tbuckley/cabot-search huggingface dataset:
Long term oxygen therapy (LTOT) prescription in chronic obstructive pulmonary disease (COPD) patients in Wigan (northwest England)
Authors: Sharada Gudur, Ayuni Zahar, Andrew Cross, Imran Aziz, Abdul Ashish
Journal: European Respiratory Journal (2012)

Background: LTOT has been shown to provide a survival benefit in severe COPD. In UK, since 2006, following a Royal college directive LTOT prescriptions were to be issued only by hospital specialists managing such patients after formal assessments (BTS working group report, January 2006). The directive aimed to standardise LTOT assessments, issue and follow up to hospital based practitioners and specialist services.

We audited the oxygen prescriptions for adult patients in Wigan between 2006-2011 to study concordance of Royal college directives with our oxygen prescriptions.

Methods : We analysed the oxygen prescription data provided by our suppliers (Air products) for the patient details and prescriber source.

Results: There were 313 patients in whom oxygen was prescribed for COPD as the indication. The breakdown of prescriber source is as below.

View this table:

Health professionals prescribing LTOT in Wigan between 2006-11





Conclusions: There are still a substantial proportion of oxygen prescriptions issued at a community level by the general practitioners and community based nurses for patients with COPD. We are unsure regarding the assessments undertaken for the adequacy of such prescriptions. This could potentially lead to harm and is likely to lead to increased cost for the healthcare services. At the current times of austerity, duplication of services should be avoided to ensure the patients and NHS gets the maximal benefit from LTOT provision.
Norovirus outbreak associated with a hotel in the west of Ireland, 2006
Authors: A Michel, R FitzGerald, D Whyte, A Fitzgerald, E Beggan, N O’Connell, T Greally
Journal: Eurosurveillance (2007)

An outbreak of gastrointestinal disease (nausea, vomiting or diarrhoea) occurred among a party of wedding guests, staff and other guests in a hotel in the west of Ireland, in October 2006. Upon notification, a multi-disciplinary outbreak control team was convened to investigate and control the outbreak. In all, 98 people were ascertained ill. The median duration of illness was 48 hours. The attack rate ranged between 48 and 85%. The hotel voluntarily notified health authorities and co-operated fully with investigation and control measures. Strict prevention and control measures were instituted promptly, including air ventilation, enhanced hand hygiene, isolation of cases, temporary "cooked food only", temporary alternative accommodation and specialised cleaning. Three cases of norovirus infection were laboratory-confirmed. There was no evidence of food- or water-borne transmission. Clinical and epidemiological findings indicated person-to-person transmission of norovirus. This report highlights the potential for large social gatherings to facilitate the spread of viral gastroenteritis by person-to-person transmission and via contaminated environment. Effective community management of this outbreak appears to have prevented its having an impact on local acute hospital services. The authors conclude that in addition to the existing national guidelines on the management of outbreaks of norovirus in healthcare settings, agreed guidelines for the management of norovirus outbreaks in the hotel and tourism industry are needed in Ireland.
Sputum neutrophilia and annual decline of FEV1 in dust exposed workers
Authors: Liv I.B. Sikkeland, Tonje B. Riste, Helle L. Johnsen, Vidar Søyseth, Johny Kongerud
Journal: European Respiratory Journal (2011)

In a previous study in the smelting industry we found a significant relationship between dust exposure and accelerated annual decline in FEV1. The aim of the present study was to investigate the association between annual decline in lung function and different inflammatory markers in induced sputum from the production workers.   Methods:  Employees (n=76 (27 current smokers)) who had been part of a longitudinal study (9-13 years) including spirometry (>6 measurements) and respiratory questionnaires, performed induced sputum and exhaled NO.   Results:  All workers had neutrophil inflammation compared to unexposed controls. However neutrophil levels in sputum samples did not differ between workers with annual decline in FEV1 (>45ml - upper tertile) compared to workers with annual decline in FEV1   Conclusion:  All production workers displayed airway inflammation characterized by neutrophilia. Surprisingly, there were no differences in the neutrophil level when comparing workers with rapid decline in lung function with those with slow decline in lung function. As expected smokers had low levels of exhaled NO, but there was no difference in neutrophil levels between smokers and non-smokers. Sputum neutrophilia was not a marker for increased decline in FEV1.
Malignant and Benign Ovarian Neoplasms Among Atomic Bomb Survivors, Hiroshima and Nagasaki, 1950–80&lt;xref ref-type="fn" rid="FN2"&gt;2&lt;/xref&gt;
Authors: S Tokuoka, K Kawai, Y Shimizu, K Inai, K Ohe, T Fujikura, H Kato
Journal: JNCI Journal of the National Cancer Institute (1987)

For 1950–80, 194 ovarian cancer cases were ascertained among the 70,030 females of the Radiation Effects Research Foundation's Life-Span Study E-85 sample, and 106 autopsied cases with benign ovarian neoplasms were ascertained among all 3,046 autopsies performed in the same sample. On the basis of microscopic review, 66% of the cancer and 84% of the benign tumor cases were classified by histologic type. The age-adjusted ovarian cancer incidence rates showed a statistically significant increase with increased exposure dose, both in the entire exposed group (P<.01) and in the microscopically reviewed subset (P<.01). This dose response was only significant (P<.01) in the latter half of the study period, 1965–80. The radiation effect was higher in the younger age group at the time of the bomb (ATB) for the specific attained age or was adjusted for attained age. In general, relative risk (≥100 rad vs. 0 rad) did not differ by attained age, except for the youngest age group, less than 20 years old ATB, where the relative risk tended to decrease with increased attained age, although cases were few in number and follow-up study was necessary. Estimated minimum latent period for radiation-induced ovarian cancer seemed to be 15–20 years. The proportion of autopsied cases with benign ovarian tumor increased with increasing exposure dose, both in the entire series of cases (P<.05) and in the microscopically reviewed subset. Statistical significance, however, was not achieved in the latter group (P>.10). The distribution of histologic types of both cancer and benign tumor of the ovary did not vary significantly with radiation dose. The data are consistent with the hypothesis that radiation injury of the ovaries and secondary excess of gonadotropic hormones are important causative factors in the development of ovarian neoplasms.
Clinic and immunologic features of the co-infection tuberculosis and HTLV-1
Authors: Maria de Lourdes Bastos, Yuri Neves, Natália Carvalho, Nathália Lisboa, Anselmo Souza, Silvane Santos, Eduardo Netto, Edgar M. Carvalho
Journal: European Respiratory Journal (2014)

Introduction: The human T cell lymphotropic virus type 1 (HTLV-1) infection increases up to 4 fold the susceptibility for tuberculosis (TB) but very little is known about the pathogenesis and clinical consequences of this co-infection. Objectives: The aims of this study were to determine the prevalence of TB in a cohort of HTLV-1, to evaluate the immunologic response that may explain the clinical consequences of this co-infection. Methods: A total of 190 HTLV-1 infected subjects followed at the HTLV-1 clinic in the Federal University of Bahia, were enrolled in the study. The diagnosis of HTLV-1 was performed by an ELISA serological test and confirmed by Western blot. They answer a questionnaire, had a complete physical and neurological examinations, chest X ray and a tuberculin skin test (TST). HTLV-1 infected subjects were classified as asymptomatic, neurogenic bladder and HTLV-1 associated myelopathy (HAM). Cytokines were measured by ELISA in supernatants of lymphocyte cultures and the pro-viral load by PCR. Results: There were 39 (20,5%) cases of TB and 76 (46%) of latent TB (P<0.05). Patients with TB and HTLV-1 had a lower production of TNF-α and higher ratio of IFN : IL-10 (P<0.05) than HTLV-1 + LTB or HTLV-1 without TB. Moreover the frequency of HAM was higher (P< 0.001) in the TB group compared to LTB and without TB. Conclusion: Our data did not support that HTLV-1 make M.tuberculosis infection more severe. While the increased susceptibility for TB in HTLV-1 may be due to a decreasing in TNF-α production, TB by inducing a more exaggerated inflammatory response in HTLV-1 influences the clinical outcome of the viral infection, contributing for the development of HAM.
Nasopharyngeal bacterial burden and antibiotics: Influence on inflammatory markers and disease severity in infants with respiratory syncytial virus bronchiolitis
Authors: M. Carmen Suárez-Arrabal, Cesar Mella, Santiago M. Lopez, Nicole V. Brown, Mark W. Hall, Sue Hammond, William Shiels, Judith Groner, Mario Marcon, Octavio Ramilo, Asuncion Mejias
Journal: Journal of Infection (2015)
Isolated intrathoracic tuberculous lymphadenopathy
Authors: P Van den Brande, J Vijgen, M Demedts
Journal: European Respiratory Journal (1991)

We report an 82 yr old man with isolated intrathoracic lymphadenopathy of tuberculous origin, which is an extremely uncommon presentation of tuberculosis especially in elderly Caucasian patients. The diagnosis was suggested by the computerized tomographic (CT)-scan showing central hypodense areas after contrast, and was subsequently proved by mediastinoscopic biopsy with histological and microbiological analysis. The atypical presentation of tuberculosis together with a negative two-step 5 international units of purified protein derivative (IU-PPD) tuberculin skin test and a frequent contact with a cavernous index case points towards a primary infection in this patient.
Ventilation – Perfusion scan outcome when the chest radiograph is abnormal
Authors: Zahra Raisi Estabragh, Arun Lakhanpal, Adeel Ashraf, Robert Hewson, Hassan Burhan
Journal: European Respiratory Journal (2011)

Introduction:  Guidelines recommend isotope lung scanning (V/Q) may be considered as first line investigation for suspected pulmonary embolism (PE) provided there are facilities on site and a chest radiograph (CXR) is normal. Occasionally, V/Q scans are performed in the presence of an abnormal CXR.   Aim:  To study the diagnostic yield of V/Q scans in patients with suspected PE and an abnormal CXR.   Method:  All patients who had a V/Q scan for suspected PE over a period of 12 months from February 2008 were included in the study. The CXR and V/Q scan reports were recorded.   Results:  1041 V/Q scans were performed at our institution with a preceding CXR. Of these, 345 CXRs were reported as abnormal.  Of the 345 patients with an abnormal CXR that had a V/Q scan, 275 (80%) were reported as Low, 25 (7%) Moderate and 40 (12%) as High probability of PE. 5 patients scans were not formally reported.  Of those in the Low Probability group, 9 had a subsequent CTPA with 1 (0.004%) being positive for PE, in the Moderate Probability group 20 had a subsequent CTPA with 5 (20%) being positive for PE and in the High Probability group 6 had a subsequent CTPA with 2 (5%) being positive for PE.   Discussion:  One third of the patients that had a V/Q scan to investigate suspected PE had an abnormal CXR. Despite this, 275 (80%) of these patients had a low probability scan, 9 of these patients went on to have a CTPA and only 1 was positive for PE.  A low probability V/Q scan may prevent unnecessary radiation exposure and adequately exclude PE, even in the presence of an abnormal CXR.
Characteristics of hemophilia patients with factor <scp>VIII</scp> inhibitors detected by prospective screening
Authors: Connie H. Miller, Anne S. Rice, Brian Boylan, Amanda B. Payne, Fiona M. Kelly, Miguel A. Escobar, Joan Gill, Cindy Leissinger, J. Michael Soucie
Journal: American Journal of Hematology (2015)

Characteristics of inhibitors identified by prospective screening may differ from those detected clinically. In a prospective study at 17 hemophilia centers with central inhibitor measurement by Nijmegen-Bethesda assay, 23 (2.8%) of 824 hemophilia A patients had new inhibitors detected: nine high-titer inhibitors (HTI: 7 ≥ 5.0 NBU plus 2 of 2.6 and 3.4 NBU at immune tolerance induction initiation) and 14 low-titer inhibitors (LTI: 0.5-1.9 NBU). HTI occurred at an earlier age (median 2 years, range 1-18, vs. median 11 years, range 2-61, P = 0.016). Both HTI (22%) and LTI (43%) occurred in non-severe patients. All HTI, but only 64% of LTI, were found to be FVIII-specific by chromogenic Bethesda assay or fluorescence immunoassay (FLI), indicating a high rate of false-positive LTI. Repeat specimens confirmed all HTI, 7/9 LTI, and 7/7 FVIII-specific LTI. FLI results were similar between HTI and FVIII-specific LTI; all included IgG1 and IgG4 subclasses. A comparable prospective study conducted from 1975 to 1979 at 13 U.S. centers found 31 (2.4%) new inhibitors among 1,306 patients. In both studies, one-third of inhibitors occurred in non-severe patients and one-quarter after 150 exposure days (ED). Significant differences were seen in the age at which inhibitors occurred (median 16 years in the older study vs. 5 years currently, P = 0.024) and in ED before inhibitor development, 10% in the older study and 43% currently study occurring within 20 ED, suggesting a temporal change in inhibitor development. Prospective screening detects inhibitors in patients of all severities, ages, and ED. Some LTI, however, are false positives.
The m-BACOD combination chemotherapy regimen in large-cell lymphoma: analysis of the completed trial and comparison with the M-BACOD regimen.
Authors: M A Shipp, B Y Yeap, D P Harrington, M M Klatt, G S Pinkus, M S Jochelson, D S Rosenthal, A T Skarin, G P Canellos
Journal: Journal of Clinical Oncology (1990)

One hundred thirty-four assessable patients with stage II-IV large-cell lymphoma (LCL) were treated with the combination chemotherapy regimen methotrexate with leucovorin, bleomycin, doxorubicin, cyclophosphamide, vincristine, and dexamethasone (m-BACOD) between July 1981 and May 1986. The m-BACOD regimen substituted moderate-dose methotrexate (200 mg/m2 x 2) for the high-dose methotrexate used in the preceding M-BACOD regimen; all other drugs were administered as with m-BACOD. Eighty-two patients (61%) in the completed m-BACOD trial achieved a complete response (CR). With a median follow-up of 3.6 years, 62 patients (76%) continue in CR. Predicted survivals of 1, 3, and 5 years for the entire m-BACOD group are 80%, 63%, and 60%, respectively, with a 5-year disease-free survival (DFS) of 74% for the patients who achieve CR. The results obtained with m-BACOD are comparable with those obtained in the preceding M-BACOD trial, which now has a median follow-up of 8.0 years. The reduction in methotrexate dosage in m-BACOD patients was not associated with an increased incidence of CNS relapse. Long-term follow-up of the 215 M/m-BACOD patients indicates that the regimens are not associated with an increased incidence of secondary malignancy. Prolonged follow-up also indicates that advanced-stage patients have a persistent rate of late relapse of about 7.0% per year for years 2 to 5 of their follow-up and that stage II patients have an approximate 2.1% per year rate of late relapse. Application of the previously described prognostic factor model to the 215 M/m-BACOD patients from the completed trials identifies a high-risk group of patients with a CR rate and predicted 5-year survival (38% and 24%, respectively) that are significantly worse than those of the group as a whole (65% and 57%, respectively).
Assessment of sleep in patients with lung cancer and breast cancer.
Authors: P M Silberfarb, P J Hauri, T E Oxman, P Schnurr
Journal: Journal of Clinical Oncology (1993)

PURPOSE AND METHODS We studied the sleep architecture and psychologic state of 32 patients with breast or lung cancer compared with 32 age- and sex-matched, normal-sleeping volunteers and 32 otherwise healthy insomniacs. RESULTS Research findings indicate that lung cancer patients slept as poorly as did insomniacs, but underreported their sleep difficulties. Breast cancer patients slept similarly to normal-sleeping volunteers. No psychiatric disorders were detected in the cancer patients, and there were no significant differences in mood between lung and breast cancer patients. CONCLUSION Lung cancer patients appear to be unique in underestimating an objectively verified sleep difficulty. The adaptive mechanism of denial in these patients is discussed.
The importance of controlling PaCO2 throughout long-term non-invasive ventilation
Authors: Tomomasa Tsuboi, Toru Oga, Kensuke Sumi, Atsuo Sato, Kazuo Chin
Journal: European Respiratory Journal (2013)

Background: Whether changes in the arterial carbon dioxide tension (PaCO2) during long-term non-invasive positive pressure ventilation (NPPV) are related to a good prognosis remains unclear.

Methods: Data on 190 patients with restrictive thoracic disease who received long-term NPPV were studied retrospectively. The annual changes in PaCO2 during NPPV were determined with a simple linear regression method in each patient who had at least four 6-month intervals of PaCO2 data. The annual changes in the PaCO2 during long-term NPPV and possible confounders were analyzed, with discontinuation of long-term NPPV as the main outcome.

Results: One hundred twenty-five patients had more than four 6-month intervals of PaCO2 data and were performed further studied. PaCO2 during long-term NPPV decreased in 41 patients (Group 1; less than 0 mmHg/y), increased slightly in 42 patients (Group 2; between 0 and 1.85 mmHg/y), and increased greatly in 42 patients (Group 3; more than 1.85 mmHg/y). Lower annual changes in PaCO2 (p=0.0002) and a control ventilator mode (p=0.008) were associated with a significantly better probability of carrying on NPPV, while lower PaCO2 3-6 months after start of long-term NPPV was not (p=0.11). 10-year probabilities of continuing NPPV were 69% for Group 1, 39% for Group 2, and 12% for Group 3.

Conclusion: Lower annual change in PaCO2 during long-term NPPV was significant prognostic variables.
Review: Enthesitis: New Insights Into Pathogenesis, Diagnostic Modalities, and Treatment
Authors: Amy S. Kehl, Maripat Corr, Michael H. Weisman
Journal: Arthritis & Rheumatology (2015)

Enthesitis is a central feature of spondyloarthritis (SpA). Although enthesitis has traditionally been considered to be a focal insertional disorder, advanced imaging and pathologic findings suggest that enthesitis is a diffuse process with effects on adjacent bone and soft tissue. As a result of repeated biomechanical stress, it appears that microdamage at the enthesis triggers an inflammatory response in the synovium, leading to synovitis. Along with mechanical stress, exogenous bacteria may play a role in activating the immune response, especially in genetically predisposed individuals whose major histocompatibility locus encodes the class I molecule HLA–B27. Recent studies in animal models suggest that autoimmunity against versican and fibrocartilage proteins, and bone morphogenetic protein (BMP) signaling play roles in enthesitis development. Finally, interleukin-23 (IL-23) has been implicated in enthesitis with inflammatory effects mediated through IL-17 and tumor necrosis factor (TNF), and new bone formation driven by IL-22.

Although prior therapeutic choices were limited to nonsteroidal antiinflammatory drugs (NSAIDs) and activity modification, in recent years TNF inhibitors have proven to be useful. Further research on the effects of IL-22 and IL-23 blockade is needed to understand the effects on the treated patient. While enthesitis is underdiagnosed by physical examination alone, the use of ultrasound has proven to be highly sensitive for the detection of enthesitis, with utility in monitoring response to therapy, and will be an invaluable tool for assessing the efficacy of newer treatments. This review summarizes the substantial progress that has been made in addressing the pathophysiology, molecular mechanisms, genetic associations, clinical features, diagnostic modalities, and treatment of enthesitis.
Evaluation of a Mental Illness Awareness Week program in public schools
Authors: J Battaglia, J H Coverdale, C P Bushong
Journal: American Journal of Psychiatry (1990)

The authors evaluated the impact of a Mental Illness Awareness Week program on the attitudes of adolescents attending public school toward seeking help for mental health problems and toward psychiatrists. Most students involved in the program liked it and indicated that they were interested in learning more about mental health topics. Students in the program showed more favorable attitudes toward seeking help and toward psychiatrists than a comparison group of students who did not participate in the program. The authors discuss the evidence for enduring effects of the program. The results support continued development of Mental Illness Awareness Week programs for adolescents in the public schools.
Towards immunotherapy of pancreatic cancer
Authors: I F C McKENZIE, V APOSTOLOPOULOS
Journal: Gut (1999)

<h3>Background</h3> Epidemiological studies in Kawasaki disease (KD) have suggested infectious aetiology. During the COVID-19 pandemic, measures for mitigating SARS-CoV-2 transmission also suppress the circulation of other contagious microorganisms. The primary objective is to compare the number and incidence of KD before and during the COVID-19 pandemic in Japan, and the secondary objective is to investigate temporal association between the KD epidemiology and activities of SARS-CoV-2 and other viral and bacterial infections. <h3>Methods</h3> A retrospective cohort study was conducted between 2016 and 2020 in Kobe, Japan. We collected information of hospitalised KD children in Kobe. Child population was identified through the resident registry system. Activity of COVID-19 and 11 other infectious diseases was derived from a public health monitoring system. Monthly change of KD incidence was analysed using a difference-in-difference regression model. <h3>Results</h3> Throughout the study period, 1027 KD children were identified. KD had begun to decline in April 2020, coinciding with the beginning of the COVID-19 pandemic. The number of KD cases (n=66) between April and December 2020 was 40% of the average in the same period in 2016–2019 (165/year). Annual KD incidence was 315, 300, 353, 347 and 188/100 000 children aged 0–4 years in 2016–2020, respectively. The difference-in-difference value of KD incidence was significantly reduced in the fourth quarter in 2020 (−15.8, 95% CI −28.0 to −3.5), compared with that in 2016–2019. Sentinel surveillance showed a marked decrease of all infectious diseases except exanthema subitum after the beginning of the COVID-19 pandemic. There were 86 COVID-19 cases aged &lt;10 years and no KD children associated with COVID-19. <h3>Conclusion</h3> This study showed that the number and incidence of KD was dramatically reduced during the COVID-19 pandemic in Japan. This change was temporally associated with decreased activities of various infectious diseases other than COVID-19, supporting the hypothesis of infection-triggered pathogenesis in KD.
Leptomeningeal Metastases in Non-Small Cell Lung Cancer Patients with an Epidermal Growth Factor Receptor Mutation
Authors: J. Kuiper, L. Hendriks, E. Buijs, J.A. De Langen, I. Bahce, E. Thunnissen, D.A.M. Heideman, E.J. Speel, A.C. Dingemans, E.F. Smit
Journal: Annals of Oncology (2014)