tbuckley/cabot-search huggingface dataset:
Time to abandon testing for microscopic haematuria in adults?
Authors: P.-U. Malmstrom
Journal: BMJ (2003)

Although there is no doubt that macroscopic haematuria is serious, the clinical significance of asymptomatic microscopic haematuria is controversial. Should it still be tested for? Macroscopic haematuria has always been considered to be serious. Hippocrates stated, "If a patient passes blood, pus, and scales, in the urine, and if it has a heavy smell, ulceration of the bladder is indicated." The clinical significance of "microhaematuria" (microscopic haematuria), on the other hand, is more controversial. No consensus exists on the role of asymptomatic microhaematuria in the diagnosis of diseases, and guidelines are contradictory.1–3 Thus, this finding, which has been brought to the fore by the wide use of dipstick testing, presents a dilemma for doctors and even for patients.4 Recently the clinical importance of symptomatic microhaematuria has also been questioned.5 This article looks at the evidence base for the diagnostic value of microhaematuria. #### Summary points Microhaematuria is poorly predictive of cancers of the urinary tract Haemoglobin dipstick testing is not a reliable way of detecting early bladder cancer in patients at high risk Microhaematuria is not reliable evidence of a stone in the ureter and may be misleading, as it is often present in other serious conditions that cause acute loin pain Testing for microhaematuria is not helpful in evaluating men with lower urinary tract symptoms I was one of a panel of Swedish general practitioners and urologists set up by National Board of Health and Welfare in Sweden 1999 to formulate evidence based policy statements and recommendations for evaluating microhaematuria in adults. The panel recommended that testing for microhaematuria should be abandoned. This article continues that work and is based on an updated computer aided literature search up to May 2002 aimed at addressing four key questions:
Carcinoma of the Lung and Cigarette Smoking
Authors: Dalia Maor, Michael E. Klein, Daniel E. Kenady, Paul B. Chretien, Michael R. Mardiney
Journal: JAMA (1978)

Serum ribonuclease levels were determined in 54 patients with lung carcinoma, 74 long-term cigarette smokers, and 172 nonsmokers. The mean serum ribonuclease level was significantly higher in patients with lung carcinoma and long-term smokers compared with healthy nonsmokers (P less than .001). The serum ribonuclease activity level was not related to chronological age, sex, or race of the smoker or nonsmoker population. Forty (75%) of 53 patients with lung cancer and 49 (66%) of 74 smokers had elevated serum ribonuclease levels compared with 13 (7%) of 179 nonsmoker healthy controls (P less than .001). The highest incidence of elevation was noted in patients with epidermoid carcinoma (95%).
Gas in the Fetal Circulation—Reliable Antepartum Roentgen Sign of Fetal Death
Authors: Mortimer R. Camiel
Journal: JAMA (1961)

THE ANTEPARTUM ROENTGEN demonstration of gas in the fetal circulation is the most important pathognomonic sign of fetal death. The phenomenon of visualized gas in the fetal circulation has never been observed in a fetus which was subsequently delivered alive. Wider dissemination of information about this phenomenon is warranted. Gas in the fetal circulation associated with fetal death was first described by Roberts,<sup>11</sup>of Victoria, B. C., in 1944. He diagnosed fetal death from antepartum roentgenograms in which there was a clear demonstration of gas in the cardiac chambers and blood vessels, and corroborated the finding by postpartum roentgen studies and autopsy. Many confirmatory reports have been published. In the approximately 100 cases reported,<sup>2-4, 9, 12-16</sup>antepartum roentgenograms revealed gas in the fetal heart and/or larger vessels or umbilical cord. The vessels in the liver were occasionally seen. In rare instances gas was visible about the kidneys. The
Management of cervical dyskaryosis National guidelines are not followed
Authors: A Saha, M Maresh, M A Thomas, L M Reay, M H Jones, J J J. J H Robertson, B Woodend, A Herbert, D Jenkins, S Gallivan, C S Johnson, C Wilkinson, T Peters, A E Raffle, E F D MacKenzie, E F D MacKenzie
Journal: BMJ (1994)

National guidelines are not followed EDITOR,-We hope that the work of G Flannelly and colleagues will help bring uniformity to the management of different grades of dyskaryosis in cervical smears.'The management of mildly dyskaryotic smears is not uniform throughout Britain.Kitchener observed in 1991 that 37% of
Medical savings accounts: Singapore's non-solution to healthcare costs
Authors: M. McKee, R. Busse
Journal: BMJ (2013)

One small part of a complex patchwork of funding



Not a model worth emulating



Because of the obvious failings of the American health system, health policy analysts in the United States have traditionally looked abroad for inspiration.1 William Haseltine, president of ACCESS Health International, is among the latest to do so. Inspired by a 2010 lecture on the health system in Singapore, he searched for a book that would provide him with a detailed explanation of how it worked. Finding that none existed, he set out to fill the gap. The result is a short, highly readable book whose title, Affordable Excellence , summarises accurately, if somewhat uncritically, his judgment on Singapore’s achievements.2 In it, he documents how Singapore has managed to contain costs while ensuring access to healthcare and achieving health outcomes that are as good, and in many cases better, than those in other developed countries.

One reason why Singapore has attracted international interest is its unique system of healthcare financing, with the concept of the medical savings account (Medisave) at its core.3 Under this system, all people are responsible for their own healthcare and that of their family. Money is saved into an account from which they can draw when …
The lupus anticoagulant, pulmonary thromboembolism, and fatal pulmonary hypertension.
Authors: N E Anderson, M R Ali
Journal: Annals of the Rheumatic Diseases (1984)

A patient with a circulating lupus anticoagulant in the absence of systemic lupus erythematosus developed recurrent deep venous thromboses and pulmonary emboli. Pulmonary emboli recurred despite prolonged oral anticoagulant therapy and resulted in fatal pulmonary arterial hypertension. Extended anticoagulant therapy alone may not prevent recurrent thromboembolism in patients with a lupus anticoagulant. Pulmonary thromboembolism may be an important factor in the pathogenesis of pulmonary hypertension in patients with a lupus anticoagulant.
The status of cardiovascular health knowledge among sixth, seventh, and eighth grade children.
Authors: C W White, M A Albanese, E E Anderson, R M Caplan
Journal: Circulation (1977)

The goals of this study were to develop and standardize a test of cardiovascular health knowledge to determine its status among primary school children, to ascertain the rate at which cardiovascular health knowledge increases as compared to other subject areas, and to demonstrate the feasibility of the use of standardized achievement tests for assessing the results of health education curricula. The Iowa Cardiovascular Health Knowledge Test (ICVHT) was developed and administered in conjunction with a standardized educational testing program, the Iowa Test of Basic Skills (ITBS), to a stratified sample of 2,675 Iowa Students from grades six, seven, and eight. The average student in the sixth, seventh and eighth grades answered 37.9 +/- 0.4, 41.2 +/- 0.3, and 43.7 +/- 0.4 (SEM) percent of the items correctly. ICVHT scores increased minimally (less than 1 item/grade) as grade levels increased, but at a 75% slower rate than scores in other subjects tested. The results document a deficiency in cardiovascular health knowledge and provide a model for use in educational assessment programs in other health disciplines.
Prurigo and pets.
Authors: S Eykyn
Journal: BMJ (1979)

days after the onset of symptoms showed a large, superficial ulcer in the mid-oesophagus.She responded well to withdrawal of emepronium bromide and to oral analgesics and nine days later repeat oesophagoscopy showed that the ulcer had healed.There have been a number of reports of oesophageal ulceration with emepronium bromide,'-4 as well as a report of mouth ulcers,; thought to be caused by prolonged contact of the tablet with the mucosa.The data sheet on this drug now suggests that the tablets should be swallowed with a glass of water, but it is apparent that this instruction is not always stressed by the doctor or followed by the patient.The tablet is formulated to distintegrate rapidly on contact with water but its hygroscopic nature can cause it to stick to the oesophageal mucosa if it is swallowed with too little water.Perhaps the time has come for the manufacturers to redevelop the presen- tation of this drug.Surely it will not be long before oesophageal perforation due to emepronium bromide is recorded.
A New Method to Analyze Lung Compliance When Pressure–Volume Relationship Is Nonlinear
Authors: WERNER NIKISCHIN, TILO GERHARDT, RUTH EVERETT, EDUARDO BANCALARI
Journal: American Journal of Respiratory and Critical Care Medicine (1998)

Changes in dynamic lung compliance during inspiration and expiration cannot be modeled accurately with conventional algorithms. We developed a simple method to analyze pressure–volume (P/V) relationships under condition of nonlinearity (APVNL) and tested it in a lung model with known resistance and nonlinear P/V relationship. In addition, pulmonary mechanics in 22 infants, 11 of them with nonlinear P/V relationships, were analyzed with the new method. The findings were compared with those obtained by a recently introduced algorithm, multiple linear regression analysis (MLR) of the equation of motion. The APVNL method described the changing compliance (C) of the lung model accurately, whereas the MLR method underestimated C especially in the first half of the breath. In infants the MLR method gave highly variable, often nonphysiological C values in the beginning of a breath. In contrast, the coefficient of variability of measurements obtained by the APVNL method was significantly smaller (p < 0.02), and the indices of model-fit showed better agreement between calculated and observed pressure than for the MLR method (p < 0.02). We conclude that the APVNL method accurately describes nonlinear P/V relationships present during spontaneous breathing or mechanical ventilation. The method may be helpful in identifying and preventing pulmonary overdistention.
Blood Lead Levels in Aberystwyth
Authors: W. H. Beasley, P. M. E. Broughton, H. T. Delves, P. C. Elwood
Journal: BMJ (1974)

<h3>Abstract</h3> Serological assays are important tools to identify previous exposure to SARS-CoV-2, helping to track COVID-19 cases and determine the level of humoral response to SARS-CoV-2 infections and/or immunization to future vaccines. Here the SARS-CoV-2 nucleocapsid protein was expressed in <i>Escherichia coli</i> and purified to homogeneity and high yield using a single chromatography step. The purified SARS-CoV-2 nucleocapsid protein was used to develop an indirect enzyme-linked immunosorbent assay for the identification of human SARS-CoV-2 seroconverts. The assay sensitivity and specificity were determined analyzing sera from 140 PCR-confirmed COVID-19 cases and 210 pre-pandemic controls. The assay operated with 90% sensitivity and 98% specificity; identical accuracies were obtained in head-to-head comparison with a commercial ELISA kit. Antigen coated plates were stable for up to 3 months at 4°C). The ELISA method described is ready to mass production and will be an additional toll to track COVID-19 cases.
Role of HHV-8 in Kaposi Sarcoma
Authors: D. Scott Schmid
Journal: JAMA (1998)

BackgroundAlthough human herpesvirus 8 (HHV-8) has been suspected to be the etiologic
agent of Kaposi's sarcoma, little is known about its seroprevalence in the
population, its modes of transmission, and its natural history.MethodsThe San Francisco Men's Health Study, begun in 1984, is a study of a
population-based sample of men in an area with a high incidence of human immunodeficiency
virus (HIV) infection. We studied all 400 men infected at base line with HIV
and a sample of 400 uninfected men. Base-line serum samples were assayed for
antibodies to HHV-8 latency–associated nuclear antigen (anti-LANA).
In addition to the seroprevalence and risk factors for anti-LANA seropositivity,
we analyzed the time to the development of Kaposi's sarcoma.ResultsAnti-LANA antibodies were found in 223 of 593 men (37.6 percent) who
reported any homosexual activity in the previous five years and in none of
195 exclusively heterosexual men. Anti-LANA seropositivity correlated with
a history of sexually transmitted diseases and had a linear association with
the number of male sexual-intercourse partners. Among the men who were infected
with both HIV and HHV-8 at base line, the 10-year probability of Kaposi's
sarcoma was 49.6 percent. Base-line anti-LANA seropositivity preceded and
was independently associated with subsequent Kaposi's sarcoma, even after
adjustment for CD4 cell counts and the number of homosexual partners.ConclusionsThe prevalence of HHV-8 infection is high among homosexual men, correlates
with the number of homosexual partners, and is temporally and independently
associated with Kaposi's sarcoma. These observations are further evidence
that HHV-8 has an etiologic role in Kaposi's sarcoma and is sexually transmitted
among men.
Significance of Mesenteric Arterial Receptors in the Reflex Regulation of Systemic Blood Pressure
Authors: GARRY O. BOYER, ALLEN M. SCHER
Journal: Circulation Research (1960)

The isolated abdominal aorta was perfused in 6 cats and 2 dogs, and perfusion of the isolated superior mesenteric arterial system was performed in another 6 cats. In every experiment, wide variations in perfusion pressure produced no alterations in the systemic pressure, although it was responsive to manipulation of the carotid pressure. A comparison of the systemic pressure responses to mesenteric artery occlusion and to carotid artery occlusion prior to and following (1) high spinal transection in 2 cats or (2) venous perfusion of sodium thiopental in 3 cats showed an obliteration of the responses to carotid occlusion while the systemic response to oclusion of the mesenteric artery persisted. The results indicate that the systemic responses seen during mesenteric artery occlusion are probably caused by mechanical diversion of blood from one vascular bed to another and do not represent true reflex responses. The observations indicate that mesenteric pressure receptors do not contribute significantly to the reflex regulation of the systemic blood pressure.
Changes in Gut Flora after Cephalexin Treatment
Authors: H. Gaya, P. I. Adnitt, P. Turner
Journal: BMJ (1970)

Eighteen patients with urinary tract infection were treated with cephalexin orally. Absorption was variable, between 29 and 89% of the total daily dose being excreted in the urine in 24 hours. A significant number of patients became faecal carriers of Pseudomonas aeruginosa compared with a control group who received no antibiotics. Four of the cephalexin-treated patients acquired a strain of Ps. aeruginosa known to be present in food from the hospital diet kitchen and one developed a urinary tract infection with this strain.
Egyptians score high on blood pressure
Authors: M Gulens
Journal: BMJ (1994)

Early results from the Egyptian national hypertension project show that about a third of the population in urban areas has high blood pressure. “Egypt suffers from one of the highest prevalences of hypertension in the world,” said Dr Mohsen Ibrahim, professor of cardiology at Cairo University. “Unless serious measures are taken to control this disease we will be facing a serious cardiovascular epidemic in the coming two decades.”

The national hypertension project, undertaken in conjunction with the American Heart, Blood, and Lung Institute and Johns. Hopkins University, is the first study of its kind in a developing country. From November 1991 to April 1993 the …
Increased Bone Mass as a Result of Estrogen Therapy in a Man with Aromatase Deficiency
Authors: John P. Bilezikian, Akira Morishima, Jennifer Bell, Melvin M. Grumbach
Journal: New England Journal of Medicine (1998)

During childhood and young adulthood, the skeleton accrues virtually all the bone mineral it will ever have.1 Since the aging process is associated with bone loss, the more bone mass one gains in the formative years, the less likely it is that increased bone resorption and decreased bone formation will result in osteoporosis. Hence, the failure to achieve optimal peak bone mass is a pathogenetic mechanism in osteoporosis. The sex steroids are critically important in helping to establish peak bone mass for both sexes. Girls with estrogen deficiency do not achieve optimal peak bone mass.2–4 Similarly, achievement of peak . . .
Human immunodeficiency virus and hepatitis C infections induce distinct immunologic imprints in peripheral mononuclear cells
Authors: Shyam Kottilil, Michael Y. Yan, Kristin N. Reitano, Xiaozhen Zhang, Richard Lempicki, Gregg Roby, Marybeth Daucher, Jun Yang, Karoll J. Cortez, Marc Ghany, Michael A. Polis, Anthony S. Fauci
Journal: Hepatology (2009)

Abstract Coinfection with hepatitis C virus (HCV) is present in one-third of all human immunodeficiency virus (HIV)-infected individuals in the United States and is associated with rapid progression of liver fibrosis and poor response to pegylated interferon (IFN) and ribavirin. In this study we examined gene expression profiles in peripheral blood mononuclear cells (PBMCs) from different groups of individuals who are monoinfected or coinfected with HIV and HCV. Data showed that HIV and HCV viremia up-regulate genes associated with immune activation and immunoregulatory pathways. HCV viremia is also associated with abnormalities in all peripheral immune cells, suggesting a global effect of HCV on the immune system. Interferon-α-induced genes were expressed at a higher level in PBMCs from HIV-infected individuals. HCV and HIV infections leave distinct profiles or gene expression of immune activation in PBMCs. HIV viremia induces an immune activated state; by comparison, HCV infection induces immunoregulatory and proinflammatory pathways that may contribute to progression of liver fibrosis. Conclusion: An aberrant type-I IFN response seen exclusively in HIV-infected individuals could be responsible for the poor therapeutic response experienced by HIV/HCV coinfected individuals receiving interferon-α-based current standard of care. (Hepatology 2009;50:34–45.)
Long-term Clearance of Linear Porokeratosis With Tacrolimus, 0.1%, Ointment
Authors: Ashley C. Parks, Kelly J. Conner, Cheryl A. Armstrong
Journal: JAMA Dermatology (2014)

Porokeratosis is a disorder of abnormal keratinization with multiple clinical variants. It is often difficult to achieve complete resolution of porokeratosis even with a variety of therapies that have been reported to have some efficacy.
FACTORS INVOLVED IN PRODUCTION OF CLOSTRIDIUM WELCHII ALPHA TOXIN
Authors: Mark H. Adams, Edelmira D. Hendee, A. M. Pappenheimer
Journal: The Journal of Experimental Medicine (1947)

Maximum production of the alpha toxin by Cl. welchii is dependent on the inclusion in the medium of several substances in addition to those required for growth. These factors include: 1. Some substance present in enzymatic digests of certain proteins such as casein and gelatine. 2. Glycerylphosphorylcholine and other substances that are present in extracts of pancreas. 3. The use of starch or dextrin as a carbohydrate source in the absence of other fermentable carbohydrates. The omission of any one of these factors from the medium results in a very low yield of alpha toxin.
THE EXPERIMENTAL DISEASE THAT FOLLOWS THE INJECTION OF HUMAN LEPROSY BACILLI INTO FOOT-PADS OF MICE
Authors: Charles C. Shepard
Journal: The Journal of Experimental Medicine (1960)

When leprosy bacilli from human patients are inoculated into the foot-pads of CFW mice, a microscopic granuloma containing acid-fast bacilli develops in a characteristic manner. This has been seen in 22 of 22 instances with leprosy bacilli from nasal washings, in 12 of 16 instances with leprosy bacilli from skin biopsies, and in none of 16 cases where the nasal washings were not observed to contain leprosy bacilli. Quantitative studies revealed a relationship between the number of bacilli inoculated and the time required for the appearance of the lesions. The incubation period was usually 1 to 2 months when the dose was 10(5.5) to 10(6.0) bacilli and about 6 months when the dose was about 10(3) organisms. After the development of the lesion, the number of bacilli harvested was usually in the range 10(4.5) to 10(6.0), regardless of the number inoculated. When the inoculum has contained 10(2.0) to 10(3.5) acid-fast bacilli, and harvests were reasonably prompt, there were regular increases of 50- to 1000-fold. Passage to new groups of mice has been successful 11 of 12 times. Most of these were second passages. One strain has been maintained in 3 passages with a total increase in acid-fast bacilli of 4 x 10(4)-fold. Another strain has been through 4 passages with a total increase of about 4 x 10(6)-fold. Cultures on bacteriological media favorable for the growth of most known mycobacterial species have not shown growth of mycobacteria.
Teaching general practice.
Authors: J Swayne
Journal: BMJ (1977)

much lcss than that of a HBeAg-positive mother.It is of particular interest that the child born to our anti-HBe-positive carrier mother and the case reported previously both developed an acute infection, in contrast to children of HBeAGpositive mothers, who became asymptomatic carriers.The only evidence of hepatitis B infection in these children after elimination of antigen was the presence of antibody.It is thus necessary to perform serial screen- ing on children born to HBsAg-positive mothers, for anti-HBs as well as HBsAg, in any study of e anti-e as a possible marker for vertical transmission.
PSYCHIATRIC ASPECTS OF UREMIA
Authors: A. B. BAKER, JULIAN KNUTSON
Journal: American Journal of Psychiatry (1946)

1. Uremia may result in irreversible damage to the central nervous system. These tissue changes may so disturb cerebral function as to result in a host of personality disorders. 2. A case of uremic psychosis is reported occurring in a 27-year-old male who had a blood urea nitrogen of 243 mg. percent. 3. Clinically a uremic psychosis may resemble almost any of the recognized varieties of the psychoses. 4. Certain features, when associated with any of the clinical forms of this illness, aid greatly in the diagnosis. These consist of: a rather sudden onset; poor physical health of the patient; frequent remissions during the course of the illness; associated neurological findings; and a poor prognosis usually with a lethal outcome. 5. A review of the literature is attempted with a listing of the types of clinical pictures described by the various authors.
IMPACT OF EXTENT OF MYOCARDIAL FIBROSIS ON OCCURRENCE OF VENTRICULAR TACHYARRHYTHMIA IN HYPERTROPHIC CARDIOMYOPATHY: RESULTS FROM MRI WITH LATE GADOLINIUM ENHANCEMENT STUDY IN GENOTYPED PATIENTS
Authors: Junichiro Yokawa, Eiichi Masuta, Noboru Fujino, Kenshi Hayashi, Katsuharu Uchiyama, Akira Funada, Yuichiro Sakamoto, Toshinari Tsubokawa, Akihiko Muramoto, Hidekazu Ino, Masakazu Yamagishi
Journal: Journal of the American College of Cardiology (2010)