bluuebunny/crossref_metadata_2025_split huggingface dataset:
DRUGS FOR TREATMENT OF ALZHEIMER'S DISEASE
Authors: Wilkinson D 
Published: April 2023

SUMMARYAlzheimer's disease is already an international problem of enormous significance, with an estimated 500,000 sufferers in the UK alone. There are currently four licensed compounds available for the symptomatic treatment of mild to moderate Alzheimer's disease, yet there is still considerable debate over their effectiveness. A variety of anti‐dementia agents affecting the various aspects of the disease are in development and the debate will continue over the potential rationing of such treatments in the future. Drugs developed from the cholinergic and glutamatergic hypotheses will be discussed, and a number of other potential treatments aimed at reducing the oxidative stress and inflammatory response associated with dementia will be reviewed. The arrival of these new treatments for Alzheimer's disease has focused attention on the management of dementia in general and has provided the catalyst for the widespread development of memory clinics to enable proper assessment of patients with dementing disorders, providing hope for both patients and carers.
‘ALWAYS CHEW YOUR CHILLIES’: A REPORT OF SMALL BOWEL OBSTRUCTION WITH PERFORATION
Authors: Rajaratnam SS , Boyle N , Owen WJ 
Published: April 2023

SUMMARYWe report an unusual case of small bowel obstruction and localised ileal perforation caused by an undigested green chilli in a 43‐year‐old man presenting in accident and emergency.
MULTIPLE ANEURYSMS ASSOCIATED WITH CONGENITAL RUBELLA
Authors: Rocker MD , Bond SE , McGuinness CL , Taylor PR 
Published: April 2023

SUMMARYWe describe the case of a woman with congenital rubella who presented with backache. Plain abdominal X‐ray revealed calcification of a superior mesenteric artery aneurysm. Intra‐arterial digital subtraction angiography demonstrated multiple aneurysms of the arteries to the upper and lower limbs and the viscera. We have not found another report in the literature of the association of congenital rubella with multiple aneurysms.
COMPARISON OF CLINICAL CHARACTERISTICS AND HIGH‐RISK FACTORS IN AUSTRALIAN ABORIGINAL AND NON‐ABORIGINAL NEONATES WITH NECROTISING ENTEROCOLITIS
Authors: Kadalraja R , Patole SK , Muller R , Whitehall JS 
Published: April 2023

SUMMARYIn a five‐year retrospective data analysis, incidence of >stage II necrotising enterocolitis (NEC) was four times higher in aboriginal (18/125) than non‐aboriginal (11/306) neonates, all ≤32 weeks' gestation. Stage III NEC occurred more frequently (10/18 vs 3/11) and related mortality was higher (44.4% vs 0%) in aboriginal than non‐aboriginal neonates. Risk factors for NEC‐prolonged rupture of membranes (50% vs 9.1%, p=0.01), prematurity (median [range] gestational age: 25 (24–28.5) vs 30 [27–33]) weeks, p=0.02), birth weight (<1 kg 13 [72%] vs 2 [18%], p=0.007) and intrauterine growth retardation (50% vs 0%, p=0.01) occurred more frequently in aboriginal neonates. Though feed type and increments per day were similar, aboriginal neonates received higher volume of feeds/kg/day (median [range]: 154 [145–189] vs 106 [103–134] ml, p< 0.05). Condition at delivery and respiratory status before development of NEC were not significantly different.
AN UNUSUAL PRESENTATION OF THYROGLOSSAL DUCT CYST
Authors: Babu E Dinakara , Harrison L , Ahmed N , Ramus NI 
Published: April 2023

SUMMARYThyroglossal duct cyst usually presents as a painless swelling in the mid‐line of the neck. This is the first documented case of an acute presentation of hoarseness and multi‐loculated swelling. It also contrasts the limitations of ultrasonography with the accuracy of magnetic resonance imaging in such atypical swellings.
SAFETY, EFFECTIVENESS AND COST EFFICACY OF DIAGNOSTIC ELECTROPHYSIOLOGY AND RADIOFREQUENCY ABLATION IN A DISTRICT GENERAL HOSPITAL
Authors: Mitchell ARJ , Patel NR , Kamalvand K , Topham A , Paul VE , Sulke AN 
Published: April 2023

SUMMARYElectrophysiological studies (EPS) are now being performed in district general hospitals (DGH) in the UK. In order to audit our results, a prospective database was established for all patients undergoing EPS and radiofrequency (RF) ablation at Eastbourne District General Hospital, East Sussex. Between 1 January 1997 and 1 July 2000, 300 EPS procedures were performed, resulting in 155 RF ablations. The average RF ablation procedure time was 119.3 minutes with an average fluoroscopy time of 19.1 minutes. Cost per RF ablation procedure was £1166.79 excluding use of facilities, pacemaker devices, medical nursing and radiography staffing costs. The overall success rate for RF ablation was 93.6% with a major complication rate of 0.6%, a total complication rate of 3.9% and no associated mortality. We have shown that RF ablation can be performed safely, effectively and economically in a DGH setting with a high rate of success and a low complication rate.
MOTOR RESTLESSNESS
Authors: Tan EK , Ondo WG 
Published: April 2023

SUMMARYMotor restlessness, characterised by an irresistible urge to move about, can be a manifestation of many underlying disorders. Unfortunately, it is often poorly recognised and underdiagnosed in clinical practice, possibly because patients do not seek medical attention, or their complaints were thought to be secondary to anxiety. While the two major conditions to consider are restless legs syndrome and neuroleptic‐induced akathisia, there are many other differential diagnoses. We provide a concise review of the clinical features and diagnostic pitfalls of these conditions. A proper detailed clinical history and examination can often help clinch the diagnosis, as most of these conditions have their unique clinical features.
MANAGEMENT OF UPPER RESPIRATORY TRACT INFECTION BY FAMILY DOCTORS
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 factors that might affect such behaviour were studied. All 1016 members of the Hong Kong College of Family Physicians were sent a postal questionnaire. A total of 730 family doctors completed the questionnaire, with an overall response rate of 71.8%. Doctors who were older, more senior, or in private practice were more likely to think antibiotics were useful for URTIs and to prescribe them. These doctors were also more likely to think their patients would expect antibiotics from them. Postgraduate vocational training in general practice/family medicine helped make family doctors think fewer patients would expect antibiotics from them but did not affect their perception of the usefulness of antibiotics for URTIs. Our results showed that doctors with certain characteristics were more likely to prescribe antibiotics for URTIs and these doctors may be targeted for continued medical education.
THE EFFICACY OF MOXIFLOXACIN IN ACUTE EXACERBATIONS OF CHRONIC BRONCHITIS: A SPANISH PHYSICIAN AND PATIENT EXPERIENCE
Authors: Miravitlles M , Ros F , Cobos A , Kubin R , Tillotson G 
Published: April 2023

SUMMARYChronic bronchitis is a debilitating disease affecting many millions of patients globally. They suffer multiple acute exacerbations each year, often requiring many courses of antimicrobials to enable them to return to normal. The impact of the condition on both the individual patient and society as a whole is considerable and growing; thus antimicrobial therapy should induce rapid and effective outcomes as soon as possible. This open, community‐based study of 5737 patients enrolled by over 2000 primary care physicians from across Spain examined the clinical effect of oral moxifloxacin on patients' signs and symptoms of acute exacerbations of chronic bronchitis (AECB) over a 45‐day period. The symptoms were assessed using daily diary cards in addition to physician evaluations. Clinical assessment at day 7 showed 93.0% of patients were cured. The patient diary card showed that two‐thirds of patients felt better by day 3 or 4. Adverse events were reported in 3.5% of patients in this study, the most common being diarrhoea, nausea and dizziness, and epigastric pain. These reactions were mild to moderate in intensity. There were no patient deaths due to infection during the study. Physicians and patients reported that once‐daily moxifloxacin gave fast relief of symptoms of acute excerbations of chronic bronchitis.
WHAT IS THE RELEVANCE OF THE HOPE STUDY IN GENERAL PRACTICE?
Authors: Kennedy J , Mogensen CE , Ball SG , Castaigne AD , Commerford PJ , Distiller L , Fisher BM , Gonzalez‐Jaunatey J , Nosadini R , Novials A , Östergren J , Palma‐Gámiz J , Perrone‐Filardi P , Schipperheijn JJ , Senges J , Trevisan R 
Published: April 2023

SUMMARYThe unique findings from the HOPE (Heart Outcomes Prevention Evaluation) study strongly support extending the use of the angiotensin‐converting enzyme (ACE) inhibitor ramipril as a preventive agent for patients at high risk of cardiovascular events with normal left ventricular function. In addition, ramipril provides significant benefit in diabetic patients. These findings will impact on how ramipril is used in primary care, where ACE inhibitors are currently underprescribed. Patients reflecting the inclusion criteria of the HOPE study should be considered as suitable candidates for long‐term ramipril therapy as an addition to their existing drug regimen. Screening should include control of kidney function (by serum creatinine), particularly within the first two weeks of treatment, in addition to regular monitoring of serum potassium. However, the HOPE study shows that ramipril is well tolerated at high doses and over a long treatment period. The effectiveness of therapy should also be regularly reviewed and dose adjustments made where necessary. If concern remains, referral to a specialist – a cardiologist or a diabetologist – may ultimately be necessary.
1. ASSESSMENT OF BREAST PROBLEMS
Authors: Fentiman IS , Hamed H 
Published: April 2023

SUMMARYPatients with discrete breast lumps, irrespective of age, should be referred for assessment. Premenopausal women with equivocal lumps can be re‐checked two weeks later and, if still present or dubious, sent to a breast clinic. Almost all women with breast pain do not need referral unless the symptoms are severe or prolonged. Careful examination will detect those individuals with underlying rib cage pain who can be reassured and given analgesics, if necessary, but not referred. Blood‐containing nipple discharge is an indication for referral but such cases can be reassured that, in the absence of a lump, it is unlikely they have breast cancer. Most women who suspect their family history of breast cancer places them at increased risk can be safely reassured and do not need to be kept under surveillance. All those women who are eligible for the NHS screening programme should be encouraged to attend when invited.
MANAGING GASTRO‐OESOPHAGEAL REFLUX DISEASE IN PRIMARY CARE
Authors: Nathoo V 
Published: April 2023

SUMMARYThe National Institute for Clinical Excellence recently issued guidance on the use of proton pump inhibitors (PPIs) in the management of dyspepsia, including gastro‐oesophageal reflux disease (GORD). GORD is a common disorder that reduces quality of life and can indicate serious disease such as reflux oesophagitis. The symptoms of GORD must be distinguished from those of other diseases, such as functional dyspepsia or cardiac problems. Furthermore, atypical alarm symptoms, such as bleeding or sudden weight loss, require urgent further investigation. Most GORD is uncomplicated and can be treated using management algorithms that make the best use of resources. Newer strategies such as ‘step‐down’ or ‘on‐demand’ therapy can cost‐effectively improve the long‐term management and quality of life of patients with recurrent GORD.
RHABDOMYOLYSIS ASSOCIATED WITH VARICELLA INFECTION
Authors: Al‐Langawi M , Al‐Marri MRHA , Al Soub H 
Published: April 2023

SUMMARYVaricella infection is a common childhood disease that usually resolves without complications. However, children under 2 months of age, adolescents, some adults and immunocompromised individuals are at high risk of certain rare life‐threatening complications. We report a case of primary varicella infection in an immunocompetent adult complicated by rhabdomyolysis. Recognition of this complication and aggressive fluid therapy with an antiviral agent helped to improve the outcome.
THE IMPACT OF CORONARY HEART DISEASE IN DETERMINING USE OF HORMONE REPLACEMENT THERAPY IN A GENERAL PRACTICE POPULATION
Authors: Chin BSP , Futaba K , Jethwa A , Lip GYH 
Published: April 2023

SUMMARYThe use of hormone replacement therapy (HRT) for cardiovascular risk reduction remains uncertain. Although previous epidemiological surveys have suggested a clear benefit and nearly 50% mortality risk reduction with HRT in postmenopausal women, recent randomised trials have largely failed to support this. The epidemiological surveys may have been biased in a number of ways including the possibility that HRT users in these studies may have been healthier and taken a greater interest in modifying cardiovascular risks. The aim of the present study was to determine to what extent the revelations from all these trials have influenced HRT prescribing in general practice, in relation to cardiovascular disease. We reviewed 140 women on HRT and 140 age‐matched controls from one city centre general practice in the west of Birmingham who were randomly selected by computer. The main indication for HRT use was presence of symptoms associated with oestrogen deficiency. The prevention of osteoporosis accounted for 7.1% of HRT indications, while the primary prevention of CHD was not an issue discussed by either the patient or the GP. Among non‐users, 86.4% did not have a known contraindication and many did not have serum lipid measurements or estimations of cardiovascular risk. There was no difference between HRT users and non‐users for smoking habits and presence of cardiovascular risk factors including diabetes, hypertension and coronary heart disease. HRT users were also less likely to undergo investigations, such as cervical smear tests and mammograms. In conclusion, this survey reflects the current uncertainty surrounding the use of HRT for cardiovascular risk prevention. Importantly, women on HRT may not be any healthier than non‐users, nor do they seek more preventive care than non‐users. This is contrary to previous presumptions that selection and prevention bias were the explanation for the apparent cardioprotective effects of HRT.
MANAGEMENT OPTIONS FOR HYPERTENSION SYNDROME
Authors: Abarquez RF 
Published: April 2023

SUMMARYHypertension is usually managed on a case‐finding basis, and yet continued blood pressure control can be inadequate. Furthermore, hypertension is often a ‘silent’ condition until comorbid events, target organ damage and subsequent heart failure become manifest, leading to a reactive rather than a proactive approach. Management of the hypertension syndrome becomes complex, because blood pressure control may not be just an isolated concern. This review considers the various options, in addition to existing guidelines, that can help to reduce hypertension‐related morbidity and mortality.
SPONTANEOUS INTRAMURAL DISSECTION OF THE OESOPHAGUS
Authors: Bandyopadhyay P , Patel CU 
Published: April 2023

SUMMARYSpontaneous intramural dissection or intramural haematoma of the oesophagus is an unusual condition and has been recognised as a separate clinical entity. The commonest presenting symptoms are chest pain, dysphagia and haematemesis usually affecting women in their sixties and seventies. Conservative management is usually thought to be adequate. We present a case of spontaneous intramural dissection in an elderly male who did not respond to conservative management and died.
A PREVENTABLE CAUSE OF ACUTE ABDOMEN
Authors: Hadjianastassiou VG , Eddleston M , Toogood G , Britton BJ 
Published: April 2023

SUMMARYHaemoperitoneum is an extremely rare presentation of hepatocellular carcinoma in the industrialised world. We present the first reported case in the UK. In contrast, up to 10% of hepatocellular carcinomas in Africa present in this way, the median time between presentation and death being just six weeks. Hepatitis B infection at birth and during childhood is the major cause of hepatocellular carcinoma in the developing world. The World Health Organisation, UNICEF and the World Bank have all advocated routine hepatitis B vaccination of children. This can reduce the burden of disease in these communities, among people in their productive years of life.
CAMPTODACTYLY IN A NEUROLOGY OUTPATIENT CLINIC
Authors: Larner AJ 
Published: April 2023

SUMMARYCamptodactyly is a non‐neurogenic flexion deformity of the proximal interphalangeal joint, most commonly affecting the little finger. The frequency of camptodactyly in patients referred to three general neurology outpatient clinics, two in district general hospitals and one in a regional neuroscience centre, over the course of one year (2000) was measured. Five out of 978 consecutive new outpatients (0.5%) had camptodactyly (2M, 3F); four had bilateral deformity. In only one was camptodactyly the reason for referral. In two cases, camptodactyly was entirely incidental to the neurological symptoms; in two others it was incidental but might have been confused with the neurological features. In three cases other family members were affected, in a manner consistent with autosomal dominant inheritance with variable penetrance. Camptodactyly is not infrequently observed in the general neurology outpatient clinic. It merits attention in order to avoid confusion with other, neurogenic, causes of clawing, and so avoid unnecessary investigation.
6. RADIOTHERAPY FOR EARLY AND ADVANCED BREAST CANCER
Authors: Harris S 
Published: April 2023

SUMMARYPostoperative radiotherapy (RT) forms an intrinsic part of breast conservation therapy, substantially reducing the risk of breast relapse. It is given 4–6 weeks postoperatively using medial and lateral beams to achieve a near homogeneous dose to the breast while minimising the dose to adjacent structures. Typically, a dose of 40 Gy in 15 daily fractions over three weeks or 50 Gy in 25 fractions over five weeks is given, with a boost of 10 Gy using low energy electrons or superficial X‐rays. RT is delivered to the chest wall after mastectomy in patients with large tumours (>5 cm), close surgical margins, or significant axillary node involvement and may result in an additional 10% survival benefit. Early complications of RT include tiredness, skin erythema and moist desquamation. Late reactions, breast fibrosis, telangiectases and peau d'orange are reduced if more treatment fractions are given. Lung irradiation is minimised by careful treatment planning and <1% of patients experience radiation pneumonitis or pulmonary fibrosis. Patients with locally advanced breast cancer may be offered a combination of systemic therapy, endocrine, chemotherapy and radical RT. Preoperative systemic and radiation therapy reduces the mastectomy rate but at present does not improve survival. Those who are unfit for radical treatment and have large ulcerating or fixed cancers are offered either endocrine or cytotoxic therapy, depending upon the oestrogen receptor status, followed by RT, which is unlikely to cure but may achieve local control for a variable duration. RT forms part of the multidisciplinary approach to palliative treatment for metastatic disease. Bone metastases occur in 75% of women with metastatic disease and RT provides effective pain relief and reducing risk of pathological fractures. Patients with brain metastases need high‐dose steroids followed by cranial RT
IS ERECTILE DYSFUNCTION A MARKER FOR CARDIOVASCULAR DISEASE?
Authors: Kirby M , Jackson G , Betteridge J , Friedli K 
Published: April 2023

SUMMARYThere is now significant evidence that erectile dysfunction (ED) can be a symptom of cardiovascular disease, and can act as a marker for disease progression. National Health Service (NHS) prescribing restrictions on treatments for ED have recently been reviewed by the Department of Health, and current arrangements will not change. Unrestricted availability of licensed treatments for ED on the NHS, irrespective of the cause of the ED, may encourage men to present for investigation, enabling early detection of cardiovascular disease. Sildenafil citrate (Viagra), an effective treatment for ED, can also have a direct beneficial effect on cardiovascular disease. Unrestricted NHS availability of ED treatments such as sildenafil could facilitate greater achievement of National Service Framework targets for coronary heart disease.
THALIDOMIDE: 40 YEARS ON
Authors: Diggle GE 
Published: April 2023

SUMMARYThalidomide was marketed in the late‐1950s as a sedative and tranquilliser of exceptionally low general toxicity, but in 1961 it was implicated separately by Lenz and MacBride as the cause of the epidemic of congenital malformations that had been puzzling the world for some years. It is a very potent teratogen in humans, but in few other mammalian species; damage to the embryo is produced at specific stages of gestation, but the mechanism of embryopathic action is still not understood. Following the withdrawal of the drug worldwide, it was consigned to the history of medical tragedies. In 1965, however, Sheskin discovered that it was effective in treating erythema nodosum leprosum, a distressing complication of leprosy. As the drug is neither an antibiotic nor an analgesic, its action was assumed to be immunosuppressive. In Brazil the drug was used widely with few regulatory controls, since when more than 100 cases of congenital malformation have appeared. Sheskin's discovery led to the experimental use of thalidomide in many other indications thought to possess some immunological component. In some cases, e.g. Behçet's syndrome, graft‐versus‐host disease and aphthous ulceration in HIV‐positive patients, the drug has been shown to possess some efficacy. And there is some evidence that it inhibits the replication of one of the immunodeficiency viruses. The AIDS community in the US has exerted much pressure on the FDA to allow the drug on to the market, although the use of a potent immunosuppressive drug of unknown mechanism in an immunodeficiency condition raises further questions. Thalidomide is not always beneficial; its use is associated with an increased mortality in epidermal necrolysis. In 1991, D'Amato confirmed it possessed antiangiogenic properties and this led to further trials in malignant conditions. Results were mixed, but those in multiple myeloma gave some grounds for optimism. In 1998, the FDA announced its extraordinary decision to grant marketing approval for thalidomide.
BILATERAL DUPUYTREN'S CONTRACTURE IN A BLACK PATIENT
Authors: Aladin A , Oni JA 
Published: April 2023

SUMMARYThe first case of Dupuytren's contracture in a black patient with no obvious caucasian admixture was reported in 1979. This condition is rare in the purely black population and since 1979 only 23 cases have been reported. We present the case of a black man with no history of caucasian admixture with bilateral Dupuytren's contracture. We suggest that this condition may not be as rare as the literature suggests and, that canvassing other hand societies for their experience, particularly in the continent of Africa, may help to establish the true incidence of this condition.
COMPLETE RESOLUTION OF REFRACTORY IMMUNE THROMBOCYTOPENIC PURPURA AFTER COLECTOMY FOR ULCERATIVE COLITIS
Authors: Kathula SK , Polenakovik H , El‐Tarabily M , Polenakovik S 
Published: April 2023

SUMMARYImmune thrombocytopenia (ITP) is a destructive thrombocytopenia caused by an autoantibody directed to platelet membrane antigens. Various immunological diseases have been associated with ITR but an association between inflammatory bowel disease (IBD) and ITP is not well recognised. We report a case of refractory immune thrombocytopenia associated with ulcerative colitis that resolved after colectomy. Although the medical treatment of inflammatory bowel disease or splenectomy are usually enough to treat ITP, it may be necessary to do a colectomy in refractory patients.