tbuckley/cabot-search huggingface dataset:
OC-026 Novel oral anticoagulants and gastrointestinal bleeding in the real world setting: incidence, endoscopic findings, intervention and use of blood products
Authors: A Kumar, R Hipkins, S Jenkins, S Ishaq, B Disney
Journal: Gut (2015)

<h3>Introduction</h3> Rivaroxaban, apixaban and dabigatran compile the novel oral anticoagulants (NOAC). Since 2012, NOACs are used as first line treatment for atrial fibrillation, pulmonary embolism and deep venous thrombosis at Russells Hall Hospital (RHH). The trial data regarding the risk of gastrointestinal (GI) bleeding has been conflicting, although a meta-analysis found an increased risk of GI bleeding with NOACs as opposed to warfarin (2.3% vs. 1.3%).<sup>1</sup>However, little is known about its incidence in the real world setting. We aimed to demonstrate the incidence of GI bleeding, endoscopic findings, time of onset of bleeding and the need for intervention in patients taking NOACs. <h3>Method</h3> We performed a retrospective review of all patients at RHH who received NOACs. These patients were identified from the anticoagulation database and cross-referenced with the GI database and patient notes. Basic demographic, clinical and laboratory data and endoscopic findings were collated. <h3>Results</h3> A total of 2487 patients were identified to be on NOACs of which 61 were found to have an episode of GI bleeding, giving an incidence rate of 2.45%. 54 of 2334 patients were on rivaroxaban, 3 of 77 on apixaban and 4 of 76 on dabigatran with an incidence of GI bleeding of 2.3%, 3.9% and 5.3% respectively. There was a greater incidence found with females than males (55% vs. 45%) with the median age 80 years (range 53–95). The 30-day mortality rate was 11.5% (n = 11). The cause of death were not directly due to GI bleeding. Of these 61 patients, 30 (49.2%) had an upper GI bleed (UGIB) and 31 (50.8%) had a lower GI bleed (LGIB). The median time from starting NOAC to having a GI bleed was 6.7 months (range 2 days-19.7 months). Endoscopy results were varied with the most common findings being haemorrhoids (15.7%), diverticular disease (14.6%), normal findings (12.4%), gastritis (7.9%) and peptic ulcer disease (7.9%). 7 patients (11.5%) required endoscopic intervention and 21 patients (34.4%) required the use of blood products. Although 12.9% of patients with LGIB required endoscopic intervention versus 10% of UGIB, patients with UGIB were more likely to be inpatients (97% vs. 35%), with a greater drop in haemoglobin (median Hb: 87 g/L versus 105 g/L) and the increased use of blood products (53% vs. 16%). <h3>Conclusion</h3> The risk of GI bleeding with NOACs is greater than warfarin, with rivaroxaban being the safest of the three drugs in our cohort and is similar to the published data. Further studies are required to confirm these findings. <h3>Disclosure of interest</h3> None Declared. <h3>Reference</h3> Capodanno D, Capranzano P, Giacchi G, Calvi V, Tamburino C. Novel oral anticoagulants versus warfarin in non-valvular atrial fibrillation: a meta-analysis of 50,578 patients. Int J Cardiol. 2013;167(4):1237–41
Screening for allergy in elite marathon runners
Authors: Renata Nakata Teixeira, Felipe Augusto Rodrigues Mendes, Milton Arruda Martins, Celso Ricardo Fernandes Carvalho
Journal: European Respiratory Journal (2013)

Background:  The prevalence of allergy in athletes is increasing and it its risk varies across sports modalities. There are evidences suggesting higher prevalence in swimmers and winter sports athletes; however, this is unknown in elite marathon runners.  Objective:  to assess the prevalence of allergy symptoms in elite marathon runners.  Methods  :  this cross-sectional study included 230 elite marathon runners (performance time for half-marathon= 70±7min and for marathon 148±19min) that fulfilled the questionnaire Allergy Questionnaire for Athletes (AQUA©). Total AQUA scores ≥5 were used as the threshold for a positive questionnaire. 1  Additional questions about running experience, distance training, and performance in marathon and half-marathon events were also included.  Results:  Twenty-nine (12.6%) refused to participate mainly due to lack of time. Sixty percent (122/201) of the assessed athletes reported allergy symptoms as defined by a positive AQUA outcome. Symptoms related to physical effort and rhinitis were the most prevalent in the AQUA group (62.3% e 56.6%, respectively). No significant differences (p>0.05) between groups (AQUA+ and AQUA-) were observed for gender, age, running experience, weekly training volume and best performance time in the half-marathon and marathon.  Conclusion:  We demonstrate that elite marathon runners have a high prevalence of allergy that was mostly related to the upper airways suggesting a possible occupational disease. Our results also suggest that AQUA ©  questionnaire should be included as part of a routine assessment for elite marathon runners.   References:   1. Bonini M, Braido F, Baiardini I, et al. Allergy Questionnaire for Athletes. Development and validation. Med Sci Sports Exerc. 2009;41:1034-1041.
Colonization and infection by colistin-resistant Gram-negative bacteria in a cohort of critically ill patients
Authors: F. Kontopidou, D. Plachouras, E. Papadomichelakis, G. Koukos, I. Galani, G. Poulakou, G. Dimopoulos, A. Antoniadou, A. Armaganidis, H. Giamarellou
Journal: Clinical Microbiology and Infection (2011)
The effects of inspiratory muscle training on interleukin-6 concentration during cycling exercise and volitional hyperpnoea
Authors: Dean Mills, Michael Johnson, Martin McPhillimey, Neil Williams, Javier Gonzalez, Yvonne Barnett, Sharpe Graham
Journal: European Respiratory Journal (2012)

The plasma concentration of interleukin-6 (IL-6) increases during cycling exercise (EX) (Starkie et al. J. Physiol 2001; 533:585-591) and inspiratory resistive breathing (IRB) (Vassilakopoulos et al. Am. J. Physiol 1999; 277:R1013–R1019). Whether inspiratory muscle training (IMT) can attenuate the magnitude of the IL-6 response to EX and volitional hyperpnoea (VH) rather than IRB is unknown. Therefore, we tested the hypothesis that IMT would reduce the IL-6 response to EX and/or VH.  Twelve male participants performed either 6 weeks of pressure-threshold IMT (n=6) or placebo (PLA) training (n=6). Before and after training, participants undertook three 1 hour experimental trials on separate days: (i) passive rest; (ii) EX; and (iii) VH. EX was performed at maximum lactate steady state power. In VH, participants voluntarily mimicked at rest the breathing and respiratory muscle recruitment pattern attained during EX.  IL-6 peaked immediately after EX for both the IMT and PLA groups (6.75 ± 1.6 and 5.64 ± 1.76 pg·mL-1). Following training, this response was reduced (-33%; P=0.027) for the IMT but not the PLA group. Blood lactate concentration ([Lac - ] B ) during EX was also reduced (-35%; P=0.009) for the IMT group only. IL-6 and [Lac - ] B  increased (P - ] B  over time for either group during passive rest.  In conclusion, 6 weeks of IMT reduces IL-6 during EX but not VH. The reduction in IL-6 concentration following IMT may be related to a decreased carbohydrate utilisation as indicated by the post-IMT reduction in [Lac - ] B  during EX but not VH.
COPD exacerbation admissions: Analysis of demographics and mortality
Authors: Florencia Tsou, Daniel Piñeiro, Horacio Di Fonzo, Stigliani Ariel, Mazzei E. Mariano
Journal: European Respiratory Journal (2013)

Chronic Obstructive Pulmonary Disease (COPD) is a characterized by exacerbations (COPD-E) during the course of the disease. COPD-E are a well known cause of morbidity and mortality. We analized retrospectively all the patients admitted to our hospital for COPD-E from january 2009 to December 2011.  There were 264 admissions for COPD-E in the admiting diagnosis: 88 were excluded because of an other dignosis was stablished during the hopsital course (CAP, Asthma, heart failure, etc), 71 were eliminated because of insuficient data, thus only 105 patients were able to be analized.  From the 105 COPD-E admissions, 48, 1 % had a previous COPD-E hospitalization, 32,4% was during the previous year, 29,4% had a previous ICU admission for COPD-E. A prior COPD diagnosis was known by the patients in 77.5% of the admitions, of the patients who knew their severity, 2.9% was mild, 6,9% was moderate, 24.5% was severe, 11.8% was very severe, the rest was unkown by the patients. Immunizations: 24,5% had a flu shot during the previous year and 22.5% pneumococcal vaccine.  During the hospital course 26 patients died (24,7%), 6 (5,7 %)because of the COPD-E and 20 (19%) because of other cause (heart failure, nosocomial pneumonia,etc).  Conclusions: Patients admited for COPD-E have a 24,7% death rate during the hospitalization, almost half of them had a previous admission for COPD-E. There was a highly low prehospital treatment rate for COPD-E and low vaccination rate.
Assessment of pulmonary embolism severity index, D-dimer, cardiac biomarkers and multi detector computed tomography findings in patient with pulmonary thromboembolism
Authors: Burcu Koyden, Fusun Alatas, Huseyin Yildirim, Guntulu Ak, Muzaffer Metintas, Sinan Erginel, Emel Kurt, Irfan Ucgun, Cengiz Bal
Journal: European Respiratory Journal (2011)

PTE should be evaluated with its clinical, radiological and laboratory findings in order to diagnose. Our aim was to determine the relationship between PESI, cardiac biomarkers and CT findings.  75 cases were diagnosed as acute PTE between September 2009-December 2010. Cases were grouped as nonmassive (group 1: 35), submassive (group 2: 27), massive (group 3: 13) PTE. Three groups were compared in term of PESI, cardiac biomarkers, CT findings (RV/LV ratio-pulmonary vascular obstruction score (PVOS))  Mean age was 58,8 (29-94). PESI (mean±SD) was 78,17±27,66 in group 1, 102,7±34,4 in group 2, 139,9±36,25 in group 3 (p
Airway inflammation, lung function and wheezing phenotypes in preschool children
Authors: Kim D.G. van de Kant, Maran Jansen, Ester M.M. Klaassen, Chris P. van der Grinten, Ger T. Rijkers, Jean W.M. Muris, Onno C.P. van Schayck, Quirijn Jobsis, Edward Dompeling
Journal: European Respiratory Journal (2011)

Background: Wheeze is a common symptom in preschool children. Currently, it is difficult to predict whether wheezing symptoms will pass or will persist and develop into asthma in later childhood.

Aim: To prospectively study whether inflammatory markers in exhaled breath condensate (EBC) and pre- and post-bronchodilator interrupter resistance (Rint) assessed at preschool age, are able to predict wheezing phenotypes at five years of age.

Methods: Children (N=227) from the ADEM study [1] were included. At preschool age (median (IQR): 3.3 (2.8-3.8) years), pre- and post bronchodilator Rint was assessed. EBC was collected using a closed-glass condenser system. Inflammatory markers ((Interleukin (IL)-2, IL-4, IL-8, IL-10, sICAM) were measured using multiplex immunoassay. Wheezing phenotypes were determined at five years of age via annual questionnaires.

Results: Children were classified as; never- (n=47), early-transient- (n=89), intermittent- (n=46), and persistent wheezers (n=45) [2,3]. Children with persistent- and intermittent wheeze had elevated levels of all interleukins compared with never wheezers (p<0.05). Moreover, children in the never- and transient wheeze group had slightly lower levels of baseline Rint compared with persistent wheezers (Median (IQR) 1.3 (1.1-1.7) and 1.4 (1.2-1.6) vs. 1.5 (1.3-1.9) kPa·s/L, p<0.10).

Conclusions: Children of the intermittent- and persistent wheeze group at age 5 years already had elevated inflammatory markers at preschool age, indicating augmented airway inflammation in these children.

References: 

*   1. van de Kant et al. BMC Public Health 2009; 9:210.

*   2. Martinez FD et al. N Engl J Med 1995; 332:133-8.

*   3. Sears MR et al. N Engl J Med 2003; 349:1414-22.
6MWT improvement after pulmonary rehabilitation (PR) is inversely associated with degree of airflow obstruction in COPD patients. A retrospective study
Authors: Andrea Zanini, Sabrina Della Ptrona, Silvia Casale, Veronica Leoni, Marco Moscheni, Francesca Cherubino, Antonio Spanevello
Journal: European Respiratory Journal (2013)

Introduction : Several studies have focused on identifying clinical and functional predictors of the beneficial effects of PR in COPD patients. FEV 1  appears to be irrelevant to obtain benefits from PR.   Aims and objectives : To evaluate associated and predictive factors of change in exercise capacity after PR in patients with COPD.   Methods : 75 stable moderate-to-severe COPD patients, allocated to a 3-weeks PR in a single-centre in 2011, were evaluated. Pulmonary function, six minute walking distance (6MWD), dyspnea and quality of life were assessed before and after PR.   Results : In the entire population and in the two groups, PR led to increased 6MWD ( p ). Compared to group A (FEV 1 ≥ 50%), group B (FEV 1  p=0.0004 ). Morever, 9% of group A patients and 39% of group B showed a clinically significant increase in 6MWD (>54 m,  p=0.002 ). In all patients baseline FEV 1  was negatively related to Δ6MWD ( r s =-0.5 ). Stepwise multiple regression selected FEV 1  as individual predictor of Δ6MWD (r 2 =0.25). Comparisons are summarized in the table (mean±SD).   Conclusions : This study shows that PR is particularly effective in the more severe COPD patients. Our results support the hypothesis that simple functional baseline findings may predict the response to a PR program in moderate-to-severe COPD patients.
Therapeutic management of the primary traumatic pulmonary pseudocysts
Authors: Athanassios Stamatelopoulos, Ioannis Gakidis, Christos Chatziantoniou, Petros Michos, Ilias Voutas, Dimitra Peristeri, Thrasivoulos Michos
Journal: European Respiratory Journal (2014)

OBJECTIVE:   Pulmonary contusion is the usual manifestation of lung parenchymal injury after blunt chest trauma. With deceleration these parenchymal lacerations can result in cavities known as primary traumatic pulmonary pseudocysts (TPPC). We present our experience in treating this rare entity.   MATERIAL:   From 1990 trough 2013, 78 young patients 62 male and 16 female ranging in age between 13 and 24 years were treated for primary TPPC in our department. Blunt chest injuries resulting from traffic accidents were the causes in all our cases. The main symptoms were pain, hemoptysis and dyspnea not associated with severe hypoxemia. The cavitary lesion was apparent in chest radiographs, but the imaging modality of choice was the computed tomography.   RESULTS:   Multisystem injury was present in 39of them. Eleven of our patients required ICU facilities but none needed mechanical ventilation. Hemopneumothorax was present in 14 cases, whereas pneumothorax in four drained by tube thoracostomy. The hospital stay ranged between 9 and 23 days. Contraction and complete radiological resolution of the PPC needed a follow up of 6-11 weeks.   CONCLUSIONS:   (1) Primary traumatic pulmonary pseudocysts are benign lesions secondary to blunt chest trauma needing only conservative treatment unless complications arise, such as hemo- or pneumothorax or infection of the cavitary lesion. (2)Computed tomography is a really sensitive method for early detection of the lesion while plain roentgenograms are sufficient for the follow up.
Hunt pledges that no junior doctor working within legal hours will face pay cut
Authors: Adrian O’Dowd
Journal: BMJ (2015)

The UK government has made a stronger commitment to ensuring that junior doctors’ pay will not suffer under the proposed new contract, during a parliamentary debate on 28 October. It pledged that no junior doctors working within legal limits on hours would see a cut to their pay.

The commitment was made during a debate in the House of Commons on the increasingly hostile dispute between the government and the BMA over a new contract for junior doctors, which is due to be the subject of a two week BMA ballot on industrial action by junior doctors in England, starting on 5 November.

Proposing the motion on 28 October, Labour’s shadow health secretary, Heidi Alexander, MP for Lewisham East, said, “I’m worried a new government imposed employment contract will be unsafe for patients and unfair for doctors.” 

Alexander said that she wanted the government to return to negotiations with the BMA but that for that to happen “what the BMA needs to see and what junior doctors need to know is that the health secretary is genuinely willing to compromise, and his performance over the last few months suggests otherwise.”

The BMA was not helping its cause by refusing to negotiate on the contract, argued Simon Hoare, Conservative MP for North Dorset. …
Impact of CCP test on personalizing treatment decisions: Results from a prospective registry of newly diagnosed prostate cancer patients.
Authors: Neal D. Shore, Judd Boczko, Naveen Kella, Brian Joseph Moran, E. David Crawford, Stephanie A. Hamilton, Rajesh R. Kaldate, Kirstin M Roundy, Michael K. Brawer, Mark L. Gonzalgo
Journal: Journal of Clinical Oncology (2015)

63 Background: The cell cycle progression (CCP) test is a validated molecular assay that assesses risk of prostate cancer−specific disease progression and mortality when combined with standard clinicopathologic parameters. PROCEDE−1000 is the largest prospective registry to evaluate CCP test impact on personalizing prostate cancer treatment. Results of an interim analysis are presented. Methods: Untreated patients with newly diagnosed (≤6 months), clinically localized prostate adenocarcinoma were enrolled (n=816). The physician’s initial therapy recommendation (pre−CCP) was recorded on the first questionnaire. The CCP test was then conducted on prostate biopsy tissue. Three post−CCP questionnaires recorded the physician’s revised treatment recommendation, physician/patient treatment decision, and actual treatment administered. Changes in treatments between the pre-CCP and post−CCP questionnaires demonstrated the impact of CCP testing on treatment decisions at each stage. Results: Visual analog scale measurements indicated a significant increase (p=0.0125) in the physician’s likelihood of recommending non−interventional treatment post−CCP test; there was an increase in active surveillance from the initial interventional therapy recommendation. From pre−CCP therapy recommendation, the CCP score caused a change in actual treatment administered in 44% of patients; 72% of changes were reductions in treatment. Reductions occurred in radical prostatectomy (27%), radiation therapy (44% primary; 56% adjuvant), brachytherapy (46% interstitial; 66% HDR) and hormonal therapy (33% neoadjuvant; 68% concurrent) treatments. While 35.9% of patients were recommended for conservative management pre−CCP testing, there was a 6.5% increase in non−interventional treatments during actual follow−up. Overall, there was a significant reduction in the number of treatment options at each successive evaluation (p&lt;0.0001). Conclusions: The CCP risk assessment score has a significant impact in helping physicians and patients reach consensus on an appropriate personalized treatment decision, often with major reductions in interventional treatment burden. Clinical trial information: NCT01954004.
Combination treatment with a tumour necrosis factor antagonist and an oral retinoid: efficacy in severe acral psoriasis?
Authors: J.R. Ingram, A.V. Anstey, V. Piguet
Journal: British Journal of Dermatology (2012)

Funding sources: none. Conflicts of interest: J.R.I., none declared; A.V.A. has received departmental research funding from Leo Pharma, Abbott and Schering Plough; V.P. has received departmental educational grants from MSD (Merck), Janssen and Basilea. Madam, Acral skin conditions have a particularly high impact on quality of life due to both functional impairment and their effect on cosmesis. We report a case of severe, treatment‐resistant, chronic acral psoriasis that responded to a combination of infliximab and acitretin therapy. Our patient was a 16‐year‐old, otherwise healthy, nonsmoking boy with no relevant family history who presented with well‐demarcated erythematous scaly plaques predominantly affecting the hands and feet (Fig. 1a–d), as well as the scalp. There was extensive nail involvement with onycholysis and pitting but skin pustules were absent and his joints were unaffected. A diagnosis of acral psoriasis was made based on the clinical features. His Psoriasis Area and Severity Index (PASI) was 8·2, reflecting the localized nature of his psoriasis. In contrast, his Dermatology Life Quality Index (DLQI) score was 16, demonstrating a very large impact on quality of life.1 This disparity is frequently observed for acral skin disease.2 The acral distribution was particularly disabling for our patient because he was a keen guitarist and racquet sports player and was undertaking written examinations. He had begun to wear a pair of black gloves whenever possible and his loss in confidence was reflected by avoidance of eye contact during consultations.
Acute myocardial infarction among Spanish adults with and without COPD: Cumulative incidence and outcomes
Authors: Javier de Miguel Díez, Rodrigo Jiménez García, Alicia Oliva Ramos, Valentín Hernández Barrera, Ana López de Andrés, Milagros Llanos Flores, Irene Jarana Aparicio, Julio Cesar Vargas Espinal, Luis Puente Maestu, Pilar Carrasco Garrido
Journal: European Respiratory Journal (2014)

Background: This study aims to describe trends in the rate of acute myocardial infarction (AMI) in patients with and without COPD in Spain, 2001-2010.  Methods: We selected all patients with a discharge of AMI using national hospital discharge data. Discharges were grouped by COPD status: COPD and non COPD. The cumulative incidence of discharges attributed to AMI were calculated overall and stratified by COPD status and year. We calculated length of stay (LOS) and in-hospital mortality (IHM).  Results: From 2001 to 2010, 513,517 discharges with AMI were identified (7.79% with COPD). The cumulative incidence of discharges due to AMI in COPD patients increased (from 15.69 cases per 100,000 in 2001 to 18.4 in 2003), then decreased to 12.77% in 2010. The pattern was similar in non-COPD patients. It increased from 193.22 cases per 100.000 in 2001 to 211.12 in 2010, and then decreased to 177.79 in 2010. LOS and IHM decreased significantly over time in both groups. LOS decreased from 10.71 (9.64) days in 2001 to 9.09 (9.21) days in 2010 in COPD patients, and from 9.97 (9.14) days in 2001 to 8.9 (9) days in 2010 in non-COPD patients. IHM also decreased from 12.29% in 2001 to 10.82% in 2010 in COPD patients, and from 11.67% to 8.17% in 2010 in non-COPD patients.  Conclusions: AMI hospitalization rates increased initially and have since declined slowly. LOS and IHM have decreased significantly in both groups, remaining higher in COPD patients.