tbuckley/cabot-search huggingface dataset:
P219 Gender Differences in GP Suggested Diagnosis For COPD in Primary Care
Authors: NJ Roberts, IS Patel, MR Partridge
Journal: Thorax (2012)

<h3>Background</h3> Mosca <i>et al</i> has shown that clinicians fail to recognise cardiovascular risk in women (1). We have explored whether the same applies to COPD. <h3>Methods</h3> Gender, demographics and symptoms were examined for patients referred by a GP to a community spirometry service with “suspected COPD or “definite COPD” over a 4 year period. These were compared with the final diagnosis after spirometry and specialist review. <h3>Results</h3> 445 GP referrals for “suspected” or “definite COPD” (221 Males, 224 females) were reviewed. When the GP suggested a diagnosis of “definite COPD” (n=180), this was confirmed in 87.5% of men (77/88) and 73.9% (68/92) of women (p=0.022). There was a trend for women to present more frequently with allergies (p=0.055) and men with progressive breathlessness as their main symptom (p=0.051). Similarly for those with suspected COPD (n=265) 60.9% (81/133) of men and 43.2% (57/132) of women had this diagnosis confirmed (p=0.004). Women were more likely to report allergies (p=0.002), although a large percentage (81%) reported symptoms starting in later decades. Females who did not receive a diagnosis of COPD (n=75) had a lower prevalence of smoking (ex/current smokers (79%, 59/75, p=0.042) compared to women who received a diagnosis of COPD (91%, 52/57). Women who did not have COPD confirmed were likely to have a non-respiratory cause for their symptoms (45%, 34/75), normal spirometry (33%, 25/75), restrictive spirometry (13%, 10/75) and asthma (8%, 6/75). Men who did not have COPD (52/133) were likely to have normal spirometry (69%, 36/52), restrictive spirometry (15%, 8/52), a non-respiratory cause (8%, 4/52) or asthma (6%, 3/52). In this group 86% of men smoked (45/52) compared to 95% (77/81) of those with confirmed COPD. <h3>Conclusions</h3> In GP referrals with “suspected” and “definite” COPD, there were significant differences in final diagnosis between men and women after spirometry. Women were more likely to have a GP diagnosis of COPD which was amended after spirometry. High levels of smoking were evident in both groups perhaps influencing GPs towards this, as opposed to other possible diagnoses, particularly in women. Mosca L et al. Circulation 2005; 111:499–510.
Infectious Diseases of the Fetus and New-born Infant
Authors: Leslie L. Barton
Journal: JAMA (1977)

A volume encompassing 1,100 pages is in itself a testimonial to the "growth and development" of the field of perinatal infectious diseases. The "book encompasses infections of the fetus and newborn infant, including those acquired<i>in utero</i>, during the delivery process, and in the early months of life." Twenty chapters, ranging from rubella, cytomegalovirus, herpes simplex, toxoplasmosis, tuberculosis, and syphilis to bacterial infections and antimicrobial agents are "expertly written by the experts." Each tightly edited chapter spans the pathophysiology, epidemiology, diagnosis and differential diagnosis, treatment (when available), and (possible) prevention of the infection. The tables and graphs are excellent; the bibliographies are encyclopedic. One may always quibble about minutiae in medicine, and the field of infectious diseases seems particularly vulnerable. For example, I believe that chloramphenicol has a greater place (than indicated) in the therapy of severe infections, especially those involving the CNS. But various disagreements do not impair the
Effect of modern analgesic drugs (tramadol, pentazocine, and buprenorphine) on the bile duct sphincter in man.
Authors: M Staritz, T Poralla, M Manns, K H Meyer Zum Buschenfelde
Journal: Gut (1986)

Modern narcotic analgesic drugs, such as tramadol, pentazocine, and buprenorphine share similarities of molecular structure with morphine which is widely believed to cause spasm of the bile duct sphincter and so impede bile flow. This study assessed the effects of intravenously administered analgesics on bile duct sphincter motor activity measured by ERCP manometry. Ten minutes after pentazocine injection the duration of contractions and baseline pressure of the bile duct sphincter rose from 6.2 +/- 0.2 to 8.2 +/- 0.27 s and from 5.1 +/- 0.6 to 8.8 +/- 0.4 mmHg respectively. Tramadol, buprenorphine and saline showed no such effect. These data indicated that the effects of such drugs on bile duct sphincter function can be safely assessed by ERCP manometry and that pentazocine adversely affects the bile duct sphincter, whilst tramadol and buprenorphine do not. We consider therefore that pentazocine is not the premedication of first choice for endoscopic procedures involving the sphincter of Oddi and should also be avoided in patients with pancreatic and biliary disorders.
"Personalising" NHS information technology in England
Authors: T. Greenhalgh, J. Keen
Journal: BMJ (2014)

The latest framework for action has learnt few lessons from recent failures

The remit of England’s National Information Board is to set strategy and commission informatics services for health and social care.1The new board recently released its first major publication, Personalised Health and Care 2020 .2

Described as a policy framework and resting heavily on unpublished “research” from the management consultancy McKinsey, the 66 page document paints a futuristic picture of an NHS in which information flows freely between citizens, general practitioners, and other care providers, and staff are freed up from inefficient and repetitive data entry to engage in more productive work.

Patients, the framework predicts, will regularly access and annotate their online health record, order repeat prescriptions, and book hospital appointments through a personal portal. They will use “kitemarked” mobile applications (apps) and wearable monitoring devices to manage their illnesses and support healthy lifestyles.

This vision is depicted as dependent on three things: a high degree of technical interoperability between systems; consistently excellent data quality; and “activated” (that is, informed, skilled, and motivated) patients and staff. An ambitious timetable promises that by March 2015, for example, all NHS patients will have online …
Catecholamine-induced lipolysis in adipose tissue of the elderly.
Authors: F Lönnqvist, B Nyberg, H Wahrenberg, P Arner
Journal: Journal of Clinical Investigation (1990)

Age-dependent alterations in the effects of catecholamines on lipolysis were investigated in 25 young (21-35 yr) and 10 elderly (58-72 yr) healthy, nonobese subjects using isolated adipocytes obtained from abdominal subcutaneous tissue. Basal lipolysis was not affected by aging, while the rate of catecholamine-stimulated lipolysis was reduced by 50% in the elderly subjects (P less than 0.005). To elucidate the mechanisms behind this phenomenon lipolysis was stimulated with agents that act at well-defined steps in the lipolytic cascade, from the receptor down to the final step: the activation of the protein kinase/hormone-sensitive lipase complex. All agents stimulated lipolysis at a 50% lower rate in elderly as compared with young subjects (P less than 0.05 or less). However, half-maximum effective concentrations of the lipolytic agents were similar in both groups. The antilipolytic effects of alpha 2-adrenoceptor agonists were also the same in young and old subjects. Moreover, the stoichiometric properties of the beta- and alpha 2-receptors did not change with increasing age. In vivo studies performed on the same individuals likewise demonstrated an impaired lipolytic responsiveness, with 50% lower plasma glycerol concentrations during exercise in the elderly subjects (P less than 0.05), in spite of a normal rise in plasma norepinephrine. The plasma glycerol levels correlated strongly to the glycerol release caused by catecholamine-stimulated lipolysis in vitro in both young and elderly subjects (r = 0.8-0.9, P less than 0.001). In conclusion, a decreased activation of the hormone-sensitive lipase complex appears to be the mechanism underlying a blunted lipolytic response of fat cells to catecholamine stimulation in elderly subjects. This finding may, explain the age-dependent decreased lipolytic response to exercise in vivo.
Retinoic acid inhibits induction of c-Jun protein by ultraviolet radiation that occurs subsequent to activation of mitogen-activated protein kinase pathways in human skin in vivo.
Authors: G J Fisher, H S Talwar, J Lin, P Lin, F McPhillips, Z Wang, X Li, Y Wan, S Kang, J J Voorhees
Journal: Journal of Clinical Investigation (1998)

Human skin is exposed daily to solar ultraviolet (UV) radiation. UV induces the matrix metalloproteinases collagenase, 92-kD gelatinase, and stromelysin, which degrade skin connective tissue and may contribute to premature skin aging (photoaging). Pretreatment of skin with all-trans retinoic acid (tRA) inhibits UV induction of matrix metalloproteinases. We investigated upstream signal transduction pathways and the mechanism of tRA inhibition of UV induction of matrix metalloproteinases in human skin in vivo. Exposure of human skin in vivo to low doses of UV activated EGF receptors, the GTP-binding regulatory protein p21Ras, and stimulated mitogen-activated protein (MAP) kinases, extracellular signal-regulated kinase (ERK), c-Jun amino-terminal kinase (JNK), and p38. Both JNK and p38 phosphorylated, and thereby activated transcription factors c-Jun and activating transcription factor 2 (ATF-2), which bound to the c-Jun promoter and upregulated c-Jun gene expression. Elevated c-Jun, in association with constitutively expressed c-Fos, formed increased levels of transcription factor activator protein (AP) 1, which is required for transcription of matrix metalloproteinases. Pretreatment of human skin with tRA inhibited UV induction of c-Jun protein and, consequently, AP-1. c-Jun protein inhibition occurred via a posttranscriptional mechanism, since tRA did not inhibit UV induction of c-Jun mRNA. These data demonstrate, for the first time, activation of MAP kinase pathways in humans in vivo, and reveal a novel posttranscriptional mechanism by which tRA antagonizes UV activation of AP-1 by inhibiting c-Jun protein induction. Inhibition of c-Jun induction likely contributes to the previously reported prevention by tRA of UV induction of AP-1-regulated matrix-degrading metalloproteinases in human skin.
Abnormal Glucose Tolerance and Other Coronary Heart Disease Risk Factors in an Isolated Aboriginal Community in Central Australia
Authors: Andrew Gault, Kerin O'Dea, Kevin G Rowley, Toby McLeay, Kathy Traianedes
Journal: Diabetes Care (1996)

OBJECTIVE To determine the age- and sex-specific prevalence of diabetes, impaired glucose tolerance (IGT), and coronary heart disease risk factors in a remote central Australian Aboriginal community maintaining some degree of traditional lifestyle, living in homeland communities on their ancestral land. RESEARCH DESIGN AND METHODS A cross-sectional survey of 437 subjects ≥ 15 years of age (189 men, 248 women), representing 80% of the adult population residing in the community at the time of the survey, was performed and the following parameters measured: BMI, glucose tolerance, circulating insulin and lipids, and blood pressure. RESULTS The mean BMI for this population was 22.9 ± 4.8 kg/m2. The prevalence of diabetes in the age group of 15–34 years (103 men and 140 women) was 2 and 6% for men and women, respectively. In the 35-years-and-older age group (86 men and 108 women), diabetes prevalence was 19 and 13% for men and women, respectively. Over half the diabetic subjects did not exhibit fasting hyperglycemia. IGT occurred in 8 and 15% of younger men and women, respectively, and in 17 and 32% of older men and women, respectively. Smoking was common among men (53% current smokers) but rare among women (2% current smokers). The prevalence of hypercholesterolemia, hypertriglyceridemia, hypertension, and overweight rose with increasing degrees of glucose intolerance. The two communities adjacent to the only store in the area had a higher prevalence of abnormal glucose tolerance than did the more remote homeland communities (odds ratio for abnormal glucose tolerance: 2.92; 95% CI 1.51−5.63). CONCLUSIONS Despite their relative leanness, this Aboriginal population exhibited relatively high prevalences of IGT and diabetes without fasting hyperglycemia. The data suggest a protective effect of a decentralized mode of living, as opposed to a more urbanized lifestyle, on the occurrence of glucose intolerance. Abnormal lipid profiles (particularly high triglycerides and low HDL cholesterol) and the high prevalence of smoking in men indicated a high-risk profile for coronary heart disease in this population.
DO CHANGES IN PULMONARY HEMODYNAMICS PREDICT CLINICAL EVENTS IN PULMONARY ARTERIAL HYPERTENSION? A META-ANALYSIS OF 17 STUDIES
Authors: Gianluigi Savarese, Francesca Musella, D&apos;Amore Carmen, Milena Cecere, Teresa Losco, Caterina Marciano, Paola Gargiulo, Pasquale Perrone-Filardi
Journal: Journal of the American College of Cardiology (2012)
Infantile kala-azar in Britain.
Authors: F G Hill, E A Letsky
Journal: BMJ (1975)

Prolapsing Thrombosed Haemorrhoids: Outcome of Conservative ManagementProlapsed thrombosed haemorrhoids are a common and painful surgical emergency.Though emergency haemorrhoidectomy was discussed as early as 19141 the usual treatment in the United Kingdom is non-operative.The natural history of thrombosed haemorrhoids managed conservatively, however, is not known and there are no reports on whether patients continue to have symptoms.We report here the incidence of continuing symptoms after recovery from an acute episode and the incidence of subsequent elective haemorrhoid- ectomy. Methods and ResultsThe records of all patients attending St. Mark's Hospital from 1962 to 1967 with prolapsed thrombosed haemorrhoids were studied.Basic information was extracted and several patients examined.Altogether 117 patients presented in this period; all were managed con- servatively.Four patients had died, 21 could not be traced, and further information was available about 92.At the time of their original presentation 47 (40 2%) patients had had their symptoms for more than three years and 10 (8 5%) for more than 10 years.More patients (69) complained of prolapse
The Effect of Ethyl Alcohol and Inhaled Cigarette Smoke on the Caliber of Atherosclerotic Coronary Arteries as Visualized by Selective Arteriography.
Authors: Hratch Kasparian
Journal: Annals of Internal Medicine (1964)

s1 October 1964The Effect of Ethyl Alcohol and Inhaled Cigarette Smoke on the Caliber of Atherosclerotic Coronary Arteries as Visualized by Selective Arteriography.Hratch Kasparian, M.D., William Likoff, M.D., F.A.C.P., J. Stauffer Lehman, M.D.Hratch Kasparian, M.D.Search for more papers by this author, William Likoff, M.D., F.A.C.P.Search for more papers by this author, J. Stauffer Lehman, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-61-4-799_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThis study used arteriography and cinéradiographic techniques to determine whether orally administered ethyl alcohol or inhaled cigarette smoke exercised a dilating or constricting effect on the caliber of atherosclerotic coronary arteries.Thirty patients with known coronary heart disease were studied: 22 had single or multiple past myocardial infarctions, 8 had angina pectoris with significant electrocardiographic indications of myocardial disease. In each patient visualization of the right and then the left coronary artery was obtained by the Sones technique using a 9-in. amplifier and was recorded cinéradiographically with a 35-mm camera. Fifteen patients were administered 60 cc of blended whiskey after... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Philadelphia, Pa. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByTension, drugs, and premature systoles 1 October 1964Volume 61, Issue 4Page: 799-799KeywordsAnginaAngiographyCoronary arteriesCoronary heart diseaseElectrocardiographyEthanolLeft coronary arteryMyocardial infarctionPatient advocacy Issue Published: 1 October 1964 PDF DownloadLoading ...
Platelet Survival in Patients with Rheumatic Heart Disease
Authors: Peter P. Steele, Hugh S. Weily, Hywel Davies, Edward Genton
Journal: New England Journal of Medicine (1974)

Platelet studies were carried out in patients with valvular heart disease to determine the correlation of results with thromboembolism. Platelet survival was normal in 11 patients with aortic stenosis, and no thromboembolism occurred. In 55 patients with mitral stenosis, average platelet survival was slightly shortened. In 29, thromboembolism had occurred, and mean platelet survival was abnormal and significantly shorter than in the 26 patients without thromboembolism. Of patients with thromboembolism, 93 per cent had short survival as compared to 31 per cent of those without thromboembolism. Thromboembolism had occurred in 83 per cent of patients with short platelet survival as compared to 10 per cent in those with normal platelet survival. The results demonstrate that short platelet survival differentiates patients with mitral-valve disease and a history of thromboembolism from those without thromboembolism. Such studies done prospectively may identify thromboembolism-prone patients in whom platelet-inhibitor therapy may prove useful. (N Engl J Med 290:537–539, 1974)
THE ROLE OF PENICILLIN-INDUCED BACTERIAL VARIANTS IN EXPERIMENTAL PYELONEPHRITIS
Authors: Richard H. Winterbauer, Laura T. Gutman, Marvin Turck, Ralph J. Wedgwood, Robert G. Petersdorf
Journal: The Journal of Experimental Medicine (1967)

1. After injection into the renal medulla of rats Escherichia coli 06 variants reverted rapidly in vivo in the absence of penicillin. These variants had previously been shown to be stable in vitro. 2. Variants failed to survive following intramedullary injection when animals were receiving penicillin. 3. Late reversion of variants also failed to occur in animals treated with penicillin for only 1 or 2 days. 4. Variants survived and reverted more readily when injected in the renal medulla, compared with liver and spleen. Classical bacteria injected into the kidney, liver, and spleen were recovered in approximately equal numbers. 5. The histologic response to nonreverting variants, medium not containing variants, and killed variants was similar and was characterized by a fibrotic reaction with moderate round cell infiltration. 6. In contrast, the histologic response to reverting variants and to classical E. coli was characterized by an intense, acute, polymorphonuclear leukocytosis typical of acute pyelonephritis.
Frontal fibrosing alopecia: A multicenter review of 355 patients
Authors: Sergio Vañó-Galván, Ana M. Molina-Ruiz, Cristina Serrano-Falcón, Salvador Arias-Santiago, Ana R. Rodrigues-Barata, Gloria Garnacho-Saucedo, Antonio Martorell-Calatayud, Pablo Fernández-Crehuet, Ramón Grimalt, Beatriz Aranegui, Emiliano Grillo, Blanca Diaz-Ley, Rafael Salido, Sivia Pérez-Gala, Salvio Serrano, Jose Carlos Moreno, Pedro Jaén, Francisco M. Camacho
Journal: Journal of the American Academy of Dermatology (2014)
Long‐term follow‐up analysis after rituximab salvage therapy in adult patients with immune thrombocytopenia
Authors: Francesco Zaja, Stefano Volpetti, Marianna Chiozzotto, Simona Puglisi, Miriam Isola, Silvia Buttignol, Renato Fanin
Journal: American Journal of Hematology (2012)

Abstract We report the long‐term outcome results of 57 consecutive adult patients with immune thrombocytopenia after being treated with rituximab. According to the different period of therapy, patients received either standard dose (SD) rituximab (i.e., 375 mg/m 2 weekly for 4 weeks) or low dose (LD) rituximab (i.e., 100 mg flat dose weekly for 4 weeks). Overall (OR) and complete response (CR) rates were 60 and 40%, respectively. Patients' median follow‐up was 52 months, 82 months in the SD, and 44 months in the LD group; 15 out of 34 responsive patients (44%) relapsed, with median response duration of 24 months (range 3–120). The estimated 4‐years event‐free survival (EFS, considering events the non response status at month 2 or relapses in responders) was 30%. Patients who received SD vs. LD rituximab had better outcome with regard to short term response (OR 66 vs. 52%, CR 50 vs. 28%), relapse rate (38 vs. 54%), probability to achieve and maintain long‐term response (41 vs. 24%) and estimated 4‐years EFS (35 vs. 23%). Patients with a longer interval between diagnosis and rituximab therapy had worse EFS [HR = 1.005; 95%IC: (1.002–1.009), P = 0.019]. Three patients developed short‐term adverse events, two‐serum sickness, and one interstitial pneumonia. Four cases of malignancies and two herpes zoster reactivations were registered during long‐term follow‐up; one patient died for cerebral bleeding. Rituximab SD appears a safe and active agent allowing in nearly 40% of cases to achieve long‐term response and splenectomy sparing effect. Am. J. Hematol. 2012. © 2012 Wiley Periodicals, Inc.
A controlled trial of traditional Chinese medicinal plants in widespread non-exudative atopic eczema
Authors: MARY P. SHEEHAN, D.J. ATHERTON
Journal: British Journal of Dermatology (1992)

Severe and widespread atopic eczema often fails to respond adequately to currently available therapies. Following the observation of substantial benefit in patients receiving oral treatment with daily decoctions of traditional Chinese medicinal plants, we undertook a placebo-controlled double-blind trial of a specific prescription formulated for widespread non-exudative atopic eczema. Forty-seven children were given active treatment and placebo in random order, each for 8 weeks, with an intervening 4-week wash-out period. Thirty-seven children tolerated the treatment and completed the study. Response to active treatment was superior to response to placebo, and was clinically valuable. There was no evidence of haematological, renal or hepatic toxicity. These findings anticipate a wider therapeutic potential for traditional Chinese medicinal plants in this disease, and other skin diseases.
Metabolism and Clinical Significance of the Carbohydrate Components of Connective Tissue
Authors: Evan Calkins, Morris Soodak, Walter Bauer
Journal: New England Journal of Medicine (1955)

CARBOHYDRATE is necessary in the body, not only as a source of energy but also as an integral part of its structure and functional components, connective-tissue matrix, nucleic acids, galactolipids of brain and many proteins. The serum, for instance, contains more hexose as part of macromolecules than in the free state, and almost as much hexosamine. Changes in the concentration of these substances occur in a wide variety of diseases. A carbohydrate, hyaluronic acid, is the chief component of synovial-fluid mucin, which usually deteriorates in active rheumatoid arthritis, providing an important clue to the diagnosis of this disease. Hexosamine-containing compounds . . .