tbuckley/cabot-search huggingface dataset:
Lesson of the Week: Anabolic steroid abuse by body builders and male subfertility
Authors: F H Lloyd, P Powell, A P Murdoch
Journal: BMJ (1996)

Steroid abuse by a minority of top class athletes is well recognised. Abuse by competitive body builders is thought to be common but has caused less public concern. Recreational body builders attending gymnasiums also abuse steroids1 but the frequency and patterns of use and the associated problems are less well known.

Among other side effects androgenic steroids induce hypogonadotrophic hypogonadism with subsequent azoospermia.2 Over the past year we have noted an increased number of men attending the infertility clinic who have been using anabolic steroids for body building. This has been associated with an apparent substantial increase in body building as a recreational pastime in the north east.

We are concerned about the lack of understanding of the consequences of steroid use by users and providers and the ease with which the diagnosis can be missed. The following five cases illustrate the problems.

Case 1—A couple (husband aged 29) requested in vitro fertilisation after primary subfertility for three years. Results of two semen analyses arranged by the general practitioner in early 1994 were normal (sperm densities 80x109 and 150x109/l). At presentation the husband was severely oligospermic (sperm densities nil and <100x106/l). His hobby was weightlifting and he admitted to taking oral steroids for two weeks 12 months earlier. Examination showed a normal muscular male physique with normal secondary sexual characteristics. However, follicle stimulating hormone and testosterone concentrations were very low, confirming steroid use. He admitted to taking a “protein health drink” which was made up by …
Accuracy of Echocardiography to Evaluate Pulmonary Vascular and RV Function During Exercise
Authors: Guido Claessen, Andre La Gerche, Jens-Uwe Voigt, Steven Dymarkowski, Frédéric Schnell, Thibault Petit, Rik Willems, Piet Claus, Marion Delcroix, Hein Heidbuchel
Journal: JACC. Cardiovascular imaging (2015)
Rapidly growing mycobacteria in Singapore, 2006–2011
Authors: S.S. Tang, D.C. Lye, R. Jureen, L.-H. Sng, L.Y. Hsu
Journal: Clinical Microbiology and Infection (2014)

Nontuberculous mycobacteria infection is a growing global concern, but data from Asia are limited. This study aimed to describe the distribution and antibiotic susceptibility profiles of rapidly growing mycobacterium (RGM) isolates in Singapore. Clinical RGM isolates with antibiotic susceptibility tests performed between 2006 and 2011 were identified using microbiology laboratory databases and minimum inhibitory concentrations of amikacin, cefoxitin, clarithromycin, ciprofloxacin, doxycycline, imipenem, linezolid, moxifloxacin, sulfamethoxazole or trimethoprim-sulfamethoxazole, tigecycline and tobramycin were recorded. Regression analysis was performed to detect changes in antibiotic susceptibility patterns over time. A total of 427 isolates were included. Of these, 277 (65%) were from respiratory specimens, 42 (10%) were related to skin and soft tissue infections and 36 (8%) were recovered from blood specimens. The two most common species identified were Mycobacterium abscessus (73%) and Mycobacterium fortuitum group (22%), with amikacin and clarithromycin being most active against the former, and quinolones and trimethoprim-sulfamethoxazole against the latter. Decreases in susceptibility of M. abscessus to linezolid by 8.8% per year (p 0.001), M. fortuitum group to imipenem by 9.5% per year (p 0.023) and clarithromycin by 4.7% per year (p 0.033) were observed. M. abscessus in respiratory specimens is the most common RGM identified in Singapore. Antibiotic options for treatment of RGM infections are increasingly limited.
Effectiveness of bi-level positive airway pressure (BiPAP) in type II respiratory failure due to post tuberculosis sequelae
Authors: Naseem Ahmed, Saima Siraj, Nadeem Rizvi
Journal: European Respiratory Journal (2013)

Introduction:  Post tuberculosis (TB) sequelae is the state with various secondary complications after healing of TB. Type II respiratory failure is frequently encountered in these patients and non invasive ventilation in the form of BiPAP is required to correct it.  Objective:  To determine the effectiveness of Bi-level Positive Airway Pressure (BiPAP) in patients presenting with type II respiratory failure due to Post tuberculosis sequelae.  Methods:  Cross sectional prospective study. Patients admitted with type II respiratory failure secondary to post TB sequealae were included in the study.  Results:  Total number of patients were 71, 40 (56.33%) were males and 31 (43.66%) were females. The mean age was 50.63 ± 19.13. BiPAP succeeded in 47(66.1%) patients while remaining 24(33.8%) either intubated or expired. Pre treatment mean GCS was 9.11 ± 2.05, mean PH was 7.23 ± 0.066,mean Paco2 was 68.94 ± 11.81mmHg and mean respiratory rate was 35.70 ± 6.57 .Post BiPAP target GCS (15/15), PH >7.35,Paco2 between 55-65mmHg and respiratory rate 14-20 breaths/min were achieved in 66.1% patients, while 33.8% had GCS, PH,PaCO2 and respiratory rate that were out of range. BiPAP was more effective in age group ≤ 50 (p =o.oo1), there was no statistically significant difference in effectiveness of BiPAP in relation to gender( p= 0.800) and duration of illness(p=0.604).  Conclusion:  BiPAP applied in post TB sequelae patients succeeded in 66.1% particularly in patients below 50 years of age, while 26.7% expired, and 7% needed endotracheal tube intubation.
Surrogate markers of right ventricular adaptation better predict long-term survival in patients with PAH than traditional prognostic variables
Authors: Franz Rischard, Steve Knoper
Journal: European Respiratory Journal (2013)

Purpose: Right ventricular (RV) function is associated with mortality in patients with PAH. We have observed that typical methods of right ventricular function vary over time in patients on therapy. RV coupling ratio, the gold standard, is a tedious method. We developed mortality predictors using models of coupling ratio obtained by routine echocardiography (echo) and/or catheterization (cath). Methods : Retrospective review of PAH Survivors (N=20) and non-survivors (N=9) with baseline PVR >6 WU and at least 2 measurements on therapy were studied. We examined Ea, a measure of afterload, by cath. Isovolemic acceleration (IVA) is a measurement derived from echo that correlates with Es, a measure of contractility. IVA/Ea was the most predictive model of coupling. Results : Survivors and non-survivors were matched for PVR >10 and cardiac index at baseline. Both indices improved significantly on therapy. All patients were eventually treated with combination therapy for average 41 months (range 12-108). TAPSE and IVA/Ea improved over time in survivors but remained significantly low in non-survivors. However, 11/20 survivors and 9/9 non-survivors had a TAPSE  2 in all survivors and <1.3 in all non-survivors on follow up. Survivors with baseline TAPSE <1.8 cm vs. non-survivors had a significantly higher IVA/Ea (2.23 vs. 0.92, P= 0.05). Conclusions : Serial measurements of IVA/Ea may prove valuable prognostically, particularly when the TAPSE is <1.8.
PSYCHOSES OCCURRING IN SOLDIERS DURING THE TRAINING PERIOD
Authors: MARGARET HITSCHMAN, ZULEIKA YARRELL
Journal: American Journal of Psychiatry (1943)

1. One hundred soldiers admitted to Bellevue Psychiatric Hospital during 1942 were studied. 2. Men who had previous hospitalizations for mental illness and those showing other signs of maladjustment prior to induction tended to break down after a longer period of military service in contrast to men whose pre-induction adjustment was adequate. 3. Army life provides precipitating factors which react upon a predisposed individual. However certain situational factors provide an occasion to bring abnormal behavior more closely to the attention of supervising personnel and thereby contribute to the detection of mental symptoms. 4. It was shown that the incidence of schizophrenia in men during military service and in civilian patients of the same age group was about equal. These findings applied to first attacks as well as recurrences. No qualitative difference in the psychoses of civilians and soldiers was found. 5. The following suggestions for lowering the incidence of psychiatric casualties during military s...
P1268 : The correlation between depression and chronic hepatic conditions as measured by the PHQ-9 depression assessment accounting for social characteristics
Authors: J.-M. Hermes, G. Mann-Deibert, A.M. Hefner, T.A. Couturier, C. Hill, R. Pozza, P.A. Reshamwala, T.I. Hassanein
Journal: Journal of Hepatology (2015)
“Stepping down” in mild-to-moderate asthmatic children being well controlled while receiving low doses of inhaled corticosteroids (ICS): Daily vs. cyclical ICS administration (prospective, randomized, multicentre, open-label trial)
Authors: Sergey Tereshchenko, Snejana Bychkovskaya, Smirnov Nicolay
Journal: European Respiratory Journal (2013)

Existing guidelines postulate regular daily use of ICS in persistent asthma although in some cases various intermittent regimes may be useful.

AIM: To compare the effects of daily with cyclical ICS administration on asthma control and exacerbations, lung function, and quality of life in stable mild-to-moderate asthmatic children.

METHODS: Main inclusion criteria were as follows: (1) children aged 6-15 years, (2) mild or moderate persistent asthma, (3) previous low doses ICS treatment 3-12 months, (4) achieving full asthma control. After a 4-wk run-in on fluticasone propionate (FP) 250 mcg/day 70 patients from 4 Russian pulmonology clinics were randomized to daily or cyclical (administration 4 days/3 days break) FP 100 mcg/day treatment regimes for 12 weeks. Two-tailed exact Fisher test was used.

RESULTS: There weren't significant differences between the treatment regimes in asthma control and exacerbations, lung function, and quality of life. Primary clinical endpoints are shown in Table 1:

View this table:



CONCLUSIONS: Cyclical administration of ICS with 3-day breaks is not less efficient than their daily use and may be offered to some patients with mild persistent asthma as an intermediate step to the withdrawal of controller medication if their disease is well controlled by regular treatment with ICS.
Phylogenetic diversity of human pathogenic Fusarium and emergence of uncommon virulent species
Authors: Husam Salah, Abdullah M.S. Al-Hatmi, Bart Theelen, Mohammed Abukamar, Samar Hashim, Anne D. van Diepeningen, Cornelia Lass-Florl, Teun Boekhout, Muna Almaslamani, Saad J. Taj-Aldeen
Journal: Journal of Infection (2015)
Has Mortality from Acute Respiratory Distress Syndrome Decreased over Time?
Authors: Jason Phua, Joan R. Badia, Neill K. J. Adhikari, Jan O. Friedrich, Robert A. Fowler, Jeff M. Singh, Damon C. Scales, David R. Stather, Amanda Li, Andrew Jones, David J. Gattas, David Hallett, George Tomlinson, Thomas E. Stewart, Niall D. Ferguson
Journal: American Journal of Respiratory and Critical Care Medicine (2008)

Rationale: It is commonly stated that mortality from acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) is decreasing.Objectives: To systematically review the literature assessing ARDS mortality over time and to determine patient- and study-level factors independently associated with mortality.Methods: We searched multiple databases (MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL) for prospective observational studies or randomized controlled trials (RCTs) published during the period 1984 to 2006 that enrolled 50 or more patients with ALI/ARDS and reported mortality. We pooled mortality estimates using random-effects meta-analysis and examined mortality trends before and after 1994 (when a consensus definition of ALI/ARDS was published) and factors associated with mortality using meta-regression models.Measurements and Main Results: Of 4,966 studies, 89 met inclusion criteria (53 observational, 36 RCTs). There was a total of 18,900 patients (mean age 51.6 years; 39% female). Overall pooled weighted mortality was 44.3% (95% confidence interval [CI], 41.8–46.9). Mortality decreased with time in observational studies conducted before 1994; no temporal associations with mortality were demonstrated in RCTs (any time) or observational studies (after 1994). Pooled mortality from 1994 to 2006 was 44.0% (95% CI, 40.1–47.5) for observational studies, and 36.2% (95% CI, 32.1–40.5) for RCTs. Meta-regression identified study type (observational versus RCT, odds ratio, 1.36; 95% CI, 1.08–1.73) and patient age (odds ratio per additional 10 yr, 1.27; 95% CI, 1.07–1.50) as the only factors associated with mortality.Conclusions: A decrease in ARDS mortality was only seen in observational studies from 1984 to 1993. Mortality did not decrease between 1994 (when a consensus definition was published) and 2006, and is lower in RCTs than observational studies.
Cardiovascular Risk in Patients with Treated Familial Hypercholesterolaemia and Patients with Severe Hypertriglyceridaemia
Authors: BPJ Way, M J Ball, M Thorogood, S M Cobbe, J I Mann
Journal: Journal of the Royal Society of Medicine (1986)

A study was performed to determine the morbidity and mortality from ischaemic heart disease (IHD) in patients with heterozygous familial hypercholesterolaemia (FH) and severe hypertriglyceridaemia (pretreatment plasma triglyceride &gt; 5 mmol/l). Twenty-nine (38%) of 76 patients with FH and 8 (44%) of 18 patients with hypertriglyceridaemia had evidence of IHD. Over a mean follow-up period of 5.5 years, 2 patients with hypertriglyceridaemia died but there were no deaths in patients with FH. This contrasts with earlier reports which showed a high mortality in FH patients. The lower mortality may be due to improved treatment and consequent lower levels of cholesterol.
Multisystemic and Multiresistant Langerhans Cell Histiocytosis: A Case Treated With BRAF Inhibitor
Authors: Letizia Gandolfi, Sarah Adamo, Alessandro Pileri, Alessandro Broccoli, Lisa Argnani, Pier Luigi Zinzani
Journal: Journal of the National Comprehensive Cancer Network (2015)

Langerhans cell histiocytosis (LCH) is a rare proliferative disease with a wide spectrum of clinical presentations and, as a consequence, the treatment choice is unclear. Recently, detection of the BRAF V600E mutation changed the perspective of this disease, suggesting a possible use for BRAF inhibitors in its treatment. Herein, a case is presented of a patient with LCH undergoing treatment with vemurafenib after several lines of therapy. After 4 months of vemurafenib treatment, skin lesions associated with cranial involvement were reduced in size at physical evaluation and nuclear imaging assessment showed a very good partial response, with the resolution of multiple lesions. Based on this very good partial response and because the patient tolerated treatment well, the patient was able to continue treatment with vemurafenib until disease progression nearly 10 months later. This approach should be considered for patients with severe and multiresistant LCH with a BRAF mutation. However, more studies are needed to evaluate the efficacy and duration of response in a larger patient population.
Are there any gender differences in presenting symptoms and outcomes in people treated for obstructive sleep apnoea syndrome
Authors: Lianne Griffin, Rachel Roberts, Lois Davies, Keir Lewis
Journal: European Respiratory Journal (2014)

INTRODUCTION:  We previously reported that females attending our sleep disordered breathing (SDB) clinic had higher Epworth scores despite milder physiological disease and those prescribed CPAP used it less than males. We update our findings with larger numbers and include only those with an eventual diagnosis of OSAHS, and after using more auto-titrating CPAP machines.  METHODS:  Subjects: 345 people from a UK SDB clinic with a positive diagnosis of OSAHS (excessive daytime sleepiness and an AHI / 4% Dip rate ≥15 events per hour) according to limited channel (Visilab, Embletta, Apnoea-Link) sleep studies, between 2011-2013.  Procedure: they were followed prospectively. CPAPs were issued to all as first line treatment. A good (early) CPAP-response was defined as someone with at least partial resolution in symptoms (e.g. Epworth score reduction by at least 4 points and falling to   RESULTS: The table compares males and females  CONCLUSION:  In those attenders eventually diagnosed with OSAHS, women had a higher BMI than men but there were no gender differences in Epworth scores, severity of OSAHs, response to or compliance with CPAP treatment.
CLL Is Associated with Development of Subclinical Cytomegalovirus Viraemia and Accumulation of Large Populations of “exhausted” CMV-Specific CD4+ T Cells
Authors: Helen M Parry, Natasha Cutmore, Nikhil Mirajkar, Annette Pachnio, Tina McSkeane, Miriam Ciaurriz, Duncan Baird, Chris Pepper, Mike Griffiths, Guy Pratt, Paul Moss
Journal: Blood (2014)
Localization and Concentration of Carcinoembryonic Antigen (CEA) in Gastrointestinal Tumors: Correlation With CEA Levels in Plasma&lt;xref ref-type="fn" rid="fn2"&gt;2&lt;/xref&gt;
Authors: C Wagener, R Müller-Wallraf, S Nisson, J Gröner, H Breuer
Journal: JNCI Journal of the National Cancer Institute (1981)

In 50 patients with gastrointestinal carcinomas, the following tumor parameters were studied: the concentration and localization of carcinoembryonic antigen (CEA) in tissue, extension, invasion, infiltration, differentiation, and necrosis. CEA concentrations were measured in plasma samples of all patients. In 7 patients with gastric carcinomas, CEA concentrations in tissue were low. Generally, only single cells or cell groups were CEA-positive. Elevated CEA levels in plasma resulted mainly from distant metastases and not from the primary tumor. In 43 colorectal carcinomas, CEA concentrations in tissue varied between 1.5 and 472 microgram/g tissue. They were closely related to the degree of accumulation of CEA-positive necrotic material in the degree of accumulation of CEA-positive necrotic material in the neoplastic glands. In 35 patients with colorectal carcinomas without CEA producing distant metastases, preoperative CEA levels in plasma were normal when tumor necrosis and perineural invasion were absent and CEA concentrations in tissue were low. CEA levels in plasma were regularly elevated when the tumor showed considerable necrosis in the presence of high CEA concentrations in tissue.
Chronic exposure to allergen and cigarette smoke induces predominantly features of COPD
Authors: Tania Maes, Katrien B. Moerloose, Chris L. Van Hove, Kurt G. Tournoy, Guy F. Joos
Journal: European Respiratory Journal (2011)

Rationale: Tobacco smoking by asthmatics correlates with disease severity and smoking is a risk factor for COPD. We previously demonstrated in a short-term mouse model that combining allergen with cigarette smoke exposure aggravated allergic airway inflammation. Here we investigated the effects of (very) long-term combined exposure to allergen and cigarette smoke.

Methods: Sensitized C57/Bl6 mice were exposed to ovalbumin (OVA) or saline (PBS) twice a week, combined with air or mainstream cigarette smoke (5 times/week) for 6 months. Bronchoalveolar lavage fluid (BAL) and lung samples were processed for immunological and histological examination.

Results: Six months exposure to OVA/air, PBS/smoke or OVA/smoke induced a pulmonary inflammation with increased macrophages, dendritic cells, lymphocytes and MIP-3α in BAL compared to PBS/air exposure. OVA and/or smoke exposure induced airway wall remodeling (goblet cells, collagen deposition) and lymphoid neogenesis.

Mice exposed to OVA/air had airway eosinophilia, which was absent or strongly reduced in the PBS/smoke and OVA/smoke groups. OVA-IgE was elevated in both OVA/air and OVA/smoke mice, although more pronounced in the former.

In contrast, PBS/smoke and OVA/smoke exposure, but not OVA/air exposure induced a marked neutrophilic inflammation (314±91×103and 208±36×103 versus 7±2×103 cells in BAL, respectively; p<0.05). This neutrophilia was paralleled by increased levels of KC. Both smoke-exposed groups also had emphysema.

Conclusion: Chronic exposure to aeroallergens in the presence of cigarette smoke results in a pathology with predominantly features of COPD, albeit limited characteristics of allergy remain present.

Funding: Belgian IAP - P6/35.
Efficacy and safety of biologics in erythrodermic psoriasis: a multicentre, retrospective study
Authors: M. Viguier, C. Pagès, F. Aubin, E. Delaporte, V. Descamps, C. Lok, M. Beylot-Barry, J. Séneschal, L. Dubertret, J.-J. Morand, B. Dréno, H. Bachelez
Journal: British Journal of Dermatology (2012)

Background Even though efficacy of biologics has been extensively studied in psoriasis vulgaris, studies in erythrodermic psoriasis, the most severe form of the disease, have been scarcely reported. Objectives To address the efficacy and safety of biologics in patients with erythrodermic psoriasis. Methods A multicentre national retrospective study was performed using the French Psoriasis Group network. Patients showing psoriasis involving at least 90% of body surface area (BSA), and in whom severity of the disease had been evaluated before and after 3 and/or 6 months of treatment with biologics, were enrolled in the study. Results were expressed using intention‐to‐treat analysis. Results We included 28 patients, representing 42 flares of erythrodermic psoriasis treated with infliximab (n =24), adalimumab (n =7), etanercept (n =6), ustekinumab (n =3) or efalizumab (n =2). A 75% improvement of BSA or Psoriais Area and Severity Index 12–14 weeks after treatment onset was reached in 48% of flares treated with infliximab, in 50% of those treated with adalimumab and in 40% of those treated with etanercept. Twelve serious adverse events, consisting of bacterial infection in seven of them, were observed. Biological treatment was discontinued for safety concern in 19% of cases. A given biologic was administered for up to 48 weeks in 34% of flares. Conclusions Biologics show overall good short‐term efficacy, but treatment switch due to lack of efficacy or side‐effects is frequently observed on a longer term, with only one‐third of patients still receiving the same drug after 1 year. The most significant safety concern consists of severe infections.