tbuckley/cabot-search huggingface dataset:
Impaired elimination of metronidazole in decompensated chronic liver disease.
Authors: G Farrell, L Zaluzny, J Baird-Lambert, M Cvejic, N Buchanan
Journal: BMJ (1983)

Impaired elimination of metronidazole in decompensated chronic liver diseaseMetronidazole is given to patients with liver disease because of its efficacy against anaerobic organisms.'Although relatively safe, it can cause uncomfortable gastrointestinal and neurological symptoms that may be related to prolonged high blood concentrations of the drug.'Cirrhotic livers have an impaired drug metabolising capacity,2 but two recent studies of elimination of metronidazole in liver disease have produced conflicting results.3We studied the disappearance of metronidazole from plasma in 10 patients with decompensated chronic liver disease and compared the results with those in nine healthy subjects.
Points: Acute renal failure in pregnancy secondary to idiopathic hydronephrosis
Authors: A S David
Journal: BMJ (1985)

reiterated my comment' on the treatment of cysticercosis with metriphonate and by means of radioimmunotherapy.Some other advances should be mentioned.In addition to praziquantel2-4 the anthelmninthic flubendazole has recently been used in the management of neurocysticercosis, with apparent success.5 Injection of quinine sulphate in distilled water into subcutaneous cysticerci has also been reported to destroy the bladderworms, thus obviating the need for their surgical excision.6
In Defense of the CPC
Authors: Robert E. Scully
Journal: New England Journal of Medicine (1979)

Dr. Lipkin has properly emphasized the importance of a physician's continuous focus on the psychologic, social, and economic factors involved in human disease. No one can argue with that viewpoint. However, his additional conclusion that CPC's are anachronistic and should be replaced by retrospective analyses highlighting the humanistic aspects of disease deserves closer scrutiny. From the purview of the editor of the Case Records of the Massachusetts General Hospital, I should like to present the opinion of our editorial staff on the educational role of the CPC, comment on practical problems raised by Dr. Lipkin's proposal, and attempt the difficult . . .
Pop-Top Finger
Authors: RONALD J. RAPOPORT
Journal: Annals of Internal Medicine (1979)

Letters and Corrections1 March 1979Pop-Top FingerRONALD J. RAPOPORT, M.D.RONALD J. RAPOPORT, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-90-3-441_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: A 30-year-old rheumatology fellow developed severe joint tenderness and ecchymotic lesion over the flexor surface of the right second distal interphalangeal joint. The lesion appeared abruptly, about 20 minutes before evaluation. He denied constitutional symptoms except fatigue; findings in a limited physical examination were normal except for facial hirsutism and (male pattern) alopecia.The patient adamantly refused biopsy but consented to be photographed (see Figure 1). After extensive evaluation over the next 30 minutes, a specific cause could not be found. Immune complexes, however, were not sought.A short time later, over a can of beer, the... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: RONALD J. RAPOPORT, M.D.Affiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPercutaneous renal embolisation in renovascular hypertensionLetterbox finger 1 March 1979Volume 90, Issue 3Page: 441-441KeywordsBeerBiopsyFatigueImmune complexLesionsRheumatology ePublished: 1 December 2008 Issue Published: 1 March 1979 PDF downloadLoading ...
The Infectious Diseases Manual
Authors: D. W Denning
Journal: BMJ (1996)

David Wilks, Mark Farrington, David Rubenstein Blackwell Science, £16.95, pp 347 ISBN 0 86542 844 1

It is increasingly difficult to write a concise text about human infection. Although all the old infectious diseases remain, except for smallpox, dozens of new pathogens and infectious disease syndromes have appeared in the past two decades. So getting the balance right in a short book is problematic.

In many places, the authors of The Infectious Diseases Manual have it exactly right—the chapters on eye infections and HIV and AIDS being strikingly good examples. In others, a disproportionate amount of space is devoted to rarities. Haemophilus ducreyi and chancroid get as much space as scabies …
Exome sequencing identifies MVK mutations in disseminated superficial actinic porokeratosis
Authors: Sheng-Quan Zhang, Tao Jiang, Min Li, Xin Zhang, Yun-Qing Ren, Sheng-Cai Wei, Liang-Dan Sun, Hui Cheng, Yang Li, Xian-Yong Yin, Zheng-Mao Hu, Zhen-Ying Wang, Yuan Liu, Bi-Rong Guo, Hua-Yang Tang, Xian-Fa Tang, Yan-Tao Ding, Jian-Bo Wang, Ping Li, Bao-Yu Wu, Wen Wang, Xiang-Feng Yuan, Jun-Sheng Hou, Wei-Wei Ha, Wen-Ju Wang, Yu-Juan Zhai, Jing Wang, Fang-Fang Qian, Fu-Sheng Zhou, Gang Chen, Xian-Bo Zuo, Xiao-Dong Zheng, Yu-Jun Sheng, Jin-Ping Gao, Bo Liang, Pan Li, Jun Zhu, Feng-Li Xiao, Pei-Guang Wang, Yong Cui, Hui Li, Sheng-Xiu Liu, Min Gao, Xing Fan, Song-Ke Shen, Ming Zeng, Guang-Qing Sun, Yu Xu, Jing-Chu Hu, Ting-Ting He, Ying-Rui Li, Huan-Ming Yang, Jian Wang, Zhong-Yi Yu, Hui-Feng Zhang, Xin Hu, Ke Yang, Jie Wang, Shi-Xiang Zhao, You-Wen Zhou, Jian-Jun Liu, Wei-Dong Du, Li Zhang, Kun Xia, Sen Yang, Jun Wang, Xue-Jun Zhang
Journal: Nature Genetics (2012)
On the Subject of Quality
Authors: George D. Zuidema, Jerome J. DeCosse
Journal: New England Journal of Medicine (1972)

The Carnegie Commission Report has been hailed as a blueprint for improvements in medical and dental education in the United States.1 The Report advocates 4500 more physicians by 1976 to improve health-care delivery and meet health manpower needs. The additional physicians will result from augmentation in class size and reduction in the duration of medical-school and postgraduate education. Meeting the health needs of this nation by the simple expedient of producing additional physicians, however, has certain inherent fallacies. It is of interest that at the time of the Flexner report, the United States had more physicians per capita than at . . .
1137-101 Elevated parathyroid hormone is an important predictor of coronary events in patients with chronic hemodialysis
Authors: Takashi Kubo, Takuzo Hano, Masahiro Obana, Toshio Imanishi, Akira Baba, Kazushi Tsuda, Yoshiaki Tomobuchi, Mikio Arita, Ichiro Nishio
Journal: Journal of the American College of Cardiology (2004)
CASE OF FRACTURE OF THE CRANIUM IN AN INFANT AT BIRTH
Authors: J. G. Swayne
Journal: BMJ (1853)

OXOIA O"NN1A[O pAM4.Ina famer part of this paper it was stated that during the previous twenty years, as compared with the last ten years, at Gibraltar, infammatory nctions were more prevalent, and at Malta they were one-third more in num- and yet, at both stations, the amount of consumption was almost identical throughout the two periods.That the fact of this total want of relation may be clearly seen, I have constructed Tables xvi andxvii.Thus, in Bermuda, where there were only 23 cases of pneumonia, there were 100 cases of phthisis, and in Nova Scotia where there were nearly fifteen times as many cases of pneumonia, there were only 150 cases of phthisis.In Canada, with 1.589 cases of pneumonia, there were only 524 cases of phthisis, whereas, in the foot guards at home, with only 497 cases of pneumonia, there were 654 of phthisis.Again, in the naval force, 2,598 cases of pneumonia corre- spond with 437 cases of phthisis, while in the military force, 2,281 cases of pneumonia correspond with 629 of phthisis. TABLE XVII.The number of cases of "acute and chronic catarrlh", with the proportion of deaths and recoveries, and thte number of admissions into hospital for phthisis, among the troops, in the UnitedlKingdom, the Jlediterranean, awed British America, and in the aggregates of the naval and militaryforces serving in the Jfediterranean.Cat.arrh.Died.Recovered.lhthisis.
A piece of my mind. A dream
Authors: H. K. Haefner
Journal: JAMA (1991)

11:55PM Shhh. Little Diane dreams. Her red hair curls softly across the pillow and strays over her calm, pale face. She is running. Where are you going, Diane? She advances awkwardly, as her legs, too long for her body, become entangled, tripping her as she reaches for the aluminum door. Slender fingers wrap themselves around the smooth handle. They whiten, trapping the blood at the tips, as she strains to open the door. One small branch of light breaks through, widening as she opens it farther. She squints at the brightness of the room. What do you see, Diane? Her face tenses. Large men, their backs to the child, seem barely to speak. Their bodies, uniformly clad in hospital green, bend over a sterile table. They leave silently, some together, others alone. They do not notice Diane trembling in the corner. With an expression of terror, she approaches the table.
Financial ties and concordance between results and conclusions in meta-analyses: retrospective cohort study
Authors: Veronica Yank, Drummond Rennie, Lisa A Bero
Journal: BMJ (2007)

<b>Objective</b> To determine whether financial ties to one drug company are associated with favourable results or conclusions in meta-analyses on antihypertensive drugs. <b>Design</b> Retrospective cohort study. <b>Setting</b> Meta-analyses published up to December 2004 that were not duplicates and evaluated the effects of antihypertensive drugs compared with any comparator on clinical end points in adults. Financial ties were categorised as one drug company compared with all others. <b>Main outcome measures</b> The main outcomes were the results and conclusions of meta-analyses, with both outcomes separately categorised as being favourable or not favourable towards the study drug. We also collected data on characteristics of meta-analyses that the literature suggested might be associated with favourable results or conclusions. <b>Results</b> 124 meta-analyses were included in the study, 49 (40%) of which had financial ties to one drug company. On univariate logistic regression analyses, meta-analyses of better methodological quality were more likely to have favourable results (odds ratio 1.16, 95% confidence interval 1.07 to 1.27). Although financial ties to one drug company were not associated with favourable results, such ties constituted the only characteristic significantly associated with favourable conclusions (4.09, 1.30 to 12.83). When controlling for other characteristics of meta-analyses in multiple logistic regression analyses, meta-analyses that had financial ties to one drug company remained more likely to report favourable conclusions (5.11, 1.54 to 16.92). <b>Conclusion</b> Meta-analyses on antihypertensive drugs and with financial ties to one drug company are not associated with favourable results but are associated with favourable conclusions.
Diagnostic evaluation of grass‐ and birch‐allergic patients with oral allergy syndrome
Authors: C. Anhoej, V. Backer, H. Nolte
Journal: Allergy (2001)

Background: Patients with birch and grass allergy often suffer from oral allergy symptoms when ingesting cross‐reacting fresh fruits and vegetables. However, fruit and vegetable allergen extracts are often readily degradable or contain clinically irrelevant cross‐reacting epitopes, resulting in diagnostic discrepancies when fruit and vegetable allergic reactions are evaluated. The risk of using nonstandardized fresh food extracts for skin testing may also be of concern. The objective was to compare and evaluate the clinical utility of selected recombinant grass and birch cross‐reacting food allergens with fresh and commercial melon, hazelnut, and apple extracts. Methods: Thirty‐six grass‐ and or birch‐allergic patients and 17 control subjects consented to participate in the study. All subjects were skin prick tested and had basophil histamine‐release tests done with fresh fruits and various extracts of hazelnut, apple, and melon. The diagnosis of oral allergy syndrome was confirmed by oral challenges. In addition, histamine release to recombinant Bet v 1 and Bet v 2, and recombinant Phl p 1 and Phl p 2, Phl p 5 was performed. Results: The skin prick test with fresh hazelnut, apple, and melon showed sensitivities of 0.97, 0.92, and 0.89, respectively. The corresponding specificities were 0.78, 0.72, and 0.82, respectively. In contrast, the histamine‐release test with hazelnut, apple, and melon gave sensitivities of 0.87, 0.71, and 1.00, respectively. The corresponding specificities were 0.65, 0.93, and 0.43. The skin prick test showed excellent negative predictive value (&gt;90%). No added value of recombinant allergen testing was noted. Oral challenge did not result in severe systemic reactions, and no systemic reactions were observed with skin prick tests with fresh fruits. Conclusions: The skin prick test showed an almost optimal diagnostic value with a satisfactory sensitivity (&gt;89%) and excellent negative predictive value with fresh fruits. When the skin prick test with fresh nut and apple cannot be performed, histamine release is a diagnostic alternative. Histamine release with melon showed lack of specificity. This was probably due to extensive IgE cross‐reactivity with pollen, since these patients also responded to recombinant Phl p 1 and Bet v 1. Skin testing and challenges with fresh fruits were safe.
The Changing Picture of Pneumonia and Empyema in Infants and Children
Authors: Mark M. Ravitch
Journal: JAMA (1961)

Data from an institution for children for the period 1934 to 1958 have been examined for evidence of changes in the course of pneumonias. During this time there were 10,632 cases of pneumonia and 214 of empyema. The hospitalization rate for pneumonia dropped from 49 to 18%. The incidence of empyema in the hospitalized patients dropped from 10 to 2% but returned to 14% with the rise of staphylococcal infections. There have not been any cases of empyema due toHemophilus influenzaesince 1944 nor any due to streptococci since 1948; there have been only 5 cases due to pneumococci since 1947. In the period 1955-1958 there were 35 cases due to staphylococci. The sharp rise in the incidence of empyema due to staphylococci has been largely confined to infants.
Acute Yellow Atrophy of the Liver, Abortion, and Post Mortem Examination of Mother and F tus
Authors: A. Ogston
Journal: BMJ (1873)

THE BRITISH MEDICAL 7OURNAL.57 use of the remedies last mentioned, he soon got quite well, and, I be- lieve, remains so.It will be seen from the remarks which have been made that I have employed the blister-treatment both as a means of cure, as ordinarily understood, and of relief.In many of the two former classes of cases it may be regarded as essentially curative, though the cure may be assisted by the employment of constitutional remedies.In the latter cases it can only be considered alleviative, and as an adjuvant, though a very important one, to the cure by constitutional means.
THE CONJUGATED, NON-PROTEIN, AMINO ACIDS OF PLASMA. V. A STUDY OF THE CLINICAL SIGNIFICANCE OF PEPTIDEMIA
Authors: Halvor N. Christensen, David G. Decker, Eleanor L. Lynch, Thayer M. Mackenzie, John H. Powers
Journal: Journal of Clinical Investigation (1947)

Peptidemia is a recurring concept of pathological chemistry which never has been either completely established or disproved.In a literature of about 100 papers only a few studies have been based upon methods which characterized the component measured as amino acids in conjugated forms.
Resurrecting Treatment Histories of Dead Patients
Authors: Peter B. Bach, Deborah Schrag, Colin B. Begg
Journal: JAMA (2004)

In this article we address whether studies of care rendered to patients prior to their death (“studies of decedents”) produce an accurate portrait of care provided to patients who are dying. Studies of decedents typically analyze the care provided to patients over a defined interval antecedent to death. Studies of dying patients analyze care provided to patients subsequent to the time that their terminal status is perceived. We address whether 2 fundamental differences between studies of decedents and studies of the dying—the ways that subjects are identified and the time periods that are examined—lead to differences in interpretation of study results. Using examples from population-based cohorts of individuals with cancer, we show that both the differences in subject selection and time period introduce very substantial biases into studies of decedents. We conclude that studying care received prior to death can lead to invalid conclusions about the quality or type of care provided to dying patients.
Practice Habits in a Group of Eight Internists
Authors: CARL B. LYLE
Journal: Annals of Internal Medicine (1976)

A method was devised to offer a group of internists a system by which to analyze their practices, allowing them to identify areas where a change in practice habits might be beneficial. More than 3000 encounters between patients and internists in an eight-man group were analyzed for a number of variables. Significant differences existed between physicians as to the percentage of encounters that were physician-initiated rather than patient-initiated. Disposition of the encounters also varied significantly. The effect that the recycling of patients has on productivity, cost, and use of hospital facilities is discussed. In addition to geographic and specialty maldistribution, the maldistribution of physician time is a significant barrier to meeting the demands for medical care.
North Korea's healthcare system is in dire straits, says Amnesty report
Authors: J. Zarocostas
Journal: BMJ (2010)

North Korea’s state healthcare system is in a crisis, with hospitals and clinics lacking essential drugs and supplies and doctors forced to reuse hypodermic needles and to carry out operations, including amputations, without anaesthesia, says a report by Amnesty International.

Many facilities are run down and often have power cuts and no heat. At night staff members sometimes have to work by candlelight, says the report.

Because of the shortages health workers “recycled medical supplies until worn, sometimes with little regard to hygiene and safety,” it says. The report draws on interviews with more than 40 North Koreans who left the country and with aid organisations and health …
Survival in HIV-Infected Patients Who Have Received Zidovudine: Comparison of Combination Therapy with Sequential Monotherapy and Continued Zidovudine Monotherapy
Authors: Neil M.H. Graham
Journal: Annals of Internal Medicine (1996)

Background: Among patients who begin receiving zidovudine during intermediate-stage human immunodeficiency virus (HIV) infection, it is unclear whether changing to combination therapy (adding didanosine or zalcitabine) or sequential monotherapy (changing to didanosine or zalcitabine) significantly improves survival. Objective: To determine, among patients who began receiving zidovudine during intermediate-stage HIV infection, the differential effects of changing to combination therapy (zidovudine with didanosine or zalcitabine) or sequential monotherapy (with didanosine or zalcitabine) or continuing zidovudine monotherapy. Patients: 1077 HIV-seropositive men in the Multicenter AIDS (acquired immunodeficiency syndrome) Cohort Study who began receiving zidovudine before an AIDS-defining illness developed. Setting: University-affiliated clinics in Baltimore, Chicago, Los Angeles, and Pittsburgh. Design: Longitudinal cohort study. Treatment groups and important prognostic variables were modeled as time-dependent covariates in Cox proportional-hazards models. Measurements: Progression to AIDS and death. Results: Compared with patients receiving continued zidovudine monotherapy, patients receiving combination therapy had a 45% improvement in survival (relative risk, 0.55 [95% CI, 0.41 to 0.74; P < 0.001]) and patients who changed to sequential monotherapy had a 32% improvement in survival (relative risk, 0.68 [CI, 0.52 to 0.89; P = 0.005]). In the landmark analyses, the median prolongation of survival associated with changing therapy was, at best, 3 to 6 months. Survival curves converged at 3.5 years for the 50 cells/mm3 disease-stage landmark, at 4.4 years for the 100 cells/mm3 landmark, and at 4.9 years for the 150 cells/mm3 landmark. Mortality within these periods was 100%, regardless of treatment group or landmark. Conclusions: For patients who began receiving zidovudine during intermediate-stage disease, changing to either combination therapy or sequential monotherapy was associated with a statistically significant survival benefit compared with continuation of zidovudine monotherapy. The absolute increase in survival was modest, however, and long-term survival remained poor. Simultaneous time-dependent adjustment for changes in therapy and in important prognostic variables is necessary to derive relatively unbiased estimates of treatment effects in observational studies of HIV infection.
Asymmetric substitution patterns in the two DNA strands of bacteria
Authors: J. R. Lobry
Journal: Molecular Biology and Evolution (1996)

Analyses of the genomes of three prokaryotes, Escherichia coli, Bacillus subtilis, and Haemophilus influenzae, revealed a new type of genomic compartmentalization of base frequencies. There was a departure from intrastrand equifrequency between A and T or between C and G, showing that the substitution patterns of the two strands of DNA were asymmetric. The positions of the boundaries between these compartments were found to coincide with the origin and terminus of chromosome replication, and there were more A-T and C-G deviations in intergenic regions and third codon positions, suggesting that a mutational bias was responsible for this asymmetry. The strand asymmetry was found to be due to a difference in base compositions of transcripts in the leading and lagging strands. This difference is sufficient to affect codon usage, but it is small compared to the effects of gene expressivity and amino-acid composition.
Incidence of Major Amputation for Diabetes in Scotland Sets a Target for Us All
Authors: William J. Jeffcoate, David J. Margolis
Journal: Diabetes Care (2012)

In this issue, Kennon et al. (1) report the incidence of amputation in diabetes across Scotland. Their findings are expressed both in terms of the total population (which is primarily a measure of national disease burden and much influenced by the changing prevalence of diagnosed diabetes) and the population with diabetes: the “at risk” population. The advantage of expressing amputation in terms of those at risk is that the results can be used as an indication of the quality of disease management, even though the data require careful interpretation (2). Unfortunately, it is not possible to calculate incidence in the population at risk without reliable information on the prevalence of diabetes in the community or country being studied, and such information is rarely available. The study by Kennon et al. (1) is, therefore, a tribute to those who created the Scottish Care Information–Diabetes Collaboration (SCI-DC) (3). However, if a reliable national database of diabetes does not exist, other—potentially less reliable—approaches must be used, including 1 ) hospital discharge coding, which has traditionally been flawed by underrecording of diabetes but is improving with increased awareness of the contribution made by diabetes to the disease burden of all nations, and 2 ) the study of particular communities, with populations selected by health care provider or insurance/reimbursement scheme (Medicare, Veterans Health Administration [VHA], etc.) or by locality (4–7). By use of the SCI-DC database, Kennon et al. (1) report that the incidence of major amputation in people with known …