tbuckley/cabot-search huggingface dataset:
Drug points: Interaction between cyclosporin and fluoxetine
Authors: R C Horton, R S Bonser
Journal: BMJ (1995)

Dr R C HORTON and Mr R S BONSER (Queen Elizabeth Hospital, Birmingham B15 2TH) write: We report an interaction between cyclosporin and fluoxetine causing a rise in cyclosporin concentrations.

A 59 year old man underwent cardiac transplantation for end stage heart failure. Cyclosporin was given as an immunosuppressant, and he was maintained on 225 mg twice daily with a stable trough whole blood concentration …
Abstract P144: Diabetes as a Risk Factor for Stroke in Women Compared with Men
Authors: Sanne A Peters, Rachel R Huxley, Mark Woodward
Journal: Circulation (2014)

Introduction: Diabetes mellitus is a major cause of death and disability worldwide and is a strong risk factor for stroke. It is currently unknown if, and to what extent, the excess risk of stroke conferred by diabetes differs between the sexes. We performed a systematic review and meta-analysis to estimate the relative effect of diabetes on stroke risk in women compared with men. Methods: PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between on January 1, 1966 and February 13, 2013. Studies were selected if they reported sex-specific estimates of the relative risk (RR) for stroke associated with diabetes, and its associated variability. The sex-specific RRs and their ratio, comparing women with men, were pooled using random effects meta-analysis with inverse variance weighting. Results: Data from 58 cohort studies representing 773,379 individuals and 12,253 fatal and non-fatal strokes were included in this analysis. The pooled maximal-adjusted RR of stroke associated with diabetes was 2.29 (95% confidence interval [CI]:1.93, 2.72) in women and 1.85 (1.61, 2.12) in men. Compared with men, women with diabetes thus had a greater risk of stroke: pooled ratio RR 1.26 (1.09, 1.46), I2=0%, with no evidence of publication bias. This finding was statistically robust and observed within all of the pre-specified subgroups and did not differ materially within any of the sensitivity analyses that were undertaken. Conclusions: The excess risk of stroke associated with diabetes is significantly higher in women than men, independent of sex differences in levels of other major cardiovascular risk factors. These data further strengthen the observation that men and women experience diabetes-related diseases differently and heighten the need for further work to clarify the biological, behavioral or social mechanisms that are involved.
Abstract 12027: Peripheral Endothelial Dysfunction Independently Correlated With Cardiovascular Events in Patients Following Coronary Stent Implantation
Authors: Noriaki Tabata, Seiji Hokimoto, Tomonori Akasaka, Yuichiro Arima, Koichi Kaikita, Kazuko Nakagawa, Hisao Ogawa
Journal: Circulation (2014)

Introduction: Percutaneous coronary intervention (PCI) is performed in patients with coronary heart disease to improve symptoms and clinical prognosis. Despite optimal therapies after PCI, some patients experience one or more adverse outcome. Therefore, to evaluate the determinants of the residual risk of cardiovascular events is still important. Endothelial dysfunction has been reported to correlate with adverse cardiovascular events in coronary heart disease. Hypothesis: We hypothesized that endothelial dysfunction could predict future cardiovascular events in patients following coronary stent implantation. Methods: We conducted a prospective cohort study of 435 patients after coronary stent implantation. All patients received aspirin and clopidogrel in addition to other optimal medications. Peripheral endothelial dysfunction was expressed as reactive hyperemia index (RHI) using reactive hyperemia peripheral arterial tonometry, and we used the median value of the RHI (0.54) to divide patients into low (n=218, male 70.2%) and high (n=217, male 70%) RHI groups. We followed cardiovascular events after coronary stent implantation. Results: There was no significant difference in clinical characteristics between the low and high group. A total of 64 patients had a cardiovascular event. The incidence of cardiovascular event was significantly higher in the low RHI group (20.2% versus 9.2%; P=0.007). Kaplan-Meier analysis demonstrated a significantly higher probability of cardiovascular events in the low RHI group than in the high RHI group (mean follow-up: 70 months; log-rank test: P=0.002). Multivariate Cox hazard analysis among various clinical factors demonstrated that body mass index (hazard ratio [HR]: 0.906; 95% confidence interval [CI]: 0.838 to 0.980; P=0.014), peripheral arterial disease (HR: 1.834; 95% CI: 1.003 to 3.351; P=0.049), Cytochrome P450 loss-of-function allele carriage (HR: 2.005; 95% CI: 1.101 to 3.651; P=0.023), and RHI (HR: 0.149; 95% CI: 0.044 to 0.502; P=0.002) as independent and significant determinants of clinical outcome. Conclusions: Peripheral endothelial dysfunction independently correlated with future cardiovascular events in patients following coronary stent implantation.
Brief Report: Relationship of Age and Body Mass Index to Skin Temperature and Skin Perfusion in Primary Raynaud's Phenomenon
Authors: Georgiana‐Aura Giurgea, Wolfgang Mlekusch, Silvia Charwat‐Resl, Markus Mueller, Alexandra Hammer, Michael E. Gschwandtner, Renate Koppensteiner, Oliver Schlager
Journal: Arthritis & Rheumatology (2014)

To assess the relationship of age and body mass index (BMI) to skin temperature and perfusion in patients with primary Raynaud's phenomenon (RP) compared with controls.Patients with RP as well as age- and sex-matched controls underwent external cold provocation by exposure to 20 °C water for 1 minute. Before and after cold provocation, skin temperature and skin perfusion were measured.Twenty-six patients with RP (20 women and 6 men; median age 41.9 years) and 22 controls (17 women and 5 men; median age 42.9 years) were studied. In RP patients, cold exposure led to a median change in skin temperature of -7% (interquartile range [IQR] -13.1, -4.1) and to a median change in skin perfusion of -26.4% (IQR -36.2, 2.9). In controls, skin temperature changed by -15.7% (IQR -18.3, -11.6) and skin perfusion by -33% (IQR -53.3, -1.1) upon cold exposure. In patients with RP, age and BMI were related to skin temperature (for age, r = 0.683, P < 0.0001; for BMI r = 0.657, P < 0.0001) and skin perfusion (for age, r = 0.595, P = 0.002; for BMI, r = 0.653, P < 0.0001), while no association was found in controls. The cold-induced decrease in skin temperature was inversely related to age (r = -0.518, P = 0.003) and BMI (r = -0.662, P < 0.0001) in patients with RP; correlations were not observed in controls. The cold-induced change in skin perfusion was not related to age or BMI in either group.The cold-induced decrease in skin temperature is related to age and BMI in patients with RP but not in controls. Further studies are needed to clarify the pathophysiology of digital ischemia in primary RP.
Abstract 5599: Relationship between Coronary Arterial Remodeling and Fibrous Cap Thickness in Patients with Acute Coronary Syndrome
Authors: Manabu Kashiwagi, Atsushi Tanaka, Hironori Kitabata, Yuichi Ozaki, Aiko Shimokado, Hiroki Matsumoto, Hiroto Tsujioka, Keishi Okouchi, Hideyuki Ikejima, Yu Arita, Akio Kuroi, Kenichi Komukai, Hideaki Kataiwa, Kouhei Ishibashi, Takashi Tanimoto, Shigeho Takarada, Nobuo Nakamura, Kumiko Hirata, Masato Mizukoshi, Toshio Imanishi, Takashi Akasaka
Journal: Circulation (2008)

The aim of this study was to evaluate the relationship between coronary arterial remodeling and the thickness of fibrous cap in patients with acute coronary syndrome (ACS). Thin-capped fibroatheroma is recognized as a precursor lesion for ACS. Positive remodeling (PR) is predominant pattern of arterial remodeling in patients with ACS. However, the relationship between PR and the thickness of fibrous cap has not been elucidated in vivo. We enrolled 41 patients with ACS who underwent both intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The arterial remodeling was assessed by IVUS and the thickness of fibrous cap was measured by OCT. The thin fibrous cap was defined as &lt;70μm in the thinnest part. Remodeling index (RI) was calculated as lesion divided by the reference external elastic membrane cross-sectional area and PR was defined as RI &gt; 1.05 (a PR group). Thin-capped fibroatheroma were observed more frequently in the PR group than in the intermediate and negative remodeling (IR/NR) groups (63% versus 16%, p=0.0057). RI was inversely correlated with the thickness of fibrous cap (r=−0.53, p=0.019). High-sensitive C-reactive protein (hs-CRP) levels were higher in the PR group than in the IR/NR groups (0.50±0.63mg/dL versus 0.20±0.15mg/dL, p&lt;0.05). Also, the hs-CRP levels were higher in patients with thin fibrous cap (0.54±0.71mg/dL versus 0.21±0.14mg/dL, p&lt;0.05). The coronary arterial remodeling, the thickness of fibrous cap and CRP level in patients with ACS were associated with each other. These results suggest that inflammatory process contributes to both plaque growth and plaque instability.
A CASE REPORT OF CUTANEOUS LEPROSY WITH A BRIEF DISCUSSION OF THE CLASSIFICATION, TREATMENT, AND EPIDEMIOLOGICAL PORTENT
Authors: Felix R. Park, J. Roderick Kitchell, Samuel G. Shepherd
Journal: Annals of Internal Medicine (1943)

Case Reports1 November 1943A CASE REPORT OF CUTANEOUS LEPROSY WITH A BRIEF DISCUSSION OF THE CLASSIFICATION, TREATMENT, AND EPIDEMIOLOGICAL PORTENTFELIX R. PARK, M.D., F.A.C.P., J. RODERICK KITCHELL, M.D., F.A.C.P., SAMUEL G. SHEPHERD, M.D., F.A.C.P.FELIX R. PARK, M.D., F.A.C.P.Search for more papers by this author, J. RODERICK KITCHELL, M.D., F.A.C.P.Search for more papers by this author, SAMUEL G. SHEPHERD, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-19-5-805 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptM. B., a 67 year old Russian Jew, was first admitted to the hospital May 26, 1937, with a simple fracture of the neck of the left femur following a fall. At this time he gave a history of dyspnea on exertion for many years, and a chronic cough for at least a year. The physical examination showed a short, thick-set, elderly man whose face was somewhat leonine and whose eyebrows were thin in the lateral thirds. The pupillary reflexes were normal. Both inferior turbinates were hypertrophied, especially the left. The pharynx was injected and the breath was fetid. His...Bibliography1. HOPKINSDENNEY ROE: A statistical study of seven hundred cases in The National Leprosarium, Jr. Am. Med. Assoc., 1929, xcii, 191-198. CrossrefGoogle Scholar2. : Report of Conference at Manila, Jr. Am. Med. Assoc., 1931, xcvii, 53-54. Google Scholar3. COLLIER DR: The use of diathermy in leprosy: a preliminary report, Thai Sci. Bull., 1940, ii, 109-116. Google Scholar4. COLLIERMCKEAN DRJH: The use of diphtheria antitoxin and toxoid in leprosy: a preliminary report, Thai Sci. Bull., 1940, ii, 117-125. Google Scholar5. COLLIER D: New treatment for lepers, Mod. Hosp., 1941, lvii, 49. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: FELIX R. PARK, M.D., F.A.C.P.; J. RODERICK KITCHELL, M.D., F.A.C.P.; SAMUEL G. SHEPHERD, M.D., F.A.C.P.Affiliations: Philadelphia, Pennsylvania*Received for publication April 7, 1942.From the Medical Services of the Presbyterian Hospital in Philadelphia. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 November 1943Volume 19, Issue 5 Page: 805-808 Keywords Dyspnea Elderly Falls Femur Jewish people Leprosy Medical services Pharynx Reflexes ePublished: 1 December 2008 Issue Published: 1 November 1943 PDF downloadLoading ...
Abstract 12931: Comparative Effectiveness of Different Angiotensin II-Receptor Blockers for Survivors of ST-Elevation Myocardial Infarction: A Nationwide Cohort Study Using Insurance Claims Database
Authors: Min-Tsun Liao, Chao-Lun Lai, Yen-Chieh Lee, K. Arnold Chan, Ho-Min Chen, Mei-Shu Lai
Journal: Circulation (2014)

Introduction:  The use of angiotensin II-receptor blockers (ARBs) is a practical alternative to angiotensin-converting enzymes inhibitor in patients after ST elevation myocardial infarction (STEMI).   Hypothesis:  There is no study to compare the effect of different kinds of ARBs. The aim of this study was to determine the impact of different ARBs on cardiovascular outcomes in patients after first STEMI.   Methods:  Patients who were discharged with first STEMI between January 1, 2003 and December 31, 2010 were identified from the National Health Insurance Research Database, Taiwan. We compared patients prescribed with losartan, valsartan, irbesartan, or candesartan within 30 days after discharge from the index hospitalization. The study end-points were all-cause death, cardiovascular death and recurrent myocardial infarction. The propensity score was constructed using logistic regression to model receipt of different ARBs as a function of the baseline patient characteristics. Treating the losartan group as the common reference, pairwise contrast approach using Cox regression model with adjustment for age, sex and the propensity score was used to compare the relative risks of different outcomes among the four different ARBs.   Results:  A total of 8036 patients were enrolled during approximately 0.94 years of follow-up (n=2061 for losartan, n=3806 for valsartan, n=1024 for irbesartan, n=1145 for candesartan). We found no difference between risks of all-cause death and recurrent myocardial infarction among the four ARB groups. However, patients in the irbesartan group had a higher risk of cardiovascular death compared with the losartan group (adjust hazard ratio [HR]: 1.60, 95% confidence interval [CI]: 1.00-2.57, p=0.051 in pairwise contrast approach; adjust HR: 1.62, 95% CI: 1.01-2.58, p=0.044 in simultaneous four-group comparison approach). In subgroup analysis, the increased risk of cardiovascular death in irbesartan group was more prominent in patients aged over 65 years (adjusted HR: 1.82, 95% CI: 1.09-3.05, p=0.022).   Conclusions:  Treatment with irbesartan in patients after first STEMI was associated with increased risk of cardiovascular death compared with losartan, valsartan and candesartan, especially in patients over 65 years old.
Maternal Obesity, Large Babies, and Diabetes
Authors: J. A. L. Gilbert
Journal: BMJ (1949)

INCREASING THE LUNG BLOOD SUPPLY MEDICALHJOURNAL capacity, but his oxygen intake and carbon dioxide production, measured as a percentage of ventilation, changed from markedly abnormal to normal figures.The results may be improved after a longer follow-up period than three to four months, but it is thought that as preliminary observations they are encouraging enough to warrant further application of the procedure to patients who for various reasons are unsuitable for the types of surgery already devised.Our thanks are due to Miss M. Young, of the Sherrington School of Physiology, and to Dr. Evan Jones and Dr. M. B. Matthews, of the cardiac department, St. Thomas's Hospital.We would also like to state that Dr.
Abstract MP45: Liver Fat Content Does Not Account for the Strong Association of Fetuin-A with Diabetes Risk in Women: The Multi-Ethnic Study of Atherosclerosis
Authors: Sarah A Aroner, Kenneth J Mukamal, David E St-Jules, Matthew J Budoff, Ronit Katz, Michael H Criqui, Matthew A Allison, Ian H de Boer, David S Siscovick, Joachim H Ix, Majken K Jensen
Journal: Circulation (2015)

Introduction: Fetuin-A, a hepatic secretory protein, has been associated with risk of diabetes. However, liver fat content may be an important confounder or effect modifier not fully accounted for in previous studies. Further, it remains unclear whether associations differ between women and men. Aim: In an ethnically diverse cohort of women and men, we assessed the association of fetuin-A with risk of diabetes and investigated the role of liver fat in this association. Methods: We conducted a case-cohort study nested in the Multi-Ethnic Study of Atherosclerosis among 1,957 subcohort members and 455 cases (265 of whom belonged to the subcohort) with follow-up from 2000-2012. Fetuin-A was measured from baseline plasma samples by enzyme-linked immunosorbent assay, and liver fat was assessed via computed tomography. Associations were estimated using multivariable-adjusted Cox models, with weighting to account for the case-cohort design. Results: The association of fetuin-A with risk of diabetes differed between women and men (p-interaction = 0.001). Each standard deviation (SD) higher fetuin-A concentration (0.10 g/L) was associated with a hazard ratio (HR) of 1.51 (95% CI: 1.32-1.74, p &lt;0.0001) among women and an HR of 1.12 (95% CI: 0.94-1.32, p = 0.20) among men. With additional adjustment for liver fat, associations were slightly attenuated in both women (HR per SD fetuin-A = 1.37, 95% CI: 1.19-1.59, p&lt;0.0001) and men (HR = 1.06, 95% CI: 0.90-1.24, p = 0.40). Additional adjustment for other clinical variables had minimal impact on multivariable-adjusted estimates (Figure). Associations did not differ by degree of liver fat content (p-heterogeneity &gt;0.25 for both women and men). Conclusions: Fetuin-A was associated with diabetes risk, particularly in women, even after adjustment for liver fat.
THE EFFECT OF A VITAMIN B COMPLEX ON THE RESIDUAL NEURAL DISTURBANCES OF TREATED PERNICIOUS ANEMIA
Authors: J. C. Zillhardt, Isabel Howard, William P. Murphy
Journal: Annals of Internal Medicine (1941)

Article1 July 1941THE EFFECT OF A VITAMIN B COMPLEX ON THE RESIDUAL NEURAL DISTURBANCES OF TREATED PERNICIOUS ANEMIAJ. C. ZILLHARDT, ISABEL HOWARD, WILLIAM P. MURPHYJ. C. ZILLHARDTSearch for more papers by this author, ISABEL HOWARDSearch for more papers by this author, WILLIAM P. MURPHYSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-15-1-44 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptUpon completion of the study of the effect of thiamin on the residual neural disturbances of treated pernicious anemia the experiment was repeated under the same conditions using a vitamin B complex. A group of 13 patients was used in this work. As with the individuals treated in the aforementioned study, neurological manifestations were present at the time the diagnosis of pernicious anemia was first made. With adequate liver therapy there was improvement of the neural disturbances. This improvement had tapered off to a more or less stationary level and there remained neural signs and symptoms that neither improved nor... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: *Received for publication March 30, 1940.From the Medical Clinic of the Peter Bent Brigham Hospital.†Furnished by Lederle Laboratories, Inc. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 July 1941Volume 15, Issue 1Page: 44-44KeywordsB vitaminsHospitalsLiverPernicious anemiaSigns and symptomsThiamine ePublished: 1 December 2008 Issue Published: 1 July 1941 PDF downloadLoading ...
AIDS in South Africa Takes Center Stage
Authors: J Stephenson
Journal: JAMA (2000)

AIDS in South Africa takes center stage at the 13th International AIDS Conference in Durban South Africa.  An estimated 3.5 million South Africans and about 13% of all adults aged 20-64 years are HIV-infected and as many as 6-10 million could die of AIDS in the next 10-15 years.  By 2010 as many as 6 million people could be living with HIV/AIDS unless major behavioral changes alter the course of the epidemic.  In addition AIDS-related deaths are expected to increase from 120000 in 2000 to as many as 635000 in 2010 and an estimated 1.5 million children younger than 15 years will be orphaned.  Despite the alarming statistics the prevention message has not yet been embraced by many South Africans and denial about the epidemic still persists.  With no HIV vaccine in the horizon fighting the epidemic requires new targeted prevention programs to reach those who are not yet infected particularly the youth.  Strategies should be targeted at attitudinal and behavioral change related to HIV risk and prevention.  A 5-year prevention plan has been launched by the government promoting safer sex voluntary HIV testing improving access to treatment and support services for people with HIV/AIDS and other sexually transmitted disease and increasing facilities for infected children and for AIDS orphans.
Intrathecal Ziconotide for Chronic Pain—Reply
Authors: Peter S. Staats
Journal: JAMA (2004)

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ABC of oral health: Improving occlusion and orofacial aesthetics: orthodontics
Authors: S. Cunningham
Journal: BMJ (2000)

Malocclusion is the abnormal positioning of the teeth or jaws. It is a variation of growth and development and can affect a person's bite (occlusion), ability to clean teeth properly, gingival health, jaw growth, speech development, and appearance.



Patient with crowded teeth and malocclusion (top) and after orthodontic treatment (bottom)



The shape and size of the face, jaws, and teeth are mainly inherited, but environmental factors can also have an impact. Factors as diverse as skeletal muscle pathology1 and sucking a digit (thumb or finger) can substantially influence the growth of the face and dentition.

Treatment of disorders such as crowded or protruding teeth may improve both aesthetics and oral function. In addition, prominent teeth can be damaged easily during childhood. The dental specialty most concerned with problems of facial growth, development of occlusion, and the prevention and correction of associated anomalies is orthodontics. The improvement of occlusion and aesthetics using restorative dental techniques is discussed in the next article.

The demand for orthodontic treatment is increasing to such an extent that an objective index of orthodontic treatment need (IOTN) has been established to ensure that resources are directed to patients with the greatest clinical need and who are likely to benefit most.2 3

#### Prevention or treatment of malocclusion may help

Apart from a thorough history and examination, photographs of the face and teeth and models of the teeth are used to provide a record and facilitate treatment planning. Several types of radiograph may also be needed. Most commonly used are panoramic radiographs, which show all the upper and lower teeth in biting position as well as any teeth still developing within the jaws, and a lateral cephalometric radiograph, which shows the relation of the teeth and jaws to the face and base of the skull.

### Treatment

#### Tooth extraction

Carefully …