tbuckley/cabot-search huggingface dataset:
Association Between Systemic Inflammation and Incident Diabetes in HIV-Infected Patients After Initiation of Antiretroviral Therapy
Authors: Todd T. Brown, Katherine Tassiopoulos, Ronald J. Bosch, Cecilia Shikuma, Grace A. McComsey
Journal: Diabetes Care (2010)

OBJECTIVE To determine whether systemic inflammation after initiation of HIV-antiretroviral therapy (ART) is associated with the development of diabetes. RESEARCH DESIGN AND METHODS We conducted a nested case-control study, comparing 55 previously ART-naive individuals who developed diabetes 48 weeks after ART initiation (case subjects) with 55 individuals who did not develop diabetes during a comparable follow-up (control subjects), matched on baseline BMI and race/ethnicity. Stored plasma samples at treatment initiation (week 0) and 1 year later (week 48) were assayed for levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and the soluble receptors of tumor necrosis factor-α (sTNFR1 and sTNFR2). RESULTS Case subjects were older than control subjects (median age 41 vs. 37 years, P = 0.001), but the groups were otherwise comparable. Median levels for all markers, except hs-CRP, decreased from week 0 to week 48. Subjects with higher levels of hs-CRP, sTNFR1, and sTNFR2 at 48 weeks had an increased odds of subsequent diabetes, after adjustment for baseline marker level, age, BMI at week 48, CD4 count at week 48 (&amp;lt; vs. &amp;gt;200 cells/mm3), and indinavir use (all Ptrend ≤ 0.05). After further adjustment for week 48 glucose, effects were attenuated and only sTNFR1 remained significant (odds ratio, highest quartile vs. lowest 23.2 [95% CI 1.28–423], P = 0.03). CONCLUSIONS Inflammatory markers 48 weeks after ART initiation were associated with increased risk of diabetes. These findings suggest that systemic inflammation may contribute to diabetes pathogenesis among HIV-infected patients.
Small-Bowel Obstruction Due to an Internal Hernia
Authors: Kao-Lang Liu, Been-Ren Lin
Journal: New England Journal of Medicine (2007)

A 48-year-old healthy woman presented with anorexia of 2 days' duration and abdominal pain in the right lower quadrant. Since appendicitis was suspected, she underwent a laparoscopic examination. An inflamed mass was seen near the cecum, and diverticulitis was diagnosed. She was treated with bowel rest, fluids, and antimicrobial agents. Two days later, her symptoms worsened, with increased pain in the right lower quadrant, abdominal distention, and decreased bowel sounds. Abdominal radiography showed dilatation of the small intestine, suggestive of obstruction, in the supine position (Panel A) and the upright position (Panel B). An axial computed tomographic scan of the . . .
Violence involving children
Authors: A. B Zwi, S. Rifkin
Journal: BMJ (1995)

objective must be to restore public confidence.But, before this can be achieved, the service must look to the confidence and morale of its own staff.Commitment to a national, evidence based service that is truly medically led would allay the fears of all reasonable clinicians.Central to any future strategy is the need to appoint the best doctors and scientists.High calibre applicants will be attracted by joint appointments with clinical or research departments.Most importantly, the government must recognise that efficient businesses decide on a strategy for reorganisation and proceed to the management of any necessary change without delay.The year's delay in the minister's decision over the proposals set out by the National Blood Authority has damaged, and continues to damage, the service.
Well informed uncertainties about the effects of treatments
Authors: Iain Chalmers
Journal: BMJ (2004)

How should clinicians and patients respond? 

Uncertainties about the effects of treatments are inevitable. Whatever the basis for judgments about the likely effects of treatments in individual patients, there is no escape from the reality that every such judgment initiates a clinical trial in which there can be no certainty that an individual patient will benefit. Sometimes the judgment will draw on the patient's past experience of the treatment, more usually on the clinician's experience of treating other patients. Increasingly, clinicians and patients are taking account of collective experience—the results of formal evaluations of treatments.1 Maybe this is because they recognise that treatments can sometimes do more harm than good, sometimes on a devastating scale.

What should happen if, after weighing the best available evidence from collective experience and taking account of patients' preferences, residual uncertainty remains about which treatment options should be chosen? Should the clinician and patient simply press ahead with yet another poorly controlled clinical trial? It is surprising that such questions seem to have been addressed relatively rarely. One attempt to do so was published in this journal three years ago by a medical ethicist. “If we are uncertain about the relative intrinsic merits of [different] treatments,” he wrote, “then …
Refeeding hypophosphataemia in anorexia nervosa and alcoholism
Authors: M F Ryan, H Pandov
Journal: BMJ (1987)

12 Lambert T. Paranoid psychoses after abuse of proprietary cold remedies.BrJ Psyckiaay (in press).Refeeding hypophosphataemia in anorexia nervosa and alcoholism SIR,-The article by Dr Allan D Cumming and colleagues on refeeding hypophosphataemia (22 August, p 490) omits a number of salient points relating to the development of convulsions in alcoholics with complex biochemical disturbances.Several combinations of the abnormalities described might account for the symptoms observed.Magnesium depletion, in particular, is well known to be a common cause of convulsions in such patients.' In addition, magnesium deficiency induces hypokalaemia and hypocalcaemia, as well as hypomagnesaemia.In the alcoholic patient described the potential contributions ofother ionic imbalances, notably hypokalaemia (3-2 mmol/l) and hypomagnesaemia (0-36 mmol/l), are ignored.This is surprising in view of the fact that this patient required "separate infusions of calcium, magnesium, and potassium" before recovery.Though we should not ignore the potential importance of refeeding hypophosphataemia, the contribution of hypophosphataemia itself to the symptoms described remains unclear.
Transfer Factor for the Prevention of Varicella-Zoster Infection in Childhood Leukemia
Authors: Russell W. Steele, Martin G. Myers, Monroe M. Vincent
Journal: New England Journal of Medicine (1980)

Sixty-one patients with leukemia and no immunity to chickenpox were given dialyzable transfer factor or placebo and followed for 12 to 30 months in a double-blind trial designed to examine the clinical efficacy of transfer factor. Sixteen patients in the transfer-factor group and 15 in the placebo group were exposed to varicella zoster, and most of them had a rise in antibody titer. Chickenpox developed in 13 of 15 exposed patients in the placebo group but in only one of 16 in the transfer-factor group (P = 1.3 x 10(-5)). In the patients treated with transfer factor and exposed to varicella without acquiring chickenpox the titer of antibody to varicella zoster was equal to that in the patients given placebo who became infected with chickenpox. Transfer factor converted negative results on skin tests for varicella zoster to positive in approximately half the recipients. Passive immunization with dialyzable transfer factor appears useful in nonimmune persons.
Effects of environmental factors on perinatal outcome: neurological development in cases of intrauterine growth retardation and school performance of children perinatally exposed to ionizing radiation.
Authors: T Ikenoue, T Ikeda, S Ibara, M Otake, W J Schull
Journal: Environmental Health Perspectives (1993)

We performed two studies to investigate environmental factors in relation to neurological development in infants. The first, a field study, examined the elementary school performance of 929 children who were born from mothers exposed to the atomic bombing of Hiroshima, Japan, August 6, 1945. The most severe mental retardation was observed in the group exposed between 8 and 15 weeks following fertilization, and the second most severely damaged group was exposed between 16 and 25 weeks. The second, a clinical investigation, examined infants in the perinatal center who survived intrauterine growth retardation (IUGR). Those who survived with abnormal neurological development had a mean growth arrest corresponding to a uterine height of 27 weeks of gestation. This was at an earlier stage than those who survived with normal neurological development and had a mean growth arrest corresponding to 29-30 weeks of gestation. A smaller head circumference at birth was closely correlated with abnormal neurological sequelae. These results indicate that the brain development of the fetuses may have been affected by neurotoxic events similar to ionizing radiation. We emphasize the importance of avoiding neurotoxic stress to pregnant women when the fetus is in the critical period of neuronal development, before 27 weeks of gestational age.
Indian doctors not accountable, says consumer report
Authors: G. Mudur
Journal: BMJ (2000)

A consumer advocacy group in India has said that patients claiming damages for medical negligence are often unable to prove their allegations because doctors are unwilling to testify against other doctors.

“The complainants cannot muster evidence to prove negligence beyond doubt,” said the Voluntary Organisation in Interest of Consumer Education in New Delhi after a survey conducted in three cities.

The survey examined grievance redress mechanisms in 81 large hospitals and small clinics …
Clarification of the Risk of Chronic Obstructive Pulmonary Disease in α<sub>1</sub>-Antitrypsin Deficiency PiMZ Heterozygotes
Authors: Kevin Molloy, Craig P. Hersh, Valerie B. Morris, Tomás P. Carroll, Catherine A. O’Connor, Jessica A. Lasky-Su, Catherine M. Greene, Shane J. O’Neill, Edwin K. Silverman, Noel G. McElvaney
Journal: American Journal of Respiratory and Critical Care Medicine (2014)

Section:ChooseTop of pageAbstract <<MethodsResultsDiscussionConclusionsReferencesCITING ARTICLES
Denial in the Medical Interview
Authors: David E. Ness
Journal: JAMA (1994)

Denial is a psychological defense in which the individual repudiates some or all of the meanings of an illness, thereby warding off an awareness of painful thoughts and feelings such as fear, grief, depression, and anger. Although it is often viewed as a problem, denial may at times be a healthy and adaptive response to illness. In the medical interview, denial may be exhibited by the patient, the physician, or both. Not all instances of denial can or should be addressed within the interview. The decision to address denial can be made based on how adaptive the denial is, what kind of psychosocial support is available to the patient, and how well prepared the patient is to deal with the fears that underlie denial. In those instances when denial should be addressed, the interviewer can use techniques of clarification, confrontation, and interpretation.
France passes “right to die” law
Authors: Brad Spurgeon
Journal: BMJ (2004)

A year and two months after a celebrated case of euthanasia incited a parliamentary commission on the subject, France has passed a law allowing terminally ill or gravely injured patients the right to die.

The law, which was passed by the National Assembly on 30 November but has to be ratified by the Senate, stops short of legalising active euthanasia. But it nevertheless clarifies a common, yet illegal, situation, according to health minister Philippe Douste-Blazy, who called it “a third way, a French way.”

The compromise follows the widely reported case of active euthanasia in which Vincent Humbert, aged 22, was seriously injured in a road accident and …
Pathogenesis of Acne Vulgaris
Authors: Ruth K. Freinkel
Journal: New England Journal of Medicine (1969)

A DISEASE does not have to be fatal, incurable or physically crippling to be devastating. Acne vulgaris causes emotionally devastating effects by disfiguring the face that the adolescent turns to the world he is just beginning to confront.The lesions of acne are located in and around the specialized pilosebaceous follicles of the face and upper trunk. In most hair follicles the size of the sebaceous gland is roughly proportional to the size of the hair. In the acne area, however, rather wide follicles are shared by a small or even rudimentary hair and a very large sebaceous gland.Clinically, . . .
Augmentation of Electrical Alternans with Lowering of the Heart Rate in Massive Pericardial Effusion
Authors: DENNIS V. COKKINOS, CONSTANTINE KELESIDES, JOHN SIATERLIS, EVANGELOS HALIMOS
Journal: Circulation (1974)

A patient with massive pericardial effusion and electrical alternans was studied. Intravenous administration of 8 mg practolol produced a decrease in heart rate from 120 to 87 beats/min, with increase of the alternans. The postulation that tachycardia is necessary for the appearance of electrical alternans in cardiac tamponade cannot be supported from this finding.
Regional blood flow, oxidative metabolism, and glucose utilization in patients with recent myocardial infarction.
Authors: J Czernin, G Porenta, R Brunken, J Krivokapich, K Chen, R Bennett, A Hage, C Fung, J Tillisch, M E Phelps
Journal: Circulation (1993)

Metabolic imaging with positron emission tomography (PET) can detect tissue viability in clinical infarct regions. With appropriate tracer kinetic models and serial PET imaging, regional myocardial blood flow and rates of metabolism can now be quantified in patients with recent myocardial infarctions.Serial PET imaging with [13N]ammonia, [11C]acetate, and 18F-deoxyglucose was performed in 22 patients with recent infarctions to measure regional blood flow (in milliliters per gram per minute), glucose metabolism (in micromoles per gram per minute), and oxidative metabolism (in clearance rate per minute). Hypoperfused clinical infarct regions were classified as "PET mismatch" if 18F was increased relative to 13N activity or "PET match" if 13N and 18F activities were reduced concordantly. Blood flows differed significantly between normal, mismatch, and match segments (0.83 +/- 0.20, 0.57 +/- 0.20, and 0.32 +/- 0.12 mL.g-1.min-1, respectively). The relation between oxidative metabolism and blood flow was piecewise linear and differed significantly between PET mismatch and PET match. Oxidative metabolism was less severely reduced than blood flow in mismatch regions but but reduced in proportion to blood flow in match regions. There was considerable overlap of blood flows between both types of PET segments.Quantification of regional blood flow and substrate metabolism in postinfarction patients revealed alterations in the relation between substrate delivery and consumption demonstrated previously only in invasive animal experiments. The preserved oxidative metabolism in myocardium with PET mismatches may be ascribed to a regional increase in oxygen extraction. Such increase together with preserved glucose utilization may be the prerequisite for survival of ischemically injured myocardium.
Stress response decreases NF-kappaB nuclear translocation and increases I-kappaBalpha expression in A549 cells.
Authors: H R Wong, M Ryan, J R Wispé
Journal: Journal of Clinical Investigation (1997)

The stress response and stress proteins confer protection against diverse forms of cellular and tissue injury, including acute lung injury. The stress response can inhibit nonstress protein gene expression, therefore transcriptional inhibition of proinflammatory responses could be a mechanism of protection against acute lung injury. To explore this possibility, we determined the effects of the stress response on nuclear translocation of the transcription factor NF-kappaB, an important regulator of proinflammatory gene expression. In A549 cells induction of the stress response decreased tumor necrosis factor-alpha (TNF-alpha)-mediated NF-kappaB nuclear translocation. TNF-alpha initiates NF-kappaB nuclear translocation by causing dissociation of the inhibitory protein I-kappaBalpha from NF-kappaB and rapid degradation of I-kappaBalpha. Prior induction of the stress response inhibited TNF-alpha-mediated dissociation of I-kappaBalpha from NF-kappaB and subsequent degradation of I-kappaBalpha. Induction of the stress response also increased expression of I-kappaBalpha. We conclude that the stress response affects NFkappaB-mediated gene regulation by two independent mechanisms. The stress response stabilizes I-kappaBalpha and induces expression of I-kappaBalpha. The composite result of these two effects is to decrease NF-kappaB nuclear translocation. We speculate that the protective effect of the stress response against acute lung injury involves a similar effect on the I-kappaB/NF-kappaB pathway.
ISONIAZID AND IPRONIAZID RESISTANCE IN PULMONARY TUBERCULOSIS
Authors: W. Grosfeld
Journal: JAMA (1952)

<h3>To the Editor:</h3> —As a result of the recent availability, commercially, of isoniazid (isonicotinic acid hydrazid), its use has become widespread in tuberculosis institutions and in the hands of private practitioners. In too many instances, it seems to us, this usage has been rather indiscriminate, based on a few overly enthusiastic medical reports, much premature lay publicity, and without regard to the proper place of this drug in the over-all long-term treatment program. In particular, there has been a scarcity of reports concerning the incidence of isoniazid-resistant strains of tubercle bacilli occurring during isoniazid therapy, the time during continuous therapy when resistance is most likely to occur, and the effect of concomitant administration of<i>p</i>-aminosalicylic acid or streptomycin on the development of resistance. Physicians treating tuberculous patients are well aware of the inherent dangers of injudicious use of the various types of antituberculosis therapy and all too often see
What it's really like at the coalface
Authors: J. Stokes
Journal: BMJ (2003)

What's wrong with the NHS? I know this will sound a little like a school homework exercise, but perhaps if we all sat down and wrote down our wishes then the changes that doctors want might move higher up the political agenda. Here are my thoughts and wishes as I leave the NHS. If you would like to mark them out of 10 and let me know then please do so.

I qualified in 1974 and have worked in the NHS since then. I am a GP principal working in Leominster, Herefordshire—a market town set in lovely countryside. I have been here for the past 20 years. I am in a partnership with five others, all very reasonable people. We are based in premises that were converted for the purpose, and we manage a dispensing branch surgery. Leominster has a local community hospital for which we cover inpatient care. I have just offered my resignation from practice, which will be effective this summer, when I …
Invasive Ductal Carcinoma Arising From Dense Accessory Breast Visualized With 99mTc-MIBI Breast-Specific γ Imaging
Authors: Hai-jeon Yoon, Sun Hee Sung, Byung In Moon, Bom Sahn Kim
Journal: Clinical Nuclear Medicine (2014)

Primary accessory breast cancer is extremely rare, and the diagnostic efficacy of 99mTc-MIBI breast-specific γ imaging (BSGI) has not been reported elsewhere. We present a case of primary carcinoma arising from dense accessory breast that was visualized with BSGI. A 43-year-old female patient with a palpable axillary mass underwent mammography, which showed dense parenchyma on both of the anatomic and accessory breasts with no abnormality. Subsequent BSGI showed no abnormal uptake in bilateral anatomic breasts, but focal abnormal uptake was noted in the accessory breast. Permanent pathologic evaluation confirmed invasive ductal carcinoma (not otherwise specified type) of the accessory breast.
Genome-wide association mapping identifies multiple loci for a canine SLE-related disease complex
Authors: Maria Wilbe, Päivi Jokinen, Katarina Truvé, Eija H Seppala, Elinor K Karlsson, Tara Biagi, Angela Hughes, Danika Bannasch, Göran Andersson, Helene Hansson-Hamlin, Hannes Lohi, Kerstin Lindblad-Toh
Journal: Nature Genetics (2010)
A crossover comparison of continuous subcutaneous insulin infusion (CSII) against multiple insulin injections in insulin-dependent diabetic subjects: improved control with CSII
Authors: P. D. Home, B. Capaldo, J. M. Burrin, R. Worth, K. G. Alberti
Journal: Diabetes Care (1982)

Ten insulin-dependent C-peptide-negative diabetic subjects, whose control had been optimized on twice-daily injection therapy, were treated for periods of 10 wk in a crossover study, with either a thrice-daily subcutaneous insulin injection regimen (Actrapid + Ultratard) or by continuous subcutaneous insulin infusion (CSII). On CSII insulin dose stabilized at 51 +/- 5 U/day, compared with 80 +/- 9 U/day (P = 0.004) on the thrice-daily injection regimen, having been 60 +/- 6 U/day on twice-daily therapy. After 10 wk glycosylated hemoglobin was 11.7 +/- 0.6% on injection therapy and 10.0 +/- 0.7% (P = 0.026) on CSII. Mean blood glucose concentration and urinary glucose excretion were lower at most points during the study on CSII than on injection therapy. Patients on pumps gained weight compared with the thrice-daily injection regimen (P = 0.023 at 10 wk) and the previous twice-daily regimen, despite the reduction in insulin dose. Considering individual patients, four markedly improved on CSII compared with the previous twice-daily regimen and five compared with Actrapid + Ultratard. No patient showed impaired control on CSII compared with either injection regimen. The benefits of portable insulin infusion pumps over injection therapy are thus clearly demonstrable under outpatient conditions even with equal and intensive medical attention.
UK research funding bodies unite against bioterrorism threat
Authors: Caroline White
Journal: BMJ (2005)

Three of the United Kingdom's largest research funding bodies have announced joint plans to curb the risk of research being misused for bioterrorism.

The Medical Research Council, the Biotechnology and Biological Sciences Research Council, and the Wellcome Trust have issued a joint policy statement announcing changes to their respective policies, guidance, and procedures for awarding grants to researchers.

The move, which is designed to identify at the grant application stage any research that could “conceivably result in harm,” and to heighten general awareness of the issues, was …
Oxidative parameters and mortality in sepsis induced by cecal ligation and perforation
Authors: Cristiane Ritter, Michael Andrades, Mário Luis C. Frota, Fernanda Bonatto, Ricardo A. Pinho, Manuela Polydoro, Fábio Klamt, Cleovaldo T. S. Pinheiro, Sérgio S. Menna-Barreto, José Cláudio F. Moreira, Felipe Dal-Pizzol
Journal: Intensive Care Medicine (2003)
Pathology: A Dynamic Introduction to Medicine and Surgery
Authors: Seth L. Haber
Journal: JAMA (1962)

Though<i>Pathology</i>is much more than<i>A Dynamic Introduction to Medicine and Surgery</i>, this inexpensive paperbound book is an adequate introduction to pathology. It is concise, well organized, and easy to follow. Each topic is begun with a definition of terms, and, after introduction of factual material, there is a short discussion. It is most unfortunate that brevity and concise organization occasionally supplant accuracy. Attempts to emphasize the dynamics of each disease are not always successful. Extensive use of sectional headings, marginal notations, and underlining of important words and phrases make this text most helpful as an outline or review. It is certainly not an adequate text for the second-year medical student who is studying pathology for the first time, and it must be supplemented by more detailed texts and reference to the journals. The student should, however, find it helpful as an introduction, perhaps to be read in its