tbuckley/cabot-search huggingface dataset:
Effect of Fenoldopam on Use of Renal Replacement Therapy Among Patients With Acute Kidney Injury After Cardiac Surgery
Authors: Tiziana Bove, Alberto Zangrillo, Fabio Guarracino, Gabriele Alvaro, Bruno Persi, Enivarco Maglioni, Nicola Galdieri, Marco Comis, Fabio Caramelli, Daniela C. Pasero, Giovanni Pala, Massimo Renzini, Massimiliano Conte, Gianluca Paternoster, Blanca Martinez, Fulvio Pinelli, Mario Frontini, Maria C. Zucchetti, Federico Pappalardo, Bruno Amantea, Annamaria Camata, Antonio Pisano, Claudio Verdecchia, Erika Dal Checco, Claudia Cariello, Luana Faita, Rubia Baldassarri, Anna M. Scandroglio, Omar Saleh, Rosalba Lembo, Maria G. Calabrò, Rinaldo Bellomo, Giovanni Landoni
Journal: JAMA (2014)

No effective pharmaceutical agents have yet been identified to treat acute kidney injury after cardiac surgery.To determine whether fenoldopam reduces the need for renal replacement therapy in critically ill cardiac surgery patients with acute kidney injury.Multicenter, randomized, double-blind, placebo-controlled, parallel-group study from March 2008 to April 2013 in 19 cardiovascular intensive care units in Italy. We randomly assigned 667 patients admitted to intensive care units after cardiac surgery with early acute kidney injury (≥50% increase of serum creatinine level from baseline or oliguria for ≥6 hours) to receive fenoldopam (338 patients) or placebo (329 patients). We used a computer-generated permuted block randomization sequence for treatment allocation. All patients completed their follow-up 30 days after surgery, and data were analyzed according to the intention-to-treat principle.Continuous infusion of fenoldopam or placebo for up to 4 days with a starting dose of 0.1 μg/kg/min (range, 0.025-0.3 µg/kg/min).The primary end point was the rate of renal replacement therapy. Secondary end points included mortality (intensive care unit and 30-day mortality) and the rate of hypotension during study drug infusion.The study was stopped for futility as recommended by the safety committee after a planned interim analysis. Sixty-nine of 338 patients (20%) allocated to the fenoldopam group and 60 of 329 patients (18%) allocated to the placebo group received renal replacement therapy (P = .47). Mortality at 30 days was 78 of 338 (23%) in the fenoldopam group and 74 of 329 (22%) in the placebo group (P = .86). Hypotension occurred in 85 (26%) patients in the fenoldopam group and in 49 (15%) patients in the placebo group (P = .001).Among patients with acute kidney injury after cardiac surgery, fenoldopam infusion, compared with placebo, did not reduce the need for renal replacement therapy or risk of 30-day mortality but was associated with an increased rate of hypotension.clinicaltrials.gov Identifier: NCT00621790.
Indurated Breast During Lactation
Authors: Guillermo Solano-López, María José Concha-Garzón, Javier Sánchez-Pérez
Journal: JAMA Dermatology (2014)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Dermatology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Dermatology journal
A house call in Nepal's Himalayas
Authors: Puncho Gurung
Journal: BMJ (2004)

The young man came into the Himalayan Rescue Association aid post in Manang at midday. He asked me to go and see a man in a nearby village who had been sick since the day before and was unable to move. I stuffed my medical gear into a backpack and followed the man to the horse that he had brought along, and, after a two hour ride, we finally arrived at his village.

We walked through the narrow alleys to the patient's house, where a cow greeted us on the ground floor, and climbed the wooden staircase to the terrace to find a middle …
Association between Injections and HIV Incidence
Authors: Naveed Zafar Janjua, Khabir Ahmad, Arshad Altaf, Mohammad Imran Khan, Hasan Bin Hamza
Journal: PLoS Medicine (2005)

I previously criticised the effective "statute of limitations" in several leading general medical journals "whereby authors of papers are immune to disclosure of methodological weaknesses once some arbitrary (short) period has elapsed" [2].Such a time limit discourages post-publication peer review, with potential correspondents deterred by the short and unambiguous deadline.I suggested that journals with such a policy should reconsider.The word limit on that article precluded additional adverse comments on journals' word limits for letters, although they were presented in Table 2 of that article [2].Subsequently, three of the six journals did revise their instructions [3-5], but each imposed tougher restrictions on letters, reducing either the maximum time limit, the maximum length, or both.The strictest current requirements are a two-week limit by The Lancet and a 175-word limit by the New England Journal of Medicine.Editors are seemingly falling over themselves to speed up and shorten letters, but this behaviour is inappropriate for a scientifi c journal.The key characteristic of science is not its infallibility, a quality it clearly does not and cannot have, but its self-correcting ability.The decision by medical editors to stifl e debate is misguided [2,6].A time limit, especially a very short one, signals that speed is more important than content, that convenience takes precedence over science.While it is reasonable to encourage early comments, there should be no time limit on comments aimed at clarifying or criticising study methodology.Likewise, it will often be impossible to explain the subtleties of methodological problems in 400 words, and impossible in only 175.Additional restrictions on the number of authors and references are also questionable.I am disappointed that PLoS Medicine has imposed a time limit of four weeks on correspondence.As explained above, I believe that such a limit is mistaken.
β-Blockers and Reduction of Cardiac Events in Noncardiac Surgery
Authors: Andrew D. Auerbach, Lee Goldman
Journal: JAMA (2002)

ContextRecent studies suggest that perioperatively administered β-blockers may reduce the risk of adverse cardiac events in patients undergoing major noncardiac surgery.ObjectiveTo review the efficacy of perioperative β-blockade in reducing myocardial ischemia, myocardial infarction, and cardiac or all-cause mortality from randomized trials.Data SourcesA MEDLINE and conventional search of English-language articles published since 1980 was performed to gather information related to perioperative cardiac complications and β-blockade. Reference lists from all relevant articles and published recommendations for perioperative cardiac risk management were reviewed to identify additional studies.Study Selection and Data ExtractionProspective randomized studies (6) were included in the analysis if they discussed the impact of β-blockade on perioperative cardiac ischemia, myocardial infarction, and mortality for patients undergoing major noncardiac surgery. Articles were examined for elements of trial design, treatment protocols, important biases, and major findings. These elements were then qualitatively compared.Data SynthesisWe identified 5 randomized controlled trials: 4 assessed myocardial ischemia and 3 reported myocardial infarction, cardiac, or all-cause mortality. All studies sought to achieve β-blockade before the induction of anesthesia by titrating doses to a target heart rate. Of studies reporting myocardial ischemia, numbers needed to treat were modest (2.5-6.7). Similarly modest numbers needed to treat were observed in studies reporting a significant impact on cardiac or all-cause mortality (3.2-8.3). The most marked effects were seen in patients at high risk; the sole study reporting a nonsignificant result enrolled patients with low baseline risk. As a group, studies of perioperative β-blockade have enrolled relatively few carefully selected patients. In addition, differences in treatment protocols leave questions unanswered regarding optimal duration of therapy.ConclusionsDespite heterogeneity of trials, a growing literature suggests a benefit of β-blockade in preventing perioperative cardiac morbidity. Evidence from these trials can be used to formulate an effective clinical approach while definitive trials are awaited.
Truncal vagotomy and pyloroplasty.
Authors: A Mitra
Journal: BMJ (1972)

mean level of serum vitamin B12 among smokers is significantly less than among non-smokers.They discuss various factors which may have affected the serum B12 level, but they do not mention folate deficiency, which is common during pregnancy.Low serum Bi2 levels have been observed in over 40% of patients with megaloblastic anaemia due to folate deficiency, and the levels rise slowly to within the normal range on treatment with folic acid alone.1 2 As Dr.McGarry and Miss Andrews have not published the serum folate levels in their group of pregnant women, it is not possible to draw conclusions from the B12 levels unless all the women were taking folic acid.-Iam, etc.,
Children with Recurrent Abdominal Pain: How Do They Grow Up?
Authors: J. Apley, B. Hale
Journal: BMJ (1973)

The results of treatment by reassurance and explanation of 30 children with recurrent abdominal pain have been compared with those in a group of 30 children seen earlier and given no such treatment. Most of the 19 treated children who responded to treatment did so more quickly than the untreated ones, and relapse did not occur in the treated group.
Dietary Supplement Use: Significant Information in the Medical History
Authors: Stuart L. Nightingale
Journal: JAMA (1993)

<h3>To the Editor.</h3> —Two recent studies have attested to the popularity of unconventional therapy and dietary supplements.<sup>1,2</sup>The Food and Drug Administration (FDA) would like to reiterate the need for physicians to obtain information regarding the ingestion of dietary supplements as part of obtaining complete medical histories and for reporting adverse events to the FDA. We have received reports of harmful effects that are the sequelae of taking dietary supplements, eg, eosinophilia-myalgia syndrome associated with L-tryptophan ingestion, and believe that reporting of such adverse events could be instrumental in mitigating similar situations in the future. When problems with specific products occur, the FDA alerts the public and the medical community, tailoring its actions to each particular situation. Recently, for example, the agency issued a press release to warn the public against consuming products containing the herbal substance chaparral, following reports of its association with acute, toxic hepatitis.<sup>3</sup>In
Polybrominated diphenyl ethers: occurrence, dietary exposure, and toxicology.
Authors: P O Darnerud, G S Eriksen, T Jóhannesson, P B Larsen, M Viluksela
Journal: Environmental Health Perspectives (2001)

Polybrominated diphenyl ethers (PBDEs) are used as flame retardants in plastics (concentration, 5--30%) and in textile coatings. Commercial products consist predominantly of penta-, octa-, and decabromodiphenyl ether mixtures, and global PBDE production is about 40,000 tons per year. PBDEs are bioaccumulated and biomagnified in the environment, and comparatively high levels are often found in aquatic biotopes from different parts of the world. During the mid-1970--1980s there was a substantial increase in the PBDE levels with time in both sediments and aquatic biota, whereas the latest Swedish data (pike and guillemot egg) may indicate that levels are at steady state or are decreasing. However, exponentially increasing PBDE levels have been observed in mother's milk during 1972--1997. Based on levels in food from 1999, the dietary intake of PBDE in Sweden has been estimated to be 0.05 microg per day. Characteristic end points of animal toxicity are hepatotoxicity, embryotoxicity, and thyroid effects as well as maternal toxicity during gestation. Recently, behavioral effects have been observed in mice on administration of PBDEs during a critical period after birth. Based on the critical effects reported in available studies, we consider the lowest-observed-adverse-effect level (LOAEL) value of the PBDE group to be 1 mg/kg/day (primarily based on effects of pentaBDEs). In conclusion, with the scientific knowledge of today and based on Nordic intake data, the possible consumer health risk from PBDEs appears limited, as a factor of over 10(6) separates the estimated present mean dietary intake from the suggested LOAEL value. However, the presence of many and important data gaps, including those in carcinogenicity, reproduction, and developmental toxicity, as well as additional routes of exposure, make this conclusion only preliminary. Moreover, the time trend of PBDEs in human breast milk is alarming for the future.
Hyperimmune globulins and same‐day thrombotic adverse events as recorded in a large healthcare database during 2008–2011
Authors: Mikhail Menis, Gayathri Sridhar, Nandini Selvam, Mikhail V. Ovanesov, Hozefa A. Divan, Yideng Liang, Dorothy Scott, Basil Golding, Richard Forshee, Robert Ball, Steven A. Anderson, Hector S. Izurieta
Journal: American Journal of Hematology (2013)

Thrombotic events (TEs) are rare serious complications following administration of hyperimmune globulin (HIG) products. Our retrospective claims-based study assessed occurrence of same-day TEs following administration of HIGs during 2008-2011 and examined potential risk factors using HealthCore's Integrated Research Database (HIRD(SM) ) and laboratory testing of products' procoagulant Factor XIa activity by U.S. Food and Drug Administration. Multivariable regression was used to estimate same-day TE risk for different products. Of 101,956 individuals exposed to 23 different HIG product groups, 86 (0.84 per 1,000 persons) had a TE diagnosis code (DC) recorded on the same day as HIG administration. Unadjusted same-day TE DC rates (per 1,000 persons) ranged from 0.4 to 148.9 for different products. GamaSTAN S/D IG >10 cc had statistically significantly higher same-day TE DC risk compared to Tetanus IG (OR = 57.57; 95% CI = 19.72-168.10). Increased TE risk was also observed with older age (≥45 years), prior thrombotic events, and hypercoagulable state(s). Laboratory investigation identified elevated Factor XIa activity for GamaSTAN S/D, HepaGam B, HyperHep B S/D, WinRho SDF, HyperRHO S/D full dose, and HyperTET S/D. Our study, for the first time, identified increase in the same-day TE DC risk with GamaSTAN S/D IG >10 cc and suggests potentially elevated TE risk with other HIGs.
Benign prostatic hyperplasia has precise meaning
Authors: P. Abrams
Journal: BMJ (2001)

EDITOR-Weijer states that the benefits of rotavirus vaccine may outweigh risks for children in developing countries.1The issue of cost effectiveness is therefore central to the choice of whether developing countries should adopt a rotavirus vaccine.We are involved in a project funded by the United Kingdom's Department for International Development that will model the impact and incremental cost effectiveness of introducing a rotavirus vaccine into routine infant immunisation programmes in Bangladesh and Peru.Frequently, poor families in developing countries must sell assets at a loss, or take out loans at high interest rates, to pay for care.2Hence optimising the use of vaccines will increase the potential for economic development of the poorest groups by reducing their out of pocket costs of obtaining treatment, especially for more severe disease.Governments also stand to benefit through reducing the burden on frequently overstretched health systems.In addition, gains will occur at the societal level, as care givers will require less time off work to provide and seek care.Yet the introduction of new or underused vaccines in developing countries has been hindered by the paucity of data related to the economic and epidemiological burden of diseases that can be prevented by vaccination.Recently Miller and McCann conducted a cost effectiveness analysis to estimate the impact of vaccination against rotavirus in national immunisation schedules.3They estimated the cost per life year saved to be $16 to $31 in a low income setting, assuming a cost per dose of $1 and vaccine efficacy of 60%; their results are encouraging.They did not include potential savings from the reduction in costs of admission to hospital, but a study from Argentina has illustrated the substantial burden placed on some health systems by rotavirus: in 1991 rotavirus infection led to roughly 84 500 outpatient visits and 21 000 admissions, each averaging four days, with associated direct medical costs of $27.7m.4It is important to identify, measure, and value the associated costs of providing the vaccine, including 11/6/2015 Future of research into rotavirus vaccine | The BMJ http://www.bmj.com/content/322/7278/106.2.full.print?2/3the cost of treating adverse events.5Further modelling and economic analyses will enable an empirical measurement of the vaccine's costs and benefits; its utility for low income settings should not be dismissed prematurely.We hope that our research will help shed light on the appropriateness of the vaccine in developing countries once it becomes available.
Growth in Familial Hypophosphatemic Vitamin-D-Resistant Rickets
Authors: Susan L. McNair, Gunnar B. Stickler
Journal: New England Journal of Medicine (1969)

Data on 36 patients with vitamin-D-resistant rickets indicate that the disease is manifested primarily by shortness of stature. This shortness appears to be limited to the lower extremities. The shortness is not related to the level of serum phosphorus or to the deformity alone, and it is similar in both sexes. Treatment with massive doses of vitamin D does not change height or deformity or improve hypophosphatemia. The only result of therapy is a decrease in level of alkaline phosphatase. Therapy, however, entails the risk of vitamin D intoxication.
Enhancement of leukotriene B4 release in stimulated asthmatic neutrophils by platelet activating factor
Authors: K. Shindo, K. Koide, M. Fukumura
Journal: Thorax (1997)

The role of platelet activating factor (PAF) in asthma remains controversial. The priming effect of PAF on leukotriene B4 (LTB4) release, 5-lipoxygenase activity, and intracellular calcium levels in asthmatic neutrophils was examined.LTB4 and other lipoxygenase metabolites in neutrophils obtained from 17 asthmatic patients and 15 control subjects were measured by reverse phase-high performance liquid chromatography (RP-HPLC). Intracellular calcium levels were monitored using the fluorescent probe fura-2.The mean (SD) basal LTB4, release from neutrophils was not significantly different between the two groups (0.05 (0.01) vs 0.03 (0.02) ng/10(6) cells); however, when stimulated with calcium ionophore A23187 (2.5 microM), neutrophils from asthma patients released more LTB4 than cells from control subjects (15.7 (1.2) vs 9.9 (1.6) ng/10(6) cells). Although PAF alone did not alter LTB4 release, it enhanced the response to subsequent A23187 stimulation. This effect was observed following treatment for five minutes with PAF at concentrations > 1.0 microM. The maximal effect was seen with 5.0 microM PAF + 2.5 microM A23187 (62.7 (2.2) vs 18.6 (2.3) ng/10(6) cells). Pretreatment with PAF also increased 5-lipoxygenase activity and intracellular calcium levels in neutrophils from asthmatic patients to a greater extent than in those from non-asthmatic patients.These findings indicate that, in neutrophils from asthmatic patients, PAF enhances LTB4 release and increases 5-lipoxygenase activity and intracellular calcium to a greater extent than in neutrophils from non-asthmatic patients.
Auscultation of the Corrigan or Water-Hammer Pulse
Authors: Francis W. Palfrey
Journal: New England Journal of Medicine (1952)

THE Corrigan or water-hammer pulse and the pistol-shot sound in the groin are time-honored physical signs of marked aortic insufficiency. Unmistakable and more serious of the two is the pistol-shot sound in the groin, which means that the diastolic blood-pressure in the femoral artery is 0 and that the aortic insufficiency is extreme.In current teaching the Corrigan pulse is often misunderstood to mean merely a radial pulse of abnormally large volume; the true Corrigan or "water-hammer" pulse is characterized not only by its large volume but also by the transmission of a sudden shock to the examiner's finger over . . .
The Public's Health Is Too Important To Be Left to Public Health Workers
Authors: Walter O. Spitzer
Journal: Annals of Internal Medicine (1989)

Practicing physicians are the key to effective health promotion and disease prevention in their communities, according to the Guide to Clinical Preventive Services released in May by the United States Preventive Services Task Force. The Guide focuses on the clinical practitioner and strongly advocates integrating preventive activities into clinical practice. It also shows how required interventions can be done by the physician normally responsible for ongoing care. Case-finding is emphasized as a viable and desirable strategy in early detection of disease. The report also acknowledges behavioral and lifestyle components of risk factors for disease and the physician's opportunities to promote change in patients' risky behavior. We discuss the implications of including patient education and counseling in the physician's clinical armamentarium, highlighting changes in educational and health care delivery systems that can make such interventions work in preventive programs. The soundness of a best-evidence synthesis method to formulate recommendations and the use of a priori scientific rules to determine the effectiveness of many current and proposed preventive activities are hallmarks of the task force's approach to integrating science and clinical practice.
An assessment of (1) cyproterone acetate and (2) ethinyl oestradiol and lynoestrenol (Minilyn) in the treatment of idiopathic hirsutism
Authors: J. A. R. ANDERSON
Journal: British Journal of Dermatology (1978)

The administration of cyproterone acetate can be effective in the treatment of ‘idiopathic’ hirsutism. In 5 similarly affected patients treated with ethinyloestradiol and lynoestrenol (Minilyn) the rate of hair growth was reduced in only two, even though the serum total testosterone was reduced in each instance.