tbuckley/cabot-search huggingface dataset:
Patients offered treatment for CHD need full information to make decision
Authors: P McCormack, M. Levine, R. E Rangno
Journal: BMJ (1998)

EDITOR—Freemantle et al's editorial on the use of statins started a debate on treatment with cholesterol lowering drugs. 1 2 The subsequent editorial by Muldoon and Criqui,3 and many of the letters on this issue,2 continued to focus on identifying a level of absolute risk reduction at which treatment of patients at risk of coronary heart disease would be advised and, presumably, paid for by a healthcare service provider. In our opinion, most of the discussion failed to separate the issue of rational policy …
Child abuse and trichotillomania
Authors: A Saraswat
Journal: BMJ (2005)

A 12 year old boy presented with two patches of hair loss on his scalp (figure). A clinical and histopathological diagnosis of trichotillomania was made. On follow up after taking a detailed history, the boy revealed that the hair was being pulled by an abusive teacher during tuition after school. I found two more children similarly abused by the teacher. I discuss the importance of this under-recognised pattern of child abuse and its similarity to trichotillomania. ![][1]</img> Child abuse has varied manifestations. Physical abuse of a child often results in identifiable dermatological signs, which can pinpoint the diagnosis. Abuse can closely resemble other dermatoses, however, resulting in diagnostic errors. Trichotillomania is a condition currently classified as an impulse control disorder, which is characterised by repetitive pulling of one's own hair resulting in alopecia. ### Case report A 12 year old boy was referred by his family physician to the dermatology outpatient department with a complaint of partial hair loss on his scalp that was noticed one week before. On examination, there were two patches of partial alopecia on the temporovertical scalp measuring 2 cm by 2 cm and 3 cm by 3 cm. The … [1]: /embed/graphic-1.gif
HLA-DQB1 Codon 57 and IDDM in Chinese Living in Taiwan
Authors: Lee-Ming Chuang, Tzuu-Shuh Jou, Chung-Yi Hu, Huey-Peir Wu, Wen-Yu Tsai, Jing-Sheng Lee, Rhong-Phong Hsieh, Kuang-Ho Chen, Tong-Yuan Tai, Boniface J Lin
Journal: Diabetes Care (1994)

To study the human leukocyte antigen (HLA)-DQB1 genetic background in the Chinese population in Taiwan and its association with the low incidence of insulin-dependent diabetes mellitus (IDDM) in this population.Forty-eight IDDM patients and 59 nondiabetic unrelated control subjects were recruited from the population in Taiwan. HLA-DQB1 exon 2 was enzymatically amplified by polymerase chain reaction. HLA-DQB1 alleles were diagnosed by dot blotting and hybridization with 16 sequence-specific oligonucleotide probes.DQB1*0201 and DQB1*0302 alleles were more frequent and DQB1*0301 and DQB1*0601 were less frequent in Chinese with IDDM than in control subjects. Genotypes for homozygous non-aspartic acid residue (NA/NA) at position 57 were positively associated with IDDM at a relative risk of 4.34 (P < 0.001), and those for homozygous aspartic acid (A/A) were negatively associated with IDDM at a relative risk of 0.14 (P < 0.001). Among the NA/A heterozygotes, only DQB1*0201/DQB1*0303 was significantly increased in IDDM subjects.The amino acid residue at position 57 of HLA-DQ beta-chain is significantly associated with the development or prevention of IDDM in Chinese subjects living in Taiwan. Other genetic and environmental factors may also play important roles in pathogenesis of IDDM.
Osteomyelitis and Cellulitis The Value of the Lateral View in Ga-67 Scintigraphy
Authors: DAVID GROSHAR, RUTH KEREN, SARA GIPS, ORA ISRAEL, DOV FRONT
Journal: Clinical Nuclear Medicine (1984)

Ga-67 scintigraphy is performed routinely in the anterior and posterior views. A lateral view in the cases presented here enabled differentiation between osteomyelitis and cellulitis.
THE MEDICINE OF OUR FOREFATHERS
Authors: JAMES J. WALSH
Journal: JAMA (1913)

In talking to the oldest medical society in this country it has seemed to me that no subject would be more suitable than what our forefathers accomplished in medicine. Our generation has become so accustomed to lauding itself as "the heirs of all the ages in the foremost files of time" and therefore so far ahead of the past that really our forefathers were to be pitied because they did not live to see our glorious time, that I have sometimes taken a little almost malicious pleasure in pointing out how many of the things that we think new are indeed very old. Anesthesia and antisepsis, sometimes looked on as the triumphs of our time, were anticipated by preceding generations in very striking ways. Tom Middleton, the English poet of the seventeenth century, has spoken of "the mercies of old surgeons who put their patients to sleep before they cut
Oesophageal mucosal changes in patients with varices.
Authors: R A Spence, J M Sloan, G W Johnston, A Greenfield
Journal: Gut (1983)

Histological examination of oesophageal rings removed at transection for varices reveals dilated intraepithelial blood filled channels. These are present in all oesophageal rings removed at transection for varices. A comparison has been made between rings removed from variceal patients with oesophageal rings removed during resections for oesophageal and gastric tumours. Although a small number of non-varices patients had intraepithelial channels they were significantly larger and more numerous in the varices patients (p less than 0.01). Similarly, the area and number of dilated subepithelial channels (just beneath the epithelium) and the area of lamina propria channels were significantly greater in the varices patients (p less than 0.05). Depth of papillae and thickness of the squamous epithelium were also significantly greater in the varices group (p less than 0.05, p less than 0.01 respectively). Under electron microscopy the channels were lined with flattened cells which were not typical of endothelial cells but stained positively for Factor VIII related antigen using indirect immunofluorescence. These channels may correspond to the cherry-red spots seen on endoscopy and may have a role in the pathogenesis of variceal haemorrhage.
The Cardiovascular Health Awareness Program reduced CV hospitalizations but not mortality in older adults
Authors: C. Raina Elley, Ngaire Kerse
Journal: Annals of Internal Medicine (2011)

Source Citation Kaczorowski J, Chambers LW, Dolovich L, et al. Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP). BMJ. 2011;342:d442. 21300712
Periprocedure myocardial infarction rates in the bypass angioplasty revascularization investigation (BARI)
Authors: Bernard R. Chaitman, Alice K. Jacobs, E.Magnus Ohman, Ronald J. Krone, Charles J. Mullany, George Sopko, Ihor Gussak, Kim Sutton-Tyrrell, Allan D. Rosen
Journal: Journal of the American College of Cardiology (1996)
Chronic obstructive pulmonary disease as a systemic disease: an epidemiological perspective
Authors: H. Andreassen, J. Vestbo
Journal: European Respiratory Journal (2003)

Chronic obstructive pulmonary disease (COPD) has been increasingly recognised as a systemic disease. The hormonal, metabolic and musculoskeletal implications of the generalised processes involving oxidative stress, inflammatory mediators, cytokines, and endocrine hormones have only begun to be understood. Only a few studies have looked into the epidemiology of inflammatory markers in patients with chronic obstructive pulmonary disease. Common extrapulmonary effects of chronic obstructive pulmonary disease include skeletal muscle dysfunction, wasting and osteoporosis. The resulting effects of a systemic inflammation can be measured at specific extrapulmonary organs such as skeletal muscle or in more general terms using body composition, body weight or derived measures, and only a few studies have set the parameters in an epidemiological context. Nevertheless, these studies indicate an association between inflammatory markers and forced expiratory volume in one second not only in subjects with severe chronic obstructive pulmonary disease. Also, it is increasingly clear that systemic markers in chronic obstructive pulmonary disease have important effects on prognosis.
Critical issue is rapidity of review of new drugs
Authors: A. Rodger
Journal: BMJ (2008)

Baroness Finlay and Lord Crisp support copayments with four essential criteria.1 The fourth criterion will fail as the denominator is described as a small group in the scale of the NHS’s customer base. There is also the assurance that this is “mostly” for drugs yet to be reviewed by the National Institute for Health and Clinical Excellence (NICE).

That is not the experience revealed by recent high profile cases in the …
Fatal Poisoning by Methyl Salicylate Liniment
Authors: E. Townsend
Journal: BMJ (1943)

JOURUALPrimary Syncope.-We had one fatal case of this in a girl aged 3 with some history of bronchitis; she was being anaesthetized for a hernia operation.The case resembled in every way the well-known primary syncope of chloroform anaesthesia, and we attribute this to the same mechanism of vagal inhibition.Sugar Metabolism.-We were able to have blood-sugar estimations in only 3 cases.In each there was a rise after 30 to 45 minutes, but much less than that recorded for chloroform or ether by Hewer (1939).Acetone was found in the urine on the mnorning following operation in 23 of 68 cases, in none of which had ether been used.This is in striking contrast to Hewer's report that he did not find acetonuria in any case at all.Post-operative Vomiting.-Thiswas absent in 52 out of 80 cases, and slight in the-remaining 28.
Auscultatory Acumen in the General Medical Population
Authors: J. Scott Butterworth
Journal: JAMA (1960)

Nine hundred and thirty-three physicians have been tested to evaluate their ability to make cardiac diagnoses by auscultation alone. Fifteen unknowns, recorded on tape and played back through individual stethophones, with simultaneous presentation of the visual pattern of the sound on the face of an oscilloscope, were used for the test. The unknowns were all classic examples of common normal and abnormal auscultatory phenomena and had been pre-tested to assure fidelity of reproduction and the ability of physicians with adequate training in auscultation to identify the examples readily. The highest scores were achieved by those physicians who had been certified in the subspecialty of cardiovascular disease while the lowest scores were made by physicians without specialized training who had been in practice for more than 20 years.
Polydisperse low-density lipoproteins in hyperalphalipoproteinemic chronic alcohol drinkers in association with marked reduction of cholesteryl ester transfer protein activity
Authors: Ken-ichi Hirano, Yuji Matsuzawa, Naohiko Sakai, Hisatoyo Hiraoka, Shuichi Nozaki, Tohru Funahashi, Shizuya Yamashita, Masaharu Kubo, Seiichiro Tarui
Journal: Metabolism (1992)
BMA welcomes expanded role for pharmacists
Authors: Lynn Eaton
Journal: BMJ (2008)

Doctors’ leaders have welcomed government plans to increase the role of pharmacists in England in diagnosing and treating illness.

Pharmacists will be able to prescribe for minor ailments, such as coughs, colds, stomach upsets, and headaches, and to offer advice and screening for long term conditions, such as diabetes and high blood pressure, under plans set out by England’s health minister Ben Bradshaw.

Pharmacists might also offer advice on diet and lifestyle, such as alcohol intake and exercise levels.

Some pharmacists already do this under contract to their local primary care trust, in what are known as local enhanced services. These range from stop smoking advice to needle exchange services (see graph on page 19 of www.official-documents.gov.uk/document/cm73/7341/7341.pdf). Other pharmacists, such as Boots, offer chlamydia screening tests to the public on a commercial basis rather than a contractual basis to the …
New Developments in the Sex Education of the Physician
Authors: Harold I. Lief
Journal: JAMA (1970)

The controversy swirling around the issue of sex education in the nation's schools has not affected the teaching of sex and marriage counseling in our medical schools. In the educational objective to increase the ability of the nation's physicians to deal more effectively and competently with the sexual and marital problems of their patients, it is difficult to discern a communist plot to undermine the morality of the country. Parenthetically, anent these absurd charges, the leading newspapers behind the iron curtain assert that sex education is a capitalist plot aimed at seducing communist youth to decrease their serious concern with social problems in favor of a frivolous attitude toward life. The recognition that there were serious deficiencies in the preparation of physicians to deal with a very important aspect of practice came slowly at first, but then accelerated. In 1963, less than a handful of schools had any formal program
Abstract 762: Therapeutic drug monitoring of Anthracyclines and Taxanes in chemotherapy of breast cancer patients
Authors: Belén Valenzuela, Vanesa Escudero, Joseba Rebollo, Manuel Sureda, Antonio Brugarolas
Journal: Cancer Research (2012)

Abstract Background: Anthracyclines (A) and Taxanes (T) remain amongst the most active drugs in breast cancer chemotherapy. However, significant toxicities are associated when administered at full doses in a number of patients (pts), so careful dose adjustments should be made in order to optimize their clinical effectiveness. A and T have high inter- and intra-patient variability, and a correlation between exposure and efficacy and toxicity has been demonstrated. Therefore, therapeutic drug monitoring (TDM) of these drugs, based on the individual pharmacokinetic (PK) parameters could personalize doses in order to diminish its toxicity and/or to improve the clinical benefit. Methods: A total of 24 pts (92 cycles) were treated with either single drugs, or combinations of two of these agents, usually with four initial cycles of A and 4 subsequent cycles of T. The initial dose was calculated using body-surface algorithm. Pts were monitored since the first cycle and subsequent doses pharmacokinetically adjusted until the target plasma concentration was reached. Bayesian estimates of individual PK parameters were calculated using a population PK models previously published and used for PK-based dose adjustment. Results: The main results are shown in the following table: 43% of pts treated with A had the initial dose increased by an average of 22% without toxicities grade II, except one pt which developed mucositis grade II. For paclitaxel, initial dose was increased in 25% of patients by an average of 22% with only one case of grade 2 asthenia. However, docetaxel initial dose of 60-75 mg/m2 was more toxic than the other drugs evaluated. The doses were reduced by an average of 22% due to toxicities such as grade 3 neutropenia, grade 2 asthenia or grade 2 leucopenia. Conclusion: Standard dosing regimen of A and T in breast cancer pts could be optimized by TDM in order to achieve the target plasma concentration during the chemotherapy treatment and ensure that pts receive the right dose. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 762. doi:1538-7445.AM2012-762
The effect of a subnormal vitamin B-6 status on homocysteine metabolism.
Authors: J B Ubbink, A van der Merwe, R Delport, R H Allen, S P Stabler, R Riezler, W J Vermaak
Journal: Journal of Clinical Investigation (1996)

Homocysteine, an atherogenic amino acid, is either remethylated to methionine or metabolized to cysteine by the transsulfuration pathway. The biochemical conversion of homocysteine to cysteine is dependent upon two consecutive, vitamin B-6-dependent reactions. To study the effect of a selective vitamin B-6 deficiency on transsulfuration, we performed oral methionine load tests on 22 vitamin B-6-deficient asthma patients treated with theophylline (a vitamin B-6 antagonist) and 24 age- and sex-matched controls with a normal vitamin B-6 status. Both groups had normal circulating vitamin B-12 and folate concentrations. Methionine loading resulted in significantly higher increases in circulating total homocyst(e)ine (P < 0.01) and cystathionine (P < 0.05) concentrations in vitamin B-6-deficient patients compared with controls. 6 wk of vitamin B-6 supplementation (20 mg/d) significantly (P < 0.05) reduced post-methionine load increases in circulating total homocyst(e)ine concentrations in deficient subjects, but had no significant effect on the increase in total homocyst(e)ine concentrations in controls. The increases in post-methionine load circulating cystathionine concentrations were significantly (P < 0.01) reduced in both groups after vitamin supplementation. It is concluded that a vitamin B-6 deficiency may contribute to impaired transsulfuration and an abnormal methionine load test, which is associated with premature vascular disease.
Effects of Low Dose combination therapy, Fluticasone Propionate/Salmeterol Combination, 100/50 (FSC 100/50) on Exhaled Nitric Oxide (eNO) and Airway Hyperresponsiveness in Mild Persistent Asthma
Authors: M.A. Pasha, P.J. Feustel, T. Smith, S. Patel, S. Sarathchandra, P. Malone, M. Evans, F. Jourd'heuil, D. Jourd'heuil
Journal: Journal of Allergy and Clinical Immunology (2011)
Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal
Authors: M. F. Mayo-Smith
Journal: JAMA (1997)

To provide an evidence-based practice guideline on the pharmacological management of alcohol withdrawal.English-language articles published before July 1, 1995, identified through MEDLINE search on "substance withdrawal--ethyl alcohol" and review of references from identified articles.Articles with original data on human subjects.Structured review to determine study design, sample size, interventions used, and outcomes of withdrawal severity, delirium, seizures, completion of withdrawal, entry into rehabilitation, adverse effects, and costs. Data from prospective controlled trials with methodologically sound end points corresponding to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were abstracted by 2 independent reviewers and underwent meta-analysis.Benzodiazepines reduce withdrawal severity, reduce incidence of delirium (-4.9 cases per 100 patients; 95% confidence interval, -9.0 to -0.7; P=.04), and reduce seizures (-7.7 seizures per 100 patients; 95% confidence interval, -12.0 to -3.5; P=.003). Individualizing therapy with withdrawal scales results in administration of significantly less medication and shorter treatment (P<.001). beta-Blockers, clonidine, and carbamazepine ameliorate withdrawal severity, but evidence is inadequate to determine their effect on delirium and seizures. Phenothiazines ameliorate withdrawal but are less effective than benzodiazepines in reducing delirium (P=.002) or seizures (P<.001).Benzodiazepines are suitable agents for alcohol withdrawal, with choice among different agents guided by duration of action, rapidity of onset, and cost. Dosage should be individualized, based on withdrawal severity measured by withdrawal scales, comorbid illness, and history of withdrawal seizures. beta-Blockers, clonidine, carbamazepine, and neuroleptics may be used as adjunctive therapy but are not recommended as monotherapy.
A Method for the Electrocardiographic Recognition of Atrial Enlargement
Authors: RADI MACRUZ, JOSEPH K. PERLOFF, ROBERT B. CASE
Journal: Circulation (1958)

New criteria for the electrocardiographic recognition of right atrial enlargement, left atrial enlargement, and combined atrial enlargement were studied in 110 patients with congenital and acquired heart disease. Precise physiologic data were available in all cases. The method of analysis was designed for application to conventional scalar electrocardiography and hence can be used without modification for routine clinical purposes.
Effects of prazosin on coronary and left ventricular dynamics in conscious dogs.
Authors: P Macho, S F Vatner
Journal: Circulation (1982)

The left ventricular (LV) and coronary vascular effects of prazosin, a drug that reduces peripheral vascular resistance by blocking postsynaptic alpha receptors, were examined in conscious dogs. Prazosin, 0.07 mg/kg/min i.v. for 7 minutes, induced sustained hypotensive effects for more than 12 hours. The peak effects occurred 30-45 minutes after administration. Prazosin increased heart rate by 28 +/- 9%, did not change mean coronary blood flow significantly, decreased mean arterial pressure by 15 +/- 4%, LV end-diastolic diameter by 10 +/- 2%, LV end-systolic diameter by 8 +/- 2%, late diastolic coronary resistance by 22 +/- 7%, and LV dP/dt by 9 +/- 4%. These effects of prazosin were not altered substantially by maintaining heart rate constant with electrical pacing or by pretreatment with beta-adrenergic blockade. However, after chronic reserpine treatment, prazosin did not reduce either mean arterial pressure or late diastolic coronary resistance. The alpha-blocking properties of the drug were established when prazosin attenuated pressure responses to phenylephrine, norepinephrine and bilateral carotid occlusion. Thus, in conscious dogs with heart rate constant, prazosin, by blocking alpha-adrenergic receptors, induces prolonged coronary vasodilation associated with reductions in the major determinants of myocardial oxygen consumption, e.g., arterial and LV pressures, LV end-diastolic diameter and LV dP/dt. However, the coronary vasodilation was not intense enough to increase coronary blood flow above control levels.
World drugs problem resists all attempts to curb it, says EU report
Authors: R. Watson
Journal: BMJ (2009)

The global illegal drug problem has not reduced during the past 10 years despite stronger policies to help users and tackle traffickers, according to a report prepared for the European Commission.

The assessment came as the United Nations Commission on Narcotic Drugs met in Vienna last week, to review the progress made since the 1998 special session of the United Nations General Assembly on drugs.

The authors of the study maintain that despite the political impetus that the UN gave to an antidrug policy, the global drug problem has …
Re: Xiao-Dong Jin, Simone Roethlisberger, Fiona C. Burkhard, Frédéric Birkhaeuser, Harriet C. Thoeny, Urs E. Studer. Long-term Renal Function After Urinary Diversion by Ileal Conduit or Orthotopic Ileal Bladder Substitution. Eur Urol 2012;61:491–7
Authors: Hao Lun Luo, Yen Ta Chen, Po Hui Chiang
Journal: European Urology (2012)
Manometric evaluation of the interdigestive antroduodenal motility in subjects with fasting bile reflux, with and without antral gastritis.
Authors: P A Testoni, L Fanti, F Bagnolo, S Passaretti, M Guslandi, E Masci, A Tittobello
Journal: Gut (1989)

The interdigestive antroduodenal motor activity was studied in 15 patients with bile reflux without gastritis (group A), 17 with bile reflux and chronic antral superficial gastritis (group B) and in nine healthy controls (group C), by manometric recording of phases of the interdigestive motility complex (IDMC) over 240 minutes, or until two consecutive migrating motor complexes (MMCs) had been recorded, whichever the shorter. In the patients with bile reflux the occurrence of MMCs was decreased and median duration of the IDMC was significantly prolonged (group A = 162.5 min; group B = 185.0 min), compared with controls (group C = 92.0 min; p less than 0.01 v groups A and B). There were no differences in motility pattern between patients with and without gastritis, suggesting that motor abnormalities are not caused by gastritis, but may precede its occurrence. Delayed occurrence of motor activity fronts increases duodenogastric reflux, but correlation with gastric mucosal lesions was not shown, suggesting that other mechanisms are involved.