tbuckley/cabot-search huggingface dataset:
Narrative Review: The New Epidemic of <i>Clostridium difficile</i>–Associated Enteric Disease
Authors: John G. Bartlett
Journal: Annals of Internal Medicine (2006)

Antibiotic-associated diarrhea and colitis were well established soon after antibiotics became available. Early work implicated Staphylococcus aureus, but in 1978 Clostridium difficile became the established pathogen in the vast majority of cases. In the first 5 years (1978 through 1983), the most common cause was clindamycin, the standard diagnostic test was the cytotoxin assay, and standard management was to withdraw the implicated antibiotic and treat with oral vancomycin. Most patients responded well, but 25% relapsed when vancomycin was withdrawn. During the next 20 years (1983 through 2003), the most commonly implicated antibiotics were the cephalosporins, which reflected the rates of use; the enzyme immunoassay replaced the cytotoxin assay because of speed of results and technical ease of performance; and metronidazole replaced vancomycin as standard treatment, and principles of containment hospitals became infection control and antibiotic control. During the recent past (2003 to 2006), C. difficile has been more frequent, more severe, more refractory to standard therapy, and more likely to relapse. This pattern is widly distributed in the United States, Canada, and Europe and is now attributed to a new strain of C. difficile designated BI, NAP1, or ribotype 027 (which are synonymous terms). This strain appears more virulent, possibly because of production of large amounts of toxins, and fluoroquinolones are now major inducing agents along with cephalosporins, which presumably reflects newly acquired in vitro resistance and escalating rates of use. The recent experience does not change principles of management of the individual patient, but it does serve to emphasize the need for better diagnostics, early recognition, improved methods to manage severe disease and relapsing disease, and greater attention to infection control and antibiotic restraint.
Parathyroidectomy reduces 25-hydroxyvitamin D3-1 alpha-hydroxylase activity in the hypocalcemic vitamin D-deficient chick.
Authors: B E Booth, H C Tsai, R C Morris
Journal: Journal of Clinical Investigation (1977)

To test the hypothesis that in the vitamin D-deficient state the activity of 25-hydroxyvitamin D3-1 alpha-hydroxylase (25-OHD3-1 alpha-hydroxylase) is modulated by parathyroid hormone and the plasma concentration of phosphate only in the presence of small amounts of 1,25-dihydroxyvitamin D3 (or some other metabolite of vitamin D), we measured the activity of this enzyme 24 h after parathyroidectomy (PTX) in frankly hypocalcemic, vitamin D-deficient chicks that were not supplemented with vitamin D or one of its metabolites. The otherwise predictable complications of PTX in this metabolic setting (hypocalcemia of increasing severity, tetany, moribundity, and death) were prevented by continuous intravenous administration of calcium (as a solution of calcium chloride/calcium gluconate 1:1) through a catheter in the external jugular vein placed at the time of PTX. The findings were as follows: (a) The activity of 25-OHD3-1 alpha-hydroxylase was significantly less in the parathyroidectomized group than in the sham-operated control chicks (P less than 0.001). (b) The reductive effect of PTX on the activity of this enzyme was significantly attenuated when hypophosphatemia was increased in severity by administration of glucose. (c) In the post-PTX state the activity of 25-OHD3-1 alpha-hydroxylase and plasma concentration of phosphate were significantly, inversely related (P less than 0.001). (d) In the sham-operated control group the activity of this enzyme and the plasma concentration of phosphate were not significantly correlated. These findings indicate that in the vitamin D-deficient state, both circulating parathyroid hormone and the plasma concentration of phosphate can significantly modulate the activity of 25-OHD3-1 alpha-hydroxylase in the absence of vitamin D or its metabolites. The findings also suggest that in the vitamin D-deficient state the plasma concentration of phosphate modulates the activity of this enzyme only when the concentration of circulating parathyroid hormone is not increased.
Cardiopulmonary Monitoring of Critically Ill Patients
Authors: Paul D. Goldenheim, Homayoun Kazemi
Journal: New England Journal of Medicine (1984)

Arterial LinesArterial lines are indicated for continuous monitoring of blood pressure and for very frequent sampling of arterial blood. Inserting arterial lines is a relatively safe and inexpensive procedure. Major complications include infection and thrombosis. The rate of catheter-associated sepsis (demonstrated by positive cultures of blood and the catheter tip that yield the same organism, with no other apparent source of infection) is about 4 per cent.16 Sepsis is more likely with surgical cutdowns if the catheter is left in place for more than four days or if evidence of local inflammation is present. The pressure transducer or flushing . . .
Correction of murine β-thalassemia after minimal lentiviral gene transfer and homeostatic in vivo erythroid expansion
Authors: Olivier Negre, Floriane Fusil, Charlotte Colomb, Shoshannah Roth, Beatrix Gillet-Legrand, Annie Henri, Yves Beuzard, Frederic Bushman, Philippe Leboulch, Emmanuel Payen
Journal: Blood (2011)
Uncontrolled and Apparent Treatment Resistant Hypertension in the United States, 1988 to 2008
Authors: Brent M. Egan, Yumin Zhao, R. Neal Axon, Walter A. Brzezinski, Keith C. Ferdinand
Journal: Circulation (2011)

Background— Despite progress, many hypertensive patients remain uncontrolled. Defining characteristics of uncontrolled hypertensives may facilitate efforts to improve blood pressure control. Methods and Results— Subjects included 13 375 hypertensive adults from National Health and Nutrition Examination Surveys (NHANESs) subdivided into 1988 to 1994, 1999 to 2004, and 2005 to 2008. Uncontrolled hypertension was defined as blood pressure ≥140/≥90 mm Hg and apparent treatment-resistant hypertension (aTRH) when subjects reported taking ≥3 antihypertensive medications. Framingham 10-year coronary risk was calculated. Multivariable logistic regression was used to identify clinical characteristics associated with untreated, treated uncontrolled on 1 to 2 blood pressure medications, and aTRH across all 3 survey periods. More than half of uncontrolled hypertensives were untreated across surveys, including 52.2% in 2005 to 2008. Clinical factors linked with untreated hypertension included male sex, infrequent healthcare visits (0 to 1 per year), body mass index &lt;25 kg/m 2 , absence of chronic kidney disease, and Framingham 10-year coronary risk &lt;10% ( P &lt;0.01). Most treated uncontrolled patients reported taking 1 to 2 blood pressure medications, a proxy for therapeutic inertia. This group was older, had higher Framingham 10-year coronary risk than patients controlled on 1 to 2 medications ( P &lt;0.01), and comprised 34.4% of all uncontrolled and 72.0% of treated uncontrolled patients in 2005 to 2008. We found that aTRH increased from 15.9% (1998–2004) to 28.0% (2005–2008) of treated patients ( P &lt;0.001). Clinical characteristics associated with aTRH included ≥4 visits per year, obesity, chronic kidney disease, and Framingham 10-year coronary risk &gt;20% ( P &lt;0.01). Conclusion— Untreated, undertreated, and aTRH patients have consistent characteristics that could inform strategies to improve blood pressure control by decreasing untreated hypertension, reducing therapeutic inertia in undertreated patients, and enhancing therapeutic efficiency in aTRH.
ARTIFICIAL RESPIRATION IN ELECTRIC SHOCK AND GAS POISONING
Authors: CECIL K. DRINKER
Journal: JAMA (1924)

Those of us who are engaged in such aspects of physiology as bring us in touch with practical problems in respiration are made aware of the fact every day that, not only are persons being overcome in novel and curious ways, but novel and curious remedies are being suggested for their revival. The lectures of Sir Arthur Keith on artificial respiration, delivered in 1909, call attention to the variety of methods used in England since the foundation of the Royal Humane Society in 1774, and these lectures are a commentary on our present day experience. He recounts the vogue of rectal instillations of tobacco smoke as a means of resuscitation after drowning. This method received high endorsement. Testimonials from eminent authorities seemed to prove its success. Similarly, a few weeks ago, I was pestered rather persistently to endorse a method of resuscitation which had as its basis an elaborate system
EVALUATION OF THE ELECTROENCEPHALOGRAMS OF SCHIZOPHRENIC PATIENTS
Authors: P. A. DAVIS
Journal: American Journal of Psychiatry (1940)

A study of 132 schizophrenic patients at Metropolitan State Hospital and McLean Hospital is in progress. The EEG's of these schizophrenics fall into three groups: Group I: Essentially normal. Group II: Dysrhythmic type, which is indistinguishable from EEG's of individuals known to have convulsive disorders. Group III: "Choppy" type, which suggests the possibility of a pathological condition in the brain. Patients in Group II frequently present in their histories the same syndrome as found in epileptics. These patients are either diagnosed as "catatonic schizophrenia" or give a history on the hospital ward of catatonic stupors and excitements.
Serial measurement of plasma cortisol in lung cancer.
Authors: I Lichter, N E Sirett
Journal: Thorax (1975)

Serial plasma cortisol estimations were carried out in 81 male lung cancer patients and in a control group of 50 male subjects with conditions other than lung cancer. It was found that group mean plasma cortisol levels, both in the morning and in the afternoon, were greater in the lung cancer patients than in the no-cancer control group. However, long-term assessment four years after the beginning of the study showed that high plasma cortisol levels were found predominantly in cancer patients within six months of death. If such patients are excluded from the study, there is no significant difference in group mean plasma cortisol levels between male lung cancer patients and a male control group.
Screening for fetal malformations using ultrasound and measurements of alpha-fetoprotein in maternal serum.
Authors: P H Persson, S Kullander, G Gennser, L Grennert, C B Laurell
Journal: BMJ (1983)

Fetal ultrasound combined with semiquantitative measurements of alpha-fetoprotein in maternal serum was used for early detection of neural tube defects and omphalocele in 10 147 pregnancies. The accurate assessment of gestational age, obtained by ultrasound, facilitated evaluation of alpha-fetoprotein concentrations in selecting cases for amniocentesis. The advantage of screening with two independent methods is suggested by the finding that eight out of 10 cases with malformations (spina bifida, encephalocele, anencephalus, omphalocele) were detected when both methods were used. Screening by routine ultrasound alone detected only four malformations and by measurement of alpha-fetoprotein alone only seven. The results suggest that, in a low risk population, ultrasound should be combined with the measurement of alpha-fetoprotein in screening for neural tube defects. Measurement of alpha-fetoprotein is indispensable in detection of the small neural tube defects, where the fetus would survive with severe sequelae. The semi-quantitative analysis of alpha-fetoprotein that may be used in combination with ultrasound examination is of negligible cost.
Long-term endothelial dysfunction is more pronounced after stenting than after balloon angioplasty in porcine coronary arteries
Authors: Heleen M.M. van Beusekom, Deirdre M. Whelan, Sjoerd H. Hofma, Stefan C. Krabbendam, Victor W.M. van Hinsbergh, Pieter D. Verdouw, Willem J. van der Giessen
Journal: Journal of the American College of Cardiology (1998)
Melasma Induced by Oral Contraceptive Drugs
Authors: Sorrel Resnik
Journal: JAMA (1967)

In a clinic group of 212 patients taking an oral contraceptive agent, melasma developed in 61 (29%) as a direct result of the drug. Both combination and sequential oral contraceptives showed the capability to produce this facial hyperpigmentation, which does not completely regress after cessation, in contrast to melanoderma in pregnancy. It appears that continued use of the newer oral contraceptive agents will lead to the conclusion that all are capable of producing hyperpigmentation. Eighty-seven percent (52 of 61) having melasma from oral contraceptives also had melanoderma during pregnancy. Thus, melasma in pregnancy can be used as an indicator in detecting the susceptible individual. The perplexing question of estrogen or progesterone as the cause of melasma remains unanswered. No lessening in the incidence of melasma could be found with decreased dosage in estrogen component.
Tuberculosis in the UK--time to regain control
Authors: I. Abubakar, M. Lipman, C. Anderson, P. Davies, A. Zumla
Journal: BMJ (2011)

Tuberculosis is increasing in incidence in many large cities in the UK. This contrasts with stable or declining rates in most western European countries. <b>Ibrahim Abubakar and colleagues</b> explain why and describe what needs to be done to regain control
Effect of Recombinant Soluble P-Selectin Glycoprotein Ligand-1 on Leukocyte-Endothelium Interaction In Vivo
Authors: Rosario Scalia, Reid Hayward, Valerie E. Armstead, Alexander G. Minchenko, Allan M. Lefer
Journal: Circulation Research (1999)

Abstract —Traumatic shock induces profound pathophysiological alterations and initiates inflammatory reactions in many tissues, thus resulting in acute multiple organ damage (eg, intestine, pancreas, and liver). In the rat, Noble-Collip drum trauma increases P-selectin expression on the vascular endothelium as a result of loss of endothelium-derived NO. Here we postulated that blockade of the earliest steps in leukocyte adhesion (ie, leukocyte rolling) via administration of a recombinant soluble form of P-selectin glycoprotein ligand-1 (PSGL-1; the recombinant soluble form is rsPSGL.Ig) would attenuate selectin-mediated events observed in the rat during traumatic shock. Using intravital microscopy of the rat mesenteric microvasculature, we found that intravenous infusion of rsPSGL.Ig significantly inhibited leukocyte-endothelium interaction (ie, leukocyte rolling, adherence, and transmigration) induced by traumatic shock as well as by activation of the microvascular endothelium with 50 μmol/L N G -nitro- l -arginine methyl ester. Immunohistochemical detection of P-selectin on the mesenteric venular endothelial surface demonstrated that rsPSGL.Ig functionally neutralizes effects of P-selectin on the endothelial cell surface rather than attenuating P-selectin expression. Systemic administration of rsPSGL.Ig to traumatized rats prolonged survival time and survival rate, significantly attenuating ileal myeloperoxidase activity and significantly preserving mesenteric endothelial function. Furthermore, PSGL-1 mRNA levels were significantly increased in the blood of traumatized rats and were reduced after systemic administration of rsPSGL.Ig. Thus, soluble recombinant forms of PSGL-1 are able to ameliorate acute shock states by suppressing selectin-mediated leukocyte-endothelium interaction at both the functional and molecular levels.
Additional thyroid dose factor from transportation sources in Russia after the Chernobyl disaster.
Authors: E M Parshkov, I V Chebotareva, V A Sokolov, C E Dallas
Journal: Environmental Health Perspectives (1997)

Beginning approximately 4 years after the Chernobyl nuclear accident a steady increase in the incidence of thyroid cancer was observed in children and adolescents of the Bryansk Oblast, which received the highest level of radionuclide contaminants in Russia. We examined the spatial relationship between the residence location of patients with identified thyroid cancer (0-18 years old at the time of the accident) and a number of geographic parameters to better account for the etiology of thyroid cancer spatial distribution. Geographic parameters analyzed included spatial distribution of 137Cs and 131I in soil, population demographics, measurements and reconstructions. of absorbed thyroid 131I doses in the population, and maps of major transportation arteries. An interesting finding is the lack of a consistent correlation between the spatial distribution of radionuclides in the soil and thyroid cancer incidence. Instead, most of the thyroid cancer cases were diagnosed in settlements situated on major railways and roads. Correlating population with thyroid cancer cases and transportation arteries reveals a much higher cancer rate on or near major roads and railways than at a distance from them, again independent of radionuclide soil concentration. There are other important factors, of course, that must be considered in future evaluations of this phenomenon. These include the influence of iodine endemic zones, genetic predisposition to thyroid cancer, and duration of residence time in contaminated areas. The feasibility of radionuclide transport on railways and roads is discussed, together with the vectors for transfer of the contaminants to the human population. Developing a model to reconstruct the radiation dose to the thyroid over time in this geographic region is proposed in light of the impact of transportation arteries. Specific studies are outlined to provide the data necessary to develop this model as well as to better characterize the feasibility and scientific validity of the contribution to human health effects of this transport factor. Transport factor refers to the transport of radionuclides on transportation arteries and the transfer of these agents to the human population residing in the vicinity of these arteries. If the impact on thyroid cancer of the transport of radionuclides on major railways and roads is indeed significant, a major reappraisal of the risk of large-scale radioactive release into the environment is necessary.
Women need better information on routine mammography: Understanding of principles of screening must be improved
Authors: J. Nottingham
Journal: BMJ (2003)

Editor—I read the paper by Thornton et al and the reply by Patnick (see next letter) with interest.1,2 Both the NHS breast screening programme and cervical screening programme have made great efforts to improve the understanding by women of the principles of screening since Anderson and I wrote a paper in 1999 that was critical of the information given.3 Unfortunately there is clearly someway to go.

Patients remain confused. The BBC, quoting from a report by the Cancer Research UK psychosocial oncology group at the University of Sussex, says that patients were flummoxed by terms used to describe screening procedures for breast and bowel cancer and that more than half of the study group either did not know or showed partial understanding of breast cancer screening techniques such as mammography.4

Disappointingly, the leaflet to which Patnick refers (Breast screening the facts) omits to mention the potential consequences of being screened—namely, invasive biopsy procedures or even mastectomy, with their attendant morbidity.2 Although these eventualities may only affect a minority of those being screened, they are surely worthy of mention in a pamphlet purporting to tell it how it is, especially since most of these women are healthy before undertaking the screening test.

Given the time and effort spent in ensuring that bereaved relatives are given appropriate information before their next of kin undergoes a postmortem examination, surely it is time the opportunity to provide truly informed consent was given to participants in screening programmes so they know exactly what they are signing up to.
A National Study of AIDS and Residency Training: Experiences, Concerns, and Consequences
Authors: Rodney A. Hayward, Martin F. Shapiro
Journal: Annals of Internal Medicine (1991)

Objective: To examine residents' experiences in the care of patients with the acquired immunodeficiency syndrome (AIDS), and to examine factors that may influence their attitudes about such care. Design: Cross-sectional, self-administered questionnaire survey conducted in 1989. Participants: All senior internal medicine and family medicine residents in ten geographically representative states who were identified through the 1986 National Residency Matching Program. Measurements and Main Results: Seventy-four percent of residents reported that patients with AIDS accounted for 5% or more of general medicine admissions, and 50% of residents reported that they were currently following one or more human immunodeficiency virus (HIV)-infected patients in their continuity clinics. Among residents who had provided ambulatory care to patients with AIDS, 77% felt that it was an excellent educational experience, and among those who planned to do general primary care in their future practices, 74% planned on providing primary care to patients with AIDS. However, 61% expressed concerns about the adequacy of their training in AIDS ambulatory care. A greater amount of contact with outpatients who had AIDS, but not with inpatients who had AIDS, was associated with residents' intending to provide AIDS primary care in their future practices. Among all residents, 23% reported that, if given a choice, they would not provide care to any patients with AIDS, and 23% reported that they would not work in an area with a high prevalence of AIDS because of concern about contracting the syndrome. Nine percent of residents reported that they had been exposed to a blood-contaminated needlestick from an HIV-seropositive patient. Conclusions: Although most residents have substantial contact with inpatients and outpatients with AIDS, most still find their education in AIDS ambulatory care to be deficient. A minority of residents would prefer not to care for patients with AIDS. Residency curricula should include training and experience in ambulatory AIDS care, explicitly address negative attitudes toward caring for patients with AIDS, and include programs to reduce needlestick exposures.
Patients Leaving Emergency Departments Without Being Seen by a Physician-Reply
Authors: Andrew B. Bindman
Journal: JAMA (1992)

<h3>In Reply.</h3> —We agree with Dr Hass that emergency department overcrowding is a sign of the inadequate provision of ambulatory care. Increasing the availability of primary care by improving the incentives for providing those services should decrease the demand for emergency department services. However, the distribution of that care will remain inequitable as long as a significant proportion of the population does not have an adequate way to pay for these services. While charity care might bridge some gaps, recent history suggests that it is far from sufficient to guarantee universal access. Dr Kunst suggests that universal access to care and cost containment are mutually exclusive. To be sure, expanding coverage by simply building on the inefficient health system that currently exists in the United States invites aggravation of the cost predicament. However, the US General Accounting Office and others have demonstrated the potential for administrative savings from national health