tbuckley/cabot-search huggingface dataset:
Diagnosis and Treatment of<i>Clostridium difficile</i>in Adults
Authors: Natasha Bagdasarian, Krishna Rao, Preeti N. Malani
Journal: JAMA (2015)

<h3>Importance</h3> Since 2000, the incidence and severity of<i>Clostridium difficile</i>infection (CDI) have increased. <h3>Objective</h3> To review current evidence regarding best practices for the diagnosis and treatment of CDI in adults (age ≥18 years). <h3>Evidence Review</h3> Ovid MEDLINE and Cochrane databases were searched using keywords relevant to the diagnosis and treatment of CDI in adults. Articles published between January 1978 and October 31, 2014, were selected for inclusion based on targeted keyword searches, manual review of bibliographies, and whether the article was a guideline, systematic review, or meta-analysis published within the past 10 years. Of 4682 articles initially identified, 196 were selected for full review. Of these, the most pertinent 116 articles were included. Clinical trials, large observational studies, and more recently published articles were prioritized in the selection process. <h3>Findings</h3> Laboratory testing cannot distinguish between asymptomatic colonization and symptomatic infection with<i>C difficile</i>. Diagnostic approaches are complex due to the availability of multiple testing strategies. Multistep algorithms using polymerase chain reaction (PCR) for the toxin gene(s) or single-step PCR on liquid stool samples have the best test performance characteristics (for multistep: sensitivity was 0.68-1.00 and specificity was 0.92-1.00; and for single step: sensitivity was 0.86-0.92 and specificity was 0.94-0.97). Vancomycin and metronidazole are first-line therapies for most patients, although treatment failures have been associated with metronidazole in severe or complicated cases ofCDI. Recent data demonstrate clinical success rates of 66.3% for metronidazole vs 78.5% for vancomycin for severe CDI. Newer therapies show promising results, including fidaxomicin (similar clinical cure rates to vancomycin, with lower recurrence rates for fidaxomicin, 15.4% vs vancomycin, 25.3%;<i>P</i> = .005) and fecal microbiota transplantation (response rates of 83%-94% for recurrent CDI). <h3>Conclusions and Relevance</h3> Diagnostic testing for CDI should be performed only in symptomatic patients. Treatment strategies should be based on disease severity, history of prior CDI, and the individual patient’s risk of recurrence. Vancomycin is the treatment of choice for severe or complicated CDI, with or without adjunctive therapies. Metronidazole is appropriate for mild disease. Fidaxomicin is a therapeutic option for patients with recurrent CDI or a high risk of recurrence. Fecal microbiota transplantation is associated with symptom resolution of recurrent CDI but its role in primary and severe CDI is not established.
Parkinson's disease: disability, review, and management.
Authors: W J Mutch, A Strudwick, S K Roy, A W Downie
Journal: BMJ (1986)

Data from a descriptive study of idiopathic Parkinson9s disease were analysed aimed at getting a clearer picture of the impact of the disease on the community and the help available to patients and carers. Altogether 267 patients aged 40-92 were identified, and the median duration of disease in those in whom this could be assessed was 7.2 years. Of the 267 patients, 204 (76.4%) were living in the community, 51 alone. A total of 201 patients were taking levodopa, 29 out of 102 had retired early, and 60 out of 84 (71.4%) had given up driving. Most patients had symptoms at the time of study, and signs such as bradykinesia, rigidity, impaired speech, and abnormal gait were often moderate or severe. Of 214 patients whose disease was assessed using the scoring system of Hoehn and Yahr, 78 (36.4%) had grade 4 and 23 (10.7%) grade 5 disability. Despite this, however, 105 of 265 patients (39.6%) were not subject to regular medical review and only 57 of 227 patients (25.1%) had been seen by an occupational therapist, 16 (7.0%) by a physiotherapist, and 10 (4.4%) by a speech therapist. Patients with Parkinson9s disease may benefit from regular medical review and being seen by therapists.
Surgical Pathology of the Nervous System and Its Coverings
Authors: Jacob L. Chason
Journal: JAMA (1983)

The second edition of this now well-known and deservedly popular text has successfully incorporated the pertinent recent literature. The additional 116 pages are the result of a modest increase in text and photographs, the latter well selected, of excellent quality and of such numbers as even to qualify this edition as an atlas. Many of the criticisms of the original edition remain: the format consists of a generic description of a disease and, separately, its secondary description at different locations within the CNS. This often requires several discussions of an entity. This is particularly true for the primary neoplasms of the brain and spinal cord. For these reasons the cautious reader will find it advantageous to use the separate illustration and subject indexes and to read all the discussions related to a disease. One neoplasm, the subependymoma, with two somewhat divergent descriptions may confuse the reader as to the authors'
Leucopenia during sulphasalazine treatment for rheumatoid arthritis.
Authors: M Marabani, R Madhok, H A Capell, J A Hunter
Journal: Annals of the Rheumatic Diseases (1989)

Leucopenia appears to be a more frequent complication of sulphasalazine treatment in rheumatoid arthritis than in inflammatory bowel disease and poses a management problem. In this study leucopenia was found in 20 patients, 14 of whom were participating in prospective studies (252 patients), giving an incidence of 5.6%. Treatment had to be discontinued in half of these patients. Most (14) episodes of leucopenia occurred early in treatment (less than 24 weeks) but some occurred late and sustained monitoring seems necessary. No predictive factors for leucopenia were elucidated. All patients recovered fully with dose adjustment or, in more severe cases, after withdrawal of sulphasalazine and appropriate supportive therapy. The incidence of leucopenia may be higher in Glasgow than in other units in Britain.
Indian endocrinologists warn of vitamin D deficiency
Authors: G. Mudur
Journal: BMJ (2003)

Vitamin D deficiency is causing severe bone loss in adults across northern India despite abundant sunlight in the region, leading Indian endocrinologists have said.

Inadequate exposure to sunlight and poor nutrition are factors contributing to the vitamin D deficiency, Dr Narayana Kochupillai, head of endocrinology and metabolism at the All India Institute of Medical Sciences, New Delhi, said.

“Based on our clinical experience and limited studies, we believe vitamin D deficiency is widespread in northern India,” Dr Kochupillai told a national conference on nutrition at the Tata Energy Research Institute, a private institution in New Delhi involved in energy and biotechnology research.

“But, unfortunately, our recommendation to …
COMPARISON OF A SMALL PROBE AND A GAMMA CAMERA FOR TUMOR DETECTION
Authors: J. M. Woolfenden, H. B. Barber, K. J. Myers, W. J. Wild, H. H. Barrett
Journal: Clinical Nuclear Medicine (1984)

We compared the ability of a small radiation detector probe and a gamma camera to detect tumors in a phantom system. We used a collimated NaI probe of 0.8 cm2 area and a Picker 4/15/37 camera. Three 1 cm3 simulated tumors were placed in a 301 tank containing 2 nCi/ml Co-57; tumor activity was 20, 80 and 200 nCi. The camera was positioned with a Tc dynamic collimator in contact with the tank, and 2 min computer images of all 3 tumors were obtained with the tumor at 0, 5, 10 and 15 cm from the tank wall. A region of interest was drawn around each tumor and a background area, and successive images were formed by raising the lower image threshold in 5% increments. Both smoothed and unsmoothed images were evaluated. The true positive and false positive fractions were calculated for each threshold, and a maximum likelihood fit was made for the receiver operating characteristic (ROC) curve. The area under the ROC curve was the figure of merit used; d' values were also calculated. Probe counts were obtained in the tank for 15 sec for each tumor at separations of 0, 1, 2 and 5 cm. Probe data were also subjected to threshold variations to generate ROC curves. Camera performance degraded rapidly with depth of tumors, and was independent of image smoothing. Probe performance was sensitive to separation from tumors, but relatively insensitive to the volume of background activity in the field of view. Probe performance was superior to camera performance for all conditions when the probe to tumor separation was less than 2 cm. We conclude that probes are superior to gamma cameras for detecting small tumors, provided the probe can be positioned close to the tumors, such as during surgery or endoscopy.
Ursodeoxycholic acid for the treatment of primary sclerosing cholangitis: A 30-month pilot study
Authors: Christopher B. O’brien, John R. Senior, Renu Arora-Mirchandani, Ashok K. Batta, Gerald Salen
Journal: Hepatology (1991)

We investigated the effects of once-daily oral administration of 10 mg/kg ursodeoxycholic acid (generic name, ursodiol) on elevated serum enzyme activities, bilirubin, cholesterol, bile acids and symptoms in patients with primary sclerosing cholangitis. A 30-mo, open-label, pilot trial was designed to cover four periods: (a) 3 mo of pretreatment observation (period 1), (b) 6 mo on ursodiol (period 2), (c) 3 mo withdrawal of treatment (period 3) and (d) 18 mo of extended retreatment (period 4). Diagnosis was confirmed by cholangiography and liver biopsy specimens. We enrolled 12 patients with persistently elevated pretreatment alkaline phosphatase and γ-glutamyltransferase levels (at least twice the upper limit of normal), and observed them for a median of 37 mo. Significant reductions in serum total cholesterol levels and in serum enzyme activities indicating cholestasis and hepatocellular injury occurred during ursodiol treatment in both treatment periods 2 and 4 and relapsed with treatment interruption in period 3. Elevated serum bilirubin and symptoms of disabling fatigue, pruritus and diarrhea were improved by ursodiol. Improvements have continued after 2 yr of treatment in 10 patients (1 patient had a transplantation after he relapsed on withdrawal of ursodiol therapy; another died of postoperative complications of colon resection for carcinoma). No other cases of clinical deterioration were observed in the retreatment period. The longer term reductions of alkaline phosphatase, transaminases, bilirubin and cholesterol after 2 yr of treatment were even greater than the initial reductions after 6 mo of treatment. These results justify initiation of larger, controlled clinical trials, with serial morphological evaluations of the liver and biliary tree. (Hepatology 1991;14:838-847).
Signal transduction of<i>Helicobacter pylori</i>during interaction with host cell protein receptors of epithelial and immune cells
Authors: Suneesh Kumar Pachathundikandi, Nicole Tegtmeyer, Steffen Backert
Journal: Gut Microbes (2013)

Helicobacter pylori infections can induce pathologies ranging from chronic gastritis, peptic ulceration to gastric cancer. Bacterial isolates harbor numerous well-known adhesins, vacuolating cytotoxin VacA, protease HtrA, urease, peptidoglycan, and type IV secretion systems (T4SS). It appears that H. pylori targets more than 40 known host protein receptors on epithelial or immune cells. A series of T4SS components such as CagL, CagI, CagY, and CagA can bind to the integrin α5β1 receptor. Other targeted membrane-based receptors include the integrins αvβ3, αvβ5, and β2 (CD18), RPTP-α/β, GP130, E-cadherin, fibronectin, laminin, CD46, CD74, ICAM1/LFA1, T-cell receptor, Toll-like receptors, and receptor tyrosine kinases EGFR, ErbB2, ErbB3, and c-Met. In addition, H. pylori is able to activate the intracellular receptors NOD1, NOD2, and NLRP3 with important roles in innate immunity. Here we review the interplay of various bacterial factors with host protein receptors. The contribution of these interactions to signal transduction and pathogenesis is discussed.
Glutathione prevents ethanol induced gastric mucosal damage and depletion of sulfhydryl compounds in humans.
Authors: C Loguercio, D Taranto, F Beneduce, C del Vecchio Blanco, A de Vincentiis, G Nardi, M Romano
Journal: Gut (1993)

Whether parenteral administration of reduced glutathione prevented ethanol induced damage to and depletion of sulfhydryl compounds in the human gastric mucosa was investigated. Ten healthy volunteers underwent endoscopy on three separate occasions. Gastric mucosal damage was induced by spraying 80% ethanol on to the gastric mucosa through the biopsy channel of the endoscope. The gastric mucosal score, total sulfhydryls, glutathione, and cysteine were evaluated in basal conditions and after ethanol administration with and without pretreatment with parenteral glutathione. Glutathione significantly decreased the extent of ethanol induced macroscopic injury to the mucosa of the gastric body and antrum. Glutathione9s protective effect is associated with appreciable inhibition of ethanol induced depletion of gastric sulfhydryl compounds. This is the first report of protection against ethanol induced gastric mucosal damage by a sulfhydryl containing agent in humans.
Preclinical Study Of Rapidly-Disintegrating Sublingual Tablets (RDST): Effect Of Epinephrine (E) Incorporated As Nano-Crystals
Authors: Keith Simons, Ousama Rachid, Mutasem Rawas-Qalaji, Belacryst Mendez, Annette Losada, F. Estelle R. Simons
Journal: Journal of Allergy and Clinical Immunology (2014)
Polymeric implants for cancer chemotherapy
Authors: Lawrence K. Fung, W.Mark Saltzman
Journal: Advanced Drug Delivery Reviews (1997)

Cancer chemotherapy is not always effective. Difficulties in drug delivery to the tumor, drug toxicity to normal tissues, and drug stability in the body contribute to this problem. Polymeric materials provide an alternate means for delivering chemotherapeutic agents. When anticancer drugs are encapsulated in polymers, they can be protected from degradation. Implanted polymeric pellets or injected microspheres localize therapy to specific anatomic sites, providing a continuous sustained release of anticancer drugs while minimizing systemic exposure. In certain cases, polymeric microspheres delivered intravascularly can be targeted to specific organs or tumors. This article reviews the principles of chemotherapy using polymer implants and injectable microspheres, and summarizes recent preclinical and clinical studies of this new technology for treating cancer.
AB0621 The timing of urinary protein creatinine ratio normalization in patients with ln treated with mycophenolate mofetil (MMF) as their first line therapy
Authors: H. Timlin, H. Fang, L. Magder, M. Petri
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Objectives</h3> Mycophenolate mofetil (MMF)has become the primary induction therapy for lupus nephritis (LN). The purpose of this study was to look at the timing of the protein creatinine ratio reaching 500mg after starting Mycophenolate mofetil (MMF) for class III, IV or V lupus nephritis. <h3>Methods</h3> 21 SLE patients began mycophenolate mofetil (MMF) shortly after a biopsy-confirmed diagnosis of LN. The baseline urine protein ranged between 0.635 to 11.91grams, with only 1 patient being below 1 gram at baseline. They consisted of 18 females, 3 males, 9 African Americans, 8 Caucasians, and 4 other ethnicities. Ages ranged from 18 to 70 with a mean age of 37 (SD=15).The mycophenolate mofetil (MMF) dose ranged between 250 to 3000 mg per day. We estimated the survival function time until the urine protein reached 0.5 grams or less after starting mycophenolate mofetil (MMF) using an approach that accommodates interval censored data. <h3>Results</h3> The graph shows an estimate of the probability that patients would still have urine protein above 500 mg by various time points after starting mycophenolate mofetil (MMF). We estimate that 50% of patients will have reached 0.5 grams of protein with 51 days of starting mycophenolate mofetil (MMF), and 77% will have reached 0.5 grams within 180 days. <h3>Conclusions</h3> This study demonstrates that the majority of patients with lupus nephritis (77%) can reach a urine protein creatinine ratio of 0.5 grams or less by 6 months after initiation of mycophenolate mofetil (MMF). These data can be used to determine sample sizes for clinical trials in lupus nephritis; but also suggest that a more stringent goal should be considered. <h3>Disclosure of Interest</h3> None Declared
COLLAGEN AND 8-ISOPROSTANE ARE KEY FACTORS OF ENHANCED PLATELET AGGREGABILITY OBSERVED IN PATIENTS WHO UNDERWENT PERCUTANEOUS CORONARY INTERVENTION
Authors: Suthipong Soontrapa, Teerapat Nantsupawat, Grace Simoni, Jan Simoni, Chanwit Roongsritong, Gary Meyerrose, Ashwani Kumar
Journal: Journal of the American College of Cardiology (2012)
Plain-Film Diagnosis of Heart Disease
Authors: Eugene Gedgaudas
Journal: JAMA (1975)

A CLINICAL evaluation, electrocardiogram, and roentgenologic study of the chest with barium swallow form the classic triad on which the diagnosis of cardiac disease rests. The four views of the heart with barium in the esophagus give information about the state of the pulmonary vasculature, heart size and contour, differential enlargement of chambers, relationship and size of the great vessels, and the presence of calcifications within the cardiac shadow or in the vessels. Such information may add new dimensions or only confirm the clinical impression. It may also provide important practical information in planning a catheterization or surgical approach; eg, awareness of an aberrant right subclavian artery would rule out the use of the right brachial artery as an approach to the ascending aorta and left ventricle at cardiac catheterization; the presence of a right aortic arch would suggest to the surgeon the use of the left subclavian artery for
Localized Pityriasis Rosea
Authors: Harry J. Hurley
Journal: JAMA (1961)

IN ITS classic form, pityriasis rosea is a distinctive dermatosis and is readily identified clinically. A diffuse distribution of skin lesions over the trunk and proximal portions of the extremities is commonly seen. The individual lesions are typically annular and oval in shape, with their long axes parallel to the so-called lines of cleavage of the skin. On the trunk this can result in a dermatomal or segmental patterning sometimes referred to as a "Christmas tree" distribution. The face, scalp, distal extremities, volar skin, and mucous membranes are involved less frequently. However, an inverse form of pityriasis rosea with principal involvement of the face and extremities and relative sparing of the trunk may be seen occasionally. Reference has been made to the occasional restriction of pityriasis rosea to certain areas, such as the lower trunk.<sup>1-4</sup>The vulnerability of this portion of the skin surface was presumed due to its
Combined single nucleotide polymorphism-based genomic mapping and global gene expression profiling identifies novel chromosomal imbalances, mechanisms and candidate genes important in the pathogenesis of T-cell prolymphocytic leukemia with inv(14)(q11q32)
Authors: J Dürig, S Bug, L Klein-Hitpass, T Boes, T Jöns, J I Martin-Subero, L Harder, M Baudis, U Dührsen, R Siebert
Journal: Leukemia (2007)
Safety and Cost-effectiveness of Solvent-Detergent—Treated Plasma
Authors: James P. AuBuchon, John D. Birkmeyer
Journal: JAMA (1994)

To determine the public health and economic implications of solvent-detergent-treated frozen plasma (SD FP). While this processing technique nearly eliminates the risk of transmitting lipid-enveloped viruses (hepatitis B and C and human immunodeficiency virus), it has associated costs and, because it requires pooling many plasma units, may increase risks of nonenveloped virus transmission.A previously published Markov decision analysis model was modified to assess transfusion-related outcomes in hypothetical cohorts of plasma recipients. In-hospital mortality and other characteristics were determined in 61 patients receiving plasma transfusions at a medium-sized tertiary care center to provide data for the model. Other parameters were obtained from the medical literature.Expected SD FP costs, benefits, and cost-effectiveness, assessed as cost per quality-adjusted life-year saved.Compared with untreated plasma, a unit of SD FP produces a net benefit of 35 minutes in quality-adjusted life expectancy at a cost of about $19. Extrapolated to the 2.2 million plasma units transfused annually in the United States, SD FP would save 147 quality-adjusted life-years at a cost of $42.5 million. The marginal cost-effectiveness, $289,300 per quality-adjusted life-year saved in the baseline analysis, was most sensitive to estimates of SD treatment cost and the clinical setting of plasma use. In sensitivity analysis, the net benefit of SD FP was negated by the existence of even a minute risk of nonenveloped virus infection.From a public health perspective, the relatively high costs and small benefits of reducing enveloped virus infection risks with SD FP (and the additional risks of noneveloped virus transmission) do not appear to justify widespread implementation of this new technology.
Intrathoracic Gastric Activity of Tc-99m Sestamibi in a Patient With Gastric Pull-Up for Esophageal Cancer
Authors: Yazan Alabed, Stephan Probst, Rajan Rakheja, Gordon Crelinsten, Marc Hickeson
Journal: Clinical Nuclear Medicine (2009)

A 69-year-old man with remote gastric pull-up was evaluated with a 2-day stress-rest dypiridamole Tc-99m sestamibi myocardial perfusion imaging, where significant tracer uptake was noted in the posterior mediastinum related to enterogastric reflux of sestamibi. These ancillary findings were suggestive of a noncardiac etiology of the patient's atypical chest pain. This case highlights the value of examining the raw projection images for incidental findings that may be present during myocardial perfusion imaging.
Noninvasive Measures of Liver Fibrosis
Authors: Don C. Rockey, Montgomery D. Bissell
Journal: Hepatology (2006)

As novel therapies for liver fibrosis evolve, non-invasive measurement of liver fibrosis will be required to help manage patients with chronic liver disease. Although liver biopsy is the current and time-honored gold standard for measurement of liver fibrosis, it is poorly suited to frequent monitoring because of its expense and morbidity, and its accuracy suffers from sampling variation. At the current writing, serum markers and imaging methods are available and increasingly in use as alternatives to biopsy. However, many questions remain about their indications, accuracy, and cost-effectiveness, and more investigation is required before they are put into widespread use. The development of safe, inexpensive, and reliable noninvasive fibrosis measurement tools remains a research priority in clinical hepatology.