tbuckley/cabot-search huggingface dataset:
Acute painless hepatitis in pregnancy--a cause for concern?
Authors: M. Ankcorn, C. Evans, S. T. Green
Journal: BMJ (2014)

A 26 year old woman, who was 19 weeks’ pregnant, was referred by her general practitioner with acute onset hepatitis and painless jaundice. She described a four week history of lethargy and palpitations on exertion. She also reported febrile episodes over the past three days, with no other clinical features on systems inquiry.

Her medical history included pre-eclampsia in her first pregnancy, which resulted in induction at 40+1 weeks and a caesarean section. She was taking aspirin at presentation but no other drugs. She had a history of allergy to penicillin and latex, which both caused a rash. She was married with a 2 year old son and worked as a pharmacy dispenser. She reported no recent travel outside the UK, no unusual hobbies, no risk factors for acquiring blood borne viruses, and no contacts with similar symptoms.

Baseline bloods tests showed alanine aminotransferase 1779 U/L (reference range 0-41; 1 U/L=0.02 µkat/L), total bilirubin 65 µmol/L (0-21), albumin 33 g/L (35-50), and prothrombin time of 11.4 s (9.7-11.5). Her full blood count was normal. During admission her transaminases rose and her prothrombin time increased.



### 1. What are the viral causes of hepatitis in pregnancy and which are of greatest concern?

#### Short answer

Viral causes include hepatitis A, B, C, D, and E, as well as cytomegalovirus and Epstein-Barr virus. These infections can occur during any trimester. Cytomegalovirus is associated with congenital infection and hepatitis E virus is associated with fulminant hepatitis in pregnancy. In rare cases herpes simplex and varicella zoster viruses can cause hepatitis and are associated with congenital and perinatal infection.

#### Long answer

Common causes of acute viral …
Definition of Germinal-Center B Cell Migration In Vivo Reveals Predominant Intrazonal Circulation Patterns
Authors: Anja E. Hauser, Tobias Junt, Thorsten R. Mempel, Michael W. Sneddon, Steven H. Kleinstein, Sarah E. Henrickson, Ulrich H. von Andrian, Mark J. Shlomchik, Ann M. Haberman
Journal: Immunity (2007)
Osteoprotegerin Deficiency and Juvenile Paget's Disease
Authors: Michael P. Whyte, Sara E. Obrecht, Patrick M. Finnegan, Jonathan L. Jones, Michelle N. Podgornik, William H. McAlister, Steven Mumm
Journal: New England Journal of Medicine (2002)

Juvenile Paget's disease, an autosomal recessive osteopathy, is characterized by rapidly remodeling woven bone, osteopenia, fractures, and progressive skeletal deformity. The molecular basis is not known. Osteoprotegerin deficiency could explain juvenile Paget's disease because osteoprotegerin suppresses bone turnover by functioning as a decoy receptor for osteoclast differentiation factor (also called RANK ligand).
Clinical recognition of early invasive malignant melanoma.
Authors: R M MacKie
Journal: BMJ (1990)

on those at high risk is adopted to the virtual exclusion of one based on population measures the impact on the community will be limited and bought at a high price.General prac- titioners and other doctors can contribute to population preventive efforts by helping all their patients to "take one small step to the left" on the distribution curve of risk of coronary heart disease.
Defective function of lymphokine-activated killer cells and natural killer cells in patients with hepatocellular carcinoma
Authors: Toshiji Saibara, Saburo Onishi, Hiroshi Sakaeda, Yasutake Yamamoto
Journal: Hepatology (1989)

Lymphokine-activated killer activity and natural killer activity in hepatocellular carcinoma patients were assessed. Maximum lymphokine-activated killer activity was induced at 3 to 5 days of incubation, and lymphokine-activated killer activity tended to increase in a manner dose dependent of recombinant interleukin-2. However, the maximum increase of lymphokine-activated killer activity in hepatocellular carcinoma was not as high as that of normal subjects or liver cirrhosis patients. Lymphokine-activated killer activity was impaired in hepatocellular carcinoma as compared to that in normal subjects. Hepatocellular carcinoma seemed to consist of two groups: i.e. a high-lymphokine-activated killer activity group and a low-lymphokine-activated killer activity group. Reduction of natural killer activity was also observed in hepatocellular carcinoma as compared with that in normal subjects and patients with liver cirrhosis. No correlation could be demonstrated between natural killer activity and lymphokine-activated killer activity in normal subjects, liver cirrhosis patients and hepatocellular carcinoma patients. With regard to the presence of HBsAg or α-fetoprotein concentration in the sera, there was no significant difference in natural killer and lymphokine-activated killer activity in hepatocellular carcinoma patients. Patients with a small mass lesion showed a low lymphokine-activated killer activity, and depressed lymphokine-activated killer activity was not necessarily related to tumor size. In comparison with the high-lymphokine-activated killer group, the low-lymphokine-activated killer group showed a significant decrease in γ-inter-feron production and a preserved function of indocyanine green clearance.
Factors Affecting Mammographic Visualization of the Breast After Augmentation Mammaplasty
Authors: Neal Handel
Journal: JAMA (1992)

<h3>Objective.</h3> —To measure the effect of various parameters on mammographic visualization of the breast after augmentation mammaplasty. <h3>Design.</h3> —Preoperative and postoperative mammography was performed in patients undergoing augmentation mammaplasty. The area of breast tissue visualized on each film was measured. Changes in the area visualized were correlated with a variety of different parameters. <h3>Setting.</h3> —The Breast Center, Van Nuys, Calif, a free-standing multidisciplinary breast diagnostic and treatment facility. <h3>Patients.</h3> —The 68 women (126 breasts) represent a consecutive sample of patients undergoing augmentation mammaplasty for whom preoperative and postoperative mammograms were available. <h3>Main Outcome Measures.</h3> —Area visualized was correlated with degree of capsular contracture, implant position, type of mammography, preoperative breast size, implant size, and implant type. <h3>Results.</h3> —The major factor affecting mammography is capsular contracture. Little or no capsular contracture results in a 30% reduction in the area visualized; moderate or severe contracture results in a 50% reduction. Other important factors include implant position (improved visualization with implant beneath pectoral muscle) and type of mammography performed (slightly more tissue seen with displacement technique). Very small preoperative breast size yields increased visualization. Implant size and type have little or no effect. <h3>Conclusions.</h3> —In most women with breast implants, there is a decrease in measurable breast tissue on the postaugmentation mammogram. Capsular contracture and implant position exert a profound effect; type of mammography performed and preoperative breast size are also significant. (<i>JAMA</i>. 1992;268:1913-1917)
Pricing Policies for the National Library of Medicine
Authors: ROBERT M. HAYES
Journal: Annals of Internal Medicine (1984)

Editorials1 April 1984Pricing Policies for the National Library of MedicineROBERT M. HAYES, PH.D.ROBERT M. HAYES, PH.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-100-4-601 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe National Library of Medicine (NLM) has been the focus of several reviews of its policies for pricing of products and services. To date, those pricing policies have been based essentially on recovery of the costs of access to its databases and have not included allocations of the costs of database creation. Private sector organizations have repeatedly questioned these policies, with the view that more "market-oriented" pricing policies should be adopted.This special attention reflects the NLM's importance for medical information, its role in developing computer retrieval, and the value of its current products and services. In all reviews, virtually...References1. MEDLARS and Health Information Policy. Washington, D.C.: Office of Technology Assessment; 1982. Google Scholar2. Report of the Senate Committee on Labor and Public Welfare, accompanying the NLM Act. Senate Report 84-2071 (1956). Google Scholar3. U.S. CONGRESS. National Library of Medicine Act, Section 387-388 of the Public Health Services Act. 42 USC 276. (1956). Google Scholar4. Medical Library Assistance Act, PL 89-291 (1965). Amendment to the Public Health Services Act, Sections 390-399. Google Scholar5. Senate Bill 800, to amend the Public Health Services Act, 1981. Google Scholar6. The National Library of Medicine's Medical Literature Analysis and Retrieval System. Washington, D.C: U. S. Government Printing Office; 1982. Google Scholar7. OMB Circular no. A-25. Executive Office of the President, Washington, D.C.: Office of Management and Budget; 1959. Google Scholar8. OMB Circular no. A-76. Washington, D.C.: Office of Management and Budget; 1979. Google Scholar9. President's Private Sector Survey on Cost Control: Report on User Charges. Washington, D.C.: President's Private Sector Survey on Cost Control; 1983. Google Scholar10. Public Sector/Private Sector Interaction in Providing Information Services: Report to the NCLIS from the Public Sector/Private Sector Task Force. Washington, D.C.: National Commission on Libraries and Information Science; 1982. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: ROBERT M. HAYES, PH.D.Affiliations: Graduate School of Library and Information Science UCLA Los Angeles, California PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 April 1984Volume 100, Issue 4Page: 601-604KeywordsComputersDatabasesLibraries ePublished: 1 December 2008 Issue Published: 1 April 1984 PDF downloadLoading ...
Antibiotic Treatment of Venereal Diseases
Authors: Thomas P. Kugelman
Journal: JAMA (1968)

This agglomeration of eight papers from two 1967 international congresses—chemotherapy (Vienna) and dermatology (Munich)—falls disappointingly short of providing the up-to-date reference work the title suggests it might. Two thirds of the book covers the antibiotic therapy of syphilis in monotonous and repetitious detail. Additional chapters briefly consider gonorrhea in the male, trichomoniasis, and nonspecific urethritis, but other venereal diseases are entirely ignored. Inevitably, with a heterogeneous group of authors such as this, the scope, style, content, and overall quality of individual papers vary greatly. "Antibiotic Treatment of Syphilis" by Guthe and Idsøe and "Trichomoniasis — Metronidazole" by Durell et al best fulfill the intent of this book, with concise and informative discussions of recent advances and problems encountered in therapy. "Late Syphilis— Prevention and Treatment" by A. Perdrup and "Causes and Treatment of Nonspecific Urethritis in the Male" by J. Meyer-Rohn, on the other hand, contribute little and would better
RELATION OF BACTEREMIA IN LOBAR PNEUMONIA TO PROGNOSIS AND THERAPY
Authors: MILTON B. ROSENBLÜTH
Journal: JAMA (1928)

In the course of the pneumonia investigation that has been conducted during the past two years at Harlem Hospital, we have had occasion to make blood cultures on 500 patients with acute lobar pneumonia. For this communication I have analyzed the statistics of these cases and have attempted to interpret them from the standpoints of prognosis and serum therapy.  As to the incidence of bacteremia in lobar pneumonia, investigators have reached widely divergent conclusions. Some, such as Prochaska and E. C. Rosenow, have reported positive blood cultures as occurring with great frequency, the former having found them in 100 per cent of a series of fifty cases, the latter in 91 per cent of a series of 175. On the other hand, there are many who find positive blood cultures in a relatively small percentage of their cases. Notable among these are Schottmueller, who reports 23 per cent as positive
England's national programme for IT
Authors: T. Greenhalgh, J. Keen
Journal: BMJ (2013)

From contested success claims to exaggerated reports of its death 

The national programme for IT, which promised to revolutionise care in the English NHS, was originally planned to run for two years and nine months from April 2003.1 Policy documents predicted that by the end of that period, a near paperless working environment would be the norm. This would include electronic systems for booking outpatient appointments, referring patients, producing discharge summaries, and transferring prescriptions between general practice and community pharmacies.2 3 4 In emergency care, key clinical details would be available at the touch of a button wherever in the NHS the patient presented.5 Patients would be “empowered” by remote access to their NHS records.1 5

The reality was different. Contracted deadlines for delivering key systems were repeatedly missed.6 7 8 Technologies that were meant to make tasks and processes more efficient at the clinical frontline were more cumbersome and time consuming, and in some cases less safe, than their paper equivalent.7 8 9 10 11 

Ten years on, only a handful of hospitals can be described as paperless, and most communication between NHS organisations still occurs by snail mail, fax, or patient messenger. …
Threefold increased risk of hip fractures with rheumatoid arthritis in Central Finland
Authors: T M Huusko, M Korpela, P Karppi, V Avikainen, H Kautiainen, R Sulkava
Journal: Annals of the Rheumatic Diseases (2001)

<h3>OBJECTIVES</h3> To evaluate the impact of rheumatoid arthritis (RA) on the incidence of hip fractures. <h3>METHODS</h3> All patients with acute hip fractures admitted to Jyväskylä Central Hospital in 1991–93 (n=517) were selected from the hospital discharge register. Medical records of these patients were studied retrospectively for RA fulfilling the American Rheumatism Association criteria. The prevalence of RA in patients with hip fractures was compared with the prevalence rates of RA obtained from the nearby city of Tampere. <h3>RESULTS</h3> 29 (5.6%; 95% CI 3.8 to 8.0) of the patients with hip fracture in Jyväskylä Central Hospital had RA. The age and sex adjusted risk of hip fractures was increased by RA (risk ratio 3.26; 95% CI 2.26 to 4.70). <h3>CONCLUSIONS</h3> Patients with RA are at increased risk of osteoporotic hip fractures.
CSF Carcinoembryonic Antigen in Meningeal Carcinomatosis From Breast Cancer
Authors: Boh-Seng Yap
Journal: JAMA (1980)

Levels of CSF carcinoembryonic antigen (CEA) were determined in 23 patients with breast cancer and meningeal carcinomatosis. Levels greater than 1.5 ng/mL were observed in 16 patients; seven patients had undetectable levels. The meningeal disease of seven patients with elevated CSF CEA levels completely responded to treatment, and their CSF CEA levels concurrently decreased. Two patients whose meningeal disease responded poorly to treatment had persistently elevated levels of CSF CEA. In two other patients, a rising CSF CEA level was detected before there was any other evidence of meningeal relapse. Serial measurement of CSF CEA may play an important role in the clinical management of meningeal carcinomatosis in patients with breast cancer. (<i>JAMA</i>244:1601-1603, 1980)
A Population-Based Comparison of Strategies to Prevent Early-Onset Group B Streptococcal Disease in Neonates
Authors: Stephanie J. Schrag, Elizabeth R. Zell, Ruth Lynfield, Aaron Roome, Kathryn E. Arnold, Allen S. Craig, Lee H. Harrison, Arthur Reingold, Karen Stefonek, Glenda Smith, Melanie Gamble, Anne Schuchat
Journal: New England Journal of Medicine (2002)

Guidelines issued in 1996 in the United States recommend either screening of pregnant women for group B streptococcal colonization by means of cultures (screening approach) or assessing clinical risk factors (risk-based approach) to identify candidates for intrapartum antibiotic prophylaxis.
Ibuprofen and Aspirin in Acute Rheumatic Fever-Reply
Authors: Mark R. Wallace
Journal: JAMA (1990)

<h3>In Reply. —</h3> The single patient with rheumatic nodules described in our article and referred to by Dr Marshall had an interesting clinical course. Believed by many observers of our outbreak to have the most severe case of acute rheumatic fever, he presented with fever, severe polyarthritis, carditis, and rheumatic nodules. He had been receiving ibuprofen prior to admission to the hospital, but compliance was uncertain. On admission he began ibuprofen therapy, 800 mg every 8 hours. As noted in his hospital record, he had a "dramatic improvement" within 48 hours of admission, with defervescence and markedly decreased joint pain, swelling, and stiffness. This rapid response was typical of the other nine patients, all of whom were treated with aspirin. Several days into his hospitalization the house staff, now convinced the diagnosis was acute rheumatic fever, considered a change to aspirin. However, the rheumatology staff physician (Dr Marshall) recommended the
The Border-zone Pattern of Cerebral Infarction Demonstrated by Nuclear Scintigraphy
Authors: ROBERT SARRECK, RAJASEKAR SHAM
Journal: Clinical Nuclear Medicine (1979)

A case of border-zone (water-shed) infarction of the brain is presented in which static nuclear brain scans demonstrated the characteristic, well defined band-like uptake in the border zones between the anterior, middle and posterior cerebral arteries.
Atrial Fibrillation Promotion by Endurance Exercise
Authors: Eduard Guasch, Begoña Benito, Xiaoyan Qi, Carlo Cifelli, Patrice Naud, Yanfen Shi, Alexandra Mighiu, Jean-Claude Tardif, Artavazd Tadevosyan, Yu Chen, Marc-Antoine Gillis, Yu-Ki Iwasaki, Dobromir Dobrev, Lluis Mont, Scott Heximer, Stanley Nattel
Journal: Journal of the American College of Cardiology (2013)
Teratogenicity of SSRIs — Serious Concern or Much Ado about Little?
Authors: Michael F. Greene
Journal: New England Journal of Medicine (2007)

In the fall of 2005, GlaxoSmithKline called attention to recently collected safety data indicating an increased risk of major congenital malformations among infants exposed during organogenesis to GlaxoSmithKline's selective serotonin reuptake inhibitor (SSRI), paroxetine. Among 527 fetuses exposed to paroxetine in the first trimester, 23 were born with major congenital malformations. Most of the malformations were cardiovascular, and the majority of those were ventricular septal defects. As compared with infants born to women taking any other antidepressant agent during the first trimester, the adjusted odds ratio for any malformation was 2.2 (95% confidence interval [CI], 1.3 to 3.6). Previously published . . .
TREATMENT OF GANGLION BY INJECTION OF CAROID A DANGEROUS PROCEDURE
Authors: J. ALBERT KEY
Journal: JAMA (1942)

In December 1940 a new treatment of ganglion by the injection of a proteolytic enzyme (caroid) was described. 1 The method is as follows:  A suspension of pulverized enzyme in the ratio of 1 drachm of enzyme to each 5 cc. of water is prepared, and 1 minim of hydrochloric acid is added to 10 cc. of suspension. This is shaken vigorously and drawn into a 10 cc. syringe fitted with a 20 gage needle. The needle is inserted and the suspension is injected into the ganglion slowly. Usually 2 cc. is sufficient. In thirty minutes the liquefaction is completed, but the solution may be allowed to remain twenty-four hours without causing any distress and the patient may return the following day for aspiration. The ganglion may then be aspirated freely and the collapsed cyst irrigated with distilled water without removal of the needle. A light pressure dressing is applied.
NOTES UPON AN EPIDEMIC OF FOWL CHOLERA AND UPON THE COMPARATIVE PRODUCTION OF ACID BY ALLIED BACTERIA
Authors: Charles H. Higgins
Journal: The Journal of Experimental Medicine (1898)

(a). The bacillus isolated by me from the outbreak of choleraic diarrhœa corresponds closely in all essential particulars with that of European chicken cholera. (b). It differs, consequently, from that isolated from previous outbreaks of choleraic diarrhœa in the United States. (c). A study of the acid production by this and allied bacilli would seem to show that the amount of acid produced by so variable a microbe varies greatly and is incapable of affording a further means of distinguishing between allied forms.
Should we treat uncomplicated symptomatic diverticular disease with fibre?
Authors: J. Smith, D. J. Humes, R. C. Spiller
Journal: BMJ (2011)

Diverticular disease is a common gastrointestinal condition in older age groups. The prevalence is increasing with the ageing of our population, and diverticular disease in younger age groups also seems to be increasing.1 Among those affected, 10-25% will develop symptoms.2 Although diverticular disease and irritable bowel syndrome share the symptoms of pain and variable bowel habit, the proportion of cases of diverticular disease that meet strict criteria for irritable bowel syndrome varies from 14% to 51%,3 4 the lower figure being no different from the incidence in those with no diverticulosis. NHS patient information websites and leaflets and the standards committee of the American Society of Colon and Rectal Surgeons recommend fibre for recurrent, short lived, non-inflammatory abdominal pain and for preventing diverticulitis; the standards committee estimates the success of fibre in preventing recurrence of diverticulitis as >70%. 

However, although low intake of fibre is associated epidemiologically with an increased risk of developing diverticulosis, the recommendations for fibre as a treatment are based on weak evidence that is old, largely observational, and uncontrolled.2 5 Although Painter’s case series of 70 patients with diverticular disease who took two teaspoons of bran three times a day showed excellent resolution of symptoms, it lacked any control and so is unconvincing.6 There is also no good evidence for the amount or type of dietary fibre needed, and clinical experience suggests that bran fibre and green vegetables may worsen symptoms in some patients. This fits with data from randomised controlled trials in irritable bowel syndrome showing that bran increases flatulence7 and may well do the same in diverticular disease. Another randomised controlled …