bluuebunny/crossref_metadata_2025_split huggingface dataset:
CHRONIC RENAL FAILURE IN A PATIENT WITH SOTOS SYNDROME DUE TO AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE
Authors: Cefle K , Yildiz A , Palanduz S , Ozturk S , Ozbey N , Kylyçaslan I , Çolakoglu S , Balci C 
Published: April 2023

SUMMARYSotos syndrome is characterised by accelerated growth, acromegalic appearance, mental retardation and social maladjustment. Most cases are sporadic, but familial cases have also been reported. We report a case of Sotos syndrome presenting with chronic renal failure due to autosomal dominant polycystic kidney disease (ADPKD). Ultrasonographic examination of the patient, his father and other family members revealed polycystic kidneys. Renal failure was present only in the Sotos case, who also had considerably larger cysts than other family members. We suggest that the underlying mechanism responsible from the somatic overgrowth in Sotos syndrome may also be linked with the development of larger cysts and earlier onset of renal failure in ADPKD. Although Sotos syndrome has been associated with urological abnormalities, chronic renal failure is very rare. To our knowledge, Sotos syndrome associated with ADPKD has not been reported before.
GIANT MYELOLIPOMA OF THE RIGHT ADRENAL GLAND
Authors: Zografos GN , Korkous D , Georgoutsos P , Antypa F , Ageli C , Fragia K , Vachliotis P , Papastratis G 
Published: April 2023

SUMMARYAdrenal myelolipoma is an unusual, benign and hormonally inactive tumour composed of mature adipose and haematopoietic tissue. In the past, these tumours were accidentally discovered at autopsy. Today, they are found much more frequently and incidentally, mainly because of the widespread use of ultrasonography, computed tomography and magnetic reasonance imaging. Adrenal myelolipoma is usually unilateral and asymptomatic. The case of a 52‐year‐old female patient, surgically treated for a symptomatic giant myelolipoma of the right adrenal gland, is reported, together with a review of the literature.
STROKE PREVENTION: MISSED OPPORTUNITIES?
Authors: Gupta A , Thomas P 
Published: April 2023

SUMMARYIdentification and modification of risk factors can prevent strokes. Certain previously unidentified risk factors for stroke can become apparent following admission with acute stroke. The aim of the study was to investigate the prior capture, identification and management of modifiable risk factors for stroke in patients admitted to a hospital following acute stroke. One hundred consecutive stroke patients admitted to a UK hospital were prospectively assessed for modifiable risk factors. The extent of pre‐admission risk factor management was also determined. Pre‐admission risk factors identified and effectively managed were hypertension in non‐diabetics (28%), hypertension in diabetics (7%), previous cerebrovascular event (100%), diabetes (29%), smoking (50% counselled), atrial fibrillation (81%), hypercholesterolaemia (100%), excess alcohol (22% counselled) and obesity (52% counselled). Twenty‐five new modifiable risk factors were identified following incident stroke. In conclusion, a significant number of patients admitted with acute stroke have their risk factors poorly identified and controlled in the community. Despite the trial evidence available, an evidence‐practice gap exists and many stroke prevention opportunities are being missed.
NON‐INVASIVE CARDIAC ASSESSMENT IN β‐THALASSAEMIA MAJOR
Authors: Ong M‐L , Hatle LK , Lai V‐M , Bosco J 
Published: April 2023

SUMMARYIron deposition in the heart occurs in β‐thalassaemia major and contributes to cardiac dysfunction. Eighteen patients with β‐thalassaemia major were assessed clinically and had non‐invasive investigations. They were young (15.5 ± 3.6 years). Two patients had clinical heart failure. Doppler echocardiography demonstrated higher transmitral peak flow velocity in early and late diastole compared with controls (e: p<0.05, a: p<0.01). Transtricuspid peak late diastolic flow velocity was higher in patients (p<0.005). Isovolumic relaxation time was shortened (p<0.001). Pulmonary venous flow velocity was higher in diastole than systole (S: 0.51 ± 0.11 m/s, D: 0.62 ± 0.08 m/s). Reversal of pulmonary venous flow during atrial systole was seen in eight patients. These diastolic filling abnormalities did not significantly change with blood transfusion. Left ventricular ejection fraction was normal in patients. Two patients had cardiomegaly on chest X‐ray. In β‐thalassaemia with iron overload, there is a restrictive pattern of diastolic dysfunction. This is not altered by recent blood transfusion. Left ventricular function remains relatively intact.
THE CHOICE OF ANTIBIOTIC IN OPEN FRACTURES IN A TEACHING HOSPITAL IN A DEVELOPING COUNTRY
Authors: Alonge TO , Salawu SA , Adebisi AT , Fashina AN 
Published: April 2023

SUMMARYOpen fracture wounds may be contaminated, and the use of an appropriate antibiotic in the early stages of management reduces the risk of osteomyelitis developing. Environmental factors influence both the type of micro‐organisms that are isolated from these wounds and the antibiotics that are chosen to manage the wounds. Before this study, the choice of antibiotic in the management of open fractures in our hospital was based on tradition and ‘best guess' antibiotics. In a prospective study of 52 open fractures seen in the accident and emergency unit of University College Hospital, Ibadan, between January and June 2000, the positive bacterial culture yield was more than 70%. Staphylococcus aureus was the commonest microbial isolate, accounting for 37.5% of total isolates. The antibiotic sensitivity pattern revealed high efficacies for pefloxacin, ciprofloxacin and ceftriaxone against the isolated micro‐organisms. In comparative costs, these antibiotics are cheaper than the combination of the ‘best guess' antibiotics that were used previously. On the strength of this finding, we have suggested a change in the antibiotic policy of the hospital with regard to the antibiotic regimen to be used to complement the surgical management of open fractures.
THE HUMAN AND ECONOMIC COSTS OF UNDERTREATMENT WITH STATINS
Authors: Durrington P 
Published: April 2023

SUMMARYSeveral guidelines for the prevention and management of coronary heart disease (CHD) have been published. These generally recommend lipid‐lowering therapy in patients with and without established CHD on the basis of their low‐density lipoprotein cholesterol (LDL‐C) levels and, for cases without established CHD, their risk‐factor profile. Statins are the preferred lipid‐lowering agent for the prevention of CHD because of overwhelming clinical trial evidence that they can significantly reduce the occurrence of CHD mortality and morbidity. Despite the guidelines, only approximately one‐third of eligible patients receive lipid‐lowering therapy in clinical practice – even for secondary prevention of CHD – and many treated patients fail to achieve their target LDL‐C levels. This underuse must affect patients' clinical outcome and quality of life and has economic consequences for society. Reasons for the underuse may include physicians' and patients' attitudes and knowledge, and the perceptions of physicians and healthcare purchasers about economic factors. Health economic evaluations have confirmed that secondary prevention with statins is cost‐effective, and that primary prevention is also reasonably cost‐effective, depending on the absolute CHD risks in targeted individuals. Newer statins with greater efficacy in reducing LDL‐C levels may allow patients to reach target levels more quickly and without the need for dose titration, thus improving clinical outcomes and being more cost‐effective in the long term. This proposition should be tested in future clinical trials.
MISSED DIAGNOSIS OF VITAMIN B12 DEFICIENCY PRESENTING WITH PARAESTHETIC SYMPTOMS
Authors: Larner AJ 
Published: April 2023

SUMMARYParaesthesia is a common presenting complaint in vitamin B12 deficiency. Since this condition is partially reversible with repletion, this is a diagnosis not to be missed. Two cases in which the diagnosis was initially overlooked are presented, emphasising that the paraesthesia associated with vitamin B12 deficiency may be central (myelopathic) or peripheral (neuropathic) in origin.
STATIN THERAPY: RATIONALE FOR A NEW AGENT, ROSUVASTATIN
Authors: Korlipara K 
Published: April 2023

SUMMARYCardiovascular disease (CVD) remains a major cause of death in industrialised societies, and elevated serum lipids are a significant, highly prevalent and undertreated risk factor for this condition. The 3‐hydroxy‐3‐methylglutaryl‐coenzyme A (HMG‐CoA) reductase inhibitors (statins) have revolutionised the treatment of hyperlipidaemia, and results from large‐scale, long‐term clinical trials have shown that the substantial reductions in low‐density lipoprotein cholesterol (LDL‐C) achieved with these drugs are associated with dramatic decreases in cardiovascular risk. Results from recent comparative clinical trials that have included a new drug in this class, rosuvastatin (Crestor®), have demonstrated that it is significantly superior to atorvastatin, pravastatin and simvastatin in reducing total cholesterol, LDL‐C and apolipoprotein B (Apo B). It is also significantly more effective than atorvastatin in increasing high‐density lipoprotein cholesterol (HDL‐C) and apolipoprotein A‐I (Apo A‐I). Rosuvastatin was also superior to all these agents in helping patients meet European Atherosclerosis Society (EAS) and National Cholesterol Education Programme (NCEP) goals for LDL‐C. The results of an increasing number of studies indicate that statins have a wide range of pleiotropic properties that almost certainly contribute to their ability to decrease cardiovascular risk and may also make them valuable for treatment of other diseases. These actions include plaque stabilisation, improvement of endothelial function, inhibition of smooth muscle cell proliferation and migration, reduction of expression of adhesion molecules, prevention of cholesterol esterification and accumulation, reduction of secretion of matrix metalloproteinases by macrophages, reduction of platelet activity, reduction of formation of thrombogenic factors, chemoprotection and induction of bone morphogenic protein‐2 (BMP‐2). Further exploration of these actions will provide key information about class effects and properties of specific members of this highly useful group of drugs.
LEUPRORELIN ACETATE IN PROSTATE CANCER: A EUROPEAN UPDATE
Authors: Persad R 
Published: April 2023

SUMMARYThis review provides an update on leuprorelin acetate, the world's most widely prescribed depot luteinising hormone‐releasing hormone analogue. Leuprorelin acetate has been in clinical use in the palliative treatment of prostate cancer for more than 20 years, but advances continue to be made in terms of convenience and flexibility of administration, and in the incorporation of leuprorelin acetate into novel treatment regimens. The drug is administered in the form of a depot injection containing leuprorelin acetate microspheres, and is at least as effective in suppressing testosterone secretion as orchiectomy. In patients with prostate cancer, serum testosterone levels are reduced to castrate levels (≤50 ng/dl) within 2–3 weeks of the first one‐month depot injection of 3.75 mg or three‐month depot injection of 11.25 mg. Both the one‐month and three‐month formulations are effective in delaying tumour progression and alleviating symptoms of locally advanced and metastatic prostate cancer. Tolerability is generally good, with side‐effects reflecting effective testosterone suppression. Recent studies have investigated the place of leuprorelin acetate as part of continuous or intermittent maximal androgen blockade (MAB) and in neoadjuvant therapy (i.e. to reduce the size of the prostate and downsize the tumour before radiotherapy). Additional formulations and presentations are in development, including a six‐month injection, with the aim of adding to the clinical flexibility and patient acceptability of this important palliative treatment for prostate cancer.
ANAL CANAL AMPUTATION AND NECROSIS OF THE ANAL SPHINCHTER DUE TO ELECTRIC CURRENT INJURY
Authors: Yildirgan MI , Basoglu M , Balik AA , Aydinli B 
Published: April 2023

SUMMARYThe pathophysiology of electrical burns differs from thermal and chemical burns and electrical injuries which are associated with significant morbidity and mortality. We report on a patient who suffered anal canal amputation and necrosis of the anal sphinchter as a result an electric current injury.
EFFECTS OF SOMATOSTATIN, OCTREOTIDE AND PITRESSIN PLUS NITROGLYCERINE ON SYSTEMIC AND PORTAL HAEMODYNAMICS IN THE CONTROL OF ACUTE VARICEAL BLEEDING
Authors: Zhang HB , Wong BCY , Zhou XM , Guo XG , Zhao SJ , Wang JH , Wu KC , Ding J , Lam SK , Fan DM 
Published: April 2023

SUMMARYTo examine the haemodynamic effects of somatostatin (SS) and octreotide (OC) versus pitressin plus nitroglycerine (PN) in the control of variceal bleeding, 224 patients with acute oesophageal and gastric variceal haemorrhage were randomly divided into three groups and treated with SS, OC and PN; they also had their Doppler ultrasound parameters measured before, during and after treatment. The success rates of bleeding control in the SS (80.9%, 86.8% and 89.7%, p<0.001) and OC (75.3%, 80.8% and 84.9%, p<0.01) groups were significantly higher than in the PN group (51.8%, 59.0% and 65.1%) at 24, 48 and 72 hours respectively, and the average duration of SS (12.7 + 6.8 h) and OC (13.8 + 8.0 h) was significantly lower than that of PN (24.6 + 15.4 h, p<0.001). Side‐effects of SS (7.4%) and OC (8.2%) were less than those of PN (41.0%, p<0.001 and p<0.01). The diameter of portal vein (PVD), velocity of portal vein (PVV), volume of portal blood flow (PVF) and hepatic artery pulsatility index (HA‐PI) in all three groups decreased significantly during initial treatment, but recovered when treatment was stopped. Heart rate and cardiac output decreased significantly in patients treated with SS and OC; mean arterial pressure was unchanged. However, heart rate and mean arterial pressure increased, and cardiac output decreased, with PN. Somatostatin and octreotide were more effective than pitressin plus nitroglycerine in patients with acute variceal haemorrhage, with fewer side‐effects, and may decrease PVF and portal vein pressure through reduction of cardiac output and dilatation of the visceral blood vessels.
PHARMACOLOGY OF PHOSPHODIESTERASE‐5 INHIBITORS
Authors: Corbin JD , Francis SH 
Published: April 2023

SUMMARYThe clinical properties (efficacy and safety profile) of a medicine are related not only to its mode of action, but also to its selectivity for its target (usually a receptor or enzyme) and are also influenced by its pharmacokinetic properties (absorption, distribution, metabolism and elimination). The growing number of phosphodiesterase inhibitors that are selective for phosphodiesterase‐5 (PDE5) represent a promising new class of compounds that are useful for the treatment of erectile dysfunction and perhaps other disorders. Some of the basic pharmacodynamic and pharmacokinetic parameters that describe drug action are discussed with regard to the new PDE5 inhibitors. Central topics reviewed are the concentration that produces a given in vitro response, or potency (IC50), maximum plasma concentration (Cmax), time to Cmax (Tmax), half‐life (t½), area under the curve (AUC), bioavailability, onset and duration of action, and the balance to achieve optimum safety and efficacy. To illustrate these concepts, a group of inhibitors with varying selectivities and potencies for PDE5 (theophylline, IBMX, zaprinast, sildenafil, tadalafil and vardenafil) are discussed. Each drug has its own set of unique pharmacological characteristics based on its specific molecular structure, enzyme inhibition profile and pharmacokinetic properties. Each PDE5 inhibitor has a distinct selectivity that contributes to its safety profile. As with all new drugs, and especially those in a new class, careful evaluation will be necessary to ensure the optimal use of the PDE5 inhibitors.
UPPER AIRWAY OBSTRUCTION AND ACUTE LUNG INJURY ASSOCIATED WITH COCAINE ABUSE
Authors: Raza S Ali , Krugar M , Houghton J 
Published: April 2023

SUMMARYWe describe the case of a 14‐year‐old boy who developed airway obstruction due to acute upper respiratory tract infection. Following emergency tracheostomy, he developed pulmonary oedema and required ventilation. The postoperative course was complicated by the development of adult respiratory distress syndrome, characterised by marked respiratory distress, diffuse pulmonary infiltrates on chest radiography, reduced pulmonary compliance and marked increase in alveolar‐arterial oxygen difference. He also developed persistent high‐grade pyrexia, renal failure and cardiac instability. A social history of substance abuse (crack cocaine, amphetamines, alcohol and cigarettes) was obtained three weeks post‐admission and is thought to have made a significant contribution to the severity of his disease.
RANDOMISED TRIAL OF THE EFFECT OF ORLISTAT ON BODY WEIGHT AND CARDIOVASCULAR DISEASE RISK PROFILE IN OBESE PATIENTS: UK MULTIMORBIDITY STUDY
Authors: Broom I , Wilding J , Stott P , Myers N ,   UK Multimorhidity Study Group
Published: April 2023

SUMMARYThe potential effect of orlistat on cardiovascular co‐morbidities may have been previously underestimated. This study assesses the efficacy of orlistat therapy for weight loss and cardiovascular risk factor reduction in obese patients with cardiovascular risk. This was a 54‐week, double‐blind, randomised, placebo‐controlled, parallel group study with 531 patients being randomised. Mean weight loss was significantly greater with orlistat than with placebo (5.8% vs 2.3%; p<0.0001). Orlistat was also associated with significantly greater improvements than placebo in diastolic BP (‐5.5 vs ‐3.1 mmHg; p<0.01), systolic blood pressure (‐6.0 vs ‐2.3 mmHg; p<0.01), oral glucose tolerance test (‐0.37 vs +0.09 mmol/l; p<0.05), fasting glucose (‐0.19 vs +0.06 mmol/l; p<0.05), total cholesterol (‐1.31% vs +3.78%; p<0.0001), LDL‐cholesterol (‐7.09% vs ‐0.55%; p<0.0001) and waist circumference (‐5.99 vs ‐2.60 cm; p<0.0001). Orlistat was well tolerated. Orlistat weight loss is associated with improvements in cardiovascular co‐morbidities, and hence cardiovascular risk.
THE EFFECTS OF ACUTE PHASE PROTEINS ON SERUM ALBUMIN, TRANSFERRIN AND HAEMOGLOBIN IN HAEMODIALYSIS PATIENTS
Authors: Kalender B , Mutlu B , Ersöz M , Kalkan A , Yilmaz A 
Published: April 2023

SUMMARYIn the present study, the effects of C‐reactive protein (CRP) and ferritin on serum albumin, transferrin and haemoglobin (Hb) were assessed to investigate the relationship between inflammation, hypoalbuminaemia and anaemia in haemodialysis patients. A total of 117 patients who were followed at three haemodialysis units in Kocaeli were enrolled. The mean age was 47.83 ± 16.85 years. The median time on dialysis was 26 (minimum 1, maximum 209) months. Serum CRR albumin and ferritin concentrations were measured in our laboratory and transferrin, urea reduction ratio (URR) and KW were calculated. There was significant inverse correlation between serum CRP level and albumin (p<0.001), serum CRP and Hb (p<0.001), and serum transferrin and ferritin (p<0.05). There was significant positive correlation between serum albumin and Hb (p<0.001), serum CRP and ferritin (p<0.05), and transferrin and URR (p<0.05). Our findings suggest that inflammation is a contributor in the development of hypoalbuminaemia and anaemia in haemodialysis patients as well as malnutrition and inadequate dialysis.
GALANTAMINE PROVIDES BROAD BENEFITS IN PATIENTS WITH ‘ADVANCED MODERATE’ ALZHEIMER'S DISEASE (MMSE ≤12) FOR UP TO SIX MONTHS
Authors: Wilkinson DG , Hock C , Farlow M , Van Baelen B , Schwalen S 
Published: April 2023

SUMMARYWe investigated whether galantamine (Reminyl®), a cholinergic agent with a dual mode of action for the treatment of mild to moderate Alzheimer's disease (AD), would benefit patients with more advanced illness. We performed a post hoc analysis on pooled data from four pivotal studies in patients with ‘advanced moderate’ AD: baseline Mini‐Mental State Evaluation (MMSE) scores ≤12 (range 10–12; mean MMSE score 11) or Alzheimer's Disease Assessment Scale‐cognitive subscale (ADAS‐cog) scores >30 (range 31–69; mean ADAS‐cog score 39). Over 5–6 months, cognitive abilities were improved with galantamine versus placebo (p<0.001; mean treatment difference 6.5 points). At 6 months, galantamine benefited functional abilities (p<0.001 vs placebo). The first quartile of galantamine patients improved over baseline by 10.5 ADAS‐cog points. Cognitive and functional abilities were maintained around baseline; behavioural symptoms were delayed. Over 6 months, galantamine provided a broad spectrum of benefits to patients with ‘advanced moderate’ AD.
ATYPICAL ANTIPSYCHOTICS: EXPERIENCE AND USE IN THE ELDERLY
Authors: Bullock R , Saharan A 
Published: April 2023

SUMMARYThe use of antipsychotics is common in the elderly. Typical antipsychotics are not without risk, especially in tardive dyskinesia, which, when balanced against relatively low efficacy, make their use debatable. Atypical antipsychotics have much less in the way of side‐effects and are much less likely to induce tardive dyskinesia. However, there is much less in the published literature about the efficacy of these drugs in the elderly and how best to use them in primary psychosis, Parkinson's disease and the behavioural and psychological symptoms of dementia. This review attempts to summarise the current literature and make some tentative recommendations for each of the commonest atypicals, based on the current evidence.
THE EFFECT OF DOXAZOSIN ON SEXUAL FUNCTION IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA, HYPERTENSION, OR BOTH
Authors: Flack JM 
Published: April 2023

SUMMARYThe prevalence of both benign prostatic hyperplasia (BPH) and hypertension increases with advancing age. These conditions coexist in almost 25% of men aged 60 years and older. The use of transurethral prostatectomy, a common surgical therapy for BPH, alleviates symptoms but results in erectile dysfunction (ED) in up to 35% of patients. Pharmacological intervention for BPH, including androgen‐suppressing agents, has resulted in an increased incidence of sexual adverse experiences compared with the incidence observed in patients receiving placebo. Patients with hypertension also frequently experience problems with sexual function; in addition, antihypertensive medications used to treat this disease may increase problems with sexual function. ED is an age‐related phenomenon, with estimated prevalence rates of 39% among men 40 years old and 67% among those 70 years old. Doxazosin, an α1‐adrenoceptor antagonist indicated for the treatment of patients with BPH and/or hypertension, is not associated with the occurrence of ED compared with other antihypertensive treatments.
POST‐STROKE DEPRESSION
Authors: Gupta A , Pansari K , Shetty H 
Published: April 2023

SUMMARYStroke is considered mainly as a physical disability, and stroke‐related depression is under‐recognised Cognitive, language and functional impairment complicates the recognition of post‐stroke depression. The pathophysiology of post‐stroke depression is poorly understood, but several risk factors have been identified. Depression following stroke can impede recovery and rehabilitation and is associated with higher mortality. Randomised trials show that antidepressants, especially selective serotonin uptake inhibitors, are effective in the treatment of this condition. Despite the evidence available, a large number of patients remain undertreated. Early identification and treatment can reduce the functional impairment and mortality related to post‐stroke depression.