deficits. He exhibited impaired executive functions, apathy, unsteadiness of gait and falling; he lacked insight and exhibited purposeless behaviour, making loud grunting noises. A CT scan at 6 months revealed no abnormality, but at 9 months CT and MRI showed a bilateral thalamic tumour. The presenting symptoms had similarities to frontal lobe dysfunction progressing to dementia.
EPIDEMIOLOGY, MORBIDITY, MORTALITY AND TREATMENT OF LIGHTNING INJURIES IN A TURKISH BURNS UNITS
Authors: Aslar A Kessaf , Soran A , Yildiz Y , Isik Y 
Published: April 2023

SUMMARYDeaths from lightning injuries are infrequent – 0.2–0.8 per million per year. The victims are mostly young, active people who are struck during various outdoor activities in the summer months. From November 1975 to October 1998; 22 lightning burns were treated in Ankara Numune Teaching and Research Hospital. The mean age of the patients was 32.9 (12–65) years, the female/male ratio 9/13 and the mean duration of hospital stay 15.4 (1–62) days. The commonest clinical symptoms were confusion, amnesia (5 patients), neurological dysfunction (2 patients), cystitis (4 patients), and cardiac arrhythmias (1 patient). There were no deaths. Sixteen surgical procedures were carried out on 14 patients; this was significantly fewer than from any other cause of burns. The commonest long‐term complication was chronic pain. Because complications are frequently seen in lightning injuries, our results revealed that patients should be hospitalised and treated as soon as possible after the accident with fluid resuscitation, cardiac resuscitation, tetanus prophylaxis and antibiotics where necessary.