bluuebunny/crossref_metadata_2025_split huggingface dataset:
UNDERSTANDING PATIENT PERCEPTIONS OF ASTHMA: RESULTS OF THE ASTHMA CONTROL AND EXPECTATIONS (ACE) SURVEY
Authors: Jones K Gruffyd , Bell J , Fehrenbach C , Pearce L , Grimley D , McCarthy TP 
Published: April 2023

SUMMARYIn spite of support among UK healthcare professionals for asthma guidelines, studies continue to show that many patients fail to reach the suggested management goals. Patient expectations and poor communication may be factors in this failure. This survey assessed patients' asthma control, expectations in respect of asthma and communication with healthcare professionals. A structured questionnaire, designed for self‐completion, was developed and distributed to asthma patients at participating pharmacies. A total of 1031 questionnaires were returned. Most of the respondents, even among those feeling well, reported lifestyle restrictions because of asthma. These restrictions were not generally discussed with healthcare professionals. One‐third did not perceive the benefits of inhaled corticosteroids. Low expectation may be a major contributor to the poor control seen in this survey. The failure to discuss lifestyle restrictions and symptom levels with healthcare professionals gives little scope for recommendation of appropriate and adequate treatment. Improved communication between healthcare professionals and patients may help such understanding and raise patient expectations.
9. ARM LYMPHOEDEMA FOLLOWING BREAST CANCER TREATMENT
Authors: Sparaco A , Fentiman IS 
Published: April 2023

SUMMARYLymphoedema of the upper limb can be a devastating consequence of breast cancer treatment. A wide range of incidence has been reported but the generally accepted rate is around 12%. The exact pathophysiological mechanisms remain unclear. Agreed working definitions are required in order to standardise future research in this area. The psychosocial importance and management is fundamental in limiting the impact of this phenomenon. Furthermore, it remains that the primary cause is dissection of the axilla. Therefore, active investigation into potential tools that may eliminate or reduce the extent of dissection without compromising prognosis is warranted.
SELECTIVE CHOLESTEROL ABSORPTION INHIBITION: A NOVEL STRATEGY IN LIPID‐LOWERING MANAGEMENT
Authors: Leitersdorf E 
Published: April 2023

SUMMARYMany individuals throughout Europe have risk factors for coronary heart disease (CHD) and are non‐compliant with recommended treatments, despite guidelines for the reduction of low‐density lipoprotein cholesterol (LDL‐C) and the prevention of CHD. Significant numbers who should receive pharmacotherapy for hypercholesterolaemia do not, and one‐third of treated patients do not achieve recommended target LDL‐C levels. Optimum doses of statins, which have demonstrated undisputed efficacy in the treatment of hypercholesterolaemia in clinical trials, are seldom used; the inconvenience of dosage adjustments and safety concerns, particularly myalgia, may constitute obstacles to their optimal use for LDL‐C reduction in clinical practice. Ezetimibe is the first selective cholesterol absorption inhibitor that has demonstrated clinical benefits when used as either monotherapy or in combination with other lipid‐modifying agents.
AN OVERVIEW OF THE PHARMACOLOGY, EFFICACY, SAFETY AND COST‐EFFECTIVENESS OF LANSOPRAZOLE
Authors: Bown RL 
Published: April 2023

SUMMARYLansoprazole is a proton pump inhibitor that reduces gastric acid secretion in a dose‐dependent manner via inhibition of H+/K+‐adenosine triphosphatase in gastric parietal cells. It also exhibits antibacterial activity againstHelicobacter pyloriin vitro. During almost 10 years of clinical use, lansoprazole has proved effective and well tolerated in a wide range of acid‐related disorders, including gastro‐oesophageal reflux disease (GORD), duodenal ulcers, gastric ulcers, non‐steroidal anti‐inflammatory drug‐related ulcers, as well as non‐ulcer dyspepsia and acid hypersecretion. It is also used, in combination with antibiotics, forH. pylorieradication. In the above indications, lansoprazole has generally proved to be superior to the histamine H2‐receptor antagonists, and is at least as effective as the other currently available proton pump inhibitors. This review aims to evaluate the pharmacology, efficacy, safety and cost‐effectiveness of lansoprazole in acid‐related disorders, with particular emphasis on its use in GORD andH. pylorieradication regimens.
ADVERSE CUTANEOUS REACTION TO NAPROXEN: A MISSED DIAGNOSIS FORTUITOUSLY RESOLVED
Authors: Bandyopadhyay P , Butler JV , Patel CU 
Published: April 2023

SUMMARYA 91‐year‐old man presented with a one‐month history of swollen legs and dyspnoea. He also complained of a 16‐year chronic rash that had caused him considerable morbidity and cosmetic problems. He had been taking naproxen for several years for osteoarthritis. Clinical examination demonstrated bilateral pitting oedema of the leg and a widespread excoriated rash that affected most of his body. A clinical diagnosis of fluid retention secondary to naproxen was made. Stopping naproxen led not only to the resolution of his leg oedema and dyspnoea, but also to the prompt and complete remission of the rash. Reviewing the patient's history revealed that the rash had almost certainly first appeared when naproxen was started many years previously.
ANAL INCONTINENCE AMONG IGBO (NIGERIAN) WOMEN
Authors: Okonkwo JEN , Obionu CN , Okonkwo CV , Obiechina NJA 
Published: April 2023

SUMMARYAnal incontinence in patients who present to the gynaecology clinic for symptoms other than pelvic organ prolapse dysfunction is fairly common. A structured pre‐tested 41‐item pelvic organ prolapse questionnaire was administered by doctors to 3963 gynaecological patients, recruited from three states of south‐eastern Nigeria, who were in the clinic for reasons other than pelvic organ prolapse dysfunction. This report considers only anal incontinence. We found a prevalence of 6.96% for anal incontinence. Of these, 2.67% were incontinent for liquid stool, 2.17% for solid stool and 2.12% for flatus. There appears to be a higher frequency of flatus incontinence in the reproductive years: 36.6% of primiparas aged <30 years had faecal incontinence. Flatus incontinence was present in 28 (43.7%) of 198 para 4 and below, and in 36 (56.3%) of 78 para 5 and above. There was thus a significant association between flatus incontinence and parity (χ2=32.4; p<0.001). Spontaneous vaginal delivery had a significant effect on anal incontinence (p=0.04). Physicians should, be able to detect this embarrassing condition and be alert to factors that may avert or ameliorate it.
MANAGEMENT OF CHRONIC OSTEOMYELITIS IN A DEVELOPING COUNTRY USING CEFTRIAXONE‐PMMA BEADS: AN INITIAL STUDY
Authors: Alonge TO , Ogunlade SO , Omololu AB , Fashina AN , Oluwatosin A 
Published: April 2023

SUMMARYChronic osteomyelitis is a debilitating disease that is fairly common in developing countries. Various operative techniques have been adopted in the management of this disease but there have been few reports of their use in Africa. In this report, we present our experience of the use of a modified two‐staged Belfast operation in patients with chronic osteomyelitis in Ibadan, Nigeria. An important modification of the procedure was the substitution of gentamicin beads (Septopal) with ceftriaxone‐polymethylmethacrylate (PMMA) beads at the saucerised segment of bone at the first stage. Thirty‐four patients with chronic osteomyelitis had the two‐stage Belfast operation in 35 long bones; of these, 32 patients had ceftriaxone‐PMMA antibiotic beads inserted at the saucerised segment of bone at the first stage, while the other two patients had gentamicin beads inserted. One of the two patients who had gentamicin beads had a residual collection of pus at second stage surgery but, following a repeat debridement, the cavity was rid of infection. There was recurrence of infection in three patients (8.6%) who had a suction drain inserted at the first stage and in six patients (17.1%) who had no suction drain at the first stage. The locally produced ceftriaxone‐PMMA beads were found to be as efficient as the commercially available gentamicin beads in eluting antibiotics locally, thereby eliminating the residual infection in the bone cavities after the first stage. Another important outcome was a fourfold saving in cost in choosing to use ceftriaxone‐PMMA beads rather than gentamicin beads.
12. TIMING OF SURGERY FOR BREAST CANCER
Authors: Fentiman IS 
Published: April 2023

SUMMARYSeveral studies have now shown that premenopausal women with early breast cancer have a significantly better prognosis if their tumours are excised during the luteal phase of the cycle. The 10‐year survival for node positive cases undergoing follicular phase surgery was 33% compared with 78% in those having surgery at other times of the menstrual cycle. Further work has shown that there is an improved survival in those with plasma progesterone levels >4 ng/ml‐1, associated with the luteal phase. Luteal phase surgery is also associated with a decreased risk of vascular invasion, implying that the tumour is more cohesive at that time. Similarly, in the heaviest quartile of postmenopausal patients, with the highest endogenous oestrogen levels, there was vascular invasion around tumours in 45% compared with only 11% of the lightest quartile. Changing the hormonal milieu at the time of surgery for breast cancer may have the ability to improve the prognosis for some patients with early breast cancer.
CERVICAL METASTASIS IN PAPILLARY CARCINOMA OF THE THYROID: A HISTOPATHOLOGICAL STUDY
Authors: Coatesworth AP , Maclennan K 
Published: April 2023

SUMMARYThe tendency of well differentiated thyroid carcinoma to remain localised, and the slow progression of these tumours, have supported the belief that this disease behaves as a low grade malignancy. However, with differentiated carcinomas of the thyroid the incidence of nodal metastasis is highest in the papillary subgroup, and the importance of cervical metastases is being increasingly recognised. We have performed and prospectively analysed 17 neck dissections in 13 patients with clinically N+ve necks and papillary carcinoma of the thyroid. In all 17 neck dissections, metastatic deposits of papillary carcinoma of the thyroid were seen, with metastases found in all levels. Our findings of positive lymph nodes in all levels of the neck, with no predictable pattern of spread, and skip metastases, support an aggressive surgical approach to the treatment of cervical metastatic papillary carcinoma of the thyroid.
THE IMPORTANCE OF CODED RADIOGRAPHIC LABELLING IN CLINICAL PRACTICE
Authors: Harding IJ , Pearce O 
Published: April 2023

SUMMARYLocating a particular radiograph from a radiographic envelope can be a frustrating and time‐consuming process. The aim of this study was to evaluate the role of colour and number coding of radiographs in reducing time taken to locate films and thereby improve efficiency. The time taken by clinicians to retrieve films from a radiographic envelope was measured. The radiographs were coded by number, number and colour or not at all. Results show a statistically significant reduction in time taken to find number coded versus non‐coded radiographs. A further benefit was gained by using colour coding in conjunction with number coding. We recommend the use of colour and number coding of radiographs in clinical practice.
MONITORING DIETARY COMPLIANCE IN COELIAC DISEASE USING RED CELL DISTRIBUTION WIDTH
Authors: Mitchell RMS , Robinson TJ 
Published: April 2023

SUMMARYRed cell distribution width (RDW) as measured on modern blood analysers is a sensitive marker of nutritional deficiency affecting red blood cell production and maturation. Such deficiencies are common in coeliac disease and it may therefore be possible indirectly to assess response to a gluten‐free diet by monitoring the RDW. We measured RDW, iron, B12, folate and endomysial antibodies (EMA) in 46 newly diagnosed coeliac patients at diagnosis and after a gluten‐free diet. RDW was elevated in 76% of patients at diagnosis. There was a significant decrease in RDW (17.3% vs 13.8%) after 12 months of diet, corresponding to sero‐conversion of EMA and normalisation of serum iron, B12 and folate levels. We conclude that monitoring RDW is a simple indirect means of assessing response to a gluten‐free diet in coeliac disease.
EFFICACY AND SAFETY OF PIOGLITAZONE IN TYPE 2 DIABETES: A RANDOMISED, PLACEBO‐CONTROLLED STUDY IN PATIENTS RECEIVING STABLE INSULIN THERAPY
Authors: Rosenstock J , Einhorn D , Hershon K , Glazer NB , Yu S 
Published: April 2023

SUMMARYThe glycaemic and lipid effects of treatment with pioglitazone in combination with a stable insulin regimen were evaluated in patients with type 2 diabetes. Patients (n=566) receiving stable insulin regimens for ≥30 days yet who had HbA1c ≥8.0% and C‐peptide >0.7 μg/l were randomised to receive once‐daily 15 mg pioglitazone, 30 mg pioglitazone, or placebo in a 16‐week multicentre, double‐blind, placebo‐controlled trial. Per study protocol, the insulin dose was to remain unchanged, but could be decreased in response to hypoglycaemia. At the end of double‐blind treatment, patients receiving pioglitazone (15 mg or 30 mg) showed statistically significant mean decreases relative to baseline HbA1c (‐1.0 and ‐1.3, respectively; p<0.0001) and fasting plasma glucose (FPG) (‐34.5 mg/dl [‐1.92 mmol/l] and ‐48.0 mg/dl [‐2.67 mmol/l], respectively; p<0.0001); these differences compared with placebo were also significant (p<0.0001). Pioglitazone (15 or 30 mg) yielded significant increases in HDL‐C levels (mean increases ranging from +7.1% to + 9.3%) compared with baseline or placebo (p<0.01). The 30 mg dose also significantly reduced mean triglyceride levels (‐23.7%) compared with placebo (p=0.0218). No consistent changes in TC or LDL‐C levels were observed. The incidence of adverse events was similar in all treatment groups, although the incidences of weight increase, hypoglycaemia and oedema were higher among patients receiving insulin plus pioglitazone. There was no evidence of hepatotoxicity or drug‐induced elevations of serum ALT ≥3 x ULN. Pioglitazone, when added to stable insulin regimens, significantly improved HbA1c and FPG in type 2 diabetes. Pioglitazone treatment also provided significant benefit with respect to plasma HDL‐C and triglyceride levels. Whether these lipid changes have an impact on overall diabetic complications remains to be determined.
13. NEW BIOLOGICAL THERAPIES FOR BREAST CANCER
Authors: Plunkett TA , Miles DW 
Published: April 2023

SUMMARYThe exploitation of biological differences between normal and malignant cells is a logical approach to novel treatments for breast cancer. The potential targets for such therapy include the products of proto‐oncogenes and oncogenes, inhibition of growth factor receptor signalling and the immunological exploitation of antigenic differences between normal and malignant cells. Monoclonal antibody technology was heralded as a potential ‘magic bullet’ for cancer therapy following its discovery in the mid‐1970s, but it is only in the past few years that such technology has entered mainstream clinical practice. The humanised murine monoclonal antibody to HER2 (trastuzumab) has significant anti‐tumour activity but with minimal toxicity, and has been licensed for use in patients with advanced breast cancer. A different approach has been the use of enzyme inhibitors to interfere with the signalling pathways downstream of growth factor receptors (e.g. farnesyl transferase inhibitors). It is likely that effective targets for such therapies will be identified in the next few years. There have been significant advances in our understanding of human immunology which have coincided with the identification of so‐called tumour‐associated antigens (TAA). These developments have resulted in a resurgence of interest in tumour immunotherapy. Peptides derived from these TAAs have been used to generate tumour‐specific immune responses. An alternative strategy has been to immunise patients using viral vectors and plasmid cDNA encoding the TAA. In some studies, notably those in patients with advanced melanoma, significant clinical responses have been observed. Cell‐based strategies including autologous tumour cell vaccines, allogeneic tumour cell vaccines and dendritic cell vaccines have been used, and significant responses have been reported in several studies. Few of these methods have so far been applied to breast cancer, but the possible benefits and drawbacks of such an approach will be discussed.
MANAGEMENT OF ACUTE AND CUTANEOUS PORPHYRIAS
Authors: Badminton MN , Elder GH 
Published: April 2023

SUMMARYThe porphyrias comprise a group of disorders of the haem biosynthesis pathway that can present with acute neurovisceral symptoms, skin lesions or both. Acute porphyrias present with severe abdominal pain, confusion and seizures which may be life‐threatening. Specific treatment with haem preparations should be instituted as soon as possible following confirmation of increased excretion of porphobilinogen in the urine. Supportive treatment includes opiate analgesia, monitoring for and treating complications such as hypertension and hyponatraemia. Follow‐up should include counselling on lifestyle modification involving avoidance of alcohol, smoking and known porphyrogenic drugs and diet. Identification and counselling of at risk relatives is essential. The cutaneous porphyrias result from porphyrin‐induced photosensitivity and can present with either acute photosensitivity or skin fragility and blisters. All cutaneous porphyrias can be alleviated by avoidance of sunlight. Treatment of erythropoietic protoporphyria involves administering large doses of β‐carotene, which may improve tolerance to sunlight. Porphyria cutanea tarda can be effectively treated by phlebotomy or low dose chloroquine. Congenital erythropoietic porphyria is a rare, early onset, severe, photomutilating condition for which bone marrow transplantation has been shown to be successful.
TADALAFIL (CIALIS™) FOR MEN WITH ERECTILE DYSFUNCTION
Authors: Eardley I , Cartledge J 
Published: April 2023

SUMMARYTadalafil is an inhibitor of phosphodiesterase type 5, and is currently undergoing regulatory review in the US and in Europe. Its chemical structure is significantly different from sildenafil, and in vitro studies confirm significant potency for PDE5 inhibition, with little activity against most of the other isoforms of the enzyme including PDE6, which is the isoform of the enzyme found within the retina. The half‐life of tadalafil is 17.5 hours and clinical studies suggest significant activity 24 hours post‐dosing. As with sildenafil, efficacy depends upon a normal sexual stimulus, and the drug can taken be as required. Tadalafil is effective in the treatment of men with erectile dysfunction, and it appears to have a relatively mild side‐effect profile, with no visual side‐effects noted.
DISCHARGE AGAINST MEDICAL ADVICE: SOCIODEMOGRAPHIC, CLINICAL AND FINANCIAL PERSPECTIVES
Authors: Aliyu ZY 
Published: April 2023

SUMMARYDischarge against medical advice (DAMA) presents healthcare providers with clinical, ethical and legal challenges. Patient factors – demographic, social and clinical – may determine the possibility of a hospitalisation ending against medical advice. All cases of DAMA from St Agnes Hospital, Baltimore, were identified from the computerised medical system. Patient factors including demographic, social and clinical variables relating to these discharges were analysed. Readmission data and cost of hospitalisation were also assessed. DAMA represented 1% of all discharges. The average length of stay was 2.3 days, at a cost of $3716.00. The average length of stay of 30‐day readmission was 4.7 days, making the cumulative cost of hospitalisation $10,761.56, 56% higher than expected. African Americans, males, lack of medical insurance and substance abuse were strongly associated with DAMA (p<0.01). Careful and proactive management strategies could mitigate the potential clinical, legal and economic implications of DAMA.
ACUTE EFFECT OF HAEMODIALYSIS ON SERUM MARKERS OF MYOCARDIAL DAMAGE
Authors: Tarakçioglu M , Erbagcl AB , Çekmen M , Usalan C , Çiçek H , Özaslan J , Camci C 
Published: April 2023

SUMMARYCardiac markers are more likely to be elevated in dialysis patients than in patients with renal failure not on dialysis. In this study, 31 patients (20 males, 11 females) undergoing chronic haemodialysis were enrolled. The effect of haemodialysis on cardiac troponin T (cTnT), I (cTnI), creatine kinase MB (CKMB) mass, CKMB activity and myoglobin assays was assessed by comparing pre‐ and post‐haemodialysis determinations. After correcting for haemoconcentration, significant differences were observed (mean ± SEM, pre‐ vs post‐dialysis) for myoglobin (178.9 ± 19.3 vs 225.0 ± 28.4 ng/ml; p=0.006) for cTnT (0.111 ± 0.028 vs 0.148 ± 0.037 ng/ml; p=0.004), for CKMB mass (2.75 ± 0.37 vs 2.59 ± 0.37 ng/ml; p=0.000) and CKMB activity (14.8 ± 0.9 vs 13.1 ± 0.9 U/l; p=0.000) assays. Our study questions the reliability of cardiac markers in dialysis patients and suggests that the clinical threshold value and diagnostic efficiency of each assay needs to be validated. Although these differences exceeded clinical threshold values in only a few patients, serum markers of myocardial damage in dialysis patients should be interpreted with caution.
RELATIONSHIP OF BONE TURNOVER PARAMETERS, ENDOGENOUS HORMONES AND VIT D DEFICIENCY TO HIP FRACTURE IN ELDERLY POSTMENOPAUSAL WOMEN
Authors: Erem C , Tanakol R , Alagöl F , Ömer B , Çetin Ö 
Published: April 2023

SUMMARYHip fracture is one of the severest consequences of osteoporosis affecting elderly women, but abnormalities of bone turnover responsible for bone loss have not been clearly defined. This study evaluated the relationship of bone turnover parameters to hip fracture in postmenopausal elderly women. We also investigated the effects of endogenous hormones and vitamin D deficiency on osteoporotic hip fracture. The subjects were 21 osteoporotic patients with hip fracture (study group) and 20 healthy postmenopausal women (control group). We measured osteocalcin levels, total and bone alkaline phosphatase (T‐ALP and B‐ALP), calcitonin, intact parathyroid hormone (iPTH), serum 25 hydroxyvitamin D (25OHD), urinary free deoxypyridinoline (D‐pyr) and cross‐linked N‐telopeptides of type 1 collagen (NTx) levels. Serum T‐ALP and B‐ALP levels in the study group were lower than those of the control group. The mean serum 25OHD levels in the study group were not significantly different from the control group, but in five cases the mean serum iPTH level was increased. The mean urinary NTx levels were significantly increased in the study group compared with the control group (p<0.05). There was no significant increase in urinary free D‐pyr between the two groups. There was significant correlation between serum T‐ALP levels and B‐ALP levels and between serum iPTH levels and B‐ALP levels. The mean serum SHBG level in the study group was higher than in the control group (p<0.05). These data suggest that postmenopausal hip fracture patients have biochemical evidence of decreased bone formation and increased bone resorption compared with postmenopausal healthy subjects. We suggest these abnormalities play a role in the decrease of bone mass and the consequent increase in bone fragility that characterises osteoporotic hip fracture.