tbuckley/cabot-search huggingface dataset:
Class of Antiretroviral Drugs and the Risk of Myocardial Infarction
Authors: Nina Friis-Møller, Peter Reiss, Caroline A Sabin, Rainer Weber, Antonella d'Arminio Monforte, Wafaa El-Sadr, Rodolphe Thiébaut, Stephane De Wit, Ole Kirk, Eric Fontas, Matthew G Law, Andrew Phillips, Jens D Lundgren
Journal: New England Journal of Medicine (2007)

We have previously demonstrated an association between combination antiretroviral therapy and the risk of myocardial infarction. It is not clear whether this association differs according to the class of antiretroviral drugs. We conducted a study to investigate the association of cumulative exposure to protease inhibitors and nonnucleoside reverse-transcriptase inhibitors with the risk of myocardial infarction.
Symptoms for anxiety and depression in COPD patients
Authors: Ricardo Coelho, Ana Sofia Santos, Dionísio Maia, Raquel Rosa, Vânia Caldeira, Tiago Sá, Luísa Semedo, João Cardoso
Journal: European Respiratory Journal (2014)

Background: Depression and anxiety are major contributors for the impact of COPD on patient's health status.

Aim: Evaluate the relation between the symptomatic components of COPD and the presence of anxiety/depression.

Methods: 100 consecutive COPD patients (pts) were assessed using the Modified Medical Research Council Dyspnea Scale (mMRC) and the COPD Assessment Test (CAT). Pts were stratified according to GOLD guidelines (using mMRC). The presence of anxiety/depression was evaluated through the Hospital Anxiety and Depression Scale.

Results: The mean age was 65±9 years, 85% were male; 13 pts had spirometric stage 1, 31 had stage 2, 35 had stage 3 and 21 had stage 4; 16 pts were A, 21 were B, 14 were C and 49 were D.

Thirty-one pts had anxiety and 45 had depression. Almost of all anxiety and depression pts had mMRC≥2 and CAT≥10 (29/31 and 44/45 respectively). The relation between anxiety/depression and mMRC and CAT (all sub-items) is shown in the table (for all the results p<0,05):

View this table:



Conclusion: The presence of anxiety and depression is associated with more severe dyspnea scores (mMRC, CAT). With CAT, others factors can be related to these comorbidities, with particular emphasis on the energy level, the ability to perform activities at home and the level of confidence to leave it.
Munchausen's Syndrome with Concurrent Neurological and Psychiatric Presentations
Authors: Patrick Kwan, Sean Lynch, Alison Davy
Journal: Journal of the Royal Society of Medicine (1997)

Munchausen's syndrome is a particular type of factitious disorder applied to individuals who repeatedly gain hospital admission or medical attention by simulating illnesses with dramatic but untruthful complaints. It was first described by Asherl who dedicated the syndrome to Baron Karl Friedrich Hieronymus Von Munchhausen (1720-1797) because of the resemblance of the wanderings and fabrications of these patients to the travels and fantastic stories attributed to the Baron. Asher described somatic complaints and grouped them into acute abdominal, haemorrhagic, and neurological types. More somatic varieties have since been reported2. Subsequently, psychological presentations have also been described, but most of the medical literature has focused on factitious disorders with physical symptoms. Psychological presentations include claims of auditory hallucinations, depression, hysteria, bizarre behaviour3'4, and post-traumatic stress disorder3. The American Psychiatric Association6 also refers to presentations with memory loss, dissociative symptoms and suicidal ideation. Not uncommonly, patients simulate more than one system, concurrently or successively3. Munchausen's syndrome is generally regarded as irremediable. There is great difficulty in both engaging and keeping these patients in psychological treatment. This is partly because of the difficulty in recognizing the patients, who often use fictitious identities. By the time a physician determines that they need psychiatric care they may have left the hospital. These patients also tend to avoid psychiatric attention, possibly because they equate it with being 'found out'. Once engaged in psychological treatment, their tendency to wander makes them uncooperative in follow up. Thus, Carney and Brown3 inferred that the 'wanderers' have a poorer prognosis than the 'non-wanderers'. Only one successful treatment by means of a structured dynamic behaviour modification programme lasting 3 years, has been found in the literature, although the patient was only followed up for 2 years after discharge7. We report here a patient presenting with neurological and psychiatric complaints concurrently, and discuss how we reached the diagnosis and attempted to engage him in psychiatric treatment.
Oral Topotecan as Single-Agent Second-Line Chemotherapy in Patients With Advanced Ovarian Cancer
Authors: D. L. Clarke-Pearson, L. Van Le, T. Iveson, C. W. Whitney, P. Hanjani, G. Kristensen, J. H. Malfetano, R. A. Beckman, G. A. Ross, S. R. Lane, Mark H. DeWitte, S. Z. Fields
Journal: Journal of Clinical Oncology (2001)

To evaluate oral topotecan as single-agent, second-line therapy in patients with ovarian cancer previously treated with a platinum-based regimen.Patients (N = 116) received oral topotecan 2.3 mg/m2 daily for 5 days every 21 days. Eligibility criteria included histologic diagnosis of International Federation of Gynecology and Obstetrics stage III or IV epithelial ovarian cancer, bidimensionally measurable disease, prior platinum-containing chemotherapy, age > or = 18 years, performance status < or = 2, and life expectancy > or = 12 weeks.Overall response rate was 21.6% (25 of 116 patients). Median duration of response was 25.0 weeks; median time to response was 8.4 weeks. Median time to progression was 14.1 weeks; median survival was 62.2 weeks. Grade 4 neutropenia was experienced by 50.4% of patients in 13.4% of courses administered. Grade 4 thrombocytopenia was experienced by 22.1% of patients in 5.1% of courses. Grade 3 or 4 anemia was experienced by 29.2% of patients in 8.5% of courses. Most frequent nonhematologic toxicities were predominantly (> 90%) grade 1 or 2 and included nausea, alopecia, diarrhea, and vomiting.Second-line oral topotecan administered at 2.3 mg/m2 for 5 days every 21 days demonstrated activity in patients with progressive or recurrent ovarian cancer after first-line platinum-based chemotherapy. This activity was comparable to that seen in previous studies with intravenous topotecan. Grade 4 neutropenia was less frequent with oral topotecan than previously reported for intravenous topotecan. Oral topotecan is an active, tolerable, and convenient formulation of an established agent for the second-line treatment of advanced epithelial ovarian cancer and may also facilitate exploring prolonged treatment schedules.
Impairment of Lung and Chest Wall Mechanics in Patients with Acute Respiratory Distress Syndrome
Authors: V. MARCO RANIERI, NICOLA BRIENZA, SERGIO SANTOSTASI, FILOMENA PUNTILLO, LUCIANA MASCIA, NICOLA VITALE, ROCCO GIULIANI, VINCENZO MEMEO, FRANCESCO BRUNO, TOMMASO FIORE, ANTONIO BRIENZA, ARTHUR S. SLUTSKY
Journal: American Journal of Respiratory and Critical Care Medicine (1997)

Recent data have suggested that the elastic properties of the chest wall (CW) may be compromised in patients with ARDS because of abdominal distension (4). We partitioned CW and lung (L) mechanics, assessed the role of abdominal distension, and verified whether the underlying disease responsible for ARDS affects the impairment of respiratory mechanics. Volume-pressure (V-P) curves (interrupter technique) were assessed in nine patients with surgical ARDS and nine patients with medical ARDS. Relative to nine patients undergoing heart surgery, V-P curves of the respiratory system (rs) and L of patients with surgical or medical ARDS showed a rightward displacement. V-P curves of the CW and the L showed an upward concavity in patients with medical ARDS and a downward concavity in patients with surgical ARDS. Although the CW and the abdomen (abd) V-P curves in patients with medical ARDS were similar to those obtained in patients undergoing heart surgery, they showed a rightward shift and a downward flattening in patients with surgical ARDS. In five of these patients, a reduction in static end-inspiratory pressure of the abd (69 ± 4%), rs (30 ± 3%), CW (41 ± 2%), and L (27 ± 3%) was observed after abdominal decompression for acute bleeding. Abdominal decompression therefore caused an upward and leftward shift of the V-P curves of the respiratory system, chest wall, lung, and abdomen. In conclusion we showed that impairment of the elastic properties of the respiratory system may vary with the underlying disease responsible for ARDS. The flattening of the V-P curve at high pressures observed in some patients with ARDS may be due to an increase in chest wall elastance related to abdominal distension. These observations have implications for the assessment and ventilatory management of patients with ARDS.
The Tridimensional Personality Questionnaire in major depression
Authors: R T Joffe, R M Bagby, A J Levitt, J J Regan, J D Parker
Journal: American Journal of Psychiatry (1993)

The authors examined Tridimensional Personality Questionnaire scores in 40 patients with unipolar nonpsychotic major depression before and after antidepressant treatment. They found that scores on the novelty seeking and reward dependence dimensions were not affected by depressed state or by treatment response status. However, scores on the harm avoidance dimension were significantly lower in antidepressant responders and were altered by depressed state.
Penetrating Ocular Fish-hook Injuries
Authors: Lloyd Paul Aiello, Mami Iwamoto, David R. Guyer
Journal: Ophthalmology (1992)

Ocular penetrating fish-hook injuries represent a rare yet potentially devastating ocular trauma. To date, only five cases have been reported in the medical literature. The authors present five new cases with long-term follow-up.All individuals who presented to the Wilmer Ophthalmological Institute emergency room with ocular fish-hook injuries between 1974 and 1990 were identified, and ophthalmic follow-up evaluations were performed.Individuals were male, between the ages of 10 and 27, with follow-up evaluation of 2.0 to 15.5 years (mean, 6.7 years). The left eye was involved in 80% and in no instance had a single hook penetrated the lid and globe simultaneously. Initial visual acuity was uniformly poor (20/200 or worse). Using specialized surgical techniques, ultimate visual outcome was excellent in 80% of cases (4 of 5 with visual acuity of 20/30 or better). One eye was enucleated because of panendophthalmitis after delayed wound closure. Similar overall results are achieved when previous reports are included in the analysis (90% with visual acuity of 20/40 or better).These results suggest that penetrating ocular fish-hook injuries may have an excellent long-term prognosis if prompt, appropriate surgical intervention is accomplished.
LSC 2013 abstract - Simulated bronchoalveolar lavage: Oral bacterial contamination of the bronchoscope affects lavage results
Authors: Rune Nielsen, Tomas Mikal Lind Eagan, Per Bakke, Marianne Aanerud, Nils Anders Leversen, Harald Wiker
Journal: European Respiratory Journal (2013)

We aimed to examine whether gargling an alcohol-containing mouth-wash and/or flushing the working channel of the bronchoscope after passing the pharynx could reduce oral bacteria contamination of lavage fluid.  20 volunteers provided oral rinse saliva before the procedure. After anesthesizing with lidocaine, the bronchoscope was advanced through the mouth until the vocal folds were visualized. The bronchoscope was retracted and a simulated lavage (SL) was performed with installation of 20 ml of 0.9% saline water into a tube, of which 10 ml was sucked into a lavage trap. The procedure was repeated immediately after gargling with antiseptic mouthwash. For 10 subjects we flushed the bronchoscope with 10 ml of 0.9% saline water that was discarded before the repeat SL. The samples were serial diluted, 100 µl of each dilution was cultured on fastidious anaerobic agar at 37°C for 48 hrs, and the total number of colony forming units (CFU) per ml was recorded.  The bacterial load in saliva decreased almost by a factor of ten when rinsing the mouth with an antiseptic (paired t-test, p  When performing bronchoalveolar lavage, the bronchoscope will be contaminated by bacteria passing the oral cavity. Antiseptic mouthwash does not reduce this contamination, but flushing the bronchoscope into a more distal segment before performing lavage might decrease it.
Evaluation of methylation and expression of FHIT (fragile histidine triad) gene in Indian female breast cancer patients.
Authors: Mohammad Raish, Arif Ahmad, Pawan Gupta, Syed Akhtar Husain
Journal: Clinical Cancer Research (2006)

A92  Fragile Histidine Triad (FHIT) gene, encompassing the FRA3B fragile site at chromosome 3p14.2 is a candidate tumor suppressor gene .The genomic region spanning exon 3-4 including the fragile site FRA3B on chromosome band 3p14.2..The present study was conducted on n= 115 breast cancer patients using Methylation specific PCR (MSP), Northern blotting coupled with immunohistochemistry. Out of n=115 patients, 45 patients (39%) portrayed 59CpG island Methylation of FHIT gene in MSP. Also, FHIT expression was figured out at transcription level as well as translation level using northern blotting and immunohistochemistry respectively. At transcriptional level (northern blotting), 9 patients (7.8 %) showed absence of FHIT gene transcript and 36 individuals (31.3%) showed less or very low expression. Immunostaning for fhit expression was also performed in 115 patients. Low and very low fhit expression was obtained in 27 patients (23.47 %) and 22 (19.13%) patients showed nil expression of FHIT while rest 66(57.39%) samples showed normal expression of FHIT in breast cancer samples.A significant correlation was found between the mRNA expression and clinical staging (P=0.03) and with histological grading (P=0.04) of breast cancer patients.Aberrant methylation of the 59CpG island of the FHIT gene is strongly associated with gene silencing as indicated by Northern blot, and immunostaining analysis. Therefore, the present studies deduce that epigenetic changes may play an vital role in the process of tumorigenesis.
One year follow-up after a program of physical activity promotion in smokers: Preliminary results
Authors: Leandro Cruz Mantoani, Karina Couto Furlanetto, Juliana Zabatiero, Demétria Kovelis, Mahara Proença, Andrea Morita, Jully Felici, Fabio Pitta
Journal: European Respiratory Journal (2012)

Background: Programs to promote the increase of physical activity in daily life (PADL) have generated growing interest aiming to prevent the deleterious effects of physical inactivity. Recent literature has shown that a short-term protocol using pedometers (or step counters) was able to increase PADL in apparently healthy smokers. However, the long-term effects of such a protocol were not yet studied.

Objectives: To evaluate the results of 1-year follow-up after a program aimed at increasing PADL in smokers.

Methods: 43 smokers without lung function impairment were studied (20 males; 52[48-58] years; 20[20-30] cigarettes-day). The 5-month program used informative booklets and pedometers in order to achieve a goal of 10000 steps/day. Subjects were assessed at baseline, immediately after the end of the program, six months and one year later. Outcomes were PADL assessed for one week at each assessment point, besides lung function, six-minute walking distance (6MWD), smoking habits and quality of life.

Results: Immediately after the program there was significant increase in steps/day (8779[5632-11021] vs 10694[8402-12482]; mean improvement of 2641[452-3436] steps/day), together with improvements in the 6MWD and general health status (p<0.05 for all). However, over the 1-year follow-up period (n=14) there was progressive reduction in steps/day when compared to the assessment at the end of the program (after six months: -599[-3476-1707] and after one year: -1876[-4297-440]). Conclusions: Improvement in PADL obtained immediately after a program of physical activity promotion in smokers does not seem to be maintained over the long term. Strategies for maintaining these gains are needed.
Value of chest radiography in predicting pulmonary hypertension
Authors: Edoardo Airò, Simonetta Monti, Roberta Pancani, Carolina Bauleo, Bruno Formichi, Carlo Marini, Massimo Miniati
Journal: European Respiratory Journal (2013)

The objective of our study was to assess the accuracy of chest radiography (CXR) in predicting or excluding pulmonary hypertension (PH).  We studied 105 consecutive patients with clinically suspected PH, who underwent diagnostic right heart catheterization (RHC). PH was diagnosed if mean pulmonary artery pressure was >25 mmHg, and mean pulmonary wedge pressure  16 mm in diameter, pruning of peripheral pulmonary vessels.  Seventy-nine patients (75%) had PH confirmed at RHC. The weighted sensitivity of CXR was 97% (95% confidence interval [CI], 95 to 98%), and the weighted specificity 96% (95% CI, 91 to 99%). The positive likelihood ratio was 25 (95% CI, 11 to 60), and the negative likelihood ratio 0.03 (95% CI, 0.02 to 0.06).  CXR is accurate in predicting or excluding PH. It can be used in clinical practice to select patients with clinically suspected PH for hemodynamic ascertainment.
Cardiac Rehabilitation Improves Functional Capacity and Patient-Reported Health Status in Patients With Continuous-Flow Left Ventricular Assist Devices
Authors: Dennis J Kerrigan, Celeste T Williams, Jonathan K Ehrman, Matthew A Saval, Kyle Bronsteen, John R Schairer, Meghan Swaffer, Clinton A Brawner, David E Lanfear, Yelena Selektor, Mauricio Velez, Cristina Tita, Steven J Keteyian
Journal: JACC Heart Failure (2014)
Respiratory intermediate care unit (RICU) – What are we doing?
Authors: Sara Salgado, Ana Sofia Oliveira, Cecília Nunes, Fernanda Oliveira, Cristina Bárbara
Journal: European Respiratory Journal (2011)

Aim:  RICUs are designed to treat invasive mechanical ventilated (IMV) stable patients for weaning and chronic care, hemodinamically stable patients with compromised gas exchange for frequent observation and/or non-invasive ventilation (NIV) and patients who require frequent vital signs monitoring or aggressive pulmonary physiotherapy. We aimed to evaluate the work developed in our RICU.   Methods:  A systematic retrospective review was made from February 1 to July 31, 2010, in an 8 beds RICU.   Results:  In the studied period, 105 patients were responsible for 126 admissions, 73% were male, mean age was 68 yrs. (16-96). Patients were referred mainly from the Emergency Department (44%), Intensive Care Unit (ICU) (21%) and Respiratory wards (11%). The reasons for admission were in 21% to step-down ICU, 52% for NIV, 24% for cardiorespiratory monitoring and 3% for other reasons. In 98% respiratory insufficiency was present, mainly hypercapnia, mostly caused by infectious respiratory exacerbations. All but 1 had chronic disease, 76% cardiac and 60% pulmonary (mostly severe). The average stay at RICU was 22 days (1-76). RICU has enabled to liberate 536 days of ICU. Eleven patients were transferred to ICU and 20 died. One of two was weaned from chronic IMV. Tracheotomy was closed in 3 of 5 patients. In respiratory failure patients, NIV succeeded in 46 (70%), 4 were transferred to ICU and 16 patients under palliative NIV died.   Conclusions:  Despite the diversity of work developed in our RICU, primarily it allowed free days in ICU and NIV practice. Although the advanced stage of chronic diseases and a high number of do not intubate patients, the possibility of close monitoring and observation is greatly responsible for NIV9s success.
Inhaled environmental/occupational irritants and allergens: mechanisms of cardiovascular and systemic responses. Introduction.
Authors: D B Yeates, J L Mauderly
Journal: Environmental Health Perspectives (2001)

The articles in this monograph focus on the mechanisms whereby ambient particulate matter (PM) and co-pollutants deposited in the respiratory tract cause cardiovascular and systemic effects, especially in persons with preexisting conditions such as allergic hyperresponsiveness and pulmonary, cardiac, and vascular diseases. During the past few years, it has become clear that inhaled pollutants cause adverse effects outside the respiratory tract and that these effects may in some cases be more important than respiratory effects. Investigators pursuing traditional approaches to understanding mechanisms of air pollution effects need to be brought together with those outside that community who have expertise in pathogenetic mechanisms by which deposited air pollutants might affect nonrespiratory organs. To this end, a workshop was held and papers were developed from a broad range of scientists having specialized expertise in allergic and cardiovascular physiology. The overall goal of this monograph is to benchmark current thinking and enhance progress toward identifying and understanding the mechanisms by which nonrespiratory health effects occur and, by extension, to facilitate the appropriate management of relationships between air quality and health. This monograph contains a compilation of multidisciplinary research that forms a framework for generating and testing plausible new research hypotheses. Not only will this information stimulate the thinking of researchers, but it will also provide an improved foundation for funding agencies and advisory groups to frame research strategies, programs, and priorities.
Post-chemotherapy retroperitoneal resection of residual masses in germ cell cancer with modified template resection
Authors: A. N. Heidenreich, D. Pfister, C. H. Ohlmann, R. Witthuhn, P. Albers
Journal: Journal of Clinical Oncology (2008)

5089 Background: Residual tumor resection (RTR) following inductive chemotherapy for metastatic germ cell tumours (GCT) is an integral part of the curative multimodality approach. It is the purpose of our study to assess the oncological necessity of full bilateral retroperitoneal RTR. Methods: 155 patients with primary NSGCT underwent retroperitoneal RTR with normalization or plateauing of previously elevated serum tumour markers. Depending on the size of the residual mass or the location of the primary testicular tumor a full bilateral (n = 51) or a modified template resection (n = 104) was performed. If patients exhibited a well defined lesion ≤ 2cm modified RTR was performed, lesions > 5cm were always treated by a full bilateral RTR. Lesions 2–5cm in diameter were approached dependent on the site of the primary tumor and the location of the mass: paraaortic and paracaval lesions were treated by a modified RTR if the metastatic site corresponded to site of the primary. Results: 89 patients (57.4%) had necrosis/fibrosis, 45 (29%) and 23 (14.8%) patients had mature teratoma and vital cancer in the RTR specimens, resp. 83 (53.5%) patients were of good risk and 38 (24.5%) and 31 (20%) patients were of intermediate and poor risk, resp. Mean tumour size in bilateral and modified RTR was 10.3cm and 4.1cm, resp. Postoperative morbidity demonstrated significantly more complications in patients undergoing bilateral RTR (p < 0.001). Antegrade ejaculation was preserved in 85% and 25% of patients undergoing bilateral and modified RTR (p = 0.02), resp.. We observed 8 (5.1%) recurrences after a mean follow-up of 39 (2 - 84) months: 1 relapse was within the boundaries of modified RTR and 7 recurrences developed outside the boundaries of full bilateral RTR. 2- year disease free survival was 65% and 91% for bilateral and modified RTR, resp. Conclusions: Full bilateral RTR should be considered as surgical approach of choice in patients with extensive residual masses, interaortacaval location or a site location of the residual mass not corresponding to the site of the primary testis tumour. In well defined small masses a modified template RTR does not interfere with oncological outcome but decreases treatment associated morbidity. No significant financial relationships to disclose.