bluuebunny/crossref_metadata_2025_split huggingface dataset:
DOUBLE‐BLIND STUDY COMPARING THE LONG‐TERM EFFICACY OF THE COX‐2 INHIBITOR NIMESULIDE AND NAPROXEN IN PATIENTS WITH OSTEOARTHRITIS
Authors: Kriegel W , Korff KJ , Ehrlich JC , Lehnhardt K , Macciocchi A , Moresino C , Pawlowski C 
Published: April 2023

SUMMARYThis double‐blind one‐year study compares the long‐term efficacy and safety of nimesulide with naproxen in patients with osteoarthritis (OA) of the knee or hip. Patients were randomised to nimesulide 100 mg twice daily (n=183) or naproxen 250 mg morning, 500 mg evening (n=187). The primary efficacy variable was change in pain intensity (WOMAC A scale) at 6 months. Nimesulide tablets showed at least equivalent efficacy to naproxen tablets in reducing pain intensity at 6 and 12 months (nimesulide ‐22.5% at 6 and 12 months; naproxen ‐22.4% at 6 months, ‐19.9% at 12 months; non‐inferiority proven). At 6 months the investigator assessed efficacy as ‘good’ or ‘excellent’ in 59.3% of nimesulide and 56.4% of naproxen‐treated patients, with corresponding values for patient assessment of 57% and 52.7%. Both treatments were well tolerated, with fewer related gastrointestinal adverse events reported with nimesulide (77 cases, 47.5%) than with naproxen (96 cases, 54.5%). This study shows nimesulide to be as effective as naproxen in the long‐term treatment of OA and to be associated with fewer gastrointestinal side‐effects.
TREATMENT GOALS IN IRRITABLE BOWEL SYNDROME
Authors: Kellow JE 
Published: April 2023

SUMMARYIrritable bowel syndrome (IBS) carries a considerable economic and social impact which may, in part, be due to inefficient diagnosis and inappropriate treatment choice leading to continued patient ill health and absenteeism. Even assuming that IBS can be diagnosed positively, using well‐established symptom‐based criteria, management difficulties remain. Thus, pharmacological treatment choice is still based on the single predominant symptom, and many currently available treatments are ineffective in the long term. A greater understanding of the pathophysiology of IBS may lead to the development of more effective treatments that can target the multiple symptoms present in IBS. A new understanding of the role of serotonin (5‐HT) and specific receptors (5‐HT3 and 5‐HT4) found in the gastrointestinal (GI) tract has led to the development of serotonergic agents which have potential clinical benefits. Recent clinical trials suggest that 5‐HT4 receptor partial agonists, in particular, may have the ability to offer multiple symptom relief, without the risk of significant adverse reactions.
PATIENT SATISFACTION WITH RIZATRIPTAN VERSUS OTHER TRIPTANS: DIRECT HEAD‐TO‐HEAD COMPARISONS
Authors: Gerth WC , McCarroll KA , Santanello NC , Vandormael K , Zhang Q , Mannix LK 
Published: April 2023

SUMMARYThis study summarises the impact of treatment with rizatriptan 10 mg versus other 5‐HT1B/1D receptor agonists (triptans) on patient satisfaction with medication. Rizatriptan is a potent, selective 5‐HT1B/1D receptor agonist shown to be fast, effective and well tolerated in the acute treatment of migraine. We investigated patients' overall satisfaction with treatment in studies in which direct comparisons with other triptans were made. Data from five double‐blind, placebo‐controlled trials in which rizatriptan 10 mg was compared with another triptan were included in the analysis. Rizatriptan 10 mg was compared with sumatriptan 100 mg in one parallel study (n=916), sumatriptan 50 mg in two crossover studies (n=1599), naratriptan 2.5 mg in one parallel study (n=502), and zolmitriptan 2.5 mg in one parallel study (n=701). Satisfaction was reported by patients on a seven‐point scale ranging from ‘completely satisfied, couldn't be better’ to ‘completely dissatisfied, couldn't be worse’ at 2 hours after dosing. The percent of patients in the top two ‘satisfied’ categories (completely or very satisfied) were analysed. More patients on rizatriptan 10 mg were completely or very satisfied compared with sumatriptan 100 mg (33% vs 26%, p<0.05), sumatriptan 50 mg (40% vs 35%, p<0.05), naratriptan 2.5 mg (33% vs 19%, p<0.01), and zolmitriptan 2.5 mg (38% vs 30%, p<0.05). In all five studies more patients treated with rizatriptan 10 mg or other triptans were completely or very satisfied with treatment than patients receiving placebo (p<0.001, except naratriptan vs placebo p=0.004). The results, combined with the superior efficacy profile (fast, effective, well tolerated) of rizatriptan 10 mg, should enhance the treatment of migraine headache and lead to improved therapeutic intervention in clinical practice.
EICOSAPENTAENOIC ACID IN TREATMENT‐RESISTANT DEPRESSION ASSOCIATED WITH SYMPTOM REMISSION, STRUCTURAL BRAIN CHANGES AND REDUCED NEURONAL PHOSPHOLIPID TURNOVER
Authors: Puri BK , Counsell SJ , Hamilton G , Richardson AJ , Horrobin DF 
Published: April 2023

SUMMARYThe n‐3 essential fatty acid eicosapentaenoic acid (EPA) was added to the conventional antidepressant treatment of a treatment‐resistant severely depressed and suicidal male patient with a seven‐year history of unremitting depressive symptoms. The niacin skin flush test and cerebral magnetic resonance scanning were carried out at baseline and nine months later. The addition of ethyl‐EPA led to a dramatic and sustained clinical improvement in all the symptoms of depression, including a cessation of previously unremitting severe suicidal ideation, within one month. Symptoms of social phobia also improved dramatically. During the nine‐month period the volumetric niacin response increased by 30%, the relative concentration of cerebral phosphomonesters increased by 53%, and the ratio of cerebral phosphomonesters to phosphodiesters increased by 79%, indicating reduced neuronal phospholipid turnover. Registered difference images showed that the EPA treatment was accompanied by structural brain changes including, in particular, a reduction in the lateral ventricular volume.
SUPRAVENTRICULAR TACHYCARDIA WITH HYDROPS IN A 27‐WEEK PREMATURE BABY
Authors: Abraham P 
Published: April 2023

SUMMARYA 27‐week baby with antenatally diagnosed supraventricular tachycardia (SVT) and hydrops fetalis was delivered by emergency caesarean section because of severe fetal bradycardia. The mother was on flecanide to control the fetal SVT. The baby was hydropic at birth and required prolonged ventilatory support. On day 6, he developed acute renal failure for which peritoneal dialysis was done. On day 23, he developed several episodes of supraventricular tachycardia (SVT) which did not respond to intravenous adenosine and amiodarone and ultimately required intravenous flecanide. This case report highlights the management of a critically ill premature hydropic baby with resistant SVT, and the successful outcome.
SEAT‐BELT SYNDROME REVISITED
Authors: Thompson NS , Date R , Charlwood AP , Adair IV , Clements WDB 
Published: April 2023

SUMMARYThis report describes a complex syndrome of injuries occurring in a young female who was a back seat passenger wearing a lap‐belt restraint in a high‐speed road traffic accident. As a consequence of the forced flexion distraction injury of her lumbar spine, she sustained a fracture‐subluxation of the first lumbar vertebra in association with a jejunal perforation and extensive small intestinal mesenteric laceration. She also had a large traumatic hernia of the anterior abdominal wall, which was overlooked at primary laparotomy. This report highlights collectively the classical combination of injuries associated with the lap‐belt syndrome and demonstrates the importance of carefully inspecting the anterior abdominal wall for deficiencies, because traumatic herniation may be easily overlooked.
THE RELATIONSHIP BETWEEN EXPRESSION OF P53/BCL‐2 AND HISTOPATHOLOGICAL CRITERIA IN BREAST INVASIVE DUCTAL CARCINOMAS
Authors: Gursan N , Karakök M , Sari I , Gursan  
Published: April 2023

SUMMARYSeventy‐five cases of invasive ductal carcinoma (IDC) on whom axillary lymph node dissection and mastectomy were performed between 1996 and 2000 were reviewed histopathologically. The slides were stained immunohistologically with p53 and Bcl‐2. In 40 cases we observed 53% Bcl‐2 and 69% p53 positivity. There were correlations between p53 and tumour grade, and also between p53 and Bcl‐2. We did not observe any connection between the main histopathological prognostic factors – lymph node metastasis, tumour size, tubule formation, pleomorphism – and p53/Bcl‐2. In our study, IDC with a high mitotic index and poor differentiation showed mutant p53 positive staining. Expression of Bcl‐2 is associated with low nuclear grade and absence of mutant p53. This study was designed to reveal the correlation between histopathological findings and the expression of p53/Bcl‐2 on prognosis.
CONVULSIVE SYNCOPE IN YOUNG ADULTS: THINK OF A CARDIAC CAUSE
Authors: Patel SJ , Jackson G , Marshall A 
Published: April 2023

SUMMARYConvulsive syncope is often misdiagnosed as epilepsy because of its similarity in clinical presentation. We present the case of a patient who had several such episodes before a definitive diagnosis was made. The diagnosis of prolonged sinus arrest was finally made with the valuable assistance of cardiac monitoring during a witnessed episode of convulsive syncope. Appropriate therapy was prompty introduced, i.e. temporary then permanent cardiac pacing. It is possible that any further delay in reaching the correct diagnosis and delivering appropriate treatment might have carried a significant risk of morbidity and mortality. Continuous electrocardiographic monitoring performed at an early stage is therefore crucial in the initial assessment of a young adult presenting with convulsive syncope, as a significant proportion may have a cardiovascular aetiology, particularly arrhythmias, for their syncopal episodes.
CONCURRENT MYELITIS AND GUILLAIN‐BARRÉ SYNDROME AFTER VARICELLA INFECTION
Authors: Chua HC , Tjia H , Sitoh YY 
Published: April 2023

SUMMARYMyelitis and Guillain‐Barré syndrome occurring concurrently after varicella infection is very rare. A 34‐year‐old man presented with progressive flaccid tetraparesis, facial palsy, respiratory failure, sensory loss and urinary incontinence one week after varicella infection. Clinical, imaging and electrodiagnostic studies supported the diagnosis of myelitis and Guillain‐Barré syndrome. He improved with intravenous acyclovir and gammaglobulin.
THE USE OF INTRAVASCULAR ULTRASOUND IMAGING FOR THE ASSESSMENT OF LEFT MAIN STEM CORONARY DISEASE BEFORE BYPASS SURGERY
Authors: Skyrme‐Jones RAP , Mottram P , Meredith IT 
Published: April 2023

SUMMARYCoronary angiography has well‐known limitations in the assessment of coronary artery disease, many of which are overcome using intravascular ultrasound (IVUS). While these limitations are particularly pronounced in the left main stem coronary artery, it is in this anatomical location that a correct decision regarding treatment modality has the most prognostic relevance to the patient. In this case report we demonstrate the importance of considering IVUS imaging in patients with apparent ostial and proximal left main stem disease before coronary bypass surgery.
CORONARY BYPASS GRAFTING IN SOUTH THAMES: THE CORRELATION BETWEEN CLINICAL SCORES AND WAITING TIMES
Authors: Chambers JB , Buckle R , Smeeton N 
Published: April 2023

SUMMARYTo determine waiting times before surgery and their correlation with clinical need, we examined the files of 1049 patients on the waiting list for coronary bypass grafting in 1996. The total waiting time to bypass grafting was 279 (SD 209) days (range 1–1579 days). Waiting time to specialist consultation was 36 (SD 43) days, and time on the waiting list for coronary angiography was 85 (SD 89) days. The mean time on the surgical waiting list was 133 (SD 134) days. Patients with a Birmingham clinical score below 10 waited between 27 and 879 days, and patients with scores above 35 waited between 3 and 282 days. Total waiting time was weakly associated with the priority score (Pearson correlation = ‐0.51). We conclude that waiting times were long with wide variation at every stage between referral and coronary bypass grafting. There was little correlation between clinical scores and waiting times.
THE SAFETY AND EFFICACY OF FORMOTEROL (OXIS®) TURBUHALER® PLUS BUDESONIDE (PULMICORT®) TURBUHALER IN MILD TO MODERATE ASTHMA: A COMPARISON WITH BUDESONIDE TURBUHALER ALONE AND CURRENT NON‐CORTICOSTEROID THERAPY IN RUSSIA
Authors: Chuchalin AG , Ovcharenko SI , Goriachkina LA , Sidorenko IV , Tsoi AN ,   Epoch Study Group
Published: April 2023

SUMMARYCurrent therapy in Russia for long‐term management of asthma is mainly non‐steroidal. This provided the opportunity to compare the efficacy and safety of formoterol (Oxis®) Turbuhaler® plus budesonide (Pulmicort®) Turbuhaler with budesonide Turbuhaler alone in adults (n=338) with mild to moderate asthma who had little previous exposure to inhaled corticosteroids. The 12‐week study followed a randomised, double‐blind, parallel group design and included an open control group of patients who were treated with conventional non‐corticosteroid therapy. Patients treated with formoterol plus budesonide benefited from a significantly greater improvement in their pulmonary function and asthma symptoms compared with budesonide alone (95% CI of difference in mean morning peak expiratory flow [PEF] 8.7–36.3 l/min, p=0.0015). Non‐corticosteroid treatment was significantly less effective than formoterol plus budesonide and budesonide alone (95% CIs of differences in mean morning PEF were 36.4–63.6 l/min and 14.1–41.1 l/min, respectively, both p=0.0001). Although the incidence and frequency of adverse events was not significantly different between the groups, formoterol plus budesonide and budesonide alone were better tolerated than non‐corticosteroid treatment, and there were fewer incidences of asthma deterioration. Overall, formoterol Turbuhaler plus budesonide Turbuhaler was the safest and most effective treatment.
THE MANAGEMENT OF METASTATIC BONE PAIN IN A DEVELOPING COUNTRY: THE ROLE OF RADIOTHERAPY AS AN ADJUNCT TO WEAK OPIOIDS
Authors: Adenipekun A , Alonge TO , Campbell OB , Oyesegun AR , Elumelu TN 
Published: April 2023

SUMMARYBone pain secondary to metastatic cancer is the commonest intractable pain and is a major concern in most oncology units the world over. Cancer pain management is multidisciplinary in approach, so there is no universal or singular modality of treatment. In a developing country like Nigeria, only external radiotherapy and adjuvant weak opioids are readily available, so it is of interest to review the response of these patients to this management option. This is a retrospective review of 92 patients aged 16–80 years with radiologically confirmed metastatic bone disease associated with pain who received external radiotherapy and weak analgesics. The results showed that 23 (25%) patients had a complete response and 67 (73%) had a partial response within four weeks of treatment. Total response was over 90%, which suggests external radiotherapy has an effective palliative role. The study also demonstrated the pattern of bony involvement among the common cancers seen in our environment. The availability of strong opioids (e.g. morphine and pethidine) will obviously consolidate the gains achieved with external radiotherapy in the management of metastatic bone pain in our environment.
TEGASEROD: A NOVEL, SELECTIVE 5‐HT4 RECEPTOR PARTIAL AGONIST FOR IRRITABLE BOWEL SYNDROME
Authors: Beglinger C 
Published: April 2023

SUMMARYIrritable bowel syndrome (IBS) is a common functional bowel disorder of unknown aetiology. It is defined by the presence of gastrointestinal (GI) symptoms including abdominal pain/discomfort, bloating and bowel motor dysfunction. No available therapy is yet effective against all the symptoms of the disorder. Current treatments therefore target individual symptoms but may be accompanied by unpleasant side‐effects. Tegaserod is a novel selective serotonin receptor type‐4 (5‐HT4) partial agonist with structural similarity to 5‐HT. Tegaserod stimulates small bowel and colonic motility and helps to normalise GI function. Clinical trials using a patient's assessment of efficacy demonstrate that tegaserod significantly improves key symptoms of IBS: abdominal pain/discomfort, bloating and constipation. Tegaserod is well tolerated with an excellent safety profile and represents a significant treatment advance in this difficult‐to‐treat disorder.
THE MRC/BHF HEART PROTECTION STUDY: PRELIMINARY RESULTS
Authors: Owen Olwen Glynn 
Published: April 2023

SUMMARYThe Heart Protection Study (HPS), with over 20,500 subjects, is the largest trial of statin therapy ever conducted. It provides important and definitive new information on women, the elderly, diabetics, and people with low baseline cholesterol pre‐treatment and those with prior occlusive non‐coronary vascular disease. It is a prospective double blind randomised controlled trial with a 2×2 factorial design investigating prolonged use (>5 years) of simvastatin 40 mg and a cocktail of antioxidant vitamins (650 mg vitamin E, 250 mg vitamin C and 20 mg beta‐carotene). The HPS specifically included patients with high risk for coronary heart disease (CHD) but characteristics that excluded them from participation in previous statin trials. Simvastatin 40 mg treatment showed benefit across all patient groups regardless of age, gender or baseline cholesterol value and proved safe and well tolerated. Results show a 12% reduction in total mortality, a 17% reduction in vascular mortality, a 24% reduction in CHD events, a 27% reduction in all strokes and a 16% reduction in non‐coronary revascularisations. Among high‐risk patients in this western population (with a minimum total cholesterol [TC] ≥3.5 mmol/l at entry) there appears to be no threshold cholesterol value below which statin therapy is not associated with benefit; even among those with pre‐treatment cholesterol levels below current national recommended targets. Over the 5.5 year study period patients and their doctors were encouraged to add an active non‐study statin to the study regimen if they wished to do so. Thus the trial eventually had only two‐thirds complying with the original intention‐to‐treat design. Nevertheless, results were highly significant for the study statin – simvastatin 40 mg once daily. Preliminary results of the HPS are negative for the antioxidant vitamin cocktail but provide reassurance that vitamins do no harm.
EFFECT OF VERAPAMIL IN ELDERLY PATIENTS WITH LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AS A CAUSE OF CONGESTIVE HEART FAILURE
Authors: Hung MJ , Cherng WJ , Kuo LT , Wang CH 
Published: April 2023

SUMMARYFifteen elderly patients with normal left ventricular (LV) systolic function and New York Heart Association functional class II‐III were studied. The effect of verapamil on LV diastolic function was assessed by congestive heart failure (CHF) score, treadmill exercise test, and Doppler echocardiography at baseline, and after each three‐month treatment period (placebo or verapamil 120 mg once daily), separated by a one‐week washout period before crossover. Blood pressure, heart rate, LV ejection fraction, LV mass, and cardiac output were unaltered by placebo or verapamil. Verapamil treatment significantly improved CHF score at 3 months (3.5 ± 0.5, p<0.05) compared with baseline (5.6 ± 0.5) or placebo (5.5 ± 0.5). The exercise time was similar at baseline (7.4 ± 1.2 min) and after placebo (7.4 ± 1.3 min) treatment but significantly (p<0.05) increased after verapamil (8.3 ± 1.2 min) treatment. The ratio of mitral A wave duration/pulmonary venous atrial systolic reversal duration increased after verapamil (1.11 ± 0.08) treatment compared with placebo (0.91 ± 0.07, p<0.05) and baseline (0.89 ± 0.08) which had similar durations. The isovolumic relaxation time was significantly (p<0.05) decreased from 84 ± 12 ms at baseline and 86 ± 13 ms with placebo to 73 ± 9 ms with verapamil. The results of this study suggest that in elderly patients with Doppler evidence of diastolic dysfunction as the cause of CHF, three months treatment with verapamil can improve CHF, increase exercise tolerance and improve LV diastolic function.
SEIZURE RECURRENCE IN TEMPORAL LOBE EPILEPSY
Authors: Hui ACF , Ma RCW , Ozaki R , Kay R , Cockram CC 
Published: April 2023

SUMMARYWe report on a patient with clinical, electroencephalographic and radiological features of temporal lobe epilepsy, whose seizures were initially controlled with antiepileptic treatment. Five years after the onset of seizures, he developed more frequent and prolonged episodes of confusion, which were misinterpreted as secondary to temporal lobe epilepsy. Further investigation revealed the presence of hypoglycaemia and the eventual diagnosis of metastatic insulinoma.
RECURRENT LENTIGO MALIGNA MELANOMA: REGRESSION ASSOCIATED WITH LOCAL AZELAIC ACID 20%
Authors: Vereecken P , Heenen M 
Published: April 2023

SUMMARYAzelaic acid has been used to treat different hyperpigmentary disorders because of its antimelanocyte activity. The efficacy of azelaic acid in the treatment of lentigo maligna and melanoma has already been described and this local treatment is considered by some as an alternative agent when other forms of therapy are not realisable. Here we report a case of a patient with local recurrence of a stage IV lentigo maligna melanoma of the cheek which cleared after treatment with azelaic acid cream 20%.
GRANULOCYTE COLONY STIMULATING FACTOR TREATMENT FOR DELAYED RECOVERY OF TICLOPIDINE‐RELATED NEUTROPENIA
Authors: Hung MJ , Wang CH , Cherng WJ 
Published: April 2023

SUMMARYWe describe the case of a patient who developed neutropenia associated with sepsis and endophthalmitis after ticlopidine therapy for coronary stenting. The neutropenia did not resolve until granulocyte colony stimulating factor (G‐CSF) was given. This uncommon case brings to attention the need for the immediate use of G‐CSF in patients with delayed recovery from drug‐related neutropenia and severe infection.
COMPARISON OF NON‐INVASIVE VENTILATION AND STANDARD MEDICAL THERAPY IN ACUTE HYPERCAPNIC RESPIRATORY FAILURE: A RANDOMISED CONTROLLED STUDY AT A TERTIARY HEALTH CENTRE IN SE TURKEY
Authors: Dikensoy O , Ikidag B , Filiz A , Bayram N 
Published: April 2023

SUMMARYThis study was designed in a tertiary health centre in south‐eastern Turkey to compare the effectiveness of non‐invasive ventilation (NIV) plus standard medical therapy (ST) to ST alone, in acute hypercapnic respiratory failure (AHRF) due to chronic obstructive pulmonary disease (COPD) exacerbation. Thirty‐four consecutive patients were randomly assigned to receive either NIV plus ST or ST alone. NIV was applied with a simple non‐invasive ventilator through a full face mask in the general ward. Initial settings for inspiratory and expiratory positive airway pressures were 9 cm HO2, and 3 cm HO2, respectively. We observed statistically significant improvements in the first hour of NIV regarding respiratory rate (p<0.001), pH (p<0.05), PaO2 (p<0.05), and PaCO2 (p<0.001). PaO2 (p<0.05) showed significant improvement only in the first hour of ST The intubation rate and duration of hospitalisation in the NIV group were significantly shorter than those in the ST group (p<0.05). We conclude that NIV provides adjunctive therapeutic benefits compared with ST alone, and should be the choice of first step treatment in the AHRF due to COPD exacerbation in the appropriate setting and in selected patients.