bluuebunny/crossref_metadata_2025_split huggingface dataset:
COMPARATIVE EFFICACY OF PERINDOPRIL AND ENALAPRIL ONCE DAILY USING 24‐HOUR AMBULATORY BLOOD PRESSURE MONITORING
Authors: Yusoff K , Razak TA , Yusof N , Rafee NM 
Published: April 2023

SUMMARYACE inhibitors are important therapeutic agents in controlling hypertension, correcting some of its pathophysiological derangement and improving its prognosis. While there are many such agents, there may be some important differences between them. This placebo run‐in, double blind, crossover study, using 24‐hour ambulatory blood pressure monitoring, compares the efficacy of perindopril 4‐8 mg and enalapril 10‐20 mg as once daily antihypertensive agents on 32 patients. For diastolic blood pressure (DBP), perindopril had a placebo‐corrected peak (P) reduction of blood pressure (BP) of ‐6.4 ± 1.3 mmHg vs its placebo‐corrected trough (T) of – 5.2 ± 1.7 mmHg. Enalapril had a reduction in DBP of ‐8.5 ± 1.3 mmHg (P) and ‐5.7 ± 1.7 mmHg (T). For systolic blood pressure (SBP), perindopril had a reduction of – 7.5 ± 1.6 mmHg (P) vs ‐7.3 ± 2.2 mmHg (T) compared to enalapril with ‐10.8 ± 1.6 mmHg (P) vs ‐8.3 ± 2.3 mmHg (T). Placebo‐corrected trough‐to‐peak ratio (SBP/DBP) for perindopril was 0.97/0.81 vs 0.77/0.67 for enalapril. There was no difference noted in 24‐hour mean BR area under the curve or post‐dose casual BP measurements. Both perindopril and enalapril were well tolerated and the two treatment groups had similar safety profiles. Perindopril thus had a predictable and sustained blood pressure effect giving a 24‐hour cover for the patient without excessive peak effect or poor trough effect.
THE TREATMENT OF METASTATIC COLORECTAL CANCER
Authors: Karapetis CS , Yip D , Harper PG 
Published: April 2023

SUMMARYMetastatic colorectal cancer represents an incurable condition, with the exception of a very select group of patients in whom surgical excision of recurrent disease is possible. Chemotherapy offers a significant palliative benefit and may prolong patient survival. The preferred cytotoxic agent is 5‐fluorouracil, though the optimal administration schedule is unknown. Recent evidence also supports the use of second‐line chemotherapy for patients who develop progressive disease following 5‐fluorouracil treatment. Promising results have been obtained with new drugs, in particular oxaliplatin and irinotecan. Novel therapeutic approaches, including immunotherapy and liver directed strategies, are undergoing clinical evaluation. Comprehensive supportive care, with appropriate community and hospital based palliative care, is essential in the management of patients with advanced colorectal cancer.
CROHN'S DISEASE AND COLORECTAL MALIGNANCY
Authors: Kirk GR , Clements WDB 
Published: April 2023

SUMMARYThere has been much debate over the past 50 years concerning the association between colorectal carcinoma and inflammatory bowel disease. Until recently, it was widely accepted there was a higher risk in those with widespread ulcerative colitis. However, evidence now suggests an almost equal incidence in those with Crohn's disease of similar extent and duration.1 We present a case that underlines the important clinical and pathological features of Crohn's disease associated colorectal carcinoma (CDAC). We present a literature review and debate the role of regular colonic surveillance in patients with Crohn's disease affecting the colon.
SWITCH TO NON‐CFC INHALED CORTICOSTEROIDS: A COMPARATIVE EFFICACY STUDY OF HFA‐BDP AND CFC‐BDP METERED‐DOSE INHALERS
Authors: Demedts M , Cohen R , Hawkinson R 
Published: April 2023

SUMMARYInhaled corticosteroids, such as beclomethasone dipropionate (BDP), recommended for the treatment of persistent, mild, moderate, or severe asthma, have traditionally been administered via chlorofluorocarbon (CFC) propellant. The imminent phasing out of CFCs from pharmaceutical preparations due to the Montreal Protocol means patients will have to switch to a CFC‐free alternative. One such preparation is hydrofluoroalkane‐BDP (HFA‐BDP), a press‐and‐breathe metered‐dose inhaler. This 8‐week, open‐label, multicentre study assessed asthma control in patients switching from CFC‐BDP to HFA‐BDP (Qvar). Patients with asthma, stabilised on 400‐1600 μg/day CFC‐BDR were randomised to HFA‐BDP (354 patients; 75%) at half their current daily dose of CFC‐BDR or to CFC‐BDP (119 patients; 25%). HFA‐BDP efficacy was found to be equivalent to that of CFC‐BDP in that no statistically significant difference was observed between the two groups in the mean change from baseline in a.m. PEF (95% CI within ±11 l/min). No statistically significant differences were observed between the two groups for increased asthma symptoms or acute asthma episodes. We conclude that asthma control was maintained over 8 weeks, with few asthma exacerbations, in patients switching from previous CFC‐BDP therapy to HFA‐BDP at half the dose.
I. THE STIGMA OF EATING DISORDERS
Authors: Gowers SG , Shore A 
Published: April 2023

SUMMARYThose who suffer from eating disorders often carry the added burden of stigmatising attitudes from the lay public and the medical profession. These attitudes not only restrict the opportunities for effective treatment but also confer additional handicaps. To some extent, stigmatising beliefs are based on partial truths about these disorders, namely their dangerousness, their sometimes poor response to treatment, the sufferers' part in their maintenance, and difficulties in communication. This review explores the truth of these beliefs and suggests ways in which a more positive approach to the management of eating disorders might help to reduce the stigma. This includes empathy with the patient's predicament and an approach to treatment in which the patient's wishes are paramount.
MUCOCOELES OF THE MAXILLARY SINUS
Authors: Jayaraj SM , Patel SK , Ghufoor K , Frosh AC 
Published: April 2023

SUMMARYMucocoeles of the paranasal sinuses most commonly occur in the frontal or anterior ethmoidal sinuses. We report two rare cases of mucocoele of the maxillary sinus and describe the presentation, investigations and treatment. A review of the literature on this rare clinical entity is included, with specific reference to diagnostic imaging to distinguish mucocoeles from neoplastic sinus disease.
ASYMPTOMATIC PITUITARY APOPLEXY AFTER AORTOCORONARY BYPASS SURGERY
Authors: Bhattacharyya A , Tymms DJ , Naqvi N 
Published: April 2023

SUMMARYPituitary apoplexy usually presents with acute neuro‐ophthalmological complications that require urgent neurosurgical intervention. We present a case of pituitary apoplexy following aortocoronary bypass surgery that was asymptomatic until the patient presented with features of hormonal deficiency three months later. Only one case of pituitary apoplexy has been described in the literature following cardiac surgery that did not require operative intervention. We discuss the aetiology of pituitary apoplexy and the possible mechanisms for such an event after cardiac surgery. Although this is rare, any unusual feature after operation such as lethargy or erectile dysfunction should remind us of hypopituitarism.
THE USE OF RECOMBINANT HUMAN G‐CSF IN THE TREATMENT OF PROPYLTHIOURACIL‐INDUCED AGRANULOCYTOSIS
Authors: Altunbas H , Yazicioglu G , Balci MK , Karayalçin Ü , Ündar L 
Published: April 2023

SUMMARYA 43‐year‐old female patient with Basedow‐Graves' disease developed agranulocytosis in the eighth month of propylthiouracil therapy. After discontinuing the drug, a broad spectrum antibiotic regimen plus recombinant human granulocyte colony‐stimulating factor (G‐CSF), a human haematopoietic growth factor, were started. Her granulocyte count returned to normal with the second dose of G‐CSF, and ulcerating pharyngitis improved rapidly. We think that in patients with propylthiouracil‐induced agranulocytosis, G‐CSF will reduce the risk and severity of infection, and should be accepted as a part of the standard therapy.
A TRIAL OF A TEST‐AND‐TREAT STRATEGY FOR HELICOBACTER PYLORI POSITIVE DYSPEPTIC PATIENTS IN GENERAL PRACTICE
Authors: Jones R , Tait C , Sladen G , Weston‐Baker J 
Published: April 2023

SUMMARYComputer models of different strategies for the management of dyspepsia in primary care indicate that a ‘test‐and‐treat’ approach is likely to be associated with the lowest costs and acceptable clinical outcomes. We present information on computer modelling studies and report the findings of a randomised trial comparing a Helicobacter pylori test‐and‐treat strategy with referral to direct access endoscopy in the management of dyspepsia in general practice. We compared costs and clinical outcomes in patients managed for one year in study (test‐and‐treat) and control (endoscopy) practices in south London. Patients aged less than 45 years presenting with persistent dyspepsia without alarm symptoms (141 study patients, 91 control patients) were studied. In the one‐year follow‐up period there were 17 endoscopies in the study group: all the control patients underwent initial endoscopy and five further endoscopies were performed. None revealed peptic ulcer or cancer. Forty‐three (30%) of the study patients compared with 16 (17%) of the controls were referred to hospital clinics (p<0.025). The cost of management per patient for one year in the study group was £205.67, compared with £404.31 in the control group (p<0.0001). Clinical outcomes in both groups at one year were comparable. An H. pylori test‐and‐treat strategy for dyspeptic patients aged less than 45, employing office‐based serology testing, appears to be associated with substantially lower costs than initial endoscopy and with similar clinical outcomes.
COMPARISON OF SPIRAMYCIN AND CLARITHROMYCIN FOR COMMUNITY‐ACQUIRED LOWER RESPIRATORY TRACT INFECTIONS
Authors: Ocha RTR , Awad CE , Ali A , Matyas R , Vital ACC , Silva COS , Dainesi SM , Salazar  , Nakatani J 
Published: April 2023

SUMMARYThis open multicentre study compared the efficacy and tolerability of clarithromycin and spiramycin in the treatment of lower respiratory tract infections in Brazil and Colombia. A total of 125 patients with a clinical and radiological diagnosis of pneumonia, acute bronchitis or exacerbation of chronic bronchitis were randomised to receive oral doses of either clarithromycin (500 mg) or spiramycin (3 MIL)) every 12 hours for courses of 5‐10 days. Patients were assessed before the start of treatment, and at days 3‐4 and days 9‐17. Twenty‐six (26) patients (16 in the spiramycin group and 10 in the clarithromycin group) reported adverse events, seven of whom withdrew from the trial. Statistical analysis detected no significant differences between efficacy (p=0.768) or tolerability (p=0.236) for the two treatment groups. Spiramycin therefore has similar efficacy to clarithromycin in the treatment of community‐acquired lower respiratory tract infections.
BACTERIOLOGICAL ERADICATION OF STREPTOCOCCUS PNEUMONIAE FROM PATIENTS WITH ACUTE EXACERBATIONS OF CHRONIC BRONCHITIS: CEFUROXIME AXETIL VERSUS CEFIXIME
Authors: Zuck P , Petitpretz P , Geslin P , Rio Y , Leblanc F 
Published: April 2023

SUMMARYThe bacteriological eradication rates of Streptococcus pneumoniae from sputum of patients experiencing acute exacerbations of chronic bronchitis (WHO definition) have been compared following therapy with either cefuroxime axetil 250 mg b.d. or cefixime 200 mg b.d. All patients were hospitalised for an acute exacerbation of chronic bronchitis. The study design was a multicentre, double‐blind, randomised, parallel group with patients giving written informed consent initially. Patients were recruited to the study if they met the WHO definition of chronic bronchitis, were aged 30‐75 years and had a high probability of S. pneumoniae infection based on initial sputum Gram stain. All S. pneumoniae isolates were serotyped and susceptibility tested at the National Reference Centre, Paris. S. pneumoniae was eradicated more rapidly following cefuroxime axetil administration than after cefixime and this difference was statistically significant (p=0.002) at 2‐4 days post‐treatment. Clinical endpoints showed a similar trend – 94% response to cefuroxime axetil compared with 71% response to cefixime (RR 6.39:1). Cefuroxime eradicated S. pneumoniae significantly more rapidly than cefixime and patients in the cefuroxime axetil arm had favourable clinical criteria. The data suggest that focused antibacterial studies may be helpful in evaluating antibiotics in acute exacerbation of chronic bronchitis.
MEASURES FOR DECREASING INPATIENT STAY IN CHILDHOOD ASTHMA
Authors: Brown DC , South M 
Published: April 2023

SUMMARYTraditionally, studies of asthma have concentrated on interventions that were mainly pharmaceutical and outcomes that were usually based on pulmonary function testing. More recently, there has been increasing emphasis on organisational procedures that can enhance the delivery of effective care, and outcomes based more on the clinical than the physiological. Minimum length of stay is targeted as one outcome of benefit for patients and their families. The methods of decreasing hospital stay for asthmatic children which have been proposed and studied are reviewed.
CURRENT HORMONE REPLACEMENT THERAPY: WHAT ARE THE SHORTCOMINGS? ADVANCES IN DELIVERY
Authors: Sturdee DW 
Published: April 2023

SUMMARYThe introduction of transdermal and other parenteral delivery systems has broadened the range of options for hormone replacement therapy (HRT). Oral oestrogen is the most common initial therapy; however, direct absorption of oestradiol via the skin results in an oestradiol‐oestrone ratio similar to that found in the pre‐menopausal state. Both oral and transdermal oestrogen therapy have been shown to be equally effective in relieving climacteric symptoms, and in preventing osteoporosis or modifying some cardiovascular disease risk factors, although transdermal therapy tends to have fewer unwanted effects than oral. Satisfactory circulating oestradiol levels are achieved with skin patches, transdermal gel, or crystalloid oestradiol implants, and adding progestogen to protect the endometrium is well established. Sequential therapy with HRT usually produces a regular bleed, which is a major cause of patient dissatisfaction. The ideal HRT regimen is probably unobtainable, but the development of SERMs and other regimens that avoid bleeding will encourage long‐term use.
II. STIGMA AND DEPRESSION: A DOUBLE WHAMMY
Authors: Searle GF 
Published: April 2023

SUMMARYThe burden of depression is increased by the stigma of mental illness and the widely held idea that psychoactive medication is useless and addictive. These preconceptions may delay and obscure diagnosis and reduce treatment adherence. A sensitive clinician should be able to recognise the difficulties in the individual patient and overcome them.
EXERCISE‐INDUCED RHABDOMYOLYSIS: EVEN THE FIT MAY SUFFER
Authors: Sharma N , Winpenny H , Heymann T 
Published: April 2023

SUMMARYKeeping fit has its risks. We describe the case of a 29‐year‐old woman who presented with rhabdomyolysis following non‐exhaustive exercise. Cases of exercise‐induced rhabdomyolysis have been reported in unfit individuals or those attempting exhaustive exercise such as marathon running or weight lifting but are unusual in fit individuals making modest changes to their normal fitness routine. Renal failure is the most serious complication of rhabdomyolysis but is apparently rarer when the rhabdomyolysis is caused by exercise. Surprisingly the published literature does not help us advise patients on the risk of suffering further episodes of acute rhabdomyolysis with further exercise. We suggest that, regardless of a person's fitness, when starting a new exercise he or she does so gradually.
ELEVATED SERUM CREATINE KINASE ACTIVITY IN A PATIENT WITH ACUTE PANCREATITIS
Authors: Randeva HS , Bolodeoku J , Mikhailidis DP , Winder AD , Press M 
Published: April 2023

SUMMARYA 62‐year‐old man presented with a five‐day history of a ‘flu‐like’ illness, epigastric pain and a state of increasing confusion. His serum values for amylase and glucose were grossly elevated, as was the creatine kinase (CK) activity, being 23 times above the upper limit of normal. CK‐MB was less than 5% of his total CK activity. There was no past history of diabetes or recent history of intramuscular injections or injury. A diagnosis of acute pancreatitis complicated by hyperosmolar non‐ketotic (HONK) diabetic pre‐coma was made. The patient was treated with intravenous fluids, insulin and subcutaneous heparin. Normal values for serum amylase and CK activity were recorded with convalescence. This case indicates a possible association of a rise in total CK activity with acute pancreatitis complicated by HONK diabetic pre‐coma. This observation was made in the absence of clinically evident muscle pathology.
LEG CRAMPS IN THE ELDERLY: PREVALENCE, DRUG AND DISEASE ASSOCIATIONS
Authors: Abdulla AJJ , Jones PW , Pearce VR 
Published: April 2023

SUMMARYTo determine the prevalence of leg cramps in elderly outpatients and their association with any underlying diseases and concomitant drug intake, we conducted a cross‐sectional study using an in‐depth questionnaire. A total of 365 patients aged 65 years and over (mean 78.5 years) attending our outpatient clinic participated in the study. The prevalence of leg cramps was 50%. Cramps were commoner in females (56%) than in males (40%). Although reported to occur anytime throughout the 24 hours, cramps were most prevalent at night (62%). In many patients, leg cramps were a long‐standing complaint: 20% had been suffering with them for more than 10 years, whereas only 9% of patients reported them first starting within the last six months. Only 73 (40%) sufferers had informed their practitioner; of these, 39 (53%) received treatment, of whom 26 gained benefit. Leg cramps were strongly associated with peripheral vascular disease (odds ratio 2.9, 95% CI 1.89‐4.55, p<0.00001), arthritis (odds ratio 2.26, 95% CI 1.48‐3.45, p=0.0001) and female gender (odds ratio 1.96, 95% CI 1.28‐3.03, p=0.002). Heart failure, hypertension, diabetes mellitus and stroke were not significantly associated. Except for a causal association with analgesic use, no positive association could be shown with any other class of drugs, including diuretics.
DOES THE ERADICATION OF HELICOBACTER PYLORI CURE DUODENAL ULCER DISEASE IN COMMUNITIES WITH A HIGH PREVALENCE RATE? COMPARISON WITH LONG‐TERM ACID SUPPRESSION
Authors: Kepekci Y , Kadayifci A 
Published: April 2023

SUMMARYThe long‐term effect of Helicobacter pylori eradication on the natural history of duodenal ulcer has been investigated and compared with long‐term acid suppression treatment in an endemic community for infection. Seventy‐three patients with endoscopically verified H. pylori positive active duodenal ulcer disease were included in this prospective study. Patients were divided into two groups. Group A patients (n=39) were given an omeprazole‐based triple eradication regimen, while group B patients (n=34) were given omeprazole alone followed by long‐term famotidine 20 mg daily as maintenance treatment. A control endoscopy was performed at the third month of treatment. The bacterium was eradicated in 32 (82%) of group A patients. All patients were followed up for two years and an endoscopy performed at the end of each year. H. pylori recurred in 13 patients and the reinfection rate was 44.8% over two years. Duodenal ulcer recurred in seven of these patients at two years (24.1%). There was a close association between H. pylori reinfection and ulcer relapse. Group B patients remained H. pylori positive during the study and the ulcer recurred in five of these patients (16.6%) despite continuous famotidine treatment. There was no statistically significant difference in ulcer relapse rate between the groups. These results suggested that H. pylori eradication is not an absolute solution for duodenal ulcer disease in high endemic regions and continuous maintenance treatment with H2‐receptor antagonists is still an alternative approach in some chronic recurrent cases.
TREATMENT WITH CARVEDILOL IS ASSOCIATED WITH A SIGNIFICANT REDUCTION IN MICROALBUMINURIA: A MULTICENTRE RANDOMISED STUDY
Authors: Fassbinder W , Quarder O , Waltz A 
Published: April 2023

SUMMARYPatients with mild to moderate essential hypertension (n=1570) were enrolled in a large, multicentre, randomised, open‐label study designed to evaluate the safety and efficacy of different regimens of carvedilol. Reported here are the effects of carvedilol on microalbuminuria (MAU) in a subset of 876 patients who underwent MAU assessment (i.e. the Micral‐TestTM) at baseline and at week 12. MAU was present at baseline in 245 (28%) of these patients. Despite different magnitudes of blood pressure reduction, improvements in MAU were similar in all groups (range 54‐60%), with complete disappearance occurring in 48‐55% of patients. The decrease in MAU did not correlate with the magnitude of blood pressure reduction, suggesting a possible renal protective effect exerted by carvedilol independent of blood pressure reduction mediated by beta‐blockade and vasodilatation.
ACETAZOLAMIDE‐INDUCED GERSTMANN SYNDROME
Authors: Lee YT , Wu JCY , Chan FKL 
Published: April 2023

SUMMARYAcute confusion induced by acetazolamide is a well known adverse drug reaction in patients with renal impairment. We report a case of acetazolamide‐induced Gerstmann syndrome in a patient with normal renal function, to highlight predisposing factors that are frequently overlooked.
A RARE CASE OF CUTANEOUS KAPOSIFORM HAEMANGIOENDOTHELIOMA
Authors: McPartlin DW , Ghufoor K , Patel SK , Jayaraj S 
Published: April 2023

SUMMARYKaposiform haemangioendothelioma is a rare vascular neoplasm with a wide anatomical distribution. We describe an unusual case arising in the post‐auricular skin of a male infant overlying a ventriculoperitoneal shunt.
ORAL GASTROGRAFIN IN NEONATES: A NOTE OF CAUTION
Authors: Tuladhar R , Daftary A , Patole SK , Whitehall JS 
Published: April 2023

SUMMARYHyperosmolar feeds are known to increase gastrointestinal permeability, predisposing to absorption of toxins. They are also associated with necrotising enterocolitis (NEC) in neonates. A case of a neonate with suspected NEC who died following Gram‐negative septicaemia possibly related to oral gastrografin is reported. Hyperosmolarity of gastrografin may have caused complete loss of mucosal integrity in the compromised bowel leading to Gram‐negative septicaemia.
CEFACLOR AF VERSUS AMOXYCILLIN/CLAVULANATE IN ACUTE BACTERIAL EXACERBATIONS OF CHRONIC BRONCHITIS: A RANDOMISED MULTICENTRE STUDY
Authors: Bandak SI , Bolzon LD , Turnak  , Johns D , Henle SK , Allen BS 
Published: April 2023

SUMMARYCefaclor and amoxycillin/clavulanate are active against Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis and Staphylococcus aureus ‐ pathogens commonly associated with acute exacerbations of chronic bronchitis (AECB). This randomised, parallel‐group, single‐blind, multicentre study investigated the comparative efficacy and safety of 7‐day treatment regimens of cefaclor AF (750 mg b.d. [n=73]) and amoxycillin/clavulanate (875/125 mg b.d. [n=72]) in AECB. A favourable clinical response was obtained in 95.9% of patients on cefaclor AF and 97.2% of patients on amoxycillin/clavulanate. There were no statistically significant differences between the groups for improvement in clinical response measured by pulmonary peak expiratory flow (PPEF), or for common symptoms associated with AECB. Both agents were well tolerated, with no statistically significant differences in overall safety; however, nausea and vomiting, and abdominal pain, the most frequently occurring adverse events in the amoxycillin/clavulanate group, were not reported in the cefaclor group. In conclusion, cefaclor AF and amoxycillin/clavulanate have similar efficacy and safety profiles in the treatment of AECB.