bluuebunny/crossref_metadata_2025_split huggingface dataset:
DOES COMBINATION THERAPY WITH A CALCIUM CHANNEL BLOCKER AND AN ACE INHIBITOR HAVE ADDITIVE EFFECTS ON BLOOD PRESSURE REDUCTION?
Authors: Edelman DA , Paul RA 
Published: April 2023

SUMMARYReports in the medical literature have suggested that the effects on blood pressure (BP) of calcium channel blockers (CCBs) and angiotensin‐converting enzyme (ACE) inhibitors are additive. Most reports have provided neither a definition of ‘additive’ nor the necessary information to determine whether the effects are additive. In this review of the medical literature, the effects of combination therapy were defined as additive if the sum of the mean reductions in BP following monotherapy with a CCB and an ACE inhibitor was not significantly different from the mean reduction in BP of combination therapy. The review generally showed that combination therapy is more effective than treatment with either monotherapy alone, based on mean decreases in either diastolic or systolic BP. The studies provided no clear evidence that the effects of combination therapy were either additive or less than additive. (Int J Clin Pract 2000; 54(2): 105‐109)
VI. STIGMA AND ALZHEIMER'S DISEASE: CAUSES, CONSEQUENCES AND A CONSTRUCTIVE APPROACH
Authors: Jolley DJ , Benbow SM 
Published: April 2023

SUMMARYThe term ‘Alzheimer's disease’ has entered the vocabulary of ordinary people. This has been useful, encouraging patients and families to seek medical help for conditions that were previously neglected as inevitable consequences of old age. Yet Alzheimer's itself can carry negative connotations. Some people who believe they have Alzheimer's disease are suffering from less sinister and more easily treated conditions. Even when the diagnosis is confirmed, many months of happy and worthwhile life continue for most patients and families if they are given appropriate information and support. It is important that neither families nor clinicians see life with presumed Alzheimer's disease as of no value. (Int J Clin Pract 2000; 54(2): 117‐119)
HOME MANAGEMENT OF FEVER IN CHILDREN: RATIONAL OR RITUAL?
Authors: Al‐Eissa YA , Al‐Zamil FA , Al‐Sanie AM , Al‐Salloum AA , Ai‐Tuwaijri HM , Al‐Abdali NM , Al‐Azzam SA 
Published: April 2023

SUMMARYFever is extremely common in childhood. Parents have been shown to have unrealistic fears, resulting in inappropriate management of fever in their children. This study was conducted to survey parents about their knowledge concerning home management of fever in children in their care. Parents of 560 febrile children were randomly recruited and interviewed in the waiting areas of the outpatient clinics or emergency room in four hospitals in Riyadh city using a standard questionnaire. Most of the interviewees were mothers, aged within 20‐39 years. Although more than one‐half of fathers and one‐third of mothers in the study were well educated, most were misinformed about recognition and definition of fever. Most parents had poor knowledge regarding minimum temperatures for administering correct doses of antipyretic drugs or for sponging/bathing with water of the correct temperature. Most parents demonstrated a poor understanding of the appropriate frequency for checking the child's temperature and administering antipyretics. Only one‐third of parents indicated a reasonable educational imprint by health‐care providers. Considerable efforts will be required to educate parents about fever and its management. (Int J Clin Pract 2000; 54(3): 138‐142)
RAPID DIAGNOSIS OF MASSIVE PULMONARY EMBOLISM IN A DISTRICT GENERAL HOSPITAL
Authors: Ong Y E , Crowther A , Miller A 
Published: April 2023

SUMMARYEffective treatment of massive pulmonary embolism is more likely if diagnostic tests are rapidly available, including during out‐of‐hours. An agreed protocol was implemented in November 1997, which allowed initiation of thrombolysis by junior doctors within an hour of clinical suspicion of the diagnosis of massive pulmonary embolism in six patients in the subsequent year. A similar approach could be considered by other acute hospitals. (Int J Clin Pract 2000; 54(3): 144‐146)
MANAGEMENT OF SEPTICAEMIC INFANTS DURING LONG‐TERM PARENTERAL NUTRITION
Authors: Page S , Abel G , Stringer MD , Puntis JWL 
Published: April 2023

SUMMARYYoung infants, particularly following gastrointestinal surgery, are at high risk of septicaemia during parenteral nutrition. Febrile illness in the absence of focal infection inevitably raises suspicion of central venous catheter sepsis and poses the following dilemma: remove the catheter (which may then prove uninfected) and lose venous access, or leave the catheter and risk clinical deterioration? We examined retrospectively the isolates from blood culture during febrile episodes in 13 children who received long‐term (>2 months) parenteral nutrition via a central venous catheter, and assessed the effectiveness of through‐catheter antibiotic treatment during 76 episodes of blood culture positive sepsis. Coagulase‐negative Staphylococci accounted for only 16% of positive isolates, with yeasts accounting for 5%, and Gram‐negative organisms accounting for 46%, suggesting that infection was often associated with bacterial translocation from the gastrointestinal tract. Treatment with the central venous catheter left in situ was successful in resolving infection in 53 (70%) of septic episodes. These findings indicate that, in this specific group of patients, through‐catheter antibiotic treatment is often effective in treating septicaemia. When long‐term venous access is essential, this approach should be tried before recourse to central venous catheter removal. (Int J Clin Pract 2000; 54(3): 147‐150)
DOXAZOSIN IN ELDERLY PATIENTS WITH HYPERTENSION
Authors: Weinberger MH , Fawzy A 
Published: April 2023

SUMMARYHypertension constitutes a major cardiovascular risk factor of high prevalence in the elderly, and reducing elevated blood pressure has been shown to be of significant benefit in decreasing the incidence of cardiovascular and cerebrovascular disease in this patient population. Elderly patients are more likely to have comorbid disorders, such as dyslipidaemia, diabetes, renal disease, atherosclerosis and, for males, benign prostatic hyperplasia (BPH). Therefore, when choosing an antihypertensive agent for elderly patients, it is particularly important to ensure that treatment does not exacerbate comorbid conditions and does not interact deleteriously with any concurrent medication that the patient is taking. The α1‐adrenoceptor antagonist, doxazosin, has been shown to be an effective, well‐tolerated antihypertensive therapy in elderly male patients and does not exacerbate – and in some cases improves – some other common disorders. Doxazosin has been shown to be effective in reducing the symptoms of BPH in elderly patients whose blood pressure is well controlled by concomitant antihypertensive medication. In addition, improvements in the symptoms of BPH as well as reductions in blood pressure have been observed in elderly men with mild‐to‐moderate hypertension. Doxazosin has been shown to have positive effects on lipid profiles and glycaemic control, which make it an attractive choice of therapy for elderly patients with hypertension and diabetes or dyslipidaemia. In addition, doxazosin is administered once daily, either in the morning or the evening, which may aid compliance, an important consideration in the elderly. (Int J Clin Pract 2000; 54(3): 181‐189)
ARE WOMEN DISCRIMINATED AGAINST FOR LIPID LOWERING THERAPY? RESULTS FROM A PROSPECTIVE COHORT OF WOMEN WITH CORONARY ARTERY DISEASE
Authors: Lloyd G , Cooper A , Mcging E , Chia H , Jackson G 
Published: April 2023

SUMMARYThe objective of the study was to compare the lipid management of men and women with documented coronary artery disease in 587 patients (433 men and 154 women) undergoing coronary angiography between 1991 and 1995. A fasting total cholesterol (TC) was measured in all patients on the morning of angiography. A postal/telephone follow‐up was carried out one year after angiography in a subpopulation of 278 patients (194 men and 84 women) who were not taking lipid‐lowering therapy (LLT) or whose TC was >5.2 mmol/l at the time of angiography. At baseline, mean TC was 5.89 mmol/l (SE 0.06) in the men and 6.47 mmol/l (SE 0.09) in the women (p=<0.0001). Action or recommendation to institute LLT was taken in 141 (32.7%) men and 62 (40.3%) women (p=0.09). In the follow‐up population, comparing men with women, 74 (38.3%) vs 39 (46.4%) were taking LLT (p=0.21); 56 (28.9%) vs 26 (31.0%) had not undergone repeat TC testing (p=0.73); when performed, repeat TC was 5.75 (0.09) mmol/l vs 5.64 (0.16) mmol/l (p=0.53); mean decrease in TC between baseline and follow‐up was 0.86 (0.10) mmol/l vs 1.01 (0.21) mmol/l (p=0.51). There was no significant gender difference in lipid management either at the time of coronary angiography or subsequent follow‐up, although the level of lipid‐lowering drug use remained inadequate in both sexes. (Int J Clin Pract 2000; 54(4): 217‐219)
BEHAVIOURAL AND CLINICAL FINDINGS IN COUPLES WHERE THE MAN PRESENTS WITH ERECTILE DISORDER: A RETROSPECTIVE STUDY
Authors: Riley A , Riley E 
Published: April 2023

SUMMARYRelevant data were extracted from the case records of a consecutive series of 128 men (median age 57 years) who presented with erectile disorder and whose partners (median age 54 years) attended on the first or second consultation. The case records included responses to questionnaires addressing issues relating to sexual behaviour, used routinely in the clinic. Of these partners, 123 agreed to be clinically examined, including pelvic examination. The duration of erectile disorder ranged from less than one year to 40 years. Only about 10% of couples had experienced sexual kissing and/or caressing in the four weeks before presentation. Almost half the couples had not experienced any sexual activity for about 2.5 years. While 83.7% of men considered intercourse to be important to themselves, only 20.2% of the women rated intercourse somewhat or very important. Clinical evidence of urogenital atrophy was present in 33.3% of women over the age of 46 years. Three women had a vaginismic response to examination in the clinic and one of these women reported long term vaginismus pre‐dating the onset of her partner's erectile disorder. One case of malignant ovarian tumour was identified. The observations from this study demonstrate the need to involve the partner in the assessment process of men presenting with erectile disorder. (Int J Clin Pract 2000; 54(4): 220‐224)
STALKING: EVIL, ILLNESS, OR BOTH?
Authors: Parrott HJ 
Published: April 2023

SUMMARYThis article considers the definition and impact of stalking behaviours, and describes recent examples, as well as the characteristics and behaviours of stalkers. Current legal frameworks and their application are reviewed, including recent changes in the law. Management and treatment issues as well as attention to minimising a violent outcome and general ethical matters are discussed. (Int J Clin Pract 2000; 54(4): 239‐242)
DMARDS IN THE TREATMENT OF RHEUMATOID ARTHRITIS: CURRENT AGENTS AND FUTURE DEVELOPMENTS
Authors: Simon LS 
Published: April 2023

SUMMARYThe purpose of this paper is to review the benefits and limitations of current disease‐modifying antirheumatic drugs (DMARDs) used for the treatment of rheumatoid arthritis (RA). Literature about DMARD use in RA, both as monotherapy and in combination therapy, is reviewed. The efficacy and safety of methotrexate, antimalarials, gold‐containing compounds, sulphasalazine, D‐penicillamine, azathioprine and cyclosporin, as well as several new antirheumatic agents are considered. Controlled short‐term clinical studies demonstrate that DMARDs are superior to placebo. Early and continuous use of DMARDs is necessary to slow joint damage and improve long‐term outcomes. Unfortunately, long‐term treatment with these drugs is frequently limited by loss of response and/or onset of serious adverse events. The efficacy of combination DMARD therapy has also been tested, but with mixed success, and the goals of combination DMARD therapy have yet to be fully realised. New DMARDs that have recently been introduced offer promise for future RA management. (Int J Clin Pract 2000; 54(4): 243‐249)
WHEN IS AN AORTIC VALVE PROSTHESIS TOO SMALL? THE NEED FOR DOBUTAMINE STRESS ECHOCARDIOGRAPHY
Authors: Das P , Chambers J , Jackson G 
Published: April 2023

SUMMARYWe describe a patient who had undergone aortic valve replacement with a small prosthesis 10 years previously and who presented with exertional breathlessness. The resting transaortic pressure gradient was only 30 mmHg but increased to 165 mmHg on dobutamine stress. Conventional resting echocardiography may fail to demonstrate abnormal prosthetic aortic valve function; in the presence of symptoms, dobutamine stress echocardiography should be considered. (Int J Clin Pract 2000; 54(4): 261‐262)
TRAINING IN SIGMOIDOSCOPY: THE EXPERIENCE OF TRAINEES IN ELDERLY MEDICINE IN EAST ANGLIA
Authors: Mallinson RH 
Published: April 2023

SUMMARYTo assess the standard of training in postgraduate sigmoidoscopy in East Anglia, a questionnaire was prepared and distributed to pre‐registration house officers (JHOs), senior house officers (SHOs) and specialist registrars (SpRs) in eight hospitals. The results suggest that practical instruction in technique is inadequate, and that most trainees perform too few sigmoidoscopies to become competent at either examining or recognising lesions. Many JHOs have not performed sigmoidoscopies or even witnessed important lesions in their early training. The training improved little during the SHO grade, with few trainees feeling happy with their training. The SpRs felt they were competent, although their training was thought inadequate. The current training programme needs detailed reassessment and improvement. (Int J Clin Pract 2000; 54(4): 265‐266)
A CASE OF NOONAN SYNDROME WITH PULMONARY AND ABDOMINAL LYMPHANGIECTASIA
Authors: Öztürk S , Çefle K , Palanduz S , Erten NB , Karan MA , Tasçioglu C , Umman S , Falay O , Vatansever S , Güler K , Cantez S 
Published: April 2023

SUMMARYNoonan syndrome is characterised by a Turner‐like phenotype and a normal karyotype. Although it is reported to be associated with abnormalities of the lymphatic system, involvement of the pulmonary lymphatics is rare. We present a case of Noonan syndrome where a whole body scintigraphy revealed lymphangiectasia of the lower extremities, abdomen and lungs. (Int J Clin Pract 2000; 54(4): 274‐276)
COST‐EFFECTIVE PRESCRIBING OF PROTON PUMP INHIBITOR THERAPY: AN AUDIT IN GENERAL PRACTICE
Authors: Cooper AL , Langworthy H , Porter S 
Published: April 2023

SUMMARYGeneral practitioners must prescribe cost effectively to control drug expenditure and provide optimal treatment for patients requiring long‐term management. An audit was implemented in general practices to review the management of dyspepsia, improve care, rationalise therapy and reduce costs. Policy included identifying patients receiving proton pump inhibitor (PPI) therapy and changing to low‐dose cost‐effective therapy. If PPI therapy was not required, patients were changed to antacids, H2 receptor antagonists or no treatment. This was an audit in general practice, not a clinical trial, therefore findings reflect outcomes in normal clinical practice. This paper describes the implementation and findings of the audit between January 1997 and July 1999 in 91 general practices involving 7121 patients. Extrapolation of the results concluded that savings of up to £50,000 could be made in a practice of 10,000 patients, allowing reinvestment in health improvement plans and optimal care. (Int J Clin Pract 2000; 54(5): 287‐292)
A COMPARISON OF A FIVE‐DAY REGIMEN OF CEFDINIR WITH A SEVEN‐DAY REGIMEN OF LORACARBEF FOR THE TREATMENT OF ACUTE EXACERBATIONS OF CHRONIC BRONCHITIS
Authors: Paster RZ , Mcadoo MA , Keyserling CH , Nemeth MA , Tack KJ , Griffin TJ 
Published: April 2023

SUMMARYTo compare the efficacy and safety of five‐day cefdinir treatment with seven‐day loracarbef treatment in patients with acute exacerbations of chronic bronchitis, 586 patients were enrolled in a multicentre, randomised, double‐blind trial. Patients received either five days of treatment with cefdinir (n=291) at 300 mg twice daily or seven days of treatment with loracarbef (n=295) at 400 mg twice daily. Microbiological assessments were done on sputum specimens obtained at admission and at the two post‐therapy visits, if available. The clinical cure rates were 86% (138/160) and 85% (141/166) for the evaluable patients treated with cefdinir and loracarbef, respectively. Respiratory tract pathogens were isolated from 457 (78%) of 586 admission sputum specimens, with the predominant pathogens being Haemophilus parainfluenzae, H. influenzae, Moraxella catarrhalis and Staphylococcus aureus. The microbiological eradication rates at the test‐of‐cure visit were 88% (193/219 pathogens) and 90% (227/251 pathogens) for the evaluable patients treated with cefdinir and loracarbef, respectively. Adverse event rates while on treatment were 30% and 21% for cefdinir‐ and loracarbef‐treated patients, respectively. These results indicate that a five‐day regimen of cefdinir is effective and safe for the treatment of patients with acute exacerbations of chronic bronchitis. (Int J Clin Pract 2000; 54(5): 293‐299)
EVIDENCE‐BASED COUNSELLING FOR VASECTOMY
Authors: Kenogbon JI 
Published: April 2023

SUMMARYCouples requesting vasectomy need to be properly counselled. Vasectomy is generally safe but it can fail in up to 6% of cases. Reversal is possible but not always successful. Most men are azoospermic six weeks after vasectomy. They must be warned that the procedure may have to be repeated if there are persistent motile sperm in their post‐vasectomy semen analysis. (Int J Clin Pract 2000; 54(5): 317‐321)
ROSIGLITAZONE
Authors: Goldstein BJ 
Published: April 2023

SUMMARYRosiglitazone, a potent thiazolidinedione oral antidiabetic agent recently approved in the US, differs structurally from pioglitazone and troglitazone (other approved thiazolidinediones), with greater PPARγ binding affinity and antihyperglycaemic potency in preclinical models. Clinical data on more than 4500 patients with type 2 diabetes show that rosiglitazone is a safe, effective monotherapy or combination therapy, producing significant reductions in haemoglobin A1c and fasting plasma glucose under different dosing regimens. Unlike troglitazone, which has been associated with idiosyncratic hepatotoxicity and rare cases of liver failure and death, rosiglitazone has shown a low incidence of liver abnormalities in more than 3500 patient‐years of exposure. No significant food or drug interactions have been reported. Particularly effective as first‐line therapy, rosiglitazone is a useful addition to the roster of oral antidiabetic agents. (Int J Clin Pract 2000; 54(5): 333‐337)
COLONIC PERFORATION ASSOCIATED WITH SLOW‐RELEASE DICLOFENAC SODIUM
Authors: Adhiyaman V , Asghar M , White AD 
Published: April 2023

SUMMARYUpper gastrointestinal tract complications due to non‐steroidal anti‐inflammatory drugs are well recognised. However, adverse effects on large intestinal mucosa are less common and less well recognised, even though they carry a significant morbidity and mortality. Here we report a case of colonic perforation in a healthy woman without any underlying colonic pathology associated with ingestion of slow release diclofenac sodium. (Int J Clin Pract 2000; 54(5): 338‐339)
ISCHAEMIC MYELOPATHY PRESENTING AS GUILLAIN‐BARRÉ SYNDROME
Authors: Hui AC‐F , Wong KS , Fu M , Kay R 
Published: April 2023

SUMMARYSpinal cord stroke is uncommon. We report a woman presenting with paraesthesia followed by tetraparesis and respiratory failure who was initially diagnosed as having Guillain‐Barré syndrome. Subsequent clinical and imaging features supported the diagnosis of an anterior spinal cord infarction. We describe the main clinical and imaging features of this condition. (Int J Clin Pract 2000; 54(5): 340‐341)
FIRST BRANCHIAL GROOVE ANOMALY
Authors: Kumar M , Hickey S , Joseph G 
Published: April 2023

SUMMARYFirst branchial groove anomalies are very rare. We report a case of a first branchial groove anomaly presented as an infected cyst in an 11‐month‐old child. Management of such lesions is complicated because of their close association with the facial nerve. Surgical management must include identification and protection of the facial nerve. Embryology and facial nerve disposition in relation to the anomaly are reviewed. (Int J Clin Pract 2000; 54(5): 342‐344)
RESEARCH: IS AN ‘IDEAL’ QUESTIONNAIRE POSSIBLE?
Authors: Charlton R 
Published: April 2023

SUMMARYWriting a research protocol and designing a questionnaire are not as easy as might be thought. Producing the ‘ideal’ questionnaire can be fraught with difficulties, and the guidelines provided are intended to avoid potential pitfalls. Designing a questionnaire takes time and patience. The importance of a pre‐test and pilot study cannot be overemphasised and resultant modifications to the questions will increase the validity, reliability and responsiveness of a questionnaire and lend support to any findings following appropriate statistical interpretation of the data. The advantages of the questionnaire research method, together with the disadvantages and the problems associated with poor response rates, are discussed. (Int J Clin Pract 2000; 54(6): 356‐359)
CLINICAL AND ELECTROMYOGRAPHIC EXAMINATION OF TREMOR IN PATIENTS WITH THYROTOXICOSIS
Authors: Milanov I , Sheinkova G 
Published: April 2023

SUMMARYTremor is a well‐known symptom of thyrotoxicosis, yet no detailed clinical and electromyographic (EMG) examination of it has been published. The aim of this investigation was to establish the clinical and EMG pattern of tremor in patients with thyrotoxicosis and to compare it with the well‐known pattern of enhanced physiological tremor caused by anxiety. Twenty‐six patients with thyrotoxicosis and tremor and 30 patients with tremor and generalised anxiety disorder were investigated. Tremor was scored clinically in all possible limb positions. EMG examination of tremor activity from antagonist hand muscles was performed. A postural and kinetic tremor with characteristics of an enhanced physiological tremor was found in patients with thyrotoxicosis and generalised anxiety disorder. Tremor involved only the upper limbs in all patients. In conclusion, tremor in thyrotoxicosis and generalised anxiety disorder is an enhanced physiological tremor which cannot be separated clinically or by EMG measurement. Both types of tremor have similar mechanisms and can be distinguished only by the circumstances responsible for their occurrence. Despite only a moderate correlation between tremor intensity and thyroid hormone levels, successful treatment of thyrotoxicosis results in a dramatic improvement of tremor. (Int J Clin Pract 2000; 54(6): 364‐367)