tbuckley/cabot-search huggingface dataset:
Elderly Man With 1-Month History of Flank and Abdominal Pain
Authors: Guillermo J. Ares, Dustin Y. Yoon, William H. Pearce
Journal: JAMA Surgery (2015)

An elderly man presented to the emergency department with a 1-month history of new-onset, persistent lower abdominal and flank pain that was sharp and constant with intermittent radiation to the back and associated anorexia with a 10-kg weight loss. What is your diagnosis?
Prevalence of HIV seropositivity amongst tuberculosis patients at Rural Government Medical College Yavatmal – A five year prospective study
Authors: Batau Bhadke, Amar Surjushe
Journal: European Respiratory Journal (2011)

Introduction: A rising trend of HIV infection has been noticed among tuberculosis patients. Very few data from rural areas has been published.  Aims and objectives: To find out the prevalence of HIV infection amongst tuberculosis (pulmonary and extra pulmonary) patients at rural Government Medical College of Yavatmal, Maharashtra and to study their demographic profile.  Study design: This study was conducted in the department of Pulmonary Medicine at Government Medical College of Yavatmal, Maharashtra for four years from 2006 to 2010. All patients attending outpatient department with symptoms suggestive of tuberculosis (pulmonary and extra pulmonary) were screened from 2006 to 2010. HIV seropositivity was assessed among 3118 bacteriologically, radiologically and/or histopathologically confirmed tuberculosis patients and demographic profile of 573 HIV seropositive patients were studied.  Results: HIV serpositivity rate was 17.92% (119 out of 664 patients) in 2006, 19.51% (193 out of 989 patients) in 2007, 15.78% (149 out of 944 patients) in 2008, 21.49% (112 out of 521 patients) in 2009and 21% (110 of 520) in 2010. Out of 573 seropositive patients 426 were male (74.34%) and 147 were female (25.65%).The most common age group affected was between 21-40 years i.e. 78.53%.  Conclusions: This study highlights increased rate of HIV infection among tuberculosis patients. Therefore, all patients with tuberculosis could be screened for HIV so that early detection and treatment of HIV could be done.
Six (or More) Drugs in Search of a Mechanism: DNA Methyltransferase and Histone Deacetylase Inhibitors in the Treatment of Myelodysplastic Syndromes
Authors: Steven D. Gore
Journal: Journal of the National Comprehensive Cancer Network (2006)

The clinical activity of the DNA methyltransferase inhibitors 5-azacitidine and 2′-deoxy-5-azacytidine in myelodysplastic syndromes (MDS) suggests that epigenetic modulation of gene transcription may play an important pathogenetic role in the development and expression of these diseases. Approximately 50% of patients treated with these compounds experience hematologic improvement, making these the most active single agents for unselected patients with MDS. Responses include complete and partial hematologic responses. Two randomized trials have shown that the use of these drugs significantly alters the natural history of MDS compared with supportive care. Histone deacetylase inhibitors, which may also impact the expression of genes through epigenetic mechanisms, seem to have measurable activity in MDS in preliminary studies. Histone deacetylase inhibitors are most likely used in combination with other agents, including DNA methyltransferase inhibitors. Despite the clinical activity of these classes of drugs, there is no conclusive evidence that their clinical activity is attributable to their impact on the epigenome. Such information will be critical in the development of more effective congeners and drug combinations in ongoing attempts to improve the outcome of patients with MDS.
Intrathoracic foreign bodies - A 11 year statistics
Authors: Iris Miron, Ovidiu Burlacu, Calin Tunea, Voicu Voiculescu, Gabriel Cozma, Ioan Petrache, Alin Nicola
Journal: European Respiratory Journal (2012)

Introduction  Although is very rare, the pathology of foreign intrathoracic bodies, either into the bronchial tree, chest wall or the pleural space is very challenging and can raise a series of problems, especially if we are dealing with debilitated patients.  Method:  In an 11 year period we had 20 admissions with different types of foreign intrathoracic bodies, with ages ranging from 16 to 75 years, with an m/f sex ratio of 17:3. The pathology was represented by 13 thoracic wounds with retention (glass, knife blades, needles, bullets), 3 foreign intra-bronchial bodies (1 syringe needle, 2 rocks), 4 intraoesophageal bodies (1 dental prosthesis, 2 copper wires, 1 bone). We performed thoracotomy in 9 cases, pleural drainage in 1 case, 1 bronchoscopy, wound explorations, one conservative treatment. The mean hospital stay was 11 days.  Results:  In all the cases the long term prognosis was excellent. We had 3 complications: pleural effusion managed by drainage in a case with esophageal perforation, aspiration pneumonia and prolonged fever.  Conclusions:  The foreign bodies are sometimes a challenge and the management requires a thoracic and abdominal surgeon, bronchologist, gastro-enterologist. Thoracotomy is the final solution of approach, minamally invasive surgery is required in most of the cases.
Beating Lyme
Authors: Phillip J. Baker
Journal: Journal of Clinical Investigation (2008)

In Beating Lyme, Constance Bean, health writer and former coordinator of health education at MIT, and Leslie Ann Fein, medical director for the Pennsylvania Lyme Disease Society, endeavor to provide insight and information on the history, diagnosis, and treatment of this disease. Unfortunately, in this reader’s opinion, much of what is presented — especially with respect to “chronic Lyme disease” as a persistent infection — is biased and not evidence based.
Institutional review boards are getting better at dealing with conflicts of interest, survey shows
Authors: Jacqui Wise
Journal: BMJ (2015)

Progress has been made in the reporting and management of conflicts of interest among people who serve on the institutional review boards of medical schools and teaching hospitals in the United States, shows a survey published in JAMA Internal Medicine .1

In the past, attention has focused mainly on researchers and their relations with the industry, with little written on the potential conflicts of interest among the members of institutional review boards, which oversee study protocols in academic health centers.

Researchers contacted a random sample of members of institutional …
Rash as a marker for the efficacy of gemcitabine plus erlotinib-based therapy in pancreatic cancer: Results from the AViTA Study
Authors: C. Verslype, W. Vervenne, J. Bennouna, Y. Humblet, J. Cosaert, E. Van Cutsem
Journal: Journal of Clinical Oncology (2009)

4532 Background: The EGFR inhibitor, erlotinib (E), in combination with gemcitabine (G), provides a significant survival benefit in metastatic pancreatic cancer. Rash, a common toxicity with EGFR inhibitors, has been proposed as a potential marker of erlotinib efficacy in multiple tumor types. The recent phase III study of GE ± bevacizumab (B) (Vervenne et al. ASCO 2008) provides a further opportunity to consider this topic. Methods: Chemo-naïve patients (pts) with metastatic pancreatic adenocarcinoma and KPS of 60–100 were randomized to GE-placebo (GE-P) or GE-B; pts received B/P 5mg/kg q2w plus E (100mg/d) and G (1,000mg/m 2 ) given weekly for 7 weeks during the first 8-weekly cycle, followed by weekly for 3 weeks during subsequent 4-weekly cycles. Results: 607 pts were recruited; the arms were well balanced with respect to baseline characteristics. The addition of B to GE produced a significant benefit in PFS (hazard ratio [HR] 0.73, p=0.0002), and a trend towards longer OS (HR 0.89, p = 0.2087; median 7.1 mo vs 6.0 mo for GE-P). GE-B was well tolerated with no new safety signals observed. The incidence of rash was higher in the GE-B arm (73% vs 62% in the GE-P arm). There was a clear trend towards longer OS with increased grade of rash (see table ); this trend was apparent in both arms of the study. There was no difference in OS between treatment groups for any rash grade. Conclusions: The observed relationship between higher grades of rash and longer median OS supports the findings of the phase III PA.3 study of G ± E (Moore et al. JCO 2007), in pts with advanced pancreatic cancer. Studies are under way to prospectively investigate the relationship between rash and efficacy with erlotinib-based regimens in pancreatic cancer. [Table: see text] [Table: see text]
A phase II study of irinotecan, paclitaxel and oxaliplatin (IPO) in patients with multiply relapsed germ cell tumours (GCT)
Authors: J. Shamash, T. Powles, K. Mutsangwa, L. Cotton, T. Oliver
Journal: Journal of Clinical Oncology (2005)

4527 Background: We have shown that many patients who have viable GCT at surgery, following chemotherapy have enhanced topoisomerase 1 staining on immuno-histochemistry. We have also found that in-vitro the combination of oxaliplatin and SN38 is highly efficacious in the treatment of cisplatin refractory GCT cell lines. Methods: Patients who had failed at least two lines of cisplatin-based therapy (one line in the case of mediastinal tumours) were treated with a novel protocol IPO (oxaliplatin 100mg/m2 on day 1, irinotecan 200mg/m2 on day 1 and paclitaxel 80mg/m2 on day 1, 8 and 15 repeated every 21 days with alternate day filgrastim) to a maximum of 4 cycles. Results: To date 21 patients have been treated of whom 20 were evaluable for response. The median age was 36 years. Eleven were cisplatin sensitive (2 had received prior HDT). Six were refractory and 4 absolutely refractory (AR) according to Beyer’s criteria. A median of 4 cycles was administered. Grade 3/4 toxicity were reported as follows:-alopecia 79%, anorexia 3%, diarrhea 8%, infection 18%, lethargy 16%, vomiting 3%,neutropenia 43%, thrombocytopenia 15%. Response Rate:CR 20%, M-vePR 45%, M+ve PR 15%, SD10% and PD10%. With a median follow up of 13.5 months Seven are currently progression free of whom 2 were AR. Four have had HDT consolidation. Both patients with mediastinal primaries responded to IPO. Two patients who had had prior HDT also responded (CR and m-ve PR). Conclusions: We conclude that IPO is a safe and effective non nephrotoxic salvage therapy in GCT which shows non-cross resistance with previous cisplatin-based chemotherapy. No significant financial relationships to disclose.
Brugada Syndrome Presenting as Polymorphic Ventricular Tachycardia–Ventricular Fibrillation Lasting 94 Seconds Recorded on an Ambulatory Monitor
Authors: Christopher R. Russo, Terrence D. Welch, Rajbir S. Sangha, Mark L. Greenberg
Journal: JAMA Internal Medicine (2015)

Cardiac arrhythmias are common causes of syncope. Brugada syndrome is an uncommon but serious genetic arrhythmia disorder that can be unmasked by medicines causing sodium channel blockade.This report documents a case of Brugada syndrome and polymorphic ventricular tachycardia-ventricular fibrillation not initially recognized in a patient taking nortriptyline and experiencing syncope. It also illustrates one of the longest episodes of ventricular fibrillation recorded on an ambulatory monitor (94 seconds). Although the baseline electrocardiogram did not demonstrate a typical appearance for Brugada syndrome, provocative testing with flecainide in this patient with documented polymorphic ventricular tachycardia revealed a Brugada electrocardiogram pattern.Vigilance should be maintained for arrhythmia substrates such as Brugada syndrome in patients with typical symptoms when they are prescribed membrane-active medicines. Long-term ambulatory rhythm monitors can provide useful information in these cases, especially when symptoms are infrequent.
Incidence, Cost, and Outcomes of Bleeding and Chemotherapy Dose Modification Among Solid Tumor Patients With Chemotherapy-Induced Thrombocytopenia
Authors: Linda S. Elting, Edward B. Rubenstein, Charles G. Martin, Danna Kurtin, Saul Rodriguez, Esa Laiho, Krishnakumari Kanesan, Scott B. Cantor, Robert S. Benjamin
Journal: Journal of Clinical Oncology (2001)

PURPOSE: To describe the incidence and outcomes of bleeding and chemotherapy dose modifications associated with chemotherapy-induced thrombocytopenia (platelets &lt; 50,000/μL). PATIENTS AND METHODS: Six hundred nine patients with solid tumors or lymphoma were followed-up during 1,262 chemotherapy cycles complicated by thrombocytopenia for development of bleeding, delay or dose reduction of the subsequent cycle, survival, and resource utilization. The association between survival and bleeding or dose modification was examined using the Cox proportional hazards model. Predisposing factors were identified by logistic regression. RESULTS: Bleeding occurred during 9% of cycles among patients with previous bleeding episodes (P &lt; .0001), baseline platelets less than 75,000/μL (P &lt; .0001), bone marrow metastases (P = .001), poor performance status (P = .03), and cisplatin, carboplatin, carmustine or lomustine administration (P = .0002). Major bleeding episodes resulted in shorter survival and higher resource utilization (P &lt; .0001). Chemotherapy delays occurred during 6% of cycles among patients with more than five previous cycles (P = .003), radiotherapy (P = .03), and disseminated disease (P = .04). They experienced similar clinical outcomes but used significantly more resources. Dose reductions occurred during 15% of cycles but were not associated with poor clinical outcomes or excess resource utilization. Significantly shorter survival and higher resource utilization were observed among the 20% of patients who failed to achieve an adequate response to platelet transfusion. CONCLUSION: The incidence of bleeding is low among solid tumor patients overall but exceeds 20% in some subgroups. These subgroups are easily identifiable using routinely available clinical information. A clinical prediction rule is being developed. Poor response to platelet transfusion is a clinically and financially significant downstream effect of thrombocytopenia and warrants further investigation.
Influence of data display formats on decisions to stop clinical trials
Authors: J. M Walker, L. S Elting, C. G Martin, S. B Cantor, E. B Rubenstein
Journal: BMJ (1999)

Editor—The abstract of Elting et al’s paper gave the impression that icon displays resulted in significantly more correct decisions than did tables (P=0.03).1 In fact, the P value of 0.03 applies only to the comparison between icon displays and bar graphs or pie charts. The P value for the comparison between icon displays and tables is not significant (P=0.17 (p 1529)).

The study showed no significant difference between icon displays and tables for time to make the decision (P=0.81) or for the quality of the decision. In view of this, the abstract and discussion are deceptive.
Clinical commissioning groups' performance will be formally assessed
Authors: C. White
Journal: BMJ (2015)

The performance of clinical commissioning groups (CCGs) is to be assessed using a formal set of criteria currently being developed by the King’s Fund health think tank for the Department of Health and NHS England, the health secretary has announced.

Jeremy Hunt said that the resulting data, which will be made public, will also be used to determine which trusts need extra help and qualify for the interventional “success regimes” outlined earlier this week by Simon Stevens, NHS England chief executive.1

In his keynote speech to the NHS Confederation’s annual conference in Liverpool on 4 June, Hunt said that the metrics would be used to look at healthcare provision in every part of the country in a bid …
Neoplasms in Children Treated With X Rays for Thymic Enlargement. I. Neoplasms and Mortality&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: James W. Pifer, Edward T. Toyooka, Robert W. Murray, Wendell R. Ames, Louis H. Hempelmann
Journal: JNCI Journal of the National Cancer Institute (1963)

Demographic information and radiation factors are presented for 2,809 children treated with X rays for thymic enlargement in an upstate New York county between 1926 and 1957. Approximately half the children had been studied previously. The remainder were new cases. Information regarding the health and mortality of the treated children of both series was collected by mail survey in 1959–60. Procedures for tracing families and other methodological aspects of the survey, including the design of the questionnaire and response rates, are described. Radiation dosage factors used in treatment are believed to be accurate. Almost all the children were irradiated before the age of 6 months. Many of the older children were given relatively high doses of X rays to large areas that often involved the posterior as well as the anterior aspects of the chest. The younger children were usually given lower doses of X rays to relatively small anterior areas. The 1,451 children previously studied had a high incidence of tumors, particularly leukemia and thyroid neoplasms. The present survey shows that these children continued to develop tumors at a higher rate than that of their untreated siblings and higher than that expected in a comparable group from the general population. Thyroid adenomas and carcinomas comprise about one half, and osteochondromas, about one sixth of all tumors. No new cases of leukemia have occurred since the previous survey. Several cases of salivary gland tumors and neurilemmomas, which are very rare neoplasms in children and young adults, were observed. Data on mortality of treated children and their siblings in both series are difficult to evaluate. The moderate excess of deaths in the children of series I after the 1st year of life can be attributed largely to 6 cases of leukemia. Relatively few other deaths have resulted from malignant disease.
Prevalence of Prediabetes and Undiagnosed Diabetes in Canada (2007–2011) According to Fasting Plasma Glucose and HbA1c Screening Criteria
Authors: Laura C. Rosella, Michael Lebenbaum, Tiffany Fitzpatrick, Aleksandra Zuk, Gillian L. Booth
Journal: Diabetes Care (2015)

OBJECTIVE To provide the first population-based estimates of prediabetes and undiagnosed type 2 diabetes prevalence in Canada. RESEARCH DESIGN AND METHODS We combined two fasting subsamples of the Canadian Health Measures Survey, which were restricted to nonpregnant adults ≥20 years of age (N = 3,494). Undiagnosed diabetes was defined as not having self-reported type 2 diabetes but having blood glucose measures that met Canadian guidelines (i.e., fasting plasma glucose [FPG] level of ≥7.0 mmol/L or hemoglobin A1c [HbA1c] level of ≥6.5% [≥48 mmol/mol]). Prediabetes was defined as an FPG level of ≥6.1 and &amp;lt;7.0 mmol/L or an HbA1c level of ≥6.0% and &amp;lt;6.5% (≥42 and &amp;lt;48 mmol/mol). All estimates were weighted using survey sampling weights. CIs were calculated with the bootstrap method. RESULTS According to FPG levels, the prevalence of undiagnosed type 2 diabetes in Canadian adults was 1.13% (95% CI 0.79, 1.62), contributing to ∼20% of total type 2 diabetes prevalence (5.62 [95% CI 4.52, 6.95]). Compared with FPG levels, the undiagnosed prevalence was greater using HbA1c level as a criterion (3.09% [95% CI 1.97, 4.81]), ∼41% of the total number of cases of diabetes (7.55 [95% CI 5.98, 9.49]). The HbA1c-only criterion resulted in a threefold increase in prediabetes prevalence overall and a sixfold increase among females (FPG 2.22%, HbA1c 13.31%). Screening based on FPG only identified older undiagnosed case patients, with a mean age of 58.7 years (95% CI 59.9, 63.4). Similarly, using HbA1c identified younger individuals with prediabetes, with reduced BMI and waist circumference compared with FPG levels. CONCLUSIONS In this first study of a nationally representative sample with biospecimen measures, we found that the prevalence of undiagnosed type 2 diabetes and prediabetes was significantly higher using HbA1c levels compared with FPG levels. Further evaluation is needed to fully assess the impact of using the HbA1c criterion.
Repeatability and inter-relationships of small airway biomarkers in asthma
Authors: Sherif Gonem, Sushiladevi Natarajan, Steven Corkill, Amisha Singapuri, Dhananjay Desai, Per Gustafsson, Christopher Brightling, Salman Siddiqui
Journal: European Respiratory Journal (2012)

Background:  There is evidence that small airway dysfunction may have an important role in asthma. We aimed to determine the within-visit and between-visit repeatability of small airway biomarkers in asthma, and explore the inter-relationships between them and with standard pulmonary function tests.   Methods:  We recruited ninety-eight patients with asthma. All participants attended a baseline visit at which they undertook spirometry, body plethysmography, measurement of carbon monoxide diffusing capacity, impulse oscillometry (IOS), multiple breath washout (MBW) and induced sputum cell count. Eighteen patients undertook two-week and three-month follow-up visits, and twenty-six patients undertook six-month follow-up visits, at which all physiological tests were repeated.   Results:  Small airway biomarkers displayed excellent within-visit repeatability (intraclass correlation coefficient [ICC] > 0.9), with the exception of S cond , which was only moderately repeatable (ICC = 0.629). The biomarkers were all very stable over a three-month time frame, but S cond  and S acin  were only moderately stable over six months. Principal components analysis of the variables derived five components, corresponding to the concepts of:  1) Expiratory flow limitation / air trapping  2) Heterogeneous airway constriction / closure  3) Ventilation heterogeneity  4) Airway inflammation  5) Impaired diffusion capacity   Conclusions:  Small airway biomarkers are repeatable and stable over three months. Moreover, they appear to provide additional and independent physiological information over and above standard pulmonary function tests.