bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical and laboratory observations of tuberculosis at a Mumbai (India) clinic
Authors: Gothi D , Joshi J M 
Published: February 2004

Abstract

Objectives
To study the positivity of sputum acid fast bacilli (AFB) smears in patients with pulmonary tuberculosis using 24 hour sputum collection. To detect HIV seropositivity in patients suffering from tuberculosis, and to analyse the pattern of tuberculosis disease in this subgroup. To determine the outcome of patients treated with directly observed therapy.

Setting
The tuberculosis referral unit of a tertiary care hospital.

Design
A total of 893 consecutive patients with tuberculosis, diagnosed between 1 November 2000 and 30 September 2002, were included in the study. An HIV test was performed in all patients, with adequate counselling and informed consent. Treatment was prescribed as per World Health Organisation treatment categories.

Results
Out of 893 patients with tuberculosis, 695 had pulmonary tuberculosis and 198 had extrapulmonary tuberculosis. Out of the 695 pulmonary tuberculosis patients, 673 (96.8%) were sputum smear AFB positive. Overall, 71 patients (8.0%) were HIV positive. The pattern of tuberculosis was the same in HIV seropositive and seronegative patients. Treatment outcome could be analysed in 112 out of 150 patients: 78 patients (70%) were declared cured or completed treatment.

Conclusions
Sputum smear AFB could be a very sensitive test when a large quantity of sputum is used. The presence of HIV coinfection does not alter the clinical presentation. Only 70% of patients treated were cured/completed treatment, in spite of a strict directly observed therapy.
Evaluation of flexible sigmoidoscopy as an investigation for “left sided” colorectal symptoms
Authors: Papagrigoriadis S , Arunkumar I , Koreli A , Corbett W A 
Published: February 2004

Abstract

Background
Colonoscopy is the best way of imaging the colon with concurrent biopsy and treatment. However it is expensive, requires full bowel preparation, and carries a risk of complications. Flexible sigmoidoscopy is an alternative way to investigate symptoms that raise the suspicion of a lesion of the rectum or left colon.

Aim of the study
To evaluate flexible sigmoidoscopy as the main investigation for “left sided” colorectal symptoms.

Methods
The clinical records of 317 patients who were assessed at a colorectal specialist clinic and were thought to have a suspicion of a lesion of the rectum or left colon were retrospectively reviewed. All patients had flexible sigmoidoscopy as the primary investigation. Primary outcome was the diagnostic yield of flexible sigmoidoscopy and secondary outcomes were any additional colonic investigations required, failure rates, and complication rates.

Results
Three hundred and sixteen patients who had flexible sigmoidoscopy with the above criteria were retrospectively analysed. Twenty four procedures (7.6%) had to be abandoned because of poor bowel preparation. The examination was considered complete when it reached the splenic flexure, which was the case in 205 cases (65%).
In 137 flexible sigmoidoscopies (43.3%) there were no abnormal findings. Of the remaining 179 a carcinoma of the rectum or colon was found in 28 cases (8.8%) and one or more polyps was found in 57 (18%) cases. On the basis of the findings it was calculated that 31% of the patients would require an additional investigation for further imaging of the right colon.

Discussion
Although flexible sigmoidoscopy has a high yield of pathologies when carried out by a specialist colorectal clinic, the presence of those pathologies makes the full imaging of the whole colon with an additional investigation necessary. Therefore the cost efficiency of flexible sigmoidoscopy is questionable. Although flexible sigmoidoscopy is indicated for certain patients, it cannot replace colonoscopy as the main investigation used by a specialist colorectal clinic.
A questionnaire survey of stress and bullying in doctors undertaking research
Authors: Stebbing J , Mandalia S , Portsmouth S , Leonard P , Crane J , Bower M , Earl H , Quine L 
Published: February 2004

Abstract

Background
Research is an increasingly important aspect of higher medical training for many doctors. Studies investigating sources of stress, isolation, and workplace bullying have not previously sought information in this setting.

Methods
An internet based questionnaire survey of doctors undertaking research (n = 259) was conducted to examine stressors and levels of job satisfaction in this potentially vulnerable group. In order to assess overall levels of satisfaction, we asked whether doctors would recommend their research post to a colleague.

Results
There was a statistically significant association between those who would not recommend their post to a colleague and those who had difficulties in arranging funding and in writing up (p&lt;0.001). Further significant correlations were found between dissatisfaction with the post and lack of help, support, and advice from supervisors and colleagues, wanting to change supervisors, experience of the major categories of workplace bullying, and having an inadequate clinical commitment (p&lt;0.001). When the significant variables were entered into a multivariate analysis, the results showed that dissatisfaction was associated with wanting to change supervisors and with a threat to professional status.

Conclusions
Stress and bullying are common in doctors undertaking research. These findings have important implications for medical training and for doctors choosing research projects. Setting up systems of support may have important benefits.
Co-occurrence of thyroid binding globulin excess and a pituitary macroadenoma containing thyroid stimulating hormone-producing cells
Authors: Soubhi Nizam M , Kennedy L 
Published: February 2004

Abstract
A patient is described in whom thyroid binding globulin (TBG) excess was found in association with a pituitary macroadenoma containing thyroid stimulating hormone (TSH)-producing cells, and the potential for diagnostic confusion arising from this unusual combination of endocrine disorders is discussed. The patient presented with visual field disturbance, and magnetic resonance imaging led to the diagnosis of a pituitary tumour. Raised levels of total thyroxine and triiodothyronine along with normal TSH levels suggested the possibility of a TSH-secreting pituitary adenoma. Immunostaining of the tumour removed at transsphenoidal surgery confirmed the presence of TSH-producing cells. When raised total thyroxine and triiodothyronine levels persisted postoperatively, the diagnosis of TBG excess was confirmed. Use of free, rather than total, thyroid hormone assays would almost certainly have prevented the diagnostic confusion concerning possible TSH-secreting pituitary adenoma, but may have resulted in the TBG excess being overlooked entirely.
Retired physicians: a survey study by the Turkish Medical Association
Authors: Gökçe-Kutsal Y , Özçakar L , Arslan Ş , Sayek F 
Published: February 2004

Abstract

Background
The aim of this study was to assess the quality of life of retired Turkish physicians. The focus was on their working conditions, their health status, and the impact of their disabilities on activities of daily life.

Methods
The survey was conducted using a 35 item questionnaire, which was distributed to the local medical chambers allied with the Turkish Medical Association and thereafter was mailed to retirees aged 65 years and older.

Results
Out of 680 physicians, 391 (57.5%) responded, and percentages are expressed according to the number of physicians answering each question. The ages of the physicians ranged between 65 years and 91 years with a mean of 72.57±5.22 years. Overall, 236 physicians (60.8%) were still actively carrying on their profession, and 152 (39.2%) were not. Of the physicians who were working, 0.8% classified their working conditions as very bad, 9.7% as unsatisfactory, 37.7% as satisfactory, 33.6% as good, and 18.2% as excellent. The number of physicians with a disability was 42 (11.8%). The number of days on which physicians were hindered in their daily tasks ranged between 0 and 30 days with a mean (SD) of 1.55 (4.88) days, and the amount of sick leave ranged between 0 and 365 days with a mean of 2.25 (21.08) days.

Conclusion
It is believed that planning for retirement in all its aspects should be a legitimate concern of all physicians. Recommendations for future retirees or the construction of guidelines for making this time of life enriching and a period of intellectual growth are awaited.
Echocardiography and the general physician
Authors: Heatlie G J , Giles M 
Published: February 2004

Abstract
Doctors from many medical specialties request echocardiography as part of their assessment of patients with a wide range of pathology. Recent advances in the technology and techniques of echocardiography are discussed. The role of echocardiography in acute medicine is reviewed and its place in general medicine is also discussed.
Poor outcome in primary intracerebral haemorrhage: results of a matched comparison
Authors: Barber M , Roditi G , Stott D J , Langhorne P 
Published: February 2004

Abstract

Background
Primary intracerebral haemorrhage (PICH) is associated with a poorer outcome than cerebral infarction. This study aimed to determine whether this is explained by the clinical severity of stroke.

Methods
An observational study of outcome in consecutive admissions with acute PICH and ischaemic stroke was undertaken. A nested case-control analysis, matched on a 1:2 basis for age, pre-stroke disability, early neurological impairment (Scandinavian Stroke Scale; SSS), and Oxfordshire Community Stroke Project classification was then performed. Follow up was at 30 days and at hospital discharge.

Results
Overall, 679 subjects were included in the analysis. Of these, 53 (8%) had PICH; this group had more severe initial neurological impairment (day 3 SSS 28 v 45 points, p&lt;0.001) and a higher prevalence of total anterior circulation strokes (55% v 21%, p&lt;0.001) than did the group admitted with ischaemic strokes. Outcomes were poorer in the PICH group, with 36% inpatient mortality and 68% of survivors having a day 30 modified Rankin Scale (MRS) of at least 3 (compared with 13% and 52%, respectively, in the ischaemic stroke group). Following matching for baseline clinical characteristics, the PICH group had a higher mortality, but this was not statistically significant; the day 30 MRS and institutionalisation rates in survivors were similar in the matched haemorrhage and infarct groups.

Conclusions
Compared with ischaemic stroke, PICH is associated with higher mortality and increased disability in survivors. The severity of clinical stroke is a major contributor to these poor outcomes; baseline characteristics, however, do not fully explain outcome differences.
Long uvula: an unusual cause of chronic cough
Authors: Pai V , Thomas H , Stewart C 
Published: February 2004

Abstract
Chronic cough is a distressing symptom for patients and parents in paediatric practice. Investigations of the child with persistent cough can be simple or complex depending on the underlying cause. There are some unusual reasons for chronic cough, which need to be kept in mind when investigating the cause. A case of a long, floppy uvula causing chronic cough through mechanical irritation of upper airway is reported.
Resolution of cryptosporidiosis with probiotic treatment
Authors: Pickerd N , Tuthill D 
Published: February 2004

Abstract
Cryptosporidium infection is usually self limited, but can be a life threatening illness in immunocompromised patients. Probiotics have been used successfully in the treatment of acute diarrhoea and they have also been shown to limit Cryptosporidium parvum infection in animal models. The first case of successful resolution of prolonged cryptosporidiosis with probiotic treatment is reported.
Body dysmorphic disorder
Authors: Veale D 
Published: February 2004

Abstract
Body dysmorphic disorder (BDD) is defined as a preoccupation with an “imagined” defect in one’s appearance. Alternatively, where there is a slight physical anomaly, then the person’s concern is markedly excessive. The preoccupation is associated with many time consuming rituals such as mirror gazing or constant comparing. BDD patients have a distorted body image, which may be associated with bullying or abuse during childhood or adolescence. Such patients have a poor quality of life, are socially isolated, depressed, and at high risk of committing suicide. They often have needless dermatological treatment and cosmetic surgery. The condition is easily trivialised and stigmatised. There is evidence for the benefit of cognitive behaviour therapy and selective serotonin reuptake inhibitors in high doses for at least 12 weeks, as in the treatment of obsessive-compulsive disorder. There is no evidence of any benefit of antipsychotic drugs or other forms of psychotherapy.
Clinical and Biochemical Results of the Metalloproteinase Inhibition with Subantimicrobial Doses of Doxycycline to Prevent Acute Coronary Syndromes (MIDAS) Pilot Trial
Authors: Brown David L. , Desai Kavita K. , Vakili Babak A. , Nouneh Chadi , Lee Hsi-Ming , Golub Lorne M. 
Published: February 2004

Background—Vulnerable plaque demonstrates intense inflammation in which macrophages secrete matrix metalloproteinases (MMPs) that degrade the fibrous cap, ultimately leading to rupture, in situ thrombosis, and an associated clinical event. Thus, inhibition of MMP activity or more general suppression of vascular inflammation are attractive targets for interventions intended to reduce plaque rupture. We hypothesized that subantimicrobial doses of doxycycline (SDD) (20 mg twice daily) would benefit patients with coronary artery disease by reducing inflammation and MMP activity and thus possibly prevent coronary plaque rupture events.Methods and Results—We conducted a prospective, randomized, double-blind, placebo-controlled pilot study of 6 months of SDD or placebo treatment to reduce inflammation and prevent plaque rupture events. A total of 50 patients were enrolled, of whom 24 were randomized to placebo and 26 to SDD. At 6 months, there was no difference in the composite endpoint of sudden death, fatal myocardial infarction (MI), non-fatal MI, or troponin-positive unstable angina in SDD compared with placebo-treated patients (8.4% versus 0%,P=0.491). Biochemical markers of inflammation were assessed in plasma at study entry and after 6 months of therapy in 30 patients. In SDD-treated patients, high-sensitivity C-reactive protein (CRP) was reduced by 46% from 4.8±0.6 μg/mL to 2.6±0.4 μg/mL (P=0.007), whereas CRP was not significantly reduced in placebo patients. Interleukin (IL)-6 decreased from 22.1±3.7 pg/mL at baseline to 14.7±1.8 pg/mL at 6 months in SDD-treated patients (P=0.025) but did not decrease significantly in placebo-treated patients. On zymography, pro-MMP-9 activity was reduced 50% by SDD therapy (P=0.011), whereas it was unchanged by placebo treatment.Conclusion—SDD appears to exert potentially beneficial effects on inflammation that could promote plaque stability. These findings should be investigated in a larger study.
Cholesterol 7α-Hydroxylase Deficiency in Mice on an APOE*3-Leiden Background Impairs Very-Low-Density Lipoprotein Production
Authors: Post Sabine M. , Groenendijk Martine , Solaas Karianne , Rensen Patrick C. N. , Princen Hans M. G. 
Published: February 2004

Objective—Cholesterol 7α-hydroxylase (cyp7a1) catalyzes the rate-limiting step in conversion of cholesterol to bile acids. To study the relationship between bile acid biosynthesis and triglyceride metabolism, we cross-bred mice lackingcyp7a1on a hyperlipidemic APOE*3-Leiden background.Methods and Results—Female mice received a chow or lipogenic diet. On both diets, fecal bile acid excretion was 70% decreased concomitantly with a 2-fold increased neutral sterol output. The differences in bile acid biosynthesis did not change plasma cholesterol levels. However, plasma triglyceride levels decreased by 41% and 38% in thecyp7a1−/−. APOE*3-Leiden mice as compared with APOE*3-Leiden mice on chow and lipogenic diet, respectively. Mechanistic studies showed that very-low-density lipoprotein (VLDL)–apolipoprotein B and VLDL–triglyceride production rates were reduced incyp7a1−/−. APOE*3-Leiden mice as compared with APOE*3-Leiden mice (−34% and −35%, respectively).Cyp7a1deficiency also increased the hepatic cholesteryl ester and triglyceride content (2.8-fold and 2.5-fold, respectively). In addition, hepatic anti-oxidative vitamin content, which can influence VLDL-production, was lower. Hepatic mRNA analysis showed decreased expression of genes involved in lipogenesis includingsrebf1.Conclusions—Cyp7a1deficiency in APOE*3-Leiden mice decreases the VLDL particle production rate, as a consequence of a strongly reduced bile acid biosynthesis, leading to a decrease in plasma triglycerides. These data underscore the close relationship between bile acid biosynthesis and triglyceride levels.
Angiotensin II Type 1a Receptor Is Involved in Cell Infiltration, Cytokine Production, and Neovascularization in Infarcted Myocardium
Authors: Toko Haruhiro , Zou Yunzeng , Minamino Tohru , Sakamoto Masaya , Sano Masanori , Harada Mutsuo , Nagai Toshio , Sugaya Takeshi , Terasaki Fumio , Kitaura Yasushi , Komuro Issei 
Published: February 2004

Objective—Angiotensin II is critically involved in left ventricular remodeling after myocardial infarction. Neovascularization has been thought to prevent the development of left ventricular remodeling and deterioration to heart failure. To elucidate the role of angiotensin II in neovascularization during cardiac remodeling, we induced myocardial infarction in angiotensin II type1a receptor (AT1) knockout (KO) mice.Methods and Results—There were more vessels in the border zone of infarcted hearts of wild-type (WT) mice and AT1KO mice at 14 days after operation, compared with in the left ventricle of sham-operated mice, and the number was larger in WT mice than in AT1KO mice. Consistent with these observations, the infarcted heart of AT1KO mice expressed lower levels of matrix metalloproteinase and endothelial nitric oxide synthase activity. More inflammatory cells such as granulocytes and macrophages were infiltrated in the infarcted hearts of WT mice than AT1KO mice at 4 days. A variety of cytokines and chemokines were increased in infarcted hearts of WT and AT1KO mice, and many of them were more remarkable in WT mice than in AT1KO mice at 14 days.Conclusions—AT1 plays a critical role in inflammatory cell infiltration, cytokine production, and neovascularization in infarcted hearts.
Rasch Analysis of Combining Two Indices to Assess Comprehensive ADL Function in Stroke Patients
Authors: Hsueh I-Ping , Wang Wen-Chung , Sheu Ching-Fan , Hsieh Ching-Lin 
Published: February 2004

Background and Purpose—To justify the summation of scores representing comprehensive activities of daily living (ADL) function, a Rasch analysis was performed to examine whether items of the Barthel Index (BI), assessing ADL, and items of the Frenchay Activities Index (FAI), assessing instrumental ADL, contribute jointly to a single, unidimensional construct in stroke patients living in the community. The number of scoring points of both indices was examined for their usefulness in discerning the various ability levels of ADL in these patients.Methods—A total of 245 patients at 1 year after stroke participated in this study. The BI and FAI were administered to the patient and/or the patient’s main caregiver by interview.Results—The initial Rasch analysis indicated that the middle scoring points for many items of the BI and FAI could be collapsed to allow only dichotomous response categories. All but 2 items of the FAI, social occasions and walking outside, fitted the model’s expectations rather well. These 2 items were excluded from further analysis. A factor analysis performed on the residuals of the Rasch-transformed scores recovered no dominant component. These results indicate that the combined 23 dichotomous items of the BI and FAI assess a single unidimensional ADL function.Conclusions—A clinically useful assessment of the comprehensive ADL function of patients at or later than 1 year after stroke can be obtained by combining the items of the BI and FAI (excluding 2 FAI items) and simplifying the responses into dichotomous categories. It is also demonstrated that the items of the new scale measure comprehensive ADL function as a single unidimensional construct when assessed at 1 year after stroke.
The role of apoptosis in the development of AGM hematopoietic stem cells revealed by Bcl-2 overexpression
Authors: Orelio Claudia , Harvey Kirsty N. , Miles Colin , Oostendorp Robert A. J. , van der Horn Karin , Dzierzak Elaine 
Published: February 2004

AbstractApoptosis is an essential process in embryonic tissue remodeling and adult tissue homeostasis. Within the adult hematopoietic system, it allows for tight regulation of hematopoietic cell subsets. Previously, it was shown that B-cell leukemia 2 (Bcl-2) overexpression in the adult increases the viability and activity of hematopoietic cells under normal and/or stressful conditions. However, a role for apoptosis in the embryonic hematopoietic system has not yet been established. Since the first hematopoietic stem cells (HSCs) are generated within the aortagonad-mesonephros (AGM; an actively remodeling tissue) region beginning at embryonic day 10.5, we examined this tissue for expression of apoptosis-related genes and ongoing apoptosis. Here, we show expression of several proapoptotic and antiapoptotic genes in the AGM. We also generated transgenic mice overexpressing Bcl-2 under the control of the transcriptional regulatory elements of the HSC marker stem cell antigen-1 (Sca-1), to test for the role of cell survival in the regulation of AGM HSCs. We provide evidence for increased numbers and viability of Sca-1+ cells in the AGM and subdissected midgestation aortas, the site where HSCs are localized. Most important, our in vivo transplantation data show that Bcl-2 overexpression increases AGM and fetal liver HSC activity, strongly suggesting that apoptosis plays a role in HSC development.
Mechanisms of early peripheral CD4 T-cell tolerance induction by anti-CD154 monoclonal antibody and allogeneic bone marrow transplantation: evidence for anergy and deletion but not regulatory cells
Authors: Kurtz Josef , Shaffer Juanita , Lie Ariadne , Anosova Natalie , Benichou Gilles , Sykes Megan 
Published: February 2004

AbstractAnti-CD154 (CD40L) monoclonal antibody (mAb) plus bone marrow transplantation (BMT) in mice receiving CD8 cell-depleting mAb leads to long-term mixed hematopoietic chimerism and systemic donor-specific tolerance through peripheral and central deletional mechanisms. However, CD4+ T-cell tolerance is demonstrable in vitro and in vivo rapidly following BMT, before deletion of donor-reactive CD4 cells is complete, suggesting the involvement of other mechanisms. We examined these mechanisms in more detail. Spot enzyme-linked immunosorbent (ELISPOT) analysis revealed specific tolerization (within 4 to 15 days) of both T helper 1 (Th1) and Th2 cytokine responses to the donor, with no evidence for cytokine deviation. Tolerant lymphocytes did not significantly down-regulate rejection by naive donor-reactive T cells in adoptive transfer experiments. No evidence for linked suppression was obtained when skin expressing donor alloantigens in association with third-party alloantigens was grafted. T-cell receptor (TCR) transgenic mixing studies revealed that specific peripheral deletion of alloreactive CD4 T cells occurs over the first 4 weeks following BMT with anti-CD154. In contrast to models involving anti-CD154 without BMT, BMT with anti-CD154 leads to the rapid induction of anergy, followed by deletion of pre-existing donor-reactive peripheral CD4+ T cells; the rapid deletion of these cells obviates the need for a regulatory cell population to suppress CD4 cell-mediated alloreactivity. (Blood. 2004;103:4336-4343)