bluuebunny/crossref_metadata_2025_split huggingface dataset:
RECOMBINANT HUMAN ACTIVATED PROTEIN C (XIGRIS®)
Authors: Levi M , De Jonge E , Van Der Poll T 
Published: April 2023

SUMMARYAn impaired function of the protein C pathway plays a central role in the pathogenesis of sepsis. Administration of human recombinant activated protein C (Xigris®) may restore the dysfunctional anticoagulant mechanism and prevent amplification and propagation of thrombin generation and formation of microvascular thrombosis but may simultaneously modulate the systemic pro‐inflammatory response. Experimental studies indicated that the administration of activated protein C could block the derangement of coagulation, inhibit inflammatory effects and preserve organ function. Randomised controlled clinical studies in patients with severe sepsis confirmed these beneficial effects and demonstrated that administration of recombinant human activated protein C resulted in a reduction of mortality in patients with severe sepsis.
BERNARD‐SOULIER SYNDROME IN A TURKISH FAMILY
Authors: Okan V , Araz M , Camci C , Aktaran S , Sahin A , Buyukberber S , Bakir K , Cakmak EA 
Published: April 2023

SUMMARYThis report describes the first Turkish family to be diagnosed with Bernard‐Soulier syndrome. The family consists of nine members (two parents, three sons and four daughters). The parents were first cousins. The index case, a 22 year‐old‐man, had a history of haemorrhagic diathesis with thrombocytopenia, giant platelets in the peripheral blood smear and a prolonged bleeding time. Refractory idiopathic thrombocytopenic purpura had been diagnosed elsewhere and a splenectomy had been performed six months previously. Ristocetin agglutination of platelets was defective and flow cytometry analysis of platelet membrane glycoprotein showed markedly reduced expression of glycoprotein lb (2.1%). Bernard‐Soulier syndrome was diagnosed. Increased mean platelet volume was found in both parents, one son and three daughters. The other son and daughter were normal.
PRESCRIBING PATTERNS IN MEDICAL OUTPATIENTS
Authors: Shankar P Ravi , Partha P , Nagesh S 
Published: April 2023

SUMMARYA drug utilisation review was carried out in the medical outpatient department of the Manipal teaching hospital, a tertiary care hospital in Pokhara, western Nepal, to determine the prescribing frequency of commonly used drugs. An attempt was made to relate prescription data to age and sex of the patients. A total of 530 prescriptions were analysed, and the mean ± SD drugs per prescription was 2.15 ± 1.71; 67.4% of the drugs were prescribed by brand name and only 39.56% of the drugs prescribed were from the WHO essential drug list. The average cost of drugs per prescription was US$2.75 ± 2.21. The frequency of prescribing of antiulcer drugs, antibiotics, antiasthma drugs, antihypertensives and analgesics was 24.15% (n=128), 23.96% (n=127), 20.56% (n=109), 19.81% (n=105) and 15.09% (n=80), respectively. This study revealed considerable scope for educating prescribers to improve their prescribing practice.
A NEW SURGICAL TREATMENT OF AN ACUTE DISLOCATION OF THE PROXIMAL TIBIOFIBULAR JOINT
Authors: Rajkumar P , Schmitgen GF 
Published: April 2023

SUMMARYAcute dislocation of the proximal tibiofibular joint is rare, and although most dislocations are treated by closed reduction, open reduction and internal fixation is sometimes required. We present the case of an injury to a professional football player where open reduction and internal fixation with bioabsorbable pins was performed.
RECTAL SALAMI
Authors: Shah J , Majed A , Rosin D 
Published: April 2023

SUMMARYWe present the case of a 63‐year‐old man who had inserted a salami into his anal canal for sexual stimulation – the commonest reason for inserting foreign bodies – and who subsequently required a laparotomy for its removal. This common surgical problem requires a thorough medical history, an examination and the use of radiographs for management. Current techniques for removal of such objects are discussed.
THERAPEUTIC APPROACH IN INSULIN RESISTANCE WITH ACANTHOSIS NIGRICANS
Authors: Tankova T , Koev D , Dakovska L , Kirilov G 
Published: April 2023

SUMMARYThe aim of the present study was to evaluate the effect of metformin in very obese subjects with acanthosis nigricans. Five patients (two obese children, mean age 14.4 ± 0.6 yr, mean BMI 35.2 ±1.9 kg/m2 and normal glucose tolerance, and three newly diagnosed obese type 2 diabetic patients, mean age 37.7 ± 3.2 yr, mean BMI 37.7 ± 2.9kg/m2) were enrolled in the study. Insulin secretion was measured during oral glucose tolerance (OGT) and intravenous glucose tolerance (IVGT) tests. Insulin resistance was assessed by the homoeostasis model assessment (HOMA) index. All the patients were treated with metformin at a mean daily dose of 2.23 ± 0.45 g. Six months after initiation of therapy we found a significant reduction in AUC for insulin secretion during OGTT (p<0.05), due to reduction in both basal and stimulated insulin secretion (p<0.05). Body weight was reduced by mean 4.7 ± 1.9% and body fat mass by 8.95 ± 3.7%. We have demonstrated a significant decrease of 36.3% in insulin resistance (p<0.01). Our results demonstrate that metformin reduces hyperinsulinaemia, body weight and fat mass and improves insulin sensitivity in patients with insulin resistance and acanthosis nigricans.
ASSESSMENT, DIAGNOSIS AND MANAGEMENT OF LOWER URINARY TRACT SYMPTOMS IN MEN
Authors: Brown CT , Das G 
Published: April 2023

SUMMARYLower urinary tract symptoms are very common and the approach to assessment and management has changed dramatically over the past few years. Previously referred to as prostatism, benign prostatic hyperplasia and bladder outflow obstruction, it is now recognised that in most men symptoms are due to a combination of benign prostatic enlargement and age‐related bladder dysfunction. Most men require only simple tests for a diagnosis, with the more complex investigations reserved for when the diagnosis is not clear. Symptom bothersomeness and effect on quality of life are the critical factors when deciding how to treat a man. A cascade of treatments exists, including conservative management, medical therapy and surgery. A man moves up the cascade when the present management strategy fails to control symptoms. Traditional surgical techniques such as transurethral resection of the prostate are still appropriate for some men, although with improved medical treatments available the number of men undergoing surgery is declining.
GENETIC HAEMOCHROMATOSIS
Authors: Rosalk SB 
Published: April 2023

SUMMARYGenetic haemochromatosis is an autosomal recessive inherited disorder of iron metabolism due to mutation of the HFE gene. In homozygotes (1 in 300 of the UK population), this results in excessive iron absorption from the gut and its deposition in major body organs. This may give rise to fatigue, arthritis, cardiac failure, diabetes mellitus, hepatic cirrhosis or skin pigmentation, occurring predominantly in males over 50 years of age. Identification uses measurement of serum iron, iron‐binding capacity (or transferrin) and ferritin, together with initial or confirmatory genetic DNA studies.
EZETIMIBE IN HYPERCHOLESTEROLAEMIA
Authors: Farnier M 
Published: April 2023

SUMMARYEzetimibe is the first member of a new class of selective cholesterol absorption inhibitors, compounds that effectively block intestinal absorption of dietary and biliary cholesterol, without affecting absorption of fat soluble vitamins or triglycerides. Ezetimibe underwent glucuronidation to a single metabolite and localised at the intestinal wall, where it prevented luminal cholesterol absorption. Pre‐clinical studies demonstrated the lipid‐lowering and antiatherosclerotic properties of ezetimibe. The efficacy and safety of ezetimibe monotherapy have been determined in phase ll/lll studies: in phase II studies, the optimal efficacy was reached with ezetimibe 10 mg per day and the pooled efficacy data have shown that ezetimibe 10 mg has a positive effect on the lipoprotein profile with a significant reduction in LDL‐cholesterol of 18.5%, an increase in HDL‐cholesterol of 3.5% and a trend towards lowering in triglyceride concentrations (‐4.9%). The monotherapy phase III studies have confirmed the efficacy with a decrease in LDL‐C of 17.4% and have demonstrated an excellent safety and tolerability profile. The potential for a pharmacokinetic and/or pharmacodynamic interaction between ezetimibe and various statins and the efficacy and safety or the co‐administration of ezetimibe and statins have been evaluated in different phase l/ll studies: ezetimibe had no significant effect on the pharmacokinetics of simvastatin or atorvastatin. Ezetimibe 10 mg co‐administrated with the starting dose of any statin induced a mean 18% additive LDL‐C lowering effect. This additive 18% reduction in LDL‐C is achieved in one step compared with the three steps necessary with statin monotherapy.
MANAGEMENT OF OSTEOPOROSIS IN AN ORTHOPAEDIC DEPARTMENT: AUDIT IMPROVES PRACTICE
Authors: Charalambous CP , Kumar S , Tryfonides M , Rajkumar P , Hirst P 
Published: April 2023

SUMMARYPatients presenting with an osteoporosis‐related fracture are at increased risk of further fractures. We performed a retrospective survey to determine if elderly patients presenting to the orthopaedic unit at Manchester Royal Infirmary with low energy hip or distal radius fractures were being managed appropriately with regards to assessment, investigation and treatment for possible osteoporosis. The initial survey demonstrated that only 16% of elderly female patients with low energy hip fractures and none of those (0%) with distal radius fractures were started on treatment or referred for further investigations for possible osteoporosis. After changes in our practice, 76% (p<0.00001) of patients with hip fractures and 81% (p<0.00001) of those with distal radius fractures were investigated, started on treatment or referred to a consultant physician for the management of osteoporosis.
A PHARMACOKINETIC COMPARISON OF THE MODIFIED RELEASE CAPSULE AND A PLAIN TABLET FORMULATION OF MEBEVERINE
Authors: Winsemius A , Meuwsen I , Boon C , Van Der Laan A , Brekle A , De Vries M 
Published: April 2023

SUMMARYThis study was conducted to compare the pharmacokinetic properties of the modified release 200 mg capsule of mebeverine and the plain 135 mg tablet of mebeverine after single and multiple doses in 12 healthy subjects in a randomised, crossover design. Single doses were given on days 1 and 7 and multiple doses (200 mg b.i.d. for the capsule and 135 mg t.i.d. for the tablet) on days 2–6 of the study. The 200 mg modified release capsule of mebeverine has extended release Properties, as indicated by a lower Cmax, a later tmax and a longer elimination half‐life than the plain tablet, while the bioavailability is optimal. No significant accumulation occurs after multiple doses of either formulation. The twice‐daily dosage regimen of the 200 mg modified release capsule is a good alternative to the three times daily dosage regimen of the 135 mg plain tablet, because the reduced daily intake is likely to benefit patient compliance.
A SYSTEMATIC APPROACH TO ERECTILE DYSFUNCTION IN THE CARDIOVASCULAR PATIENT: A CONSENSUS STATEMENT – UPDATE 2002
Authors: Jackson G , Betteridge J , Dean J , Eardley I , Hall R , Holdright D , Holmes S , Kirby M , Riley A , Sever P 
Published: April 2023

EXECUTIVE SUMMARY
Sexual activity is no more stressful to the heart when compared with a number of other natural daily activities, e.g. walking one mile on the level in 20 minutes.
The cardiac risk of sexual activity in patients diagnosed with cardiovascular disease is minimal in properly assessed and advised patients.
Erectile dysfunction (ED) is extremely common, affecting over half of men aged 40–70 years, and increases in frequency with age.
ED and cardiovascular disease share many of the same risk factors and commonly coexist.
ED in the otherwise asymptomatic man may be a marker for underlying coronary artery disease.
ED in the diagnosed cardiovascular patient should be identified by routine questioning in general practice. Modern therapies can restore a sexual relationship in the majority of patients with ED and can lead to a substantial improvement in quality of life.
The majority of patients assessed to be at low or intermediate cardiac risk, as defined later in this paper, can be effectively managed in primary care. Primary care treatment for ED in patients defined as high risk can be initiated following a specialist opinion and/or confirmation that the patient's cardiovascular condition is stabilised.
There is no evidence that currently licensed treatments for ED add to the overall cardiovascular risk in patients with or without diagnosed cardiovascular disease.
If one form of therapy is not effective, follow‐up will identify the need for alternative approaches.
The pro‐active management of ED in the cardiovascular patient provides an ideal and effective opportunity to address other cardiovascular risk factors and improve treatment outcomes.
FEMALE STRESS AND URGE INCONTINENCE IN FAMILY PRACTICE: INSIGHT INTO THE LOWER URINARY TRACT
Authors: Viktrup L 
Published: April 2023

SUMMARYAs many as 25% of all women are affected by urinary incontinence, but only a few are treated. This frequent, often medically unrecognised, condition occurs in women of all ages. The continence mechanism is based on bladder detrusor control, intact anatomical structures in and around the urethra, correct positioning of the bladder neck and a comprehensive innervation of the lower urinary tract. Age and childbearing are established risk factors for the development of urinary incontinence, but other factors are currently suggested. The evaluation of urinary incontinence should include history, gynaecological examination, urine test, frequency‐volume diary and a pad‐weighing test. Female urinary incontinence can be treated in general practice by simple means, e.g. pelvic floor muscle training, bladder training, electrostimulation, drug therapy, or a combination of these approaches. This review updates the knowledge of the continence mechanism and summarises the epidemiology, risk factors, assessment and treatment of urinary incontinence in general practice.
TYPE 2 DIABETES MELLITUS AND THYROTOXICOSIS PRESENTING CONCURRENTLY
Authors: Shah D , Turnbull CJ 
Published: April 2023

SUMMARYThe symptoms of thyrotoxicosis and diabetes mellitus can be quite similar, and in patients presenting with diabetes, thyrotoxicosis could be missed unless specifically tested for. There are few reports of the two conditions presenting at the same time. We report on two such cases. In a patient who is diagnosed as having both conditions concurrently, an oral glucose tolerance test should be repeated after successful treatment of thyrotoxicosis before a diagnosis of diabetes mellitus is made.
DONEPEZIL: TOLERABILITY AND SAFETY IN ALZHEIMER'S DISEASE
Authors: Pratt RD , Perdomo CA , Surick IW , Ieni JR 
Published: April 2023

SUMMARYThe tolerability and safety of donepezil HCI in patients with mild to moderate Alzheimer's disease (AD) were examined in an integrated analysis of phase ll/lll placebo‐controlled trials. Patients with mild to moderately severe AD (n=1920) were randomised to receive donepezil (n=1291) or placebo (n=629). Adverse events, physical examinations and clinical laboratory tests were assessed. A high completion rate (79%) was achieved in these trials. Of the 1291 patients receiving donepezil only, 142 (11%) withdrew because of an adverse event compared with 43 of the 629 (7%) placebo patients. The most common adverse events included nausea, diarrhoea, headache, insomnia, dizziness, rhinitis, vomiting, asthenia/fatigue and anorexia. Donepezil had no clinically significant effect on any laboratory evaluations and was not associated with hepatotoxicity. These results demonstrate that donepezil is well tolerated and has a favourable safety profile at clinically effective, once‐daily doses of 5 mg and 10 mg.
GUIDEWIRE‐INDUCED DISSECTION OF THE RIGHT CORONARY ARTERY AND ADJACENT AORTIC WALL DURING PERCUTANEOUS CORONARY ANGIOPLASTY
Authors: Hung M‐J , Kuo L‐T , Wang C‐H , Cherng W‐J 
Published: April 2023

SUMMARYWe describe two patients in whom right coronary artery dissection and retrograde dissection of the sinus of Valsalva occurred during guidewire advancement for percutaneous coronary angioplasty. Both patients were treated successfully by coronary stenting. These cases illustrate that contrast medium injection can detect early complications during guidewire advancement for coronary intervention.
IS DAILY MVI REQUIRED IN PATIENTS RECEIVING PARENTERAL NUTRITION?
Authors: Firdose R , Chalekson J , Leonard J , Smith M , Elamin EM 
Published: April 2023

SUMMARYBetween November 1996 and January 1999 there was a nationwide shortage of intravenous multivitamins (MVI) in the US. We investigated whether patients who received parenteral nutrition (PN) with MVI three times per week instead of daily developed clinical manifestations of vitamin deficiency during that period. Five patients were enrolled in the study. All received home PN as their sole source of nutrition for at least six months. None of these patients showed clinical manifestations of vitamin deficiency. In addition, compared to daily MVI administration, supplementation with MVI three times per week saved $1000 per patient per year. This preliminary study raises the question of how much MVI is needed to prevent vitamin deficiency. Using MVI three days a week instead of daily would substantially reduce the cost of treatment and might reduce the risk of infections for these patients.
SHOCK WAVES DO MORE THAN JUST CRUSH STONES: EXTRACORPOREAL SHOCK WAVE THERAPY IN PLANTAR FASCIITIS
Authors: Rajkumar P , Schmitgen GF 
Published: April 2023

SUMMARYHeel pain is a common orthopaedic problem, The cause of this clinical entity remains an enigma. The overall prognosis is good, however, and the symptoms generally settle well with time. There appears to be little evidence of the effectiveness of local steroid injections and dorsiflexion night splints. Extracorporeal shock wave therapy (ECSW) has been used in orthopaedics since the 1980s. With this, a new tool has become available for the treatment of plantar fasciitis, achillis tendinitis, shoulder pain and tendinosis of the elbow. In our pilot study we found good results with the use of ECSW therapy in resistant plantar fasciitis. Additional controlled studies are required to define the precise role of this new modality in the treatment of chronic plantar fasciitis.
19. MALE BREAST CANCER: AETIOLOGY, GENETICS AND CLINICAL MANAGEMENT
Authors: Tischkowitz MD , Hodgson SV , Fentiman IS 
Published: April 2023

SUMMARYMale breast cancer (MBC) is a rare disease with an older average age of presentation than in women. Predisposing factors include increased exposure to oestrogen and being a carrier of a BRCA2 mutation. Most MBC is ductal and the majority are oestrogen receptor positive. Modified radical mastectomy is the treatment of choice for local disease and adjuvant radio‐, hormonal and chemotherapy should all be considered. Stage for stage, the prognosis for MBC is similar to that for female breast cancer. Despite a wealth of small retrospective studies on MBC, its rarity means there is a lack of prospective randomised controlled treatment trials, which needs to be addressed if significant advances are to be made in the treatment of this unusual and challenging disease.
20. ORAL CONTRACEPTIVES, HORMONE REPLACEMENT THERAPY AND BREAST CANCER
Authors: Fentiman IS 
Published: April 2023

SUMMARYBoth oral contraceptives (OCs) and hormone replacement therapy (HRT) are widely used by healthy women, so that any increase in breast cancer has to be considered in relation to the avoidance of either pregnancy or menopausal symptoms. Use of OCs for more than four years before first full term pregnancy leads to a small but significant increase in risk of breast cancer (6.5 extra cases per 10,000 women aged 20–29) that persists for 10 years after cessation. Risk is not amplified by a positive family history and OC‐induced breast cancers are more likely to be localised to the breast. For those taking HRT there is an increased relative risk of breast cancer of 2.3% per year, similar to the increase in risk for each extra year spent in a premenopausal state. The increase in risk disappears five years after cessation. HRT does not lead to any increase in risk of dying of breast cancer. Some breast cancer patients can safely take HRT, and it is possible that some formulations may reduce the subsequent risk of relapse.
HIGH DENSITY LIPOPROTEIN: GUARDIAN OF THE VASCULAR SYSTEM?
Authors: Packard C , Nunn A , Hobbs R ,   members of the Future Forum Editorial Board*
Published: April 2023

SUMMARYThe role of low‐density lipoprotein in the development of coronary heart disease (CHD) is well recognised. There is also growing evidence that high‐density lipoprotein cholesterol (HDL‐C) is a powerful inverse predictor for premature CHD and that maintaining a high HDL‐C level may guard against atherosclerosis. Patients with low HDL‐C levels often also have central obesity, insulin resistance and other features of the metabolic syndrome. This syndrome is both increasingly common and strongly implicated in the growing worldwide epidemic of type 2 diabetes. HDL‐C may be increased by lifestyle changes, e.g. weight loss, physical activity and smoking cessation. Pharmacological agents such as fibrates, niacin and statins have also been shown significantly to elevate HDL‐C. Although current guidelines are beginning to recognise the protective role of HDL‐C level in preventing coronary events, HDL‐C should be adopted soon as a target for intervention in its own right.
A HYALURONAN PREPARATION (500–730 KDA) IN THE TREATMENT OF OSTEOARTHRITIS: A REVIEW OF CLINICAL TRIALS WITH HYALGAN®
Authors: Maheu E , Ayral X , Dougados M 
Published: April 2023

SUMMARYThe purpose of this paper is to review the intra‐articular treatment of osteoarthritis (OA) of the knee with the hyaiuronan preparation 500–730 kDa (Hyalgan®). Reviewing the results of 24 clinical trials, it can be concluded that 3–5 weekly injections of Hyalgan significantly improve the pain and functional status of patients with OA. Although the onset of improvement is delayed by 3–4 weeks, the effect can last at least six months and up to one year after treatment cessation. The benefits of Hyalgan compared with intra‐articular corticosteroids are also addressed. The potential for Hyalgan to have a structure‐modifying action by retarding stuctural progression in OA of the knee is considered. However, further studies of Hyalgan in OA in other joints, and in damaged joints in rheumatoid arthritis, are needed.
DOUBLE DISLOCATION OF THE PROXIMAL AND DISTAL INTERPHALANGEAL JOINTS OF THE LITTLE FINGER
Authors: Charalambous CP , Rajkumar P , Samarj1 R 
Published: April 2023

SUMMARYA 32‐year‐old amateur goalkeeper sustained simultaneous dislocation of the proximal and distal interphalangeal joints following a hyperextension injury. This was reduced under a digital nerve block. Neighbour finger strapping and early mobilisation achieved a full range of movements at both joints when reviewed three weeks after the initial injury.