tbuckley/cabot-search huggingface dataset:
Effects on adrenal function of a new combination of fluticasone propionate/formoterol fumarate administered to asthmatic patients and healthy subjects
Authors: Michael Tamm, Kirsten Kaiser, Brigit Grothe, Mark Lomax
Journal: European Respiratory Journal (2011)

Background: Corticosteroid treatment is known to affect adrenal function via suppression of the hypothalamic-pituitary-adrenal axis. This effect was assessed for a new asthma therapy combining the corticosteroid fluticasone (FLUT) with formoterol (FORM) in a single aerosol inhaler (FLUT/FORM; flutiform ®).

Methods: Healthy subjects and patients with mild to severe asthma were treated for 4 to 12 weeks with FLUT/FORM (100/10μg, 250/10μg, or 500/20μg b.i.d.) in 3 randomised, parallel-group studies comparing FLUT/FORM with FLUT, FLUT+FORM from separate inhalers, or placebo. The endpoints were changes in urinary and serum cortisol levels from baseline to end of study.

Results: No significant differences were observed in mean urinary cortisol levels with FLUT/FORM 100/10μg (N=38; mean 21.51μg/24h; p=0.733) or FLUT/FORM 250/10μg (N=40; mean 24.01μg/24h; p=0.510) compared with placebo (N=39; mean 21.95μg/24h). In a study using FLUT/FORM 100/10μg or 250/10μg, patients had similar mean urinary cortisol levels at baseline and end of study (N=27; 5.1 vs 6.0nmol/L). The corresponding mean serum cortisol levels were 372.9 vs 412.6nmol/L (N=104). Healthy subjects given FLUT/FORM 500/20μg had a decrease in both urinary and serum cortisol levels at end of study but this was less than with FLUT 500μg+FORM 24μg (urinary: N=24; 13 to 7nmol/24h vs 14 to 4nmol/24h; serum: N=24; 399 to 272nmol/L vs 430 to 154nmol/L).

Conclusions: Fluticasone/formoterol 100/10μg or 250/10μg showed no significant changes in urinary or serum cortisol levels. Fluticasone/formoterol 500/20μg had some effect on adrenal function but less than FLUT+FORM given at the same nominal dose.
Pathophysiological mechanisms of exercise‐induced anaphylaxis: an EAACI position statement
Authors: L. Ansley, M. Bonini, L. Delgado, S. Del Giacco, G. Du Toit, M. Khaitov, M. Kurowski, J. H. Hull, A. Moreira, P. J. Robson‐Ansley
Journal: Allergy (2015)

Abstract This document is the result of a consensus on the mechanisms of exercise‐induced anaphylaxis (EIAn), an unpredictable and potentially fatal syndrome. A multidisciplinary panel of experts including exercise physiologists, allergists, lung physicians, paediatricians and a biostatistician reached the given consensus. Exercise‐induced anaphylaxis (EIAn) describes a rare and potentially fatal syndrome in which anaphylaxis occurs in conjunction with exercise. The pathophysiological mechanisms underlying EIAn have not yet been elucidated although a number of hypotheses have been proposed. This review evaluates the validity of each of the popular theories in relation to exercise physiology and immunology. On the basis of this evidence, it is concluded that proposed mechanisms lack validity, and it is recommended that a global research network is developed with a common approach to the diagnosis and treatment of EIAn in order to gain sufficient power for scientific evaluation.
Abstract 19392: A Landmark Analysis of 30-day Mortality after Coronary Artery Bypass Surgery in Patients with Ischemic Heart Failure: Results of the Surgical Treatment for Ischemic Heart Failure (STICH) Trial
Authors: Krzysztof Wrobel, Susanna R Stevens, Robert H Jones, Craig H Selzman, Andre Lamy, Thomas M Beaver, Ljubomir T Djokovic, Nan Wang, Eric J Velazquez, George Sopko, Irving L Kron, Micheal J DiMaio, Robert E Michler, Kerry L Lee, Michael Yii, Yeow Leng Chua, Marian Zembala, Jean L Rouleau, Hussein Al-Khalidi, Richard Daly
Journal: Circulation (2014)

Background: Among patients (pts) with coronary artery disease (CAD) who are candidates for coronary artery bypass graft surgery (CABG), a reduced ejection fraction (EF) identifies a high-risk group. The profile of pre-operative, intra-operative and post-operative factors contributing to 30 day (d) mortality in pts with low EF undergoing CABG has not been well characterized. Methods: The STICH trial enrolled 2136 pts with CAD amenable to CABG with an LVEF &lt; 35% who were treated with medical therapy (MED) alone, MED with CABG, or with MED plus CABG and surgical ventricular resconstruction (SVR). Multivariable logistic regression models utilizing extensive baseline, intra-operative and post-operative care variables were developed to determine factors associated with mortality at 30d in a landmark analysis among pts surviving the first 36 hours (h). Results: Among those enrolled, 1460 pts received CABG; 673 (46.1%) on pump, 160 (11.0%) off pump, 132 (9.0%) with a mitral valve procedure (MVR), 393 (26.9%) with SVR, and 102 (7.0%) received CABG with SVR and MVR. Mortality in the operating room (OR) was 0.3 %, within the first 36h was 1.0%, and at 30d was 5.1%. The rate of in-hospital acute myocardial infarction was 0.8%, stroke 1.6%, mediastinitis 1.7%, worsening renal insufficiency 8.4%, and return to OR was 6.9%. Inotropes were used in 43.6% and intra-aortic balloon pump in 18.6%. At 36h, 148 pts (10.2%) remained intubated. Among pts who survived to 36h, a robust multivariable model (Table, c-statistic 0.89) was developed to predict 30d mortality. A prolonged intubation time (&gt;36h) was the strongest marker of 30d mortality (odds ratio 7.4, 95% CI 3.8, 14.5, p&lt;0.0001). Conclusions: Among pts with ischemic heart failure, CABG can be performed with a low rate of complications and intra-operative mortality. Prolonged intubation time (&gt;36h) after CABG is an integrated clincal marker that may serve to identify those pts with the least likelihood of survival to 30d.
Pressure from tobacco industry is delaying vital law in Pakistan, say activists
Authors: Jocalyn Clark
Journal: BMJ (2015)

A tobacco control coalition has issued a high court petition to prevent the Pakistan Ministry of National Health Services, Regulation and Coordination, from withdrawing promised legislation to reduce tobacco use. 

The new law—which was due to come into force on 31 July, after a delay from 30 March1—requires 85% of tobacco packaging to be covered with graphic photos of the health consequences of smoking. Now, after …
Mumps epidemiology in the Mid-West of Ireland 2004-2008: increasing disease burden in the university/college setting
Authors: D Whyte, F O’Dea, C McDonnell, N H O’Connell, S Callinan, E Brosnan, J Powell, R Monahan, R FitzGerald, M Mannix, T Greally, A Dee, P O’Sullivan
Journal: Eurosurveillance (2009)

Mumps is a contagious vaccine-preventable viral disease that is experiencing a revival in students attending second and third level colleges. Large mumps outbreaks have been reported in several countries despite the presence of childhood immunisation programmes over many years, including measles, mumps, and rubella (MMR) vaccination. In 2008, 1,377 cases of mumps were notified in Ireland and 1,734 in the first three months of 2009 (provisional data). This paper reviews the recent epidemiology of mumps in the Mid-West region of Ireland and highlights preventive measures. A substantial proportion of cases were not laboratory-confirmed and it is important that doctors continue to notify suspected cases. In the Irish Mid-West, data from enhanced surveillance shows a high proportion of mumps in the age group 15-24 years. Complications were uncommon and rarely severe. Where data were available, over half of the cases did not recall having received two doses of MMR, but most recalled one dose. Parents should continue to ensure children receive both MMR vaccinations so that uptake is optimal for protection. Steps were taken to increase awareness of the disease in the school, college and university settings. Preventive measures implemented to limit mumps transmission in the school/college setting over recent years included vaccination of close contacts, isolation for five days and hand hygiene.
High diversity of Panton–Valentine leukocidin-positive, methicillin-susceptible isolates of Staphylococcus aureus and implications for the evolution of community-associated methicillin-resistant S. aureus
Authors: S. Monecke, P. Slickers, M.J. Ellington, A.M. Kearns, R. Ehricht
Journal: Clinical Microbiology and Infection (2007)
Trainees perception and experience in pleural procedures
Authors: Burhan Khan
Journal: European Respiratory Journal (2013)

Introduction

Since the National Patient and Safety Agency(NPSA) 2008 report highlighted concerns around intercostal chest drains there has been a drive to improve clinical practice and patient safety.The NPSA and BTS advocate using ultrasound (US) when inserting drains for pleural effusions and the 2011 BTS pleural audit confirms that safer practices have been adopted albeit disparately. Trainees experience and training remains variable, and ascertaining practice and competence can be difficult to qualify or quantify.

Aim

To survey CMT (year 3 and 4 interns) experience and practices in pleural procedures for pleural effusions.

Methodology

CMTs at a Kent, Surrey & Sussex (KSS) Deanery regional training day were surveyed using audience response devices ensuring respondent anonymity and 100% response rate on their practice surrounding pleural procedures for effusions.

Results

Of 151 CMTs from 19 hospitals,49 trainees were anonymously surveyed.All trainees had done a diagnostic or therapeutic pleural tap, but only 37% with bedside US.97% of them had inserted a chest drain, of which 79% by seldinger techniques, 3% by surgical dissection method, and 15% having done both methods.Only 20% of trainees had inserted more than 10, 50% between 1 and 5 and 30% only one. 38% of chest drains were inserted with no US guidance;15% had “X” marks the spot by radiology and drain subsequently inserted on the ward;and 47% used bedside US at time of insertion.

Conclusion

Despite increased awareness on the potential for harm with chest drains,clinical practice remain variable.A more focussed approach which includes e-learning, simulation and practical workshops is needed to improve trainees’ competence and skill and consequently patient safety.
Time to Clinical Response: An Outcome of Antibiotic Therapy of Febrile Neutropenia With Implications for Quality and Cost of Care
Authors: Linda S. Elting, Edward B. Rubenstein, Kenneth Rolston, Scott B. Cantor, Charles G. Martin, Danna Kurtin, Saul Rodriguez, Tony Lam, Krishnakumari Kanesan, Gerald Bodey
Journal: Journal of Clinical Oncology (2000)

PURPOSE: To determine whether antibiotic regimens with similar rates of response differ significantly in the speed of response and to estimate the impact of this difference on the cost of febrile neutropenia. METHODS: The time point of clinical response was defined by comparing the sensitivity, specificity, and predictive values of alternative objective and subjective definitions. Data from 488 episodes of febrile neutropenia, treated with either of two commonly used antibiotics (coded A or B) during six clinical trials, were pooled to compare the median time to clinical response, days of antibiotic therapy and hospitalization, and estimated costs. RESULTS: Response rates were similar; however, the median time to clinical response was significantly shorter with A-based regimens (5 days) compared with B-based regimens (7 days; P = .003). After 72 hours of therapy, 33% of patients who received A but only 18% of those who received B had responded (P = .01). These differences resulted in fewer days of antibiotic therapy and hospitalization with A-based regimens (7 and 9 days) compared with B-based regimens (9 and 12 days, respectively; P &lt; .04) and in significantly lower estimated median costs ($8,491 v $11,133 per episode; P = .03). Early discharge at the time of clinical response should reduce the median cost from $10,752 to $8,162 (P &lt; .001). CONCLUSION: Despite virtually identical rates of response, time to clinical response and estimated cost of care varied significantly among regimens. An early discharge strategy based on our definition of the time point of clinical response may further reduce the cost of treating non–low-risk patients with febrile neutropenia.
Co-sensitization to silkworm moth (Bombyx mori) and 9 inhalant allergens among allergy patients in Guangzhou, Southern China
Authors: Guangqiao Zeng, Baoqing Sun, Peiyan Zheng
Journal: European Respiratory Journal (2014)

Objectives:  This study aimed to investigate the profile of sensitization to silkworm moth ( Bombyx mori ) and other 9 common inhalant allergens among patients with allergic diseases in southern China. Methods:  A total of 175 patients were tested for serum sIgE against silkworm moth in addition to combinations of other allergens:  Dermatophagoides pteronyssinus ,  Dermatophagoides farinae ,  Blomia tropicalis ,  Blattella germanica ,  Periplaneta americana , cat dander, dog dander,  Aspergillus fumigatus  and  Artemisia vulgaris  by using the ImmunoCAP system. Correlation between sensitization to silkworm moth and to the other allergens was analyzed. Results:  Of the 175 serum samples tested, 86 (49.14%) were positive for silkworm moth sIgE. With high coincidence rates, these silkworm moth sensitized patients were concomitantly sensitized to  Dermatophagoides pteronyssinus  (94.34%),  Dermatophagoides farinae  (86.57%),  Blomia tropicalis  (93.33%),  Blattella germanica  (96.08%), and  Periplaneta americana  (79.41%). Moreover, there was a correlation in sIgE level between silkworm moth and  Dermatophagoides pteronyssinus  (r = 0.518),  Dermatophagoides farinae  (r = 0.702),  Blomia tropicalis  (r = 0.701),  Blattella germanica  (r = 0.878), and  Periplaneta americana  (r = 0.531) among patients co-sensitized to silkworm moth and each of these five allergens. Conclusion:  In southern Chinese patients with allergic diseases, we showed a high prevalence of silkworm moth sensitization, and a co-sensitization between silkworm moth and other five allergens. Such co-sensitization may also result from cross-reactivity of allergens, rendering future studies needed for clarification.
MCPIP1 Endoribonuclease Activity Negatively Regulates Interleukin-17-Mediated Signaling and Inflammation
Authors: Abhishek V. Garg, Nilesh Amatya, Kong Chen, J. Agustin Cruz, Prerna Grover, Natasha Whibley, Heather R. Conti, Gerard Hernandez Mir, Tatiana Sirakova, Erin C. Childs, Thomas E. Smithgall, Partha S. Biswas, Jay K. Kolls, Mandy J. McGeachy, Pappachan E. Kolattukudy, Sarah L. Gaffen
Journal: Immunity (2015)
Immigrant Women's Health: Problems and Solutions
Authors: Annette MacKay Rossignol
Journal: BMJ (2001)

Eds Elizabeth J Kramer, Susan L Ivey, Yu-Wen Ying 

Jossey-Bass Publishers, £35.95, pp 438

ISBN 0 7879 4294 4

Rating: ![Graphic][1] ![Graphic][2] 

There is clearly a need for improved understanding about immigrant women's health. Nevertheless, I have a couple of philosophical bones to pick with this book.

Firstly, the topics covered deal almost exclusively with immigrant women's health care and not with other important determinants of health status such as health related behaviour, implementation of culturally appropriate health promotion efforts, sanitation and environment, or prevention more generally. Thus, I find the book's title misleading and the contents incomplete. …

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Activity of Exemestane in Metastatic Breast Cancer After Failure of Nonsteroidal Aromatase Inhibitors: A Phase II Trial
Authors: Per Eystein Lønning, Emilio Bajetta, Robin Murray, Michèle Tubiana-Hulin, Peter D. Eisenberg, Elizabeth Mickiewicz, Luigi Celio, Paula Pitt, Monica Mita, Neil K. Aaronson, Camilla Fowst, Alexei Arkhipov, Enrico di Salle, Anna Polli, Giorgio Massimini
Journal: Journal of Clinical Oncology (2000)

PURPOSE: To evaluate the antitumor activity and toxicity of a new steroidal aromatase inactivator, exemestane, in postmenopausal women with metastatic breast cancer who had progressive disease (PD) after treatment with a nonsteroidal aromatase inhibitor. PATIENTS AND METHODS: In this phase II trial, eligible patients were treated with exemestane 25 mg daily (n = 241) followed, at the time PD was determined, by exemestane 100 mg daily (n = 58). RESULTS: On the basis of the intent-to-treat analysis by independent review, exemestane 25 mg produced objective responses in 6.6% of patients (95% confidence interval [CI], 3.8% to 10.6%) and overall success (complete response + partial response + no change for 24 weeks or longer) in 24.3% (95% CI, 19.0% to 30.2%). The median durations of objective response and overall success were 58.4 weeks (95% CI, 49.7 to 71.1 weeks) and 37.0 weeks (95% CI, 35.0 to 39.4 weeks), respectively. Increasing the dose of exemestane to 100 mg upon the development of PD produced one partial response (1.7%; 95% CI, 0.0% to 9.2%). Both dosages were well tolerated and were discontinued because of adverse events in only 1.7% of patients. CONCLUSION: Exemestane 25 mg once daily seems to be an attractive alternative to chemotherapy for the treatment of patients with metastatic breast cancer after multiple hormonal therapies have failed.
Prevalence of chronic hepatitis B virus (HBV) infection in U.S. households: National Health and Nutrition Examination Survey (NHANES), 1988‐2012
Authors: Henry Roberts, Deanna Kruszon‐Moran, Kathleen N. Ly, Elizabeth Hughes, Kashif Iqbal, Ruth B. Jiles, Scott D. Holmberg
Journal: Hepatology (2015)

The number of persons with chronic hepatitis B virus (HBV) infection in the United States is affected by diminishing numbers of young persons who are susceptible because of universal infant vaccination since 1991, offset by numbers of HBV-infected persons migrating to the United States from endemic countries. The prevalence of HBV infection was determined by serological testing and analysis among noninstitutionalized persons age 6 years and older for: antibody to hepatitis B core antigen (anti-HBc), indicative of previous HBV infection; hepatitis B surface antigen (HBsAg), indicative of chronic (current) infection; and antibody to hepatitis B surface antigen (anti-HBs), indicative of immunity from vaccination. These prevalence estimates were analyzed in three periods of the National Health and Nutrition Examination Survey (NHANES): 1988-1994 (21,260 persons); 1999-2008 (29,828); and 2007-2012 (22,358). In 2011-2012, for the first time, non-Hispanic Asians were oversampled in NHANES. For the most recent period (2007-2012), 3.9% had anti-HBc, indicating approximately 10.8 (95% confidence interval [CI]: 9.4-12.2) million noninstitutionalized U.S. residents having ever been infected with HBV. The overall prevalence of chronic HBV infection has remained constant since 1999: 0.3% (95% CI: 0.2-0.4), and since 1999, prevalence of chronic HBV infection among non-Hispanic blacks has been 2- to 3-fold greater than the general population. An estimated 3.1% (1.8%-5.2%) of non-Hispanic Asians were chronically infected with HBV during 2011-2012, which reflects a 10-fold greater prevalence than the general population. Adjusted prevalence of vaccine-induced immunity increased 16% since 1999, and the number of persons (mainly young) with serological evidence of vaccine protection from HBV infection rose from 57.8 (95% CI: 55.4-60.1) million to 68.5 (95% CI: 65.4-71.2) million.Despite increasing immune protection in young persons vaccinated in infancy, an analysis of chronic hepatitis B prevalence in racial and ethnic populations indicates that during 2011-2012, there were 847,000 HBV infections (which included ~400,000 non-Hispanic Asians) in the noninstitutionalized U.S. POPULATION.
Six-minute-walk test: Desaturation index in diffuse parenchymal lung disease
Authors: Dina Visca, Angelo De Lauretis, Giuliana Pasciuto, Giuseppina Gioffrè, Smargiassi Andrea, Riccardo Inchingolo, Francesco Macagno, Giuseppe Maria Corbo, Salvatore Valente
Journal: European Respiratory Journal (2011)

Six minute walk test (6MWT) is widely used in the functional evaluation of diffuse parenchymal lung diseases (DPLD). To date, distance walked is the most studied 6MWT parameter.  We focused our study on desaturation index (DI) in 6MWT.  We retrospectively evaluated serial lung functions of 59 consecutive DPLD patients: 28 idiopathic interstitial pneumonia (IIP), 11 connective tissue disease (CTD), 13 sarcoidosis and 7 other DPLD.  DI was calculated as the ratio between the area above the curve, which was created using each peripheral oxygen saturation (SpO2) value obtained every 2 seconds, and the distance walked.  Composite physiologic index (CPI) was used to assess disease severity. Disease progression (“time to irreversible decline” in either FVC levels of 10% from baseline or DLCO levels of 15% from baseline) was quantified from the date of the first 6MWT available, by using proportional hazards analysis.  Of the 59 patients, 38 were females, mean age was 66.3 (±11.8 SD), mean FVC was 90% predicted (±24) and mean DLCO was 55% (±24). Median length of follow up was 24.7 months.  Among 6MWT parameters, only DI (p=0.02), lowest SpO2 (p=0.01) and SpO2 at 1 minute of recovery (p=0.02) significantly differed between IIP and sarcoidosis.  DI showed more correlations with other physiologic variables than distance walked; the strongest one was with DLCO (r=-0.53, p=0.0001).  After controlling for age, gender, smoking status, diagnosis and disease severity, DI remained predictive of disease progression (p=0.04).  DI and SpO2 at 1 minute of recovery are two new promising parameters in the assessment of DPLD. DI is associated with disease progression, independently of disease severity.
Microbiological factors of acute attack in patients with bronchiectasis
Authors: Sermin Borekci, Deniz Demir, Cigdem Zuhur, Benan Musellim
Journal: European Respiratory Journal (2013)

Aim:  We aimed to evaluate the factors of acute attack in patients with bronchiectasis   Methods:  Between 1996-2013 years, data of all patients who admitted to bronchiectasis clinic of Cerrahpasa medical school pulmonology department, and diagnosed with high resolution computed tomography or multislice computed tomography were evaluated retrospectively. Statical analysis was performed by using SPSS 15.0 programs.   Results:  403 acute attacks in 130 patients of all 232 patients were evaluated. The isolated bacterias were; 135 (33.5%) the flora of bacteria; 87 (21.6%) H. Influenzae; 4 (1%) H. Parainfluenzae; 15 (3.7%) indistinguishable haemophilus type bacteria; 62 (15.4%) P. Aeruginosa; 1 (0.2%) P.alcaligenes; 30 were pseudomonas type of bacteria that its type can not be distinguished; 26 (6.5%) S. pneumoniae;14 (3.5%) M.catarrhalis; 8 (2%) E. coli, 4 (1%) enterobacter; 4 (1%) alpha-hemolytic streptococci;3 (0.7%) beta-hemolytic streptococcus; 2 (0.5%) Staphylococcus aureus; 22 (0.5%) Stenotrphonas maltophilia; and 1 (0.2%) P.mirabilis.   Conclusion:  While bacterial factors can not be detected in one third of acute attacts in bronchiectasis, Haemophilus type bacterias are responsible for one-quarter of the acute attacts. Pseudomonas type bacterias were determined in approximately one fifth of the patients in acute exacerbation.However, the proportion of patients that S. pneumoniae and M.catarrhalis was detected as a factor, remained at about 5%.