tbuckley/cabot-search huggingface dataset:
The Risk for and Severity of Bleeding Complications in Elderly Patients Treated with Warfarin
Authors: Stephan D. Fihn
Journal: Annals of Internal Medicine (1996)

Objective: To determine whether increasing age is associated with an increased risk for bleeding during warfarin treatment. Design: Combined retrospective and prospective cohort studies. Setting: 6 anticoagulation clinics. Patients: 2376 patients receiving warfarin for various indications. Measurements: Bleeding events categorized as minor (resulting in no costs or consequences), serious (requiring testing or treatment), life-threatening, or fatal. Results: 812 first bleeding events (4 fatal, 33 life-threatening, 222 serious, and 553 minor) occurred during 3702 patient-years. Age was inversely related to the mean warfarin dose and dose-adjusted prothrombin time ratio. The unadjusted incidence of minor bleeding complications did not vary according to age group: 18.0 per 100 patient-years for patients younger than 50 years of age, 21.5 for patients 50 to 59 years of age, 24.0 for patients 60 to 69 years of age; 23.5 for patients 70 to 79 years of age, and 16.3 for patients 80 years of age and older. The unadjusted incidence of serious bleeding complications also did not vary according to age group: 9.3 per 100 patient-years for patients younger than 50 years of age, 7.1 for patients 50 to 59 years of age, 6.6 for patients 60 to 69 years of age, 5.1 for patients 70 to 79 years of age, and 4.4 for patients 80 years of age and older. The unadjusted incidence of life-threatening or fatal complications combined was significantly higher among the oldest patients: 0.75 per 100 patient-years for patients younger than 50 years of age, 0.97 for patients 50 to 59 years of age, 1.10 for patients 60 to 69 years of age, 0.68 for patients 70 to 79 years of age, and 3.38 for patients 80 years of age and older. Patients 80 years of age and older had a relative risk of 4.5 (95% CI, 1.3 to 15.6) compared with patients younger than 50 years of age. After adjustment for the intensity of anticoagulation therapy and the deviation in the prothrombin time ratio using Cox and Poisson regression, age was not generally associated with the occurrence of bleeding; relative risk estimates ranged from 0.99 to 1.03 per year of age (lower-bound 95% CI, 0.97 to 1.01; upper-bound 95% CI, 1.00 to 1.09). The single exception was life-threatening and fatal complications in patients 80 years of age or older (relative risk, 4.6 [CI, 1.2 to 18.1]). Conclusions: Age did not appear to be an important determinant of risk for bleeding in patients receiving warfarin, with the possible exception of age 80 years or older. The intensity of anticoagulation therapy and the deviation in the prothrombin time ratio were much stronger predictors of risk for bleeding.
Paroxetine is associated with malformation during pregnancy
Authors: D. Mangin, D. Healy, B. Mintzes
Journal: BMJ (2011)

In their clinical review of the diagnosis and management of premenstrual disorders O’Brien and colleagues state1: “Obviously, some patients may become pregnant while taking SSRIs [selective serotonin reuptake inhibitors] and these drugs have not been shown to be teratogenic” with a reference to an article reviewing the adverse effects of SSRIs in pregnancy.2 This is incorrect and is inconsistent …
Can Proopiomelanocortin Methylation Be Used as an Early Predictor of Metabolic Syndrome?
Authors: Jae Young Yoo, Sangmi Lee, Hye Ah Lee, Hyesook Park, Yoon Jung Park, Eun Hee Ha, Young Ju Kim
Journal: Diabetes Care (2013)

OBJECTIVE The objectives of this study were to compare early predictive marker of the metabolic syndrome with proopiomelanocortin (POMC) methylation status and to determine the association among birth weight, ponderal index, and cord blood methylation status. RESEARCH DESIGN AND METHODS We collected pregnancy outcome data from pregnant women, cord blood samples at delivery, and blood from children (7–9 years old; n = 90) through a prospective cohort study at Ewha Womans University, MokDong Hospital (Seoul, Korea), from 2003–2005. POMC methylation was assessed by pyrosequencing. We divided subjects into three groups according to cord blood POMC methylation: the low methylation (&amp;lt;10th percentile), mid-methylation, and high methylation (&amp;gt;90th percentile) groups. We analyzed the association of POMC methylation status at birth with adiposity and metabolic components using ANCOVA and multiple linear regression analysis. RESULTS Birth weights (P = 0.01) and ponderal indices (P = 0.01) in the high POMC methylation group were significantly lower than in the mid-POMC methylation group. In terms of metabolic components of childhood, blood triglycerides (57.97, 67.29 vs. 113.89 mg/dL; P = 0.03, 0.01) and insulin (7.10, 7.64 vs. 10.13 μIU/mL; P = 0.05, 0.02) at childhood were significantly higher in the high POMC methylation group than in the low and mid-POMC methylation group. CONCLUSIONS High POMC methylation in cord blood was associated with lower birth weight, and children with high POMC methylation in cord blood showed higher triglycerides and higher insulin concentrations in blood. Thus, POMC methylation status in cord blood may be an early predictive marker of future metabolic syndrome.
Properties of the exchangeable splenic platelets released into the circulation during exercise‐induced thrombocytosis
Authors: Kevin G. Chamberlain, Michael Tong, David G. Penington
Journal: American Journal of Hematology (1990)

Abstract The human spleen normally retains about one‐third of the body's platelets in an exchangeable pool which can be released into the circulation by α‐adrenergic stimulation. Some previous investigators concluded that the splenic platelet population was enriched in a subpopulation of large, young, dense platelets (megathrombocytes) but more recent research suggests that platelet size, age, and density are largely independent variables. In this investigation the properties of the splenic platelets were studied after their release into the circulation by acute strenuous exercise in 11 normal subjects. The exercise caused a rise in mean platelet count from 245 ± 49 to 328 ± 71 × 10 9 /L—a net increase of 24 ± 6% after correction for haemoconcentration. The mean platelet volume (MPV) of citrated platelets increased from 6.38 ± 0.78 to 6.59 ± 0.68 fL after exercise ( P &lt; 0.01)—a rise of 3.7 ± 4.1% suggesting that the MPV of the splenic platelet population was about 20% greater than that of the normal circulating population. The age distribution of the platelets was studied by measuring the platelet monoamine oxidase (MAO) activity several days after irreversible inhibition by tranylcypromine, when the young platelets had normal MAO activity but the older platelets had only 20% of normal activity. The mean platelet MAO activity did not change after exercise, indicating that the age distributions of the circulating and splenic populations were very similar. The platelet contents of several putative markers of platelet age (sialic acid, serotonin, β‐thromboglobulin, β‐N‐acetylglucosaminidase) were also unchanged after exercise. Modal platelet density decreased slightly but not significantly after exercise. The splenic platelet population has a larger MPV but appears to have similar age and density distributions to the basal circulating population.
Decline in mortality in children with HIV in the UK and Ireland
Authors: S W P Mhlongo, P M H Maduna
Journal: BMJ (2004)

Screening without evidence of efficacy Thyroid ultrasonography is another exampleEditor-I agree with Law's view of screening, that screening of unproved value should not be advocated. 1 As a clinical endocrinologist I often have to deal with patients' anxieties about non-palpable incidental findings on thyroid ultrasonography, often performed for wrong or unjustified reasons.Sometimes patients arrive with already established surgical complications after unnecessary thyroid operations.Although a substantial number of incidental thyroid nodules may be histologically malignant, 2 their clinical importance has never been proved.A recent preliminary study indicates that the progression rate of non-palpable proved thyroid malignant nodules to clinically significant lesions may be very low. 3 Thyroid ultrasonography is an additional example of an often used, often non-efficacious screening modality that may lead to "cascade iatrogenesis." 4
Life in flats.
Authors: D. A. Johnson
Journal: BMJ (1970)

Life in FlatsSIR,-Your leading article on life in flats (19 September, p. 661) rightly stresses the disadvantages for inhabitants of modern tower blocks, particularly for families with young children.It would, however, be quite wrong to think that these are the only rehoused families who suffer social and geo- graphical isolation.It would also be quite wrong to draw any conclusions as to aetiology of their unhappiness or ill-health by studying families only in the new environment.Published studies on the effect of rehousing on the health of the individual or family unit are few, but the major studies into the psychiatric aspects"-4 all agreed that the prevalence of neurotic illness was the same in new towns as in other comparable populations in older urban areas.It was further shown that individuals suffering with psy- chiatric symptoms attributable to the new environment were similarly troubled before rehousing, and would therefore be regarded as vulnerable personalities.My own study into the situation in Salford' confirmed this latter finding.While not in any way wishing to discour- age the immediate implementation of the suggestions of the N.S.P.C.C. report,6 which would undoubtedly improve the living con- ditions for young families, it would be quite wrong to draw any conclusions from the report as to the effect on health as opposed to happiness.-Iam, etc.,
Suicidal Ideation and Suicide Attempts Among Adults With Psychotic Experiences
Authors: Jordan E. DeVylder, Ellen P. Lukens, Bruce G. Link, Jeffrey A. Lieberman
Journal: JAMA Psychiatry (2015)

Suicide is a leading cause of preventable death, especially among individuals with psychotic disorders, and may also be common among nonclinical populations of adults with subthreshold psychotic experiences. Understanding this association has the potential to critically bolster suicide prevention efforts.To examine the association between 12-month suicidality and 12-month psychotic experiences and to test the hypotheses that psychotic experiences are associated with increased prevalence of suicidal ideation and suicide attempts during the concurrent period and with greater severity of suicidal behavior.Cross-sectional survey data were drawn from a large general population-based sample of households in the United States identified through the Collaborative Psychiatric Epidemiology Surveys (2001-2003). Adult household residents (n = 11,716) were selected using a clustered multistage sampling design with oversampling of racial/ethnic minority groups. Logistic regression models were adjusted for potential demographic confounders and co-occurring DSM-IV mental health conditions.Twelve-month psychotic experiences assessed with the Composite International Diagnostic Interview, version 3.0 psychosis screen.Twelve-month suicidal ideation and suicide attempts.Respondents reporting psychotic experiences were more likely to report concurrent suicidal ideation (odds ratio [OR], 5.24; 95% CI, 2.85-9.62) and suicide attempts (OR, 9.48; 95% CI, 3.98-22.62). Most respondents with psychotic experiences (mean [SE], 65.2% [4.2%]) met criteria for a DSM-IV depressive, anxiety, or substance use disorder. Among respondents with suicidal ideation, those with psychotic experiences were likely to make an attempt during the concurrent 12-month period (OR, 3.49; 95% CI, 1.05-11.58) when adjusting for co-occurring psychiatric disorders. In contrast, depressive (OR, 1.67; 95% CI, 0.62-4.52), anxiety (OR, 1.57; 95% CI, 0.40-6.09), and substance use disorders (OR, 1.64; 95% CI, 0.24-11.17) did not reliably identify those at risk for attempts among respondents with suicidal ideation. The mean (SE) 12-month prevalence of suicide attempts among individuals reporting ideation and psychotic experiences and meeting criteria for any psychiatric disorder was 47.4% (10.9%) compared with 18.9% (4.8%) among those with just ideation and a disorder. Psychotic experiences were especially prevalent among individuals reporting severe attempts and may account for nearly one-third of attempts with intent to die (population attributable risk, 29.01%) in the United States annually.Assessment of psychotic experiences among individuals with suicidal ideation has potential clinical and public health utility in reducing the prevalence of suicide attempts, particularly attempts with intent to die.
RHINOCEREBRAL PHYCOMYCOSIS IN DIABETICS WITHOUT ACIDOSIS
Authors: MORRIS BERK
Journal: Annals of Internal Medicine (1967)

Letters and Comments1 October 1967RHINOCEREBRAL PHYCOMYCOSIS IN DIABETICS WITHOUT ACIDOSISMORRIS BERK, M.D.MORRIS BERK, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-67-4-907_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the Editor: In the April (1967) issue of the ANNALS, two cases of rhinocerebral phycomycosis in association with diabetic ketoacidosis are reported. The article embodies a table of previously reported cases (16) of the fungal disease (all treated with amphotericin B), including a case reported by my coauthors and me. All such listed cases were "associated" with an acidotic state (diabetic, except for one secondary to diarrhea). The implication appears to be that an acidotic "soil" is a necessity for the invasiveness of this fungus (which is a saprophyte and often a human contaminant).I should like to correct... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: MORRIS BERK, M.D. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byLES PROBLEMES DE LA PATHOGENIE DANS LA MYCOLOGIE 1 October 1967Volume 67, Issue 4Page: 907-907KeywordsAmphotericinDiarrheaFungal diseases ePublished: 1 December 2008 Issue Published: 1 October 1967 PDF downloadLoading ...
Heart failure programmes in countries with a primary care‐based health care system. Are additional trials necessary? Design of the DEAL‐HF study
Authors: Pieta W.F. Bruggink‐André de la Porte, Dirk J.A. Lok, Jan van Wijngaarden, Jan H. Cornel, Dian Pruijsers‐Lamers, Dirk J. van Veldhuisen, Arno W. Hoes
Journal: European Journal of Heart Failure (2005)
HIGHER RESISTIN LEVELS ARE ASSOCIATED WITH POOR BLOOD PRESSURE RESPONSE IN NEW ONSET STAGE I HYPERTENSION
Authors: Mehmet Ali N. Sendur, Gülay Sain Güven, Kudret Aytemir, Hikmet Yorgun, Ahmet H. Ateş, Uğur Canpolat, Hamza Sunman, Barls Kaya, Bahram Sakirati, Kamer Kilinņ, Ali Oto
Journal: Journal of the American College of Cardiology (2011)
Long-Term Care for Frail Elderly People — The On Lok Model
Authors: Thomas Bodenheimer
Journal: New England Journal of Medicine (1999)

In January 1999, President Bill Clinton placed the issue of long-term care on the nation's health care agenda. He proposed that families be given a $1,000 annual tax credit to help pay for home health care visits, adult day care, and other needed long-term care.Long-term care ranks high on the list of our health care system's failings.1 Many elderly people spend their life savings to pay for assistance in the home or for nursing home care. Family members (usually women) make personal and financial sacrifices to care for a disabled spouse or parent.2 Over a million people live in . . .
Secularism needs a distinctive medical voice
Authors: C. Brewer
Journal: BMJ (2011)

Historically, doctors have been prominent sceptics about benevolent, interventionist deities, perhaps because, more than most people, they see the nastier side of life and the randomness of disaster. Medieval scholars quipped, “ Ubi tres physici, ibi duo athei ” (“Where there are three doctors, there are two atheists”), but from ancient Rome’s adoption of Christianity until fairly recent times, expressing such doubts was dangerous. Leading clerics who complain that so called new atheists like Richard Dawkins are disrespectful about their faith forget monotheism’s savage history. Ordinary British Protestants hanged the Edinburgh student Thomas Aikenhead for atheism in 1697. Ordinary French Catholics burned the physician-philosopher Lucilio Vanini—after tearing out his tongue—for merely questioning theism. Noting Vanini’s fate, the French priest Jean Meslier, modern Europe’s first published atheist, wisely waited until dying in 1729 before revealing his excoriating Testament . Some Victorian atheists, sensing post-Darwinian Britain’s steadily increasing distaste for imprisoning sceptics, felt able to be much ruder than Dawkins.

The Liverpool physician Matthew Turner was Britain’s first surviving public atheist and only in 1783 did he risk declaring himself, but unbelievers are still vilified by religious leaders. Popes, archbishops, and imams …
Malaria Chemoprophylaxis In Vietnam and Post-Vietnam
Authors: William R. Bunge
Journal: JAMA (1970)

To the Editor.—  While stationed in Vietnam, US servicemen take a pill once a week which contains chloroquine phosphate, 500 mg (equivalent to 300 mg of the base), and primaquine phosphate, 79 mg (equivalent to 45 mg of the base).  The combination of chloroquine and primaquine has proved much more effective—100% effective in servicemen who take the pill regularly—than chloroquine alone for the prevention of malaria due to Plasmodium vivax . However, it has no prophylactic value for malaria due to P falciparum in Southeast Asia. Therefore, those servicemen stationed in an area where falciparum malaria is endemic take a daily dose of dapsone, 25 mg, in addition to the chloroquine-primaquine pill.  Upon return to the United States, servicemen are instructed to take one chloroquine-primaquine pill weekly, for eight weeks following departure from Vietnam. In addition, those servicemen who have been stationed in an area where falciparum malaria is endemic are
Prisoners: an end to second class health care?
Authors: R. Smith
Journal: BMJ (1999)

Prisoners in England and Wales receive inferior health care.1–3Soon they should have the same health care as everybody else. At the moment their health care is the responsibility of the Home Office, the government department that oversees the criminal justice system. Soon it should be the responsibility of the National Health Service. Last week a joint report from the NHS and the prison service recommended a “formal partnership” between the two services to improve the health and health care of prisoners.2* The report stopped short of adopting the recent recommendation of the chief inspector of prisons that the NHS should take over prison health care completely.3 But many of those who have watched the excruciatingly long and slow minuet between the prison service and the NHS will think that the final step of the NHS taking full responsibility must and should come soon.

The joint report summarises the familiar problems well. “Health care in prisons is characterised by considerable variation in organisation, and …
Can Toxoplasmic Lymphadenitis Be Diagnosed Histologically?
Authors: Walter G. J. Putschar
Journal: New England Journal of Medicine (1973)

Elsewhere in this issue of the Journal Dorfman and Remington supply data with which to answer this question. The histopathologic evaluation of lymphnode biopsies falls essentially into three groups of diagnoses: inflammatory lesions with recognizable cause, neoplasia (primary and metastatic) and reactive hyperplasias of undetermined origin. It is this large third group that is under discussion.Out of the multitude of reactive patterns, Robb-Smith, as early as 1947, singled out a morphologically and clinically characteristic group under the name of medullary lymphohistiocytic reticulosis of unknown cause.1 Independently, Piringer-Kuchinka, in 1952, described this type of lymphadenitis in more detail, morphologically and . . .
Symptomatic Diffuse Esophageal Spasm and Its Relation to Gastrin Supersensitivity
Authors: SIDNEY COHEN
Journal: Annals of Internal Medicine (1975)

Editorial Notes1 May 1975Symptomatic Diffuse Esophageal Spasm and Its Relation to Gastrin SupersensitivitySIDNEY COHEN, M.D.SIDNEY COHEN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-82-5-714_2 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe gastrointestinal hormones, a group of peptides released at different portions of the gastrointestinal tract, have diverse effects on the motor activity of each luminal and sphincteric portion of the gut. The effects of these hormones are summarized in Table 1. Although these hormonal actions have been confirmed in multiple laboratories, the physiological significance of their effects has been challenged (1). Is each motor response to a hormone a meaningful physiological action occurring in the normal digestive state? Unfortunately the answer to this question is not known. To date, there are no proved, valid criteria upon which to base an...References1. GROSSMAN M: Gastrointestinal hormones: spectrum of actions and structural activity relations, in Endocrinology of the Gut. Thorofare, New Jersey, Charles B. Slack, Inc., 1974. Google Scholar2. COHENLIPSHUTZHUGHES SWW: Gastrin supersensitivity in the pathogenesis of lower esophageal sphincter hypertension in achalasia. J Clin Invest 50:1241-1247, 1971 CrossrefMedlineGoogle Scholar3. HARVEYREAD RA: Effect of cholecystokinin on colonic motility and symptoms in patients with the irritable-bowel syndrome. Lancet 1:1-3, 1973 CrossrefMedlineGoogle Scholar4. ECKARDTWEIGAND VH: Supersensitivity to pentagastrin in diffuse oesophageal spasm. Gut 15:706-709, 1974 CrossrefMedlineGoogle Scholar5. ECKARDTKRUGER VA: The effect of pentagastrin on esophageal peristalsis in diffuse esophageal spasm (abstract). Clin Res 22:693A, 1974 Google Scholar6. DIMARINOCOHEN AS: Characteristics of lower esophageal sphincter function in symptomatic diffuse esophageal spasm. Gastroenterology 66:1-6, 1974 CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: SIDNEY COHEN, M.D.Affiliations: Gastrointestinal Section Hospital of the University of Pennsylvania Philadelphia, Pennsylvania PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byEsophageal motility disordersPeptides: Gastrointestinal HormonesResponse of the canine lower esophageal sphincter to endogenous hypergastrinemiaPentagastrin in diffuse oesophageal spasm.The effects of pentagastrin in achalasia and diffuse esophageal spasmEffect of gastrin heptadecapeptide (G17) on oesophageal contractions in patients with diffuse oesophageal spasm.Motor Disorders of the Esophagus 1 May 1975Volume 82, Issue 5Page: 714-715KeywordsGastrinGastrointestinal tractHormonesPeptide hormones ePublished: 1 December 2008 Issue Published: 1 May 1975 PDF downloadLoading ...