bluuebunny/crossref_metadata_2025_split huggingface dataset:
BECLOMETHASONE DIPROPIONATE EASYHALER® IS AS EFFECTIVE AS BUDESONIDE TURBOHALER® IN THE CONTROL OF ASTHMA AND IS PREFERRED BY PATIENTS
Authors: Jäger L ,   German Study Group, Laurikainen K , Leinonen M , Silvasti M 
Published: April 2023

SUMMARYThis randomised, crossover study compared the efficacy, safety, acceptability and patient preference of two multidose powder inhalers (MDPIs) – beclomethasone dipropionate Easyhaler® (BDP‐EH) and budesonide Turbohaler® (BUD‐TH) – in 79 stable asthmatics who used inhaled steroids but had no experience of MDPIs. After eight weeks' treatment a mean increase in morning PEF of 16 l/min from a baseline of 356 ±112 l/min was observed for each treatment. Similar improvements occurred in evening PEF, FEV1, FVC and asthma symptoms. Both treatments had only minimal effect on morning serum Cortisol levels. Compliance with both treatments was high (>97%) but almost twice as many patients favoured the EH (59%) compared with the TH (33%); 7% rated the devices equally. Scores of device acceptability were significantly in favour of the EH (p=0.001). BDP‐EH and BUD‐TH showed comparable efficacy and safety in the treatment of asthma. Each MDPI had a high rate of compliance, but patients registered greater preference for the EH than the TH. (Int J Clin Pract 2000; 54(6): 368‐372)
UNSTABLE ANGINA – A DEFINITIVE ROLE FOR STATINS IN SECONDARY PREVENTION
Authors: Colquhoun D 
Published: April 2023

SUMMARYUnstable angina is a life‐threatening disease. The overall incidence is estimated to be between 0.1 and 0.2% and, of those admitted to hospital, up to 5% die within the first six weeks. With such a high prevalence and poor prognosis, there is still a clear need for improved secondary preventive treatment. Several landmark statin trials (CARE, LIPID and 4‐S) have now shown the benefits of lowering cholesterol, starting months after an acute coronary event, and several smaller studies (such as L‐CAD, PTT and RECIFE) have demonstrated the clinical benefits of very early statin treatment. Recent research suggests the underlying cause of the disease, atherosclerosis, is a dynamic and potentially reversible process. Statins may tip this balance in favour of resolution by cholesterol lowering and through pleiotropic effects independent of lipid lowering. Pravastatin, when given very early in the clinical course, has already been shown to improve both plaque stability and endothelial function, as well as clinical outcome, suggesting it as the drug of choice in early secondary prevention. (Int J Clin Pract 2000; 54(6): 383‐389)
ANOMALOUS CORONARY ARTERIES OF AORTIC ORIGIN
Authors: Felmeden D , Singh SP , Lip GYH 
Published: April 2023

SUMMARYAnomalous coronary arteries cause only uncharacteristic symptoms and are therefore often an incidental finding during conventional coronary angiography, with an incidence of 0.3‐0.8%. The commonest anomaly is an aberrant origin of the main left or right coronary artery from the wrong sinus of Valsalva. Rarely there is a fistula draining into one of the cardiac cavities (right ventricle, right atrium, left ventricle or, rarely, superior vena cava) or displaced connection, as seen in anomalous origin of coronary artery from the pulmonary artery, resulting in a left‐to‐right shunt. In congenital heart disease, especially Fallot's tetralogy, the incidence of abnormal coronary arteries may be 2% or more. The proximal course in the former category may be misdiagnosed in up to 50% of cases. Aortic root injection with subtraction angiography, further detailed investigation with transoesophageal echocardiography or magnetic resonance angiography are therefore required as these have potential implications on subsequent surgery. Because of the abnormal course between aorta and pulmonary artery/outflow tract of the right ventricle and acute angulation there is a risk of angina, acute myocardial infarction or sudden death during or after exercise. It is therefore important to identify the exact cardiac anatomy, particularly in patients undergoing angioplasty, stenting or cardiac surgery. (Int J Clin Pract 2000; 54(6): 390‐394)
FATAL CHOLESTATIC JAUNDICE ASSOCIATED WITH AMITRIPTYLIN
Authors: Randeva HS , Bangar V , Sailesh S , Hillhouse EW 
Published: April 2023

SUMMARYA 75‐year‐old woman was admitted with a two‐week history of anorexia and vague abdominal pain. She had been taking amitriptyline 75 mg at night for depression for four months before her admission. On presentation she was jaundiced, but with no stigmata of chronic liver disease. Initial liver function tests showed a slightly raised bilirubin, but were otherwise normal. Over the next three weeks her bilirubin concentration continued to rise without evidence of biliary obstruction on ultrasound examination. Her condition continued to deteriorate, and she later developed renal failure consistent with hepatorenal syndrome. Seven weeks after admission she died following a large gastrointestinal bleed. At autopsy, liver histology confirmed pure cholestasis consistent with amitriptyline ingestion. (Int J Clin Pract 2000; 54(6): 405‐406)
WHAT INFLUENCES OUTCOME OF STROKE – PYREXIA OR DYSPHAGIA?
Authors: Sharma JC , Fletcher S , Vassallo M , Ross I 
Published: April 2023

SUMMARYTo investigate the significance of pyrexia and dysphagia as risk factors for mortality at 90 days in patients admitted with an acute stroke when controlled with other confounding factors, 202 stroke patients admitted to acute medical wards were prospectively studied for demographic and neurological details, stroke syndromes and pathology. A number of other factors were recorded within three days of admission, including pyrexia and dysphagia. Cox's proportional hazards model was used to identify the effect of 10 factors on mortality at 90 days; 59 (29%) patients had died by 90 days. Univariate analysis revealed pyrexia and dysphagia to be independently and significantly associated with indices of stroke severity and 90 day mortality (p<0.001 for both). Cox's proportional hazards model, however, revealed that stroke mortality was associated with dysphagia (relative risk 2.6, 95% CI 1.2–5.4; p=0.009), pre‐existing diabetes mellitus (2.4, CI 1.2–4.5; p=0.006), higher age >75 years (1.8, CI 1.0–3.1), ischaemic heart disease (2.1, CI 1.1–4.2, p=0.025), total anterior circulation syndromes (2.8, CI 1.5–5.2) and previous stroke (1.8, CI 1.0–3.2, p=0.028). Pyrexia was not a significant factor (p=0.50). Although both pyrexia and dysphagia are associated with higher mortality in acute stroke patients, dysphagia was a significant variable predicting death at 90 days when controlled for other factors known to influence stroke mortality. Pyrexia is not significant when other variables are considered.
THE PHARMACOLOGY UNDERLYING PHARMACOTHERAPY FOR TOBACCO DEPENDENCE: A FOCUS ON BUPROPION
Authors: Balfour DJK 
Published: April 2023

SUMMARYTobacco dependence remains the major preventable cause of early mortality and morbidity in the developed world. The primary reinforcer of the dependence is the nicotine present in tobacco smoke and, for many smokers, successful treatment depends upon breaking this dependence. Until recently, the only specific pharmacotherapy available for tobacco dependence was nicotine replacement therapy (NRT). Although this approach does significantly increase long‐term cessation rates, it is by no means a panacea for the many smokers who require help to quit. Recently, a new drug, bupropion (Zyban®), has been licensed as an additional pharmacological aid for smoking cessation. This commentary discusses the mechanisms that may account for its efficacy in this indication and considers the impact its introduction may have on the approach of healthcare systems to the treatment of tobacco dependence.
EFFICACY AND SAFETY OF ‘HOT’ TONSILLECTOMY
Authors: Maheshwar A A , Jones MB , Evans RA 
Published: April 2023

SUMMARYRecurrent acute tonsillitis, peritonsillar infections and quinsy (peritonsillar abscess) are common clinical conditions that present to a general practitioner. Management in general practice and in hospital is confounded by apparently conflicting treatment options in the medical literature. We have developed clear guidelines as part of an ongoing audit cycle which include performing quinsy or ‘hot’ tonsillectomy in selected cases, alongside conservative treatments to ensure the speedy recovery and minimal hospitalisation of all patients, with resultant cost benefits.
LESSER EVALUATED DETERMINANTS OF FISTULA FORMATION IN CHILDREN WITH HYPOSPADIAS
Authors: Ratan SK , Sen A , Pandey RM , Hans C , Roychaudhary S , Ratan J 
Published: April 2023

SUMMARYDeterminants of fistula formation, some of them not previously evaluated, were studied in 30 consecutive children admitted for hypospadias repair to our centre. All children were screened for any urinary or local infections. Vicryl and catgut were used alternately for reconstruction of the neo‐urethra. Per urethral drainage was employed in all patients. The presence of unfavourable local anatomical factors, the surgeon's satisfaction at the end of the procedure and duration of surgery were noted. The patients were followed up for any urethrocutaneous fistula. Unsatisfactory surgery (chi‐square=6.53, p=0.01), unfavourable anatomical factors (chi‐square=10.80, p=0.001) and local infection (chi‐square=5.66, p=0.017) had a strong association with fistula formation, whereas urine leakage and a history of previous surgery had only a marginal association. On application of stepwise binary logistic regression, unfavourable local anatomical factors (OR [95% Cl]: 13.19 [1.20–143.50]) and urine leakage (OR [95% Cl]: 14.35 [1.20–171.45]) emerge as strong risk factors for urethrocutaneous fistula, and local infection (OR [95% Cl]: 8.70 (0.93–81.01]) as a moderate risk factor.
INSIGHT INTO SCHIZOPHRENIA: PLANNING MENTAL HEALTH SERVICE PROVISION FOR SCHIZOPHRENIA USING A BRIEF PSYCHOLOGICAL INTERVENTION
Authors: Pelton J ,   Insight into Schizophrenia Research Group
Published: April 2023

SUMMARYSix nurses were trained to deliver an Insight programme to patients with schizophrenia and their main carers. One outcome of the intervention was the highlighting of recommendations for future treatment. These were fed back on an individual basis through an exit letter to the patient's consultant psychiatrist and key worker. The individual treatment recommendations were then collated into a report for each site and presented to clinical co‐ordinators and business managers. It is envisaged that the recommendations could be used by managers in developing a business case for future mental health provision in schizophrenia. The complete results of the study are due to be published in the near future.
ACUTE ADRENOCORTICAL CRISIS: THREE DIFFERENT PRESENTATIONS
Authors: Bhattacharyya A , Macdonald J , Lakhdar AA 
Published: April 2023

SUMMARYThe adrenal cortex normally produces three principal steroid hormones: the glucocorticoid cortisol, the mineralocorticoid aldosterone, and a small quantity of sex steroids. In primary adrenocortical insufficiency, there is a deficiency of both cortisol and aldosterone with characteristic clinical and laboratory findings. In contrast, with a pituitary disorder there is isolated hypocortisolism, because its production is dependent on pituitary adrenocorticotropic hormone (ACTH), whereas aldosterone production is controlled by extracellular fluid volume, renin and serum potassium. Acute adrenocortical crisis is an absolute medical emergency and its presentation is not always typical. We describe three recent cases of acute adrenocortical crisis in our hospital who presented in three different ways in three different wards.
PELVIC LIPOMATOSIS PRESENTING AS URAEMIC ENCEPHALOPATHY
Authors: Sharma S , Nabi G , Seth A , Thulkar S , Ghai S 
Published: April 2023

SUMMARYPelvic lipomatosis is a benign disorder of unknown aetiology, characterised by deposition of mature fat in the pelvis. It has a variable natural history, manifesting either with symptoms attributable to the lower urinary tract or varying degrees of renal failure. Owing to the mild, non‐specific initial symptoms and slow progression, presentation is delayed and patients are often lost to follow‐up, only to present with advanced renal failure later on. We report a case of a young patient with pelvic lipomatosis who, after an initial diagnosis, was lost to follow‐up for several years and then presented with uraemic encephalopathy. The case highlights the importance of regular follow‐up and an early intervention before irreversible changes occur.
HIGHER ANTI‐HEPATITIS B RESPONSE WITH COMBINED DTPw‐HBV VACCINE COMPARED WITH SEPARATE ADMINISTRATION IN HEALTHY INFANTS AT 3, 4 AND 5 MONTHS OF AGE IN SLOVAKIA
Authors: Prikazsky V , Bock HL 
Published: April 2023

SUMMARYTo help achieve universal infant immunisation against hepatitis B, the World Health Organisation has recommended the development of a combined diphtheria, tetanus and pertussis (DTP) and hepatitis B vaccine (HBV). The advantages come from the fact that DTP coverage is estimated to be over 80% worldwide and a combined DTP‐HB vaccine would increase the coverage of HBV. This study was conducted to compare the immunogenicity and reactogenicity of a combined DTP‐HB vaccine with separate, concomitant administration of DTP and HBV vaccines. One hundred and twenty infants were randomised in a 1:1 ratio to one of the two vaccination regimens, given as three injections at approximately 3, 4 and 5 months of age. The only difference in immunogenicity between the two regimens was a higher antibody response to hepatitis B in the group given the combined vaccine, possibly as a result of the adjuvant effect of the whole cell pertussis component of the DTP vaccine. Both vaccine regimens were well tolerated.
IMPROVED GLYCAEMIC CONTROL WITH THE USE OF SELF‐PREPARED MIXTURES OF INSULIN LISPRO AND INSULIN LISPRO PROTAMINE SUSPENSION IN PATIENTS WITH TYPES 1 AND 2 DIABETES
Authors: Roach P , Strack T , Arora V , Zhao Z 
Published: April 2023

SUMMARYA total of 166 patients (102 type 1, 64 type 2) were randomised to insulin lispro (LP) combined with insulin lispro protamine suspension (NPL), an intermediate‐acting formulation of LP, or to regular human insulin (HR) combined with human NPH insulin (NPH) in this open‐label, parallel study. Insulin doses were similar at endpoint. Blood glucose (BG) measurements (before and two hours after meals, bedtime, 3 a.m.)(mmol/l) were lower with LP/NPL two hours after breakfast (8.84 ± 0.32 vs 10.29 ± 0.41, p<0.001), before lunch (6.21 ± 0.20 vs 7.10 ± 0.31, p=0.016), two hours after the evening meal (10.18 ± 0.36 vs 7.86 ± 0.28, p<0.0.001), and at bedtime (7.85 ± 0.28 vs 9.43 ± 0.40, p=001). HbA1c was lower for LP/NPL at endpoint (7.54 ± 0.11% vs 7.92 ± 0.10%, p=0.019). There was no difference in hypoglycaemia or insulin antibody levels. LP/NPL resulted in better glycaemic control than HR/NPH without increasing the risk of hypoglycaemia.
MANAGING INFLUENZA: AMANTADINE, RIMANTADINE AND BEYOND
Authors: Fleming DM 
Published: April 2023

SUMMARYAmantadine and rimantadine are effective in the treatment and prophylaxis of influenza A. Neither drug, however, has achieved widespread acceptance because of the rapid development of viral resistance, their lack of activity against influenza B and, in the case of amantadine, adverse events. Complete cross‐resistance occurs with these compounds and is associated with a single nucleotide change in the M2 protein. Resistant variants are transmissible and fully pathogenic. Zanamivir is the first widely approved neuraminidase inhibitor for the treatment of influenza. It is delivered directly to the primary site of viral replication, the respiratory tract, and is well tolerated and effective in the treatment of both influenza A and B. Data in prophylaxis are also encouraging. During the extensive clinical programme no evidence for the emergence of drug‐resistant strains with acute therapy was found. Zanamivir represents a significant advance over older agents in the management of influenza A and B.
TUMOUR NECROSIS FACTOR AS A THERAPEUTIC TARGET IN RHEUMATOID ARTHRITIS AND OTHER CHRONIC INFLAMMATORY DISEASES: THE CLINICAL EXPERIENCE WITH INFLIXIMAB (REMICADE™)
Authors: Bondeson J , Maini RN 
Published: April 2023

SUMMARYTherapeutic strategies that aim to neutralise the important pro‐inflammatory cytokine tumour necrosis factor α (TNFα) have gained considerable prominence in the therapy of chronic inflammatory diseases, notably rheumatoid arthritis and Crohn's disease. This drug focus review will concentrate on the antitumour necrosis factor antibody infliximab (Remicade™), which has been approved for the treatment of rheumatoid arthritis and Crohn's disease in both the US and Europe. In addition, infliximab is under investigation for several other indications, mainly inflammatory rheumatic diseases. Clinical trials have been persuasive that infliximab is both safe and effective, and it has been proven to be far superior to the conventional drug therapy in both rheumatoid arthritis and Crohn's disease. Remarkably, infliximab in combination with methotrexate controls both the inflammatory joint symptoms and the progression of joint damage, which renders it a very attractive therapeutic option in moderate to severe, therapy‐resistant rheumatoid arthritis.
CROHN'S DISEASE PRESENTING AS LEFT GLUTEAL ABSCESS
Authors: Hussien M , Mudd DG 
Published: April 2023

SUMMARYAlthough abscesses and fistulae are common complications of Crohn's disease, the gluteal area is a rare site for abscess formation. The abscess results from extension of pus through the fascial plains of the pelvis and through the greater sciatic foramen into the gluteal area. This is the first reported left gluteal abscess due to Crohn's disease as pus extends across the midline to the left side. The clinical picture can be misleading and diagnosing the source of infection may be difficult. Incision of this abscess without identifying the source of infection will result in enterocutaneous fistula. Ultrasound guided aspiration of the abscess as well as treatment of metabolic deficiencies and septicaemia before definitive surgical treatment of the bowel disease will reduce the morbidity and mortality of this rare complication. The clinical picture, management of this complication and review of the literature are discussed.
ERECTILE DYSFUNCTION: IS THERE SILENT OBSTRUCTIVE CORONARY ARTERY DISEASE?
Authors: O'Kane PD , Jackson G 
Published: April 2023

SUMMARYErectile dysfunction (ED) has long been ascribed to the ageing process. Patients presenting with ED often have their symptoms ignored in terms of both underlying aetiology and treatment. It is now clear that, in many cases, the pathological processes in ED are common to those involved in vascular disease. Men with proven coronary artery disease (CAD) have a high incidence of ED when directly questioned. In some, the onset of ED pre‐dates the symptoms and diagnosis of CAD as exemplified in our two cases. Patient 1 developed ED two months before an acute anterior myocardial infarction. Patient 2 had several cardiovascular risk factors but only the presence of ED prompted investigations which eventually led to an angiographic diagnosis of three‐vessel disease. The presence of silent co‐existing myocardial ischaemia should be considered in men who present with ED, particularly when they have other cardiovascular risk factors.
BUPROPION OVERDOSE: A POTENTIAL PROBLEM WITH THE NEW ‘MIRACLE’ ANTI‐SMOKING DRUG
Authors: Bhattacharjee C , Smith M , Todd F , Gillespie M 
Published: April 2023

SUMMARYBupropion (Zyban) has recently been launched in the UK as an aid to smoking cessation. As a result of the considerable publicity, there has been unprecedented demand for this new drug in primary care. Within a few weeks of its launch, four patients presented to our A&E department having taken bupropion as an intentional overdose. Three recovered with simple supportive measures; one one was critically ill and required admission to the intensive care unit. There are several case reports on bupropion overdose in the US but none so far in the UK.
POST‐TRAUMATIC COMBINED TRANSDIAPHRAGMATIC INTERCOSTAL AND LUMBAR HERNIA
Authors: Çubukçu A , Gönüllü NN , Arslan SA , Alponat A 
Published: April 2023

SUMMARYTraumatic rupture of the diaphragm following blunt trauma is rare. Lumbar hernia in association with blunt trauma is even rarer. To our knowledge, the combination of these two entities has not previously been reported. We describe such a case and review the literature.
ANTIHYPERTENSIVE EFFICACY AND TOLERABILITY OF LOW‐DOSE PERINDOPRIL/INDAPAMIDE COMBINATION COMPARED WITH LOSARTAN IN THE TREATMENT OF ESSENTIAL HYPERTENSION
Authors: Chanudet X , De Champvallins M 
Published: April 2023

SUMMARYThe aim of the study was to evaluate the antihypertensive efficacy and tolerability of the low‐dose combination of the angiotensin‐converting enzyme inhibitor perindopril 2 mg plus the diuretic indapamide 0.625 mg (P/I) compared with the angiotensin II antagonist losartan 50 mg (L50) in the treatment of essential hypertension. Patients (n=277) were randomised, double‐blind and allocated to receive either P/I or L50 once daily for a period of 12 weeks. Responder and normalisation rates in the two groups were compared by a chi2 test. Ambulatory blood pressure monitoring results were compared using the one‐tailed Student's t‐test. Normalisation rates were significantly greater in the P/I group (76.0%) than in the L50 group (60.0%) (p=0.009). Responder rates were significantly higher in the P/I group (91.7%) than in the L50 group (81.8%) (p=0.025). The average blood pressure reductions were: in sSBP (P/I‐L50 = ‐2.4 mmHg; CI: 6.2; 1.3) and sDBP (P/I‐L50 = ‐2.0 mmHg; CI: ‐4.2; 0.2). The average night‐time SBP decrease (ABPM) was significantly greater in the P/I group (p=0.041). The tolerability was comparable between the two groups in terms of emergent adverse events related to treatment (12.4% for P/I patients and 8.4% for L50 patients). Laboratory evaluations did not show any significant variations. It was concluded the low‐dose P/I combination had significantly higher responder and normalisation rates than L50. This study also confirmed the good tolerability of both treatments.
A COST‐EFFECTIVENESS MODEL OF ALTERNATIVE STATINS TO ACHIEVE TARGET LDL‐CHOLESTEROL LEVELS
Authors: Maclaine GDH , Patel H 
Published: April 2023

SUMMARYAn economic model was developed to estimate the relative cost‐effectiveness of alternative HMG‐CoA reductase inhibitors (statins) – atorvastatin, cerivastatin, fluvastatin, pravastatin and simvastatin – to achieve target low‐density lipoprotein cholesterol (LDL‐C) levels in a population of secondary CHD prevention patients. By using a cholesterol target as the endpoint of interest and a dose titration approach, the model assumes that the statins demonstrate a class effect through cholesterol lowering. The model was used to estimate the proportion of patients achieving target LDL‐C levels (<3 mmol/l) under each scenario tested. Total costs and incremental cost‐effectiveness relative to no treatment and to the lowest cost option were estimated for each scenario. Total costs were highest for pravastatin and lowest for cerivastatin. Compared with no treatment, the incremental cost per patient treated to target LDL‐C varied between £383 (atorvastatin) and £1213 (pravastatin). Incremental cost‐effectiveness ratios in comparison with the lowest cost treatment (cerivastatin) were £141 per additional patient achieving target LDL‐C with atorvastatin, and £275 with simvastatin. Fluvastatin and pravastatin were both less effective and more expensive than the lowest cost therapy. Although cerivastatin was associated with lowest expected costs, therapy with atorvastatin achieved the lowest cost‐effectiveness ratios. Hence atorvastatin would allow the largest number of patients to be treated to target LDL‐C within a fixed drug budget. Choosing between drug therapies on the basis of price alone may be misleading if the effectiveness of therapies varies.