bluuebunny/crossref_metadata_2025_split huggingface dataset:
WOMEN'S AWARENESS OF, AND ATTITUDES TOWARDS, HORMONE REPLACEMENT THERAPY: ETHNIC DIFFERENCES AND EFFECTS OF AGE AND EDUCATION
Authors: Lydakis C , Kerr H , Hutchings K , Lip GYH 
Published: April 2023

SUMMARYTo investigate ethnic differences and the effect of age and education on awareness and attitudes of women towards hormone replacement therapy (HRT), we conducted a questionnaire survey of 180 women attending a gynaecology clinic, of whom 152 (84.4%) responded. Seventy‐one of the women had heard of HRT. Awareness of HRT was higher in the 50‐59 year age group and in women with higher education, but lower in Indo‐Asian women than in white and black/Afro‐Caribbean women. Friends, relatives and the media were important sources of information (apart from the doctor), especially among the younger age groups. The women themselves ranked their overall understanding of HRT as ‘low’; 78% felt they did not know enough about the subject. A distorted perception of benefits/risks associated with HRT was also noted – cardiovascular protection was not appreciated, whereas there was an excessive fear of breast cancer. Twenty‐eight per cent of the menopausal, postmenopausal and hysterectomised women surveyed were current HRT users. We conclude that factors such as ethnicity, age and educational level have an impact on women's awareness of and attitudes towards HRT. Some confusion about the real benefits/risks still exists, which probably accounts for low acceptance of this treatment, and suggests that clinicians prescribing HRT need to be aware of these problems.
TSH SECRETING PITUITARY ADENOMA: A RARE CAUSE OF THYROTOXICOSIS
Authors: So WY , Yeung VTF , Chow CC , Ko GTC , Szeto CC , Cockram CS 
Published: April 2023

SUMMARYThyroid‐stimulating hormone (TSH) secreting pituitary adenoma is a rare but important cause of thyrotoxicosis. It poses a challenge for both diagnosis and management. We report the case of a young Chinese man presenting with thyrotoxicosis, complicated by congestive heart failure, secondary to a TSH secreting pituitary adenoma. The case illustrates the importance of prompt diagnosis and allows discussion of both medical and surgical management, including the use of a long‐acting somatostatin analogue.
AN UNUSUAL PRESENTATION OF SACRAL AGENESIS IN A NEWBORN BABY
Authors: Oei J , Koh THHG 
Published: April 2023

SUMMARYA potentially difficult situation can arise when a sick newborn baby presents with a common clinical sign that subsequently turns out to be a manifestation of a rare condition. The baby's birth sometimes results in the diagnosis of a new condition in other members of the family.1 Necrotising enterocolitis is the commonest surgical condition among babies in the neonatal intensive care unit (NICU). We report a case where abdominal distension in an acutely ill baby at high risk of necrotising enterocolitis masqueraded as an unusual presentation of familial sacral agenesis.
COMMUNITY‐ACQUIRED CLOSTRIDIUM DIFFICILE‐ASSOCIATED DIARRHOEA IN A PATIENT WITH COLONIC CARCINOMA
Authors: Heymann TD , Rampton DS 
Published: April 2023

SUMMARYIn the vast majority of cases, Clostridium difficile‐associated diarrhoea and pseudomembranous colitis develop following the use of antibiotics. We report a case in which C. difficile‐associated diarrhoea was diagnosed in the absence of previously reported predisposing factors. It transpired that the patient had a colonic carcinoma. We suggest that a diagnosis of C. difficile‐associated diarrhoea in the absence of a history of antibiotics or other established causes should prompt a colonoscopy to search for alternative explanations for the alteration in bowel flora which such an infection indicates.
ACUTE EFFECTS OF HORMONE REPLACEMENT WITH TIBOLONE ON MYOCARDIAL ISCHAEMIA IN WOMEN WITH ANGINA
Authors: Lloyd GWL , Patel NR , McGing EA , Cooper AF , Kamalvand K , Jackson G 
Published: April 2023

SUMMARYThis study was designed to evaluate whether hormone replacement therapy with tibolone demonstrated similar effects to those observed with oestrogen on myocardial ischaemia and angina. Ten postmenopausal women with documented coronary artery disease were evaluated by treadmill exercise electrocardiograms before and 24 hours after the oral administration of tibolone 2.5 mg. Onset of myocardial ischaemia, as defined by ST segment depression, increased by a median 102 seconds (p=0.022). Time to onset of angina increased by 31 seconds (p=0.038), while total exercise time was not significantly affected (p=0.24). Haemodynamic variables in the form of heart rate, systolic blood pressure and their product were unaffected by tibolone administration. We conclude that tibolone appears to show similar anti‐ischaemic properties to oestrogen.
CHARACTERISTICS OF CHILDREN UNDER 5 REFERRED TO HOSPITAL WITH CONSTIPATION: A ONE‐YEAR PROSPECTIVE STUDY
Authors: Gallagher B , West D , Puntis JWL , Stringer MD 
Published: April 2023

SUMMARYConstipation in the pre‐school child can cause considerable distress to the individual and to the family. Most cases are idiopathic and with early diagnosis and effective treatment prognosis is good. In a teaching hospital paediatric unit, a year‐long prospective study identified 42 new referrals for constipation in children under 5. Before referral for a specialist opinion there appeared to be considerable variation in both duration of symptoms and treatment given. Psychological factors in the family, as well as advice regarding simple behaviour modification and management of common secondary behavioural problems, seemed largely overlooked. Guidelines for treating constipation in the community could help standardise and improve care. For children with refractory constipation referred to a specialist centre, we recommend a multidisciplinary assessment including paediatrician, paediatric surgeon, and member of the child mental health team.
PURE AGRAPHIA FOLLOWING PERI ENDARTERECTOMY STROKE
Authors: Nagaratnam N , Plew J , Cooper S 
Published: April 2023

SUMMARYWe report on a patient with pure agraphia due to perioperative stroke following left carotid endarterectomy. Her writing was illegible, slow and laborious, with impaired copying. Her oral spelling skills were normal. There was no limb apraxia. The CT brain scan revealed two hypodense areas – one anterior, the other posterior – at the level of the left centrum semi‐ovale.
FATAL SEPTICAEMIA IN A PREVIOUSLY HEALTHY MAN FOLLOWING A DOG BITE
Authors: Saab M , Corcoran JP , Southworth SA , Randall PE 
Published: April 2023

SUMMARYA rare case of fatal septicaemia after a dog bite in a previously healthy individual is presented and discussed. Capnocytophaga canimorsus (DF‐2 bacterium) was isolated from blood cultures. Our case shows the importance of immediate antibiotic treatment for all dog and cat bites, regardless of severity.
A COMPARISON OF NISOLDIPINE COAT‐CORE AND FELODIPINE IN THE TREATMENT OF MILD‐TO‐MODERATE HYPERTENSION
Authors: Hoglund C , Hutchinson HG 
Published: April 2023

SUMMARYThe efficacy and safety of nisoldipine CC and felodipine were compared in a multicentre, randomised, double‐blind, trial in patients with mild‐to‐moderate hypertension (n=229). Following a two‐week placebo run‐in period, patients were randomised to 16 weeks' active treatment with nisoldipine coat core (CC) 20‐40 rng or felodipine 5‐10 mg once daily. At week 16, a higher proportion of patients in the nisoldipine CC group were on low‐dose therapy (51% vs 36%, p=0.07). The proportion of treatment responders was 77.8% with nisoldipine CC and 66.5% with felodipine. The mean change from baseline in systolic/diastolic blood pressure was ‐18.8/‐13.6 mmHg with nisoldipine CC and ‐17.4/‐11.3 mmHg with felodipine. The most common adverse events included peripheral oedema and headache; neither treatment affected heart rate. Thus, nisoldipine CC and felodipine provide comparable antihypertensive efficacy. The adverse effects of both drugs are related to their vasodilator properties and are common to the class.
PYRUVATE KINASE DEFICIENCY: AN UNUSUAL CAUSE OF PUERPERAL JAUNDICE
Authors: Esen UI , Olajide F 
Published: April 2023

SUMMARYWe present one of the rarer causes of pregnancy‐associated jaundice in the immediate puerperium. A 30‐year‐old multipara with pyruvate kinase deficiency became jaundiced within a few hours of delivery, following an uneventful pregnancy and labour at term. She responded to conservative management, the jaundice clearing and the altered liver function showing a steady return to normal. Pyruvate kinase deficiency may cause pregnancy‐associated jaundice. A thorough investigation is still necessary to exclude other causes of jaundice in pregnancy and the puerperium.
A CASE OF PICA AND IRON DEFICIENCY ANAEMIA IN NOTTINGHAM
Authors: Parry SD , Perkins AC , Hawkey CJ 
Published: April 2023

SUMMARYPica is the persistent eating of a non‐nutritional substance (as defined by the American Psychiatric Association) and is often associated with iron deficiency. Current literature leaves uncertain whether pica causes iron deficiency via its proposed effect on iron absorption or, conversely, whether iron deficiency causes pica. We report the case of a young girl from Nottingham who we believe developed pica secondary to her iron deficiency anaemia. To determine that her pica was not affecting gastrointestinal iron absorption we carried out iron absorption studies first under pica and then under normal dietary conditions.
FIRST‐DOSE RESPONSE TO ANGIOTENSIN‐CONVERTING ENZYME INHIBITION IN CONGESTIVE CARDIAC FAILURE: A MALAYSIAN EXPERIENCE
Authors: Navookarasu NT , Rahman ARA , Abdullah I 
Published: April 2023

SUMMARYDespite their proven value in reducing morbidity and mortality in different grades of heart failure, angiotensin converting enzyme (ACE) inhibitors continue to be underused. One reason for this is clinicians' apprehension of first‐dose hypotension. We conducted a double‐blind, randomised, placebo‐controlled parallel group study to investigate the effect of various ACE inhibitors on first‐dose hypotension. Eighty unselected patients were randomised into five treatment groups: placebo, captopril 6.25 mg, enalapril 2.5 mg, perindopril 2 mg and lisinopril 2.5 mg. Blood pressure was measured at baseline, half hourly for two hours and hourly for three hours after drug treatment. The maximum drops in mean arterial pressure (in mmHg ± SD) were placebo 5.89 ± 2.65, perindopril 5.29 ± 2.49, enalapril 13.28 ± 3.31, lisinopril 15.04 ± 5.74 and captopril 16.76 ± 5.74 (all p< 0.05 vs placebo except for perindopril). Perindopril, unlike the other ACE inhibitors studied, did not produce first‐dose hypotension following its initiation in patients with congestive heart failure.
IMPROVED BLOOD PRESSURE CONTROL BY MONITORING COMPLIANCE WITH ANTIHYPERTENSIVE THERAPY
Authors: Waeber B , Vetter W , Dariolp R , Keller U , Brunner HR 
Published: April 2023

SUMMARYCompliance with antihypertensive therapy was monitored for three months using an electronic medication dispenser in 35 patients remaining hypertensive despite the once‐daily administration of a blood pressure lowering drug (either as monotherapy or as fixed‐dose combination therapy). During the monitoring of compliance, the treatment was unchanged but blood pressure decreased significantly (p<0.001) from 167.9/100.4 ± 16.3/7.2 mmHg (mean ± SD) to 152.5/90.9 ± 20.9/11.5 mmHg. The percentage of days with one opening per day was 80.8 ± 20.5. Thus, discussing with the patient about compliance with the prescribed drug regimen and monitoring compliance for a few months allows better control of blood pressure. This most likely reflects increased compliance with antihypertensive drug therapy.
THE ANTIPHOSPHOLIPID OR HUGHES' SYNDROME: AN UNDERDIAGNOSED CAUSE OF THROMBOSIS
Authors: Williams FMK , Hunt BJ 
Published: April 2023

SUMMARYThe antiphospholipid or Hughes' syndrome is the association between antiphospholipid antibodies, recurrent venous and arterial thromboses and recurrent fetal loss. There are many clinical manifestations arising from this acquired thrombophilia and these are described in the article. The pathogenic mechanism by which the antibodies cause thrombosis is the subject of much debate, and current theories are described. The diagnosis and management of patients with the syndrome are also discussed.
MANAGEMENT OF NIDDM BY FAMILY DOCTORS IN HONG KONG: A QUESTIONNAIRE SURVEY
Authors: Lam TP , Chan TYK 
Published: April 2023

SUMMARYThe management approach to non‐insulin‐dependent diabetes mellitus among family doctors in Hong Kong was studied using two case histories. In 1996, all 804 fellows, members and associate members of the Hong Kong College of Family Physicians were sent a letter and a questionnaire. Of the 512 who responded, 405 were male and 95 were female (12 were discarded) with ages ranging from 24 to 77 years (median 40). For the 48‐year‐old obese man who showed improvements in blood glucose and symptoms after diet for 6 weeks (Case 1), most respondents suggested adding a sulphonylurea (39.0%) or metformin (21.1%), or continuing diet (35.2%). Younger and more junior doctors tended to use metformin plus diet. Of 192 respondents who wanted to use a sulphonylurea, gliclazide (45.8%) and glibenclamide (42.7%) were chosen most often. For the 76‐year‐old overweight woman with symptomatic diabetes despite diet therapy (Case 2), most respondents suggested adding a sulphonylurea (41.9%), metformin (25.6%) or both (19.2%). Younger and more junior doctors tended to use metformin plus diet, whereas older doctors tended to use insulin plus diet. Older and more experienced doctors tended to use diet plus metformin and sulphonylurea. Of 208 respondents who wanted to use a sulphonylurea, gliclazide (47.8%) and glibenclamide (30.1%) were chosen most often. The management approach to NIDDM varied with the age and experience of the doctor.
SCREENING FOR ACUTE MYOCARDIAL INFARCTION IN ELDERLY PATIENTS WITH COLLAPSE, CONFUSION AND FALLS
Authors: Phillips JRN , Carroll J , Ehsanullah M 
Published: April 2023

SUMMARYFalls, collapse and confusion are frequent causes of admission to hospital in the elderly, and myocardial infarction (Ml) can present atypically. The study was designed to assess the incidence of Ml in this group of patients and provide information on the value of screening methods. A total of 142 elderly patients with a mean age of 83 years (range 76‐99) were admitted with unexplained collapse, confusion or falls. Serial ECGs and cardiac enzymes were performed. Eighty‐two patients (59%) had normal ECGs; of these, 80 (98%) had normal or non‐significantly elevated cardiac enzymes; 72/108 patients without chest pain had normal ECGs compared with 10/32 who had chest pain (p<0.01). Cardiac enzymes were elevated in 5/108 without chest pain and 10/32 with chest pain (p<0.01). Thirty‐two (23%) had chest pain, 14 (10%) had an acute Ml. In those presenting with chest pain, 32% had an Ml, compared with only 1.9% of those without chest pain (p<0.01); 18% of patients with an initially abnormal ECG had an Ml compared with only 5% of those with a normal ECG (p=0.02). None of the patients with a normal ECG who were free of chest pain were subsequently proven to have an Ml. Cardiac enzymes are often non‐specifically elevated in this group of patients due to muscle injury. The incidence of Ml is low in patients without chest pain and we would not advocate routine screening with serial cardiac enzymes, unless there is chest pain or an abnormal 12‐lead ECG on admission.
THE INCIDENCE OF COUGH: A COMPARISON OF LISINOPRIL, PLACEBO AND TELMISARTAN, A NOVEL ANGIOTENSIN II ANTAGONIST
Authors: Lacourciere Y ,   the Telmisartan Cough Study Group
Published: April 2023

SUMMARYDry cough is a troublesome side‐effect associated with certain antihypertensive agents that act by modulating aspects of the renin‐angiotensin‐aldosterone system. The incidence of dry cough associated with two of these therapies, the novel All receptor antagonist telmisartan and the ACE inhibitor lisinopril, was assessed in a multicentre, randomised, parallel‐group, double‐blind, placebo‐controlled, 8‐week study of 88 patients with mild to moderate hypertension who previously demonstrated ACE inhibitor‐related cough. Patients received either telmisartan 80 mg, lisinopril 20 mg, or placebo once daily. Cough incidence, measured at each visit by a self‐administered symptom assessment questionnaire, was significantly higher with lisinopril (60%) than with telmisartan (15.6%) or placebo (9.7%). A visual analogue scale demonstrated a similar trend for cough frequency. Thus the incidence of cough with telmisartan 80 mg is significantly less than that seen with lisinopril 20 mg and is comparable to placebo.
PULMONARY ARTERIOVENOUS MALFORMATION AS A CAUSE OF SEVERE EXERTIONAL DYSPNOEA
Authors: Bain DJ , Webb KA , O'Donnell DE 
Published: April 2023

SUMMARYA 48‐year‐old woman presented to the respiratory clinic with progressive exertional dyspnoea and an abnormal chest radiograph. Examination revealed mucosal telangiectasia and pulmonary angiography confirmed the presence of two pulmonary arterial venous malformations (PAVM). After therapeutic coil embolisation, dyspnoea was markedly improved, and exercise tolerance increased. Comparison of exercise test responses before and after this therapeutic intervention provides new insights into the physiological mechanisms of exertional dyspnoea in this condition.
THE EFFECT OF SUPPLEMENTATION WITH MILK FERMENTED BY LACTOBACILLUS CASEI (STRAIN DN‐114 001) ON ACUTE DIARRHOEA IN CHILDREN ATTENDING DAY CARE CENTRES
Authors: Pedone CA , Bernabeu AO , Postaire ER , Bouley CF , Reinert P 
Published: April 2023

SUMMARYThe objective of this study was to determine if supplementation with milk fermented by yogurt cultures and Lactobacillus casei (strain DN‐114 001) could lessen acute diarrhoea in healthy children. The study was conducted over six months, with 287 children aged 18.9 (SD 6.0) months, comprising three periods of one month supplementation, each month being followed by one month without supplementation. Subjects were supplemented daily with either 125 g or 250 g (according to age) of one of three tested dairy products: standard yogurt, milk fermented by yogurt cultures and Lactobacillus casei (108 cfu/ml), or a jellied milk (control product). A daily record was kept of the number and type of stools. Although the incidence of diarrhoea was not shown to be different between the groups, the severity of diarrhoea over the six‐month study was significantly decreased (4.3 days) with the supplementation of L. casei fermented milk compared with the jellied milk (8.0 days) (p=0.009).
ACUTE PULMONARY OEDEMA COMPLICATING ADENOTONSILLECTOMY FOR OBSTRUCTIVE SLEEP APNOEA
Authors: Motamed M , Djazaeri B , Marks R 
Published: April 2023

SUMMARYAcute pulmonary oedema can sometimes complicate adenotonsillectomy carried out for obstructive sleep apnoea. Early recognition and adequate oxygenation are the key to management. We report such a case; the pathophysiology and management of this rare complication of a common procedure are discussed.
A NATIONAL SURVEY OF THORACIC SURGICAL PRACTICE IN THE UK
Authors: Khan IH , Vaughan R 
Published: April 2023

SUMMARYWe conducted a survey of thoracic surgery in the UK today. Questionnaires were sent to 75 cardiothoracic surgeons, known to perform thoracic surgery regularly; we had a 100% response. The commonest preoperative investigations for carcinoma of the oesophagus were serum alkaline phosphatase (90%), GGT (69%), contrast swallow (80%), ultrasound of abdomen (71%) and CT scan of chest and abdomen (60%). After oesophagectomy, 84% of the surgeons inserted nasogastric tubes and 31% sent their patients to the intensive care unit. Oral fluids were started on days 3‐5 in 81% of cases, and 58% of the surgeons requested a postoperative contrast swallow, usually between the seventh and tenth postoperative days, after oral fluids had been started. Most of the surgeons nearly always used staplers for a given procedure or else completely avoided them for that part of the operation. The commonest use of staplers was for bronchial closure in pneumonectomy (67%) and lobectomy (48%) and in constructing an oesophageal anastomosis (25%). Twenty per cent of the surgeons did not insert a chest drain after pneumonectomy, while 65% observed the protocol of chest drain insertion with short intermittent unclamping, usually every hour, followed by removal of the drain, usually the next morning. Thoracic surgeons vary widely in their surgical practices. In a well structured training programme, trainees should rotate between several units so they are exposed to different techniques and ideas and acquire a broad based training.
EFFICACY OF TWICE‐DAILY AMOXYCILLIN/CLAVULANATE IN LOWER RESPIRATORY TRACT INFECTIONS
Authors: Balgos AA , Rodriguez‐Gomez G , Nasnas R , Mahasur AA , Margono BP , Tinoco‐Favila JC , Sansores‐Martinez RH , Hassan M , Beppo O , Wongsa A , Cukier A , Vargas F 
Published: April 2023

SUMMARYIn this double‐blind, double‐dummy study, 324 patients with clinical evidence of community‐acquired pneumonia (CAP) or an acute exacerbation of chronic bronchitis were randomly assigned to receive 10 days' treatment with either amoxycillin/clavulanate 875/125 mg twice daily or amoxycillin/clavulanate 500/125 mg three times daily. At the end of therapy, clinical success rates were 92.4% for the twice daily regimen and 94.2% for the three times daily regimen. There was no statistically significant difference between treatments (p=0.647) and the 95% confidence interval around the treatment difference indicated that the two treatments were equivalent. Treatment equivalence was also confirmed at follow‐up, four weeks after the end of treatment. Both regimens were well tolerated. In conclusion, amoxycillin/clavulanate 875/125 mg twice daily is as effective as amoxycillin/clavulanate 500/125 mg three times daily for the treatment of community‐acquired lower respiratory tract infections and could improve patient compliance.
RISK FACTOR MODIFICATION EXTENDS THE BENEFIT OF CORONARY ARTERY REVASCULARISATION PROCEDURES
Authors: Shepherd J 
Published: April 2023

SUMMARYThe management of coronary artery disease has undergone major changes in the past three decades. Early medical preventive strategies rapidly gave way to surgical intervention by the end of the 1960s; 10 years later this was supplemented by the introduction of angioplasty. Both of these approaches offered rapid symptomatic relief but were dogged by a predisposition to restenosis. While technical improvements have helped reduce this problem, there is a growing perception that the imbalance between the enthusiastic adoption of surgical intervention and the jaundiced neglect of secondary medical prevention needs to be redressed. This can be achieved without stepping back in time, for, since the 1960s, agents far more effective in the struggle against ischaemic vascular disease have proven their worth in the clinical arena. Graft protection following bypass surgery is vital, but equally important is the need to target the metabolic derangement which caused the occlusion in the first place. This article reviews medical strategies designed to add life to coronary artery revascularisation procedures.