tbuckley/cabot-search huggingface dataset:
Noninvasive Ventilation in Severe Hypoxemic Respiratory Failure
Authors: Miquel Ferrer, Antonio Esquinas, Miguel Leon, Gumersindo Gonzalez, Antonio Alarcon, Antoni Torres
Journal: American Journal of Respiratory and Critical Care Medicine (2003)

The efficacy of noninvasive ventilation (NIV) to avoid intubation and improve survival was assessed in 105 patients with severe acute hypoxemic respiratory failure (arterial O2 tension or saturation persistently 60 mm Hg or less or 90% or less, respectively; breathing conventional Venturi oxygen at a maximal concentration [50%]), excluding hypercapnia, admitted into intensive care units of three hospitals. Patients were randomly allocated within 24 hours of fulfilling inclusion criteria to receive NIV (n=51) or high-concentration oxygen therapy (n=54). The primary end-point variable was the decrease in the intubation rate. Both groups had similar characteristics. Compared with oxygen therapy, NIV decreased the need for intubation (13, 25% vs. 28, 52%, p=0.010), the incidence of septic shock (6, 12% vs. 17, 31%, p=0.028), and the intensive care unit mortality (9, 18% vs. 21, 39%, p=0.028) and increased the cumulative 90-day survival (p=0.025). The improvement of arterial hypoxemia and tachypnea was higher in the noninvasive ventilation group with time (p=0.029 each). Multivariate analyses showed NIV to be independently associated with decreased risks of intubation (odds ratio, 0.20; p=0.003) and 90-day mortality (odds ratio, 0.39; p=0.017). The use of noninvasive ventilation prevented intubation, reduced the incidence of septic shock, and improved survival in these patients compared with high-concentration oxygen therapy.
Sucess of smoking cessation in the elderly: A challenge
Authors: Marta Fradinho, Cristina Matos, Fernando Nogueira
Journal: European Respiratory Journal (2013)

Introduction:  World Health Organization defines elderly as being ≥65 years old. In Portugal, 13% of smokers had between 65-74 years old. Elderly smokers have dificult accepting effects of smoking and quitting. The ones who do have a success rate of 15%. Tobacco causes premature death in elderly, but cessation decreases morbi-mortality.  Objective:  Characterization and evaluation of smoking cessation sucess in elderly.  Material/methods:  Retrospetive study of records of smoking cessation consultation of Pulmonology service of Center Hospital of West Lisbon (Hospital de Egas Moniz) from 2008 to 2012 and phone calls. Analyzed parameters: gender, age, educational level, referral to consultation, number of queries, tobacco intake, nicotine dependence (Fagerstrom test), motivation (Richmond test) and current smoking habits.  Results:  Were evaluated 28 patients, 64% were male and 36% female. Mean age was 71±4,1years (65-78 years). Educational level didn’t go beyond 3rd cycle of basic education in 61%. Most patients were referred from General Pulmonology (21%) and 18% came from its own initiative. Eleven patients were evaluated in only one query (maximum query per patient was 7). Thirty six percent had a nicotine load (NL) from 40 to 60 cigarettes/day (minimum of 25 and maximum of 200). At 1 st query 50% had median nicotine dependence and 46% low motivation. Patients were contacted by phone and 3 of them were not currently smoking. Success rate of consultation in the elderly was 11%.  Conclusion:  Studies on the effect of age on smoking cessation sucess are rare, but some suggest that smoking cessation can be as successful in the elderly as in younger. The success rate of this study is in accordance with that described in the literature.
Effects of diesel exhaust particles on human bronchial epithelial cells at air-liquid interface
Authors: Annalicia Vaughan, Svetlana Stevanovic, Branka Miljevic, Zoran Ristovski, Felicia Goh, Vandana Relan, Leanne Morrison, Rayleen Bowman, Kwun Fong, Ian Yang
Journal: European Respiratory Journal (2014)

Diesel exhaust particles (DEPs) are a major contributor to the adverse health effects of air pollution. We characterised the effects of diesel emissions on human bronchial epithelial cells (HBECs), using an in vitro model of culture at air-liquid interface (ALI) and Cultex RFS aerosol delivery system.

Methods : Primary HBECs (3 cell lines) developed from patients undergoing lung resection were differentiated at ALI for >28 days. Diesel emissions were generated by a Euro III engine, diluted and tested with aerosol characterisation instruments. Diesel emissions were modified by removal of particles (to generate a gas component) or removal of organic compounds from the surface of diesel particles (leaving only soot or black carbon particles).

Results : Exposure of cells to primary diesel emissions resulted in a reduction in cell viability, variable changes in CYP1A1 and TNF-α mRNA expression, and increases in IL-8 and IL-6 secretion, which varied in response between cells. Removal of organic content from the diesel particles resulted in variable changes in the CYP1A1 and TNF-α mRNA expression and cytokine (IL-8 and IL-6) responses, depending on duration of exposure. Removal of particles (gas component) resulted in improved cell viability and reduced cytokine responses when compared to neat diesel.

Conclusions : These in vitro studies using a physiologically-relevant model emphasise the biological importance of both the complex chemical composition of DEPs and cellular factors in the response of HBECs at ALI to diesel emissions.

Support: ARC Discovery Grant, NHMRC Career Development Fellowship (IY), NHMRC Practitioner Fellowship (KF), The Prince Charles Hospital Foundation.
Patent Ductus Arteriosus in the Absence of a Continuous Murmur
Authors: J. FRANCIS DAMMANN, C. GORDON R. SELL
Journal: Circulation (1952)

The diagnosis of patent ductus arteriosus is difficult when the classic continuous murmur is not present. In infancy, in the presence of cardiac decompensation and when the ductus approximates the aorta in size, the continuous murmur is frequently absent. A correct diagnosis may be important, however, for a large patent ductus arteriosus can cause serious difficulty. Early surgical treatment may be lifesaving. In this series a large patent ductus was associated with pulmonary hypertension, great cardiac enlargement and absence of the continuous murmur. The presence of pulmonary hypertension is further reason for early surgical treatment.
Combined Diet and Physical Activity Promotion Programs for Prevention of Diabetes: Community Preventive Services Task Force Recommendation Statement
Authors: Nicolaas P. Pronk, Patrick L. Remington
Journal: Annals of Internal Medicine (2015)

Community Preventive Services Task Force recommendation on the use of combined diet and physical activity promotion programs to reduce progression to type 2 diabetes in persons at increased risk.The Task Force commissioned an evidence review that assessed the benefits and harms of programs to promote and support individual improvements in diet, exercise, and weight and supervised a review on the economic efficiency of these programs in clinical trial, primary care, and primary care-referable settings.Adolescents and adults at increased risk for progression to type 2 diabetes.The Task Force recommends the use of combined diet and physical activity promotion programs by health care systems, communities, and other implementers to provide counseling and support to clients identified as being at increased risk for type 2 diabetes. Economic evidence indicates that these programs are cost-effective.
Evaluation of different domains of the Saint George's respiratory questionnaire (SGRQ) according to the severity levels of chronic obstructive pulmonary disease (COPD)
Authors: Filipe Athayde, Rosana Sampaio, Bruna Vieira, Danielle Vieira, Raquel Britto, Verônica Parreira
Journal: European Respiratory Journal (2011)

Relevance:  Spirometric parameters used to determine disease severity may not be appropriate to infer about the different components of functioning in patients with COPD.   Purpose:  To compare and correlate the scores of the different SGRQ domains according to the GOLD severity levels in patients with COPD.   Methods:  A cross-sectional study was conducted at a hospital university. Comparison (Kruskal-Wallis) and correlation (Spearman) tests were used after performing normality tests. This study was approved by the Ethics Committee.   Results:  Table 1 summarizes the data for each GOLD stage. No significant difference was observed between stages I and II or I and III for any of the SGRQ domains. There were no significant correlations between FEV 1  and the SGRQ scores.   Conclusion:  The results suggest that there is no linearity between the severity levels of COPD and the SGRQ scores, including the activity and psychosocial impact domains.
Role of medical thoracoscopy in diagnosis of recurrent undiagnosed pleural effusion
Authors: Ramadan Bakr, Ibrahim Elmahallawy, Osama Mansour, Ahmad Ali, Samy El-Dahdouh
Journal: European Respiratory Journal (2012)

Background:   The urge for the resurgence of thoracoscopic techniques came essentially from the depressive situation of chronic exudates not diagnosed in 20-40% of cases after using the ordinary diagnostic methods.    Methods:   This study comprised 20 cases with exudative pleural effusion, all of them were subjected to full history taking, clinical examination, laboratory investigations, radiological examination (chest x- ray and CT), abdominal US, chest US if needed, tuberculin test, sputum for AFB, ABG and ECG. For all patients, pleural tapping and biochemical, cytological, bacteriological and immunological examinations for the pleural aspirates, as well as blind Abrams needle pleural biopsy and histopathological examination were done. The etiologic diagnosis of pleural effusion was not settled after all these investigations, and thus, medical thoracoscopy, under local anesthesia, was carried out for each patient.    Results:   The mean age of patients was 57.6 years. The diagnosis was achieved in 85% of cases, while 15% of cases diagnosed as non specific pleuritis. The result of biopsies were 65% malignancy (20% mesothelioma, 35 % metastatic adenocarcinoma, 5 % of either lymphoma or thymoma), and 35% of cases were nonmalignant, 15% undiagnosed, 10% TB, 5% of either empyma or RA). 20% of cases had complication in the form of 10% malposition of the intercostal tube and 5% of either hematoma or infection at the site of tube entry.    Conclusion:   Medical thoracoscopy, under local anesthesia and conscious sedation, is an effective procedure for diagnosing the underlying etiology of recurrent pleural effusion of unknown etiology, with minimal complications.
Comparison of the Densities of Clonogenic Cells From EMT6 Fibrosarcoma Monolayer Cultures, Multicell Spheroids, and Solid Tumors in Ficoll Density Gradients2
Authors: C. E. Ng, W. R Inch
Journal: JNCI Journal of the National Cancer Institute (1978)

The densities of viable EMT6 cells grown in vitro as monolayer exponential and plateau-phase cells or as multicell spheroids or in vivo as a solid tumor in BALB/c mice were determined with the use of isopyknic centrifugation in linear Ficoll gradients. Exponential cells banded at a density of 1.069 g/ml, whereas plateau-phase cells appeared at 1.073 g/ml. Cells grown as spheroids were more dense than the monolayer cells and were recovered mainly at 1.081. Solid-tumor cells, separated under the same conditions, banded at 1.080. Narrowing the range of the Ficoll gradient failed to resolve more than one band of cells in the solid-tumor separation. This provides evidence that the density of cells obtained from the spheroids is greater than that of the monolayer cells but agrees well with the density of the solid-tumor cells. Ficoll was demonstrated to be nontoxic to the cells, and plating efficiency assays showed similar cell viabilities between noncentrifuged and centrifuged cells. The plating efficiency of the peak fraction of exponential cells after centrifugation was 68%, and that of plateau-phase cells was 50%. Corresponding figures for the multicell spheroid and solid-tumor cells were 62 and 28%, respectively. The recovery of cells after centrifugation in the Ficoll gradients ranged from 62 to 83%. The effects of cell load and centrifugation time on the density distributions of the EMT6 cells were also investigated.
Emergence of CTX-M-15 extended-spectrum β-lactamase-producing Klebsiella pneumoniae isolates in Bosnia and Herzegovina
Authors: A. Dedeic-Ljubovic, M. Hukic, Y. Pfeifer, W. Witte, E. Padilla, I. López-Ramis, S. Albertí
Journal: Clinical Microbiology and Infection (2009)
Ginseng — A Root Just like a Carrot?
Authors: Alcuin Wilkie, Christopher Cordess
Journal: Journal of the Royal Society of Medicine (1994)

Ginseng has been used for thousands of years in the East as a ‘tonic’, and in recent years its use has extended to Western society. In the light of the current interest in complementary medicine, we summarize the effects and purported mechanisms of action of ginseng and present two vignettes of its use in relation to psychiatric patients, followed by a general discussion of the implications of the use of herbal products by these patients.
Steatorrhoea
Authors: P. H. Friedlander, V. Gorvy
Journal: BMJ (1955)

Idiopathic steatorrhoea " can now be classified into the pancreatogenous, hepatogenous, and enterogenous groups.The last named can be further differentiated into gluten-induced enteropathy, tropical sprue, or one of the anastomotic syndromes.Steatorrhoea is taken to mean the passage of loose, bulky, pale, fatty, offensive stools.The steatorrhoeic stool has an increased water content, increased dry weight, normal amount of pigment, which is paler than normal, increased amount of long-chain fatty acids, and increased short-chain volatile fatty acids.The long-chain fatty acids may be of dietary or non-dietary origin, or both.The non-dietary fat may be excreted, or it may be synthesized in the intestine.Increased activity of intestinal organisms may play an important part in the stool changes.Steatorrhoea is, usually, secondary to defective intestinal absorption.The dietary regime is planned to reduce bacterial activity in the intestine.Specific measures in appropriate cases include replacement of pancreatic enzymes or bile salts, a gluten-free diet, folic acid therapy in early sprue, antibacterial therapy in more chronic cases, and correc- tive surgery.Cortisone is helpful in some cases of idiopathic steatorrhoea.
Outcomes of High-Dose Chemotherapy and Autologous Stem-Cell Transplantation in Stage IIIB Inflammatory Breast Cancer
Authors: D. Adkins, R. Brown, K. Trinkaus, R. Maziarz, S. Luedke, C. Freytes, B. Needles, D. Wienski, P. Fracasso, T. Pluard, W. Moriconi, T. Ryan, K. Hoelzer, S. Safdar, T. Rearden, G. Rodriguez, H. Khoury, R. Vij, J. DiPersio
Journal: Journal of Clinical Oncology (1999)

PURPOSE: To evaluate the disease-free survival (DFS) and overall survival (OS), prognostic factors, and treatment-related mortality of women with stage IIIB inflammatory breast cancer (IBC) treated with combined modality therapy (CMT) and high-dose chemotherapy (HDCT) with autologous stem-cell transplantation. PATIENTS AND METHODS: Between 1989 and 1997, 47 consecutive patients with stage IIIB IBC were treated with CMT and HDCT and were the subject of this retrospective analysis. Chemotherapy was administered to all patients before and/or after definitive surgery. Neoadjuvant and adjuvant chemotherapy was administered to 33 and 34 patients, respectively, and 20 patients received both. All patients received HDCT with autologous stem-cell transplantation, and 41 patients received locoregional radiation therapy. Tamoxifen was prescribed to patients with estrogen receptor (ER)–positive cancer. RESULTS: The mean duration of follow-up from diagnosis was 30 months (range, 6 to 91 months) and from HDCT was 22 months (range, 0.5 to 82 months). At 30 months, the Kaplan-Meier estimates of DFS and OS from diagnosis were 57.7% and 59.1%, respectively. At 4 years, the Kaplan-Meier estimates of DFS and OS from diagnosis were 51.3% and 51.7%, respectively. In a multivariate analysis, the only factors associated with better survival were favorable response to neoadjuvant chemotherapy (P = .04) and receipt of tamoxifen (P = .06); however, the benefit of tamoxifen was only demonstrated in patients with ER-positive breast cancer. At last follow-up, 28 patients (59.6%) were alive and disease-free. Seventeen patients (36.2%) developed recurrent breast cancer. Seventeen patients died: 15 from disease recurrence and two (4.2%) from treatment-related mortality due to HDCT. CONCLUSION: In this analysis, the early results of treatment with CMT and HDCT compare favorably with other series of patients with stage IIIB IBC treated with CMT alone. These outcomes must be confirmed with longer follow-up and controlled studies.
Multidrug resistant acinetobacter baumanii pneumonia: Mortality analysis and comparison of intravenous versus aerosolized therapy
Authors: Sara Abreu, Inês Silveira, João Pedro Ferreira, Sara Rocha, Pedro Leuschner, João Correia
Journal: European Respiratory Journal (2014)

Acinetobacter baumannii (AB) is an emerging cause of nosocomial outbreaks. Multidrug resistance (MDR) strains, only colistin (PxE) sensitive are a matter of concern. Objectives: The purpose of this study was to compare the effectiveness and risks of aerosolized (AS) versus intravenous (IV) PxE in patients with MDR AB pneumonia (Pn).

Methods: A retrospective unicentric analysis of respiratory MDR AB isolates from January of 2009 to June of 2013. Of the 680 MDR AB isolates retrieved by the database, we selected patients treated with AS and/or IV PxE. The primary end-point was all-cause mortality and the safety end-point was renal function.

Results: Of the 139 patients with MDR AB Pn 50 (36,5%) died during hospitalization; 96 (70,1%) were men; 42 (30,7%) had COPD, 11 (8%) had bronchiectasis, 23 (16,8%) had active cancer and 4 (2,9%) were on dialysis. The mean age was 69,6 years; mean length of stay was 51,1 days; 116 (84,7%) patients were treated with IV PxE alone and 21 (15,3%) patients had AS PxE. IV PxE, creatinine increase, dialysis, and treatment failure during hospitalization were associated with higher mortality (all p<0,05). Patients on IV PxE had higher rates of renal, treatment failure and death rates (all p<0,05).

Conclusion: Our results demonstrate that AB is associated with prolonged hospital stay and high mortality rates. Renal function deterioration and treatment failure are associated with increased mortality, and these findings occur more often in IV PXE . These results should encourage clinicians to include inhaled colistin in the treatment of patients with AB pneumonia and are a step forward in the treatment of this MDR pathogen.
Pneumococcal Meningitis in the Intensive Care Unit
Authors: MARC AUBURTIN, RAPHAËL PORCHER, FABRICE BRUNEEL, AGNÈS SCANVIC, JEAN LOUIS TROUILLET, JEAN PIERRE BÉDOS, BERNARD RÉGNIER, MICHEL WOLFF
Journal: American Journal of Respiratory and Critical Care Medicine (2002)

We have undertaken this retrospective study to determine factors associated with in-hospital mortality and morbidity in 80 adult patients with severe Streptococcus pneumoniae meningitis. Clinical characteristics at admission of patients infected with susceptible (n = 54) and nonsusceptible (n = 17) strains to penicillin G were similar: age: 51 ± 19 versus 58 ± 15 yr (p = 0.16); Simplified Acute Severity Score (SAPS II): 39 ± 14 versus 41 ± 11 (p = 0.68); and Glasgow Coma Score: 8 ± 3 versus 9.5 ± 3 (p = 0.21), respectively. In-hospital mortality was 25% (20/80), with one death among the 17 patients (6%) infected with a nonsusceptible strain (p = 0.03). High-dose dexamethasone was used in 22 cases. By multivariate analysis, three factors were independently associated with death: platelet count < 100 G/L (adjusted odds ratio [aOR] = 32.7; 95% CI = 3.2 to 332.5; p = 0.0032), arterial pH > 7.47 (aOR = 33.1; 95% CI = 3.4 to 319.7; p = 0.0025), and mechanical ventilation (aOR = 48.8; 95% CI = 2.6 to 901.5; p = 0.009). When adjusting for the identified prognostic factors, corticosteroids significantly reduced the risk of death (aOR = 0.069; 95% CI = 0.005 to 0.9; p = 0.048). Only SAPS II was predictive of adverse outcome (death or neurologic deficit). We conclude that in intubated patients with S. pneumoniae meningitis, hyperventilation should be used with caution. Nonsusceptibility to penicillin G is not associated with a worse outcome. High-dose corticosteroids may be beneficial in the most severely ill patients.
Margaret McCartney: Taking patient safety seriously means minimum staffing levels
Authors: Margaret McCartney
Journal: BMJ (2015)

What is essential care? Being clean, washed, dressed. Being helped to eat, drink, use the toilet. Receiving appropriate drugs on time. Being able to rest. Being treated humanely and with kindness. Being monitored properly. Being noticed when in pain or distressed, if blood pressure falls, if agitated, or if the bathroom door has been locked for so long that something may be seriously wrong.

Basic healthcare is far beyond “basic”; it is everything. Without it, patients are not safe.

The evidence that having more staff is associated with longer survival has been accumulating and should be difficult to ignore.1 2 3 Strikingly, a nurse looking after one extra patient is associated with a 7% increase in the likelihood of patient death within 30 days of admission (the overall death …
An Immunohistologic Study of Shope Fibroma Virus in Rabbits: Tumor Rejection by Cellular Reaction in Adults and Progressive Systemic Reticuloendothelial Infection in Neonates&lt;xref ref-type="fn" rid="fn2"&gt;2&lt;/xref&gt;&lt;xref ref-type="fn" rid="fn3"&gt;3&lt;/xref&gt;
Authors: S Sell, C B Scott
Journal: JNCI Journal of the National Cancer Institute (1981)

The development of lesions in adult and neonatal New Zealand White rabbits following intradermal inoculation of Shope fibroma virus was studied by immunofluorescence for viral antigens. T-cells, and immunoglobulin. In adults a self-limiting local fibroxanthosarcomatous tumor was rejected within 10-12 days in association with a dense infiltration of T-cells. In neonates expanding skin lesions were associated with systemic presence of virus in the reticuloendothelial system. In surviving infected neonates, granulomas formed at the site of infection after 3 weeks. These reactions may have limited further dissemination of the virus. These results support the hypothesis that the progressive disease produced by Shope fibroma virus in neonatal rabbits may be due to the inability of the reticuloendothelial system to clear infectious virus.
Predicting the risk of Clostridium difficile infection following an outpatient visit: development and external validation of a pragmatic, prognostic risk score
Authors: J.L. Kuntz, E.S. Johnson, M.A. Raebel, R.W. Platt, A.F. Petrik, X. Yang, M.L. Thorp, S.J. Spindel, N. Neil, D.H. Smith
Journal: Clinical Microbiology and Infection (2014)
The prognostic value of serum myoglobin in patients with non–ST-segment elevation acute coronary syndromes
Authors: James A de Lemos, David A Morrow, C.Michael Gibson, Sabina A Murphy, Marc S Sabatine, Nader Rifai, Carolyn H McCabe, Elliott M Antman, Christopher P Cannon, Eugene Braunwald
Journal: Journal of the American College of Cardiology (2002)