tbuckley/cabot-search huggingface dataset:
Tetanus Immunization in Adults-Reply
Authors: Roland W. Sutter
Journal: JAMA (1994)

<h3>In Reply.</h3> —A single tetanus booster for adults at the age of 65 years, as proposed by Drs Balestra and Littenberg,<sup>1</sup>may appear to be an appropriate tetanus prevention policy on the basis of cost-effectiveness analysis. For several reasons, however, we do not recommend changing the vaccination policy of decennial booster doses of tetanus and diphtheria toxoid (Td) at this time. First, neither person who developed tetanus in Kansas in 1993 had a history of receiving any tetanus vaccination.<sup>2</sup>Furthermore, serologic surveys have indicated that 31% to 71% of older adults (who may have never received the primary three-dose Td series) lack protective levels of antibody against tetanus.<sup>3</sup>Although compliance with the decennial Td vaccination policy recommended by the Advisory Committee on Immunization Practices (ACIP)<sup>4</sup>may be suboptimal, these doses may provide catch-up immunizations to people who never received the primary series. Second, many persons, such
PREDICTORS OF HIGH ON-TREATMENT PLATELET REACTIVITY EARLY AFTER CLOPIDOGREL LOADING IN ST ELEVATION MYOCARDIAL INFARCTION PATIENTS
Authors: Ioanna Xanthopoulou, Grigorios Tsigkas, Anastasia Damelou, Konstantinos C. Theodoropoulos, George Kassimis, Konstantinos Chouchoulis, Periklis Davlouros, John Chiladakis, George Hahalis, Dimitrios Alexopoulos
Journal: Journal of the American College of Cardiology (2012)
[600] EFFICACY OF RIBAVIRIN PLUS INTERFERON-ALFA IN ELDERLY PATIENTS WITH CHRONIC HEPATITIS C
Authors: T. Honda, Y. Katano, F. Urano, K. Hayashi, M. Ishigami, I. Nakano, K. Yoshioka, H. Toyoda, T. Kumada, H. Goto
Journal: Journal of Hepatology (2007)
A Cost-Effectiveness Analysis of Combination Antiplatelet Therapy for High-Risk Acute Coronary Syndromes: Clopidogrel plus Aspirin versus Aspirin Alone
Authors: Mark D. Schleinitz, Paul A. Heidenreich
Journal: Annals of Internal Medicine (2005)

Background: Although clopidogrel plus aspirin is more effective than aspirin alone in preventing subsequent vascular events in patients with unstable angina, the cost-effectiveness of this combination has yet to be examined in this high-risk population. Objective: To determine the cost-effectiveness of clopidogrel plus aspirin compared with aspirin alone. Design: Cost–utility analysis. Data Sources: Published literature. Target Population: Patients with unstable angina and electrocardiographic changes or non–Q-wave myocardial infarction. Time Horizon: Lifetime. Perspective: Societal. Interventions: Combination therapy with clopidogrel, 75 mg/d, plus aspirin, 325 mg/d, for 1 year, followed by aspirin monotherapy, was compared with lifelong aspirin therapy, 325 mg/d. Outcome Measures: Lifetime costs, life expectancy in quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio. Results of Base-Case Analysis: Patients treated with aspirin alone lived 9.51 QALYs after their initial event and incurred expenses of $127 700; the addition of clopidogrel increased life expectancy to 9.61 QALYs and costs to $129 300. The incremental cost-effectiveness ratio for clopidogrel plus aspirin compared with aspirin alone was $15 400 per QALY. Results of Sensitivity Analyses: The analysis of 1 year of therapy was robust to all sensitivity analyses. In the probabilistic sensitivity analysis, fewer than 3% of simulations resulted in cost-effectiveness ratios over $50 000 per QALY. The cost-effectiveness of longer combination therapy depends critically on the balance of thrombotic event rates, durable efficacy, and the increased bleeding rate in patients taking clopidogrel. Limitations: This analysis may not apply to patients with severe heart failure, those undergoing long-term anticoagulant therapy, those recently managed with revascularization, or those undergoing short-term treatment with glycoprotein IIb/IIIa inhibitors. Conclusions: In patients with high-risk acute coronary syndromes, 1 year of therapy with clopidogrel plus aspirin results in greater life expectancy than aspirin alone, at a cost within the traditional limits of cost-effectiveness. The durable efficacy of clopidogrel relative to the risk for hemorrhage should be further explored before more protracted therapy can be recommended.
Status Asthmaticus-Reply
Authors: Robert M. Senior
Journal: JAMA (1975)

<h3>In Reply.—</h3> The letter of Drs Rothstein and Shapiro regarding our article, "Status Asthmaticus" (231:1277, 1975), makes several important points on which we wish to comment. First, we would emphasize that our remarks were directed mainly at the adult asthmatic patient. The distinction between the adult and small child is important because, as Drs Rothstein and Shapiro imply, children may be more responsive to sympathomimetic agents. Also, significant metabolic acidosis accompanying status asthmaticus is not uncommon in children, whereas it is unusual in adults. We agree that vigorous hydration and large doses of antiinflammatory corticosteroids may result in fluid retention and that caution is warranted, especially in the patient with underlying cardiac disease. Indeed, attention to daily weights and to fluid intake and output are crucial for the avoidance of overhydration and pulmonary edema. In suggesting a dosage of steroids, we were not recommending hydrocortisone necessarily as the steroid of
Granulocyte Transfusions in Infants-Reply
Authors: Ian M. Smith
Journal: JAMA (1978)

In Reply.—  Dr Strauss's letter strengthens and adds to the comment I made in regard to leukocyte transfusions in children. He pointed out that the children responded to only one or two granulocyte transfusions, which may illustrate the relative volume differences in the transfusion and the size of the patient. I would thoroughly agree that this must be regarded as experimental therapy for which informed consent must be obtained. No doubt in the near future there will be control studies available in children. I thank Dr Strauss for his interest in this matter.
Rectal examination in general practice.
Authors: T W Hennigan, P J Franks, D B Hocken, T G Allen-Mersh
Journal: BMJ (1990)

OBJECTIVE--To investigate factors influencing a general practitioner9s decision to do a rectal examination in patients with anorectal or urinary symptoms. DESIGN--Postal questionnaire survey. SETTING--General practices in inner London and Devon. SUBJECTS--859 General practitioners, 609 (71%) of whom returned the questionnaire. MAIN OUTCOME MEASURES--Number of rectal examinations done each month; the indication score, derived from answers to a question asking whether the respondent would do a rectal examination for various symptoms; and the confidence score, which indicated the respondent9s confidence in the diagnosis made on rectal examination. RESULTS--279 General practitioners did five or fewer rectal examinations each month and 96 did more than 10 each month. Factors significantly associated with doing fewer rectal examinations were a small partnership and being a female general practitioner, and the expectation that the examination would be repeated. Lack of time in the surgery, and a waiting time of less than two weeks for an urgent outpatient appointment were also important. General practitioners were deterred from doing rectal examinations by reluctance of the patient (278), the expectation that the examination would be repeated (141), and lack of time (123) or a chaperone (39). Confidence in diagnosis was significantly associated with doing more rectal examinations, the perception of having been well taught to do a rectal examination at medical school, and being a male general practitioner. CONCLUSIONS--Factors other than clinical judgment influence the frequency of rectal examination in general practice. Rectal examination may become commoner with the trend towards larger group practices and if diagnostic confidence is increased and greater emphasis put on rectal examination in undergraduate and postgraduate teaching.
HAS TUBERCULOUS COW'S MILK CAUSATIVE INFLUENCE IN TUBERCULOSIS OF INFANCY?
Authors: FRANK S. PARSONS
Journal: JAMA (1895)

In the discussion of this subject, two questions enter into it, upon which the etiology of tuberculosis, and the degree of danger arising from the ingestion of tuberculous cow's milk, largely depend. Is tuberculosis<i>solely</i>dependent on the tubercle bacillus for its development? Is the tubercle bacillus found in the milk of<i>all</i>tuberculous cows? As to the first question, I believe, at the present day, it should be generally admitted that we must look beyond the simple introduction of the so-called germ to the system for the production of this disease and recognize a condition that is not inherent in the healthy human organism upon which the development of tuberculosis depends. The absence of this condition precludes the possibility of infection from the germ, because of the absence of a cultivation field. The presence of this condition establishes a reason for great apprehension in regard to the
Study raises concerns over racial discrimination in MRCGP exam
Authors: Z. Kmietowicz
Journal: BMJ (2013)

Racial discrimination may be behind the high failure rate of UK ethnic minority doctors in the clinical skills part of the examination for membership of the Royal College of General Practitioners (MRCGP), researchers say after analysing two years of results.

The study of pass rates between 2010 and 2012, published in the BMJ , found that British doctors from ethnic minority groups were nearly four times as likely to fail the clinical skills assessment of the MRCGP exam at their first attempt as white UK candidates (17% versus 4.5%) (odds ratio 3.5 (95% confidence interval 2.7 to 4.6); P<0.001).1

In the clinical skills assessment, examiners observe a doctor’s clinical expertise in a range of scenarios from general practice in which actors play patients.

The difference between non-white …
Serious Arrhythmias with Vasopressors During Halothane Anesthesia in Man
Authors: Alfred J. Catenacci, Joseph R. DiPalma, John D. Anderson, Warren E. King
Journal: JAMA (1963)

THE INTRODUCTION OF a new anesthetic agent presents many clinical problems dealing with the concomitant use of other drugs, which might not be convincingly recorded in the data of the pilot studies of the new agent. The use of various vasopressor drugs during halothane (Fluothane) anesthesia presents such a problem. Raventos<sup>1</sup>has advised against the use of epinephrine with halothane. In this respect, it resembles its congener, chloroform. When cyclopropane, a nonhalogenated hydrocarbon, dominated the anesthesiological literature some 25 years ago, the ardenalin-hydrocarbon arrhythmia of Levy<sup>2</sup>was known to every novice and experienced clinician who used this anesthetic agent. Those who experienced these frightful arrhythmias that went on to cardiac arrest believed in these hazards and avoided such combinations. Other investigators and clinicians were never really convinced that such incompatibilities existed and attributed their occurrences to faulty administration of cyclopropane. The old cliche, "history repeats itself," describes
A10.17 Interleukin-36α is Expressed by Synovial Plasma Cells and Induces Cytokine Production in Human Fibroblasts
Authors: Silke Frey, Anja Derer, Maria-Elena Messbacher, Serena Bugatti, D Baeten, Carlomaurizio Montecucco, Georg Schett, Axel J Hueber
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background and Objectives</h3> The interleukin (IL)-36α is a recently described member of the IL-1 cytokine family with pro-inflammatory and clearly pathogenic properties in psoriasis arthritis (PsA). The majority of patients with PsA and rheumatoid arthritis (RA) benefit from cytokine blocking therapies against TNFα; however, despite novel developments, subgroups of patients do not respond to this therapy. Therefore it is necessary to get a better understanding of the pathogenesis of synovitis in PsA and RA to learn more about the complex cellular interplay and to develop new treatment approaches. Therefore, we wanted to determine the IL-36α expression in PsA compared to RA and osteoarthritis (OA). <h3>Materials and Methods</h3> Synovial tissue obtained from arthritis patients were stained for IL-36α, IL-36 receptor (IL-36R) and IL-36R antagonist (IL-36Ra) by immunohistochemistry and immunofluorescence. Lysates were tested for IL-36α by immunoblotting. Synovial fibroblasts (FLS) cultured in the presence of IL-36α were assessed for cytokine expression by quantitative real time PCR and Multiplex assay. IL-36α-induced signal transduction in FLS was analysed by immunoblotting. <h3>Results</h3> The IL-36R and its ligands IL-36α and IL-36Ra could be detected in inflammatory arthritis in the synovial lining layer as well as cellular infiltrates. IL-36α was significantly higher expressed in PsA and RA synovium compared to OA (p = 0.0011 and p &lt; 0.0001, respectively). No differences were seen in IL-36R and IL-36Ra. The expression of IL-36α was confirmed by western blot analysis. IL-36α induced expression of IL-6 and IL-8 in FLS. CD138-positive plasma cells were defined as a major cellular source for IL-36α. Functionally, IL-36α induced the expression of IL-6 and IL-8 in FLS through NF-κB/p38-activation. <h3>Conclusions</h3> Here, we describe that the novel cytokine IL-36α, mainly expressed by plasma cells, is upregulated in PsA and RA synovium and leads to IL-6 and IL-8 production by synovial fibroblasts. This finding needs further studies to determine if the IL-36 family can function as a potential target for arthritis therapy.
THE RESULTS OF THE SERUM TREATMENT IN THIRTEEN HUNDRED CASES OF EPIDEMIC MENINGITIS
Authors: Simon Flexner
Journal: The Journal of Experimental Medicine (1913)

The data brought together in this report have been gathered from a wide territory and for a period extending over several years. The antimeningitis serum was first employed in 1906 and the latest figures relating to its use included in this report were furnished in 1912. There is no longer doubt that the serum has come to be applied under conditions fairly representing all known manifestations of epidemic meningitis. Hence the test of the serum treatment may be regarded as having been a rigorous one. The initial difficulties surrounding the administration by direct subdural injection have been largely overcome and doubtless will be still further mastered. Already the serum is being successfully applied in private as well as in hospital practice. This gain will probably be reflected in a still further diminution of the mortality since early injection plays such a large part in determining the results achieved. The 1,300 cases studied in this report are a part only of a far greater number of cases actually treated with the serum supplied by the Rockefeller Institute. It was not found possible to secure histories of all the cases treated; but there is no reason to suppose that the results of the analysis would have been essentially different if reports of a still larger number of cases had been returned. The decision arrived at is not based upon statistical computations alone, but upon objective data as well that are not readily misinterpreted. The conclusion that follows was first stated in 1909 as the result of an analysis of 400 serum-treated cases. It is supported by the study of the larger series of cases just presented. "In view of the various considerations presented, the conclusion may be drawn that the antimeningitis serum, when used by the subdural method of injection, in suitable doses and at proper intervals, is capable of reducing the period of illness; of preventing, in large measure, the chronic lesions and types of the infection; of bringing about complete restoration of health, in all but a very small number of the recovered, thus lessening the serious, deforming, and permanent consequences of meningitis; and of greatly diminishing the fatalities due to the disease."
Negligence settlements in England increase sevenfold in five years
Authors: S. Mayor
Journal: BMJ (2002)

The <i>FKHL7</i> gene has been implicated in the pathogenesis of glaucoma/autosomal dominant iridogoniodysgenesis (IGDA) (<i>IRID1</i>). This has been supported by mutations in some glaucoma and IGDA patients and the development of anterior eye chamber anomalies in patients with 6p deletions affecting the 6p25 region. We report a case with anterior eye chamber anomalies and an interstitial deletion of 6p24-p25 that does not include the<i>FKHL7</i> gene, suggesting the possible additional involvement of another locus, within 6p24-6p25, in anterior eye chamber development. A candidate gene is<i>AP-2α</i>, which is contained within the deleted segment and plays a role in anterior eye chamber development.
Use of Non-Steroidal Anti-Inflammatory Drugs That Elevate Cardiovascular Risk: An Examination of Sales and Essential Medicines Lists in Low-, Middle-, and High-Income Countries
Authors: Patricia McGettigan, David Henry
Journal: PLoS Medicine (2013)

Certain non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., rofecoxib [Vioxx]) increase the risk of heart attack and stroke and should be avoided in patients at high risk of cardiovascular events. Rates of cardiovascular disease are high and rising in many low- and middle-income countries. We studied the extent to which evidence on cardiovascular risk with NSAIDs has translated into guidance and sales in 15 countries.Data on the relative risk (RR) of cardiovascular events with individual NSAIDs were derived from meta-analyses of randomised trials and controlled observational studies. Listing of individual NSAIDs on Essential Medicines Lists (EMLs) was obtained from the World Health Organization. NSAID sales or prescription data for 15 low-, middle-, and high-income countries were obtained from Intercontinental Medical Statistics Health (IMS Health) or national prescription pricing audit (in the case of England and Canada). Three drugs (rofecoxib, diclofenac, etoricoxib) ranked consistently highest in terms of cardiovascular risk compared with nonuse. Naproxen was associated with a low risk. Diclofenac was listed on 74 national EMLs, naproxen on just 27. Rofecoxib use was not documented in any country. Diclofenac and etoricoxib accounted for one-third of total NSAID usage across the 15 countries (median 33.2%, range 14.7-58.7%). This proportion did not vary between low- and high-income countries. Diclofenac was by far the most commonly used NSAID, with a market share close to that of the next three most popular drugs combined. Naproxen had an average market share of less than 10%.Listing of NSAIDs on national EMLs should take account of cardiovascular risk, with preference given to low risk drugs. Diclofenac has a risk very similar to rofecoxib, which was withdrawn from worldwide markets owing to cardiovascular toxicity. Diclofenac should be removed from EMLs.
Drug-Associated Cardiotoxicity
Authors: Aman U. Buzdar, Sewa S. Legha, Gabriel N. Hortobagyi, George R. Blumenschein
Journal: JAMA (1979)

To the Editor.—  The letter from Israel and Olson (240:1585, 1978) describing congestive heart failure with vinblastine sulfate in a patient previously treated with doxorubicin hydrochloride was of great interest to us. It was mentioned in the letter that recently the patient was treated with mitomycin and vinblastine. It was not clear whether the patient received vinblastine and mitomycin simultaneously or sequentially. It was suggested that vinblastine might have exacerbated doxorubicin-induced myocardial damage. Although vinblastine might have been the causal agent in this instance, the authors should clarify the temporal relationship of congestive heart failure and mitomycin therapy, because mitomycin could have played a role in precipitating this episode. Mitomycin has been reported to be cardiotoxic 1 and has also recently been shown to potentiate the subclinical damage induced by doxorubicin. 2
The Experience of Cardiac Surgery
Authors: C.P. Kimball, D. Quinlan, Florence Osborne, B. Woodward
Journal: Psychotherapy and Psychosomatics (1973)

180 patients undergoing cardiac surgery were evaluated psychiatrically prior to surgery and followed afterwards for a period of up to 30 months. An analysis of the interview led to the identification of variables identifying four groups having prognostic value for long-term survival. Psychological tests, surgical, and demographic variables were found to be less helpful for predicting survival. A previous study by the investigators demonstrated that short-term survival was more a function of operative variables and related to the postoperative factor orientation. A second postoperative factor, dysphoria correlating with complications, predicted long-term mortality. These findings suggest the need for the psychological evaluation of patients both preoperatively and postoperatively, in order to identify emotional and defensive states that are associated with untoward results. Whether psychotherapeutic intervention in these states would alter prognosis requires further study.
BCL-2 oncoprotein (p26) in splenic lymphoma with villous lymphocytes: A comparative study with other chronic B-cell disorders
Authors: Margarida Lima, Maria dos Anjos Teixeira, Maria Luís Queirós, Ana Helena Ribeiro dos Santos, Benvindo Justiça
Journal: American Journal of Hematology (1997)

We compared the expression of the BCL-2 oncoprotein (p26) on B cells from 24 patients with splenic lymphoma with circulating villous lymphocytes (SLVL) with that observed on normal, mature B lymphocytes and on neoplastic B cells from 91 patients with other chronic B-cell malignancies. SLVL B cells showed levels of p26 intermediate between those found on normal B lymphocytes and on neoplastic B cells from patients with other chronic B-cell lymphoproliferative disorders. Am. J. Hematol. 56:122–125, 1997. © 1997 Wiley-Liss, Inc.
Noninvasive imaging of pancreatic inflammation and its reversal in type 1 diabetes
Authors: S. E. Turvey
Journal: Journal of Clinical Investigation (2005)

A major stumbling block for research on and treatment of type 1 diabetes is the inability to directly, but noninvasively, visualize the lymphocytic/inflammatory lesions in the pancreatic islets. One potential approach to surmounting this impediment is to exploit MRI of magnetic nanoparticles (MNP) to visualize changes in the microvasculature that invariably accompany inflammation. MNP-MRI did indeed detect vascular leakage in association with insulitis in murine models of type 1 diabetes, permitting noninvasive visualization of the inflammatory lesions in vivo in real time. We demonstrate, in proof-of-principle experiments, that this strategy allows one to predict, within 3 days of completing treatment with an anti-CD3 monoclonal antibody, which NOD mice with recent-onset diabetes are responding to therapy and may eventually be cured. Importantly, an essentially identical MNP-MRI strategy has previously been used with great success to image lymph node metastases in prostate cancer patients. This success strongly argues for rapid translation of these preclinical observations to prediction and/or stratification of type 1 diabetes and treatment of individuals with the disease; this would provide a crucially needed early predictor of response to therapy.