tbuckley/cabot-search huggingface dataset:
Tuberculosis Among Tibetan Immigrants From India and Nepal in Minnesota, 1992-1995
Authors: Dung H. Truong
Journal: JAMA (1997)

To study screening outcomes among a group of Tibetan immigrants at high risk for developing active tuberculosis (TB) after arrival in Minnesota.Retrospective cohort study.A total of 191 Tibetan immigrants undergoing medical screening.Occurrence and treatment outcomes of active TB.A health maintenance organization and a public TB clinic in Minneapolis, Minn.Positive (induration, > or =10 mm) tuberculin skin test results were documented in 98% of Tibetans, compared with 44% of Vietnamese, 10% of Hmong, and 51% of Russian refugees in Minnesota (P<.001 for each group). Sixteen active cases (8.4%) were confirmed by isolation of Mycobacterium tuberculosis; however, 5 (31%) were culture-negative on initial screening in Minnesota. Seven cases (44%) were diagnosed during initial screening efforts, and 9 cases (56%) were diagnosed a mean of 19 months (range, 10-27 months) after their initial medical evaluation. Of these 9 cases, 6 (38% of all Tibetan cases) had isolates resistant to 1 or more antituberculous drugs, and 3 (19% of all Tibetan cases) were multidrug resistant (MDR TB). All 3 MDR TB cases were culture-negative on initial screening; these cases constituted 75% of the MDR TB isolates in Minnesota in 1994. The presence of MDR TB was associated with a known history of active TB in Asia (P<.02). Any abnormality on chest radiograph noted either during the Immigration and Naturalization Service screening evaluation in India (relative risk [RR], 5.2; P=.006) or on arrival in Minnesota (RR, 6.8; P=.005) was associated with an increased risk of subsequent active TB.Tuberculosis infection is nearly universal among Tibetans settling in Minnesota. A single screening evaluation failed to detect the majority of TB cases among Tibetans. Even in the face of negative M tuberculosis cultures, persons with a history of active TB require particularly close follow-up.
Genetic polymorphism of hepatocyte nuclear factor-4α influences human cytochrome P450 2D6 activity
Authors: Sang Seop Lee, Eun‐Young Cha, Hyun‐Ju Jung, Ji‐Hong Shon, Eun‐Young Kim, Chang‐Woo Yeo, Jae‐Gook Shin
Journal: Hepatology (2008)

Hepatocyte nuclear factor-4 alpha (HNF4A) is an essential transcriptional regulator for many genes that are expressed preferentially in the liver. Among the important functions of the liver is drug metabolism in response to xenobiotic exposure. Recent studies have suggested that HNF4A regulates the expression of cytochrome P450 (CYP), including CYP2D6 and CYP3A4, which show large individual variations in their activities. To understand the genetic factors that influence individual CYP activities, a genetic variant of HNF4A and the effects of genetic variants of HNF4A on CYP activity were investigated. Here, we report the identification of a novel coding variant of HNF4A that influences CYP2D6 activity in humans. After direct sequencing, a polymorphism search revealed the HNF4A G60D variant in Koreans. This variant was unable to bind to the recognition site in the CYP2D6 promoter and therefore lacked the regulatory function for this gene. Human liver specimens with the heterozygous HNF4A G60D genotype showed a tendency toward lower levels of CYP2D6 activity than the wild-type genotype in the same genetic background of CYP2D6. Furthermore, human subjects with the HNF4A G60D genotype tended to have lower CYP2D6 activity than those with the wild-type HNF4A. The HNF4A G60D variant was detected at low frequency in Asian populations, including Koreans, Chinese, and Vietnamese, and was not found in Africans or Caucasians.This is the first report to show that the genetic polymorphism of liver-enriched nuclear receptor HNF4A influences downstream CYP2D6 function in human subjects.
Recovery from Cl. welchii Meningitis
Authors: J. K. Henderson, W. F. C. Kennedy, J. M. Potter
Journal: BMJ (1954)

MEDICAL MEMORANDA MEDICATLSJORNAL 1 gr.(65 mg.) was absorbed, when allowance is made for dilution of the drug throughout much of the tissues of the body considerably less than the detectable amount must have remained in the relatively small specimens analysed.This is particularly so when it is remembered that some must have been excreted and lost before death occurred.Moreover, only part of the specimens analysed was utilized for the cantharidin test, as these had to be divided into several portions in order to test for other irritants.Grateful acknowledgment is made to Dr. R. T. Gaunt for access to the clinical details of this case.
74 year old GP refuses to take part in deputising service
Authors: Tony Sheldon
Journal: BMJ (2007)

A long running dispute over working practices between the Dutch medical authorities and a septuagenarian general practitioner, portrayed as a cause celebre for older people's rights, is to go before the Netherlands' highest administrative court.

The Council of State, which advises on legislation and governance, will judge whether a 74 year old can be stopped from working as a GP if she refuses to join colleagues in out of hours deputising services. Dr Tonny Bakhoven from Driebergen near Utrecht says she prefers to see her patients herself during nights, weekends, and holidays. But the …
Tetracycline for Gonorrhea
Authors: James C. Cobey
Journal: JAMA (1972)

To the Editor.—  This is in reference to the article by Neumann and Baecker ( 219 :471, 1972) recommending tetracyclines for treatment of gonorrhea. Though tetracyclines may be effective and eliminate the danger of anaphylactic shock, we have often found poor results using oral medication, such as tetracyclines, because of patient noncompliance. Time and time again at the Venereal Disease Clinic of the Preventive Medicine Service of Madigan General Hospital, treating permanent party personnel as well as South Viet Nam returnees, in spite of receiving careful instruction, the patient receiving oral medication will take half the dose and give half to his girl friend, resulting in treatment failure.  Though microbiologically orally taken tetracyclines may be very effective, socially it has met with many failures. We strongly recommend one-shot therapy for gonorrhea of procaine penicillin, 4.8 million units with 1 gm of probenecid (Benemid) administered 30 minutes prior to treatment, followed by
Developing nurse prescribing in the UK
Authors: Anthony J Avery, Veronica James
Journal: BMJ (2007)

Prescribing should be integrated into education for advanced nursing practice

The United Kingdom has seen a recent major expansion in the scope of nurse prescribing, reflecting government policy1 and the international trend towards advanced nursing practice.2 In the 1990s it became possible for community based nurses to prescribe independently from a limited formulary, thereby facilitating their traditional roles such as wound management and bowel care. From 2000, further changes in legislation radically altered the professional restrictions on prescribing, and since May 2006 independent nurse prescribers in England have been able to “prescribe any licensed medicine for any medical condition within their competence.”3 Each stage of the development of nurse prescribing in the UK has had its advocates and detractors, but this recent initiative has proved the most controversial, fuelling debate about the adequacy of training of nurse prescribers and risks to patient safety.4

The training for independent nurse prescribers consists of a …
War crimes and medical science
Authors: J. Leaning
Journal: BMJ (1996)

<h3>Introduction</h3> Patients with progressive idiopathic fibrotic interstitial lung disease (ILD), such as those with idiopathic pulmonary fibrosis (IPF), can have an aggressive disease course, with a median survival of only 3–5 years from diagnosis. The palliative care needs of these patients are often unmet. There are calls for new models of care, whereby the patient’s usual respiratory clinician remains central to the integration of palliative care principles and practices into their patient’s management, but the optimal model of service delivery has yet to be determined. <h3>Methods</h3> We developed a novel, collaborative, multidisciplinary team (MDT) meeting between our palliative care, psychology and ILD teams with the principal aim of integrating specialist care to ensure the needs of persons with ILD, and their caregivers were identified and met by referral to the appropriate service. The objective of this study was to assess the effectiveness of this novel MDT meeting on the assessment of a patient’s palliative care needs. <h3>Results</h3> Significant increases in advance care planning discussions were observed, in conjunction with increased referrals to community courses and teams, following introduction of this novel MDT. <h3>Conclusions</h3> Our results suggest that our collaborative MDT is an effective platform to address patients’ unmet palliative care needs. Further work is required to explore the effect of our model on achieving the preferred place of death and reductions in unplanned hospital admissions.
Cholescintigraphy in the Diagnosis and Follow Up of Hepatobiliary Injury
Authors: JOHAN WIG, INGE ROMSLO, JAN ERIK THORESEN, HELGE MYRVOLD
Journal: Clinical Nuclear Medicine (1988)

Cholescintigraphy is a simple and reliable way of detecting a liver injury accompanied by biliary leakage and is also well suited to assess the effectiveness of treatment and to follow recovery. To emphasize these points, a case report of a patient suffering from a severe injury to the liver is presented.
Remarks ON THE OPERATIVE CURE OF ASCITES DUE TO LIVER CIRRHOSIS
Authors: R. Morison
Journal: BMJ (1912)

treatment of hepatic cirrhosis four years later I were we aware that aney one had a prior claim to our own in respect to the procedure suggested.As Professor Talmta's sua- fgestion and case were recorded in a Dutclhjournal anid in D utch languagae, w ith which neither of us wn tas acquainted, our ignorance will cause no surprise.
INSULIN TREATMENT OF THE TOXEMIC VOMITING OF PREGNANCY
Authors: WILLIAM THALHIMER
Journal: JAMA (1924)

I previously reported 1 a series of cases in which postoperative, nondiabetic acidosis was successfully treated with a combination of hypodermic injections of insulin and the intravenous administration of glucose solution. One of the statements in this article was that an opportunity is awaited to use this method of treatment in a series of patients suffering from the acidosis of toxemic vomiting of pregnancy.  Thus far, the opportunity has occurred of treating only three patients 2 with severe, toxemic vomiting of pregnancy, but the results have been so striking, and parallel so exactly the results in all patients with postoperative acidosis, similarly treated, that they seem sufficiently important to report.  REPORT OF CASES  Case 1.  —Mrs. H., aged 18, admitted to the service of Dr. R. W. Roethke, Aug. 15, 1923, was about three months pregnant, and had been vomiting practically everything she had eaten for the last three weeks.
Positive F-18 FDG Positron Emission Tomography in the Perineum After Anorectal Reconstruction
Authors: MAX LONNEUX, BERNARD E. VAN BEERS, ALEX KARTHEUSER
Journal: Clinical Nuclear Medicine (2002)

LONNEUX, MAX M.D.*; VAN BEERS, BERNARD E. M.D., Ph.D.†; KARTHEUSER, ALEX M.D., M.Sc., Ph.D.‡ Author Information
Heterogeneity of action potential waveforms and potassium currents in rat ventricle
Authors: R B Clark, R A Bouchard, E Salinas-Stefanon, J Sanchez-Chapula, W R Giles
Journal: Cardiovascular Research (1993)

Objective: The ionic mechanisms for differences in action potential waveforms in rat left ventricle were studied by recording L-type Ca2+ current, transient outward K+ current, and inwardly rectifying background K+ current in single myocytes. Methods: Single cells were obtained from adult rat hearts by enzymatic dispersion of tissue segments from the epicardium at the apex and the endocardium at the base of the left ventricle. Whole cell voltage clamp methods together with cell shortening measurements were used to identify the K+ currents involved in early and late repolarisation and to correlate changes in action potential shape with inotropic responses. 4-Aminopyridine was used to block the transient outward K+ current, It, to evaluate the contribution of this current to repolarisation. Results: Action potential recordings demonstrated that cells from endocardial tissue at the base of the left ventricle have a considerably longer action potential than those from epicardial tissue at the apex. 4-Aminopyridine had a much more pronounced action potential lengthening and inotropic effects on cells from epicardium than on myocytes from endocardium suggesting that It is larger in the epicardium. Voltage clamp measurements confirmed this. In contrast, the L-type Ca2+ current, the resting membrane potential, and the inwardly rectifying background K+ current were very similar in these two regions of left ventricle. Conclusions: One significant factor contributing to the heterogeneity of action potential waveforms in rat left ventricle is a differential distribution of a Ca+ independent transient outward K+ current, It. Regional differences in action potential duration have important implications for the gradient of repolarisation in rat left ventricle, for the genesis of the T wave of the electrocardiogram, and for both electrical and mechanical restitution (refractoriness). Cardiovascular Research 1993;27:1795-1799
Doctors' Errors and Mistakes of Medicine: Must Health Care Deteriorate?
Authors: Neville W Goodman
Journal: BMJ (2004)

Medicine is immersed in an orgy of self doubt. I am reminded of a scene in Bergman's film The Seventh Seal , in which the knight and the squire watch a stream of flagellants walk and crawl past, beating themselves and each other in an attempt to avert the plague. As we beat ourselves, there are some who wish us to whip even harder and a small number who deem us incapable of redemption. There cannot be any among us who still doubt the existence of the plague. …
Mite‐allergen levels in Norwegian homes
Authors: P. I. Gaarder
Journal: Allergy (1998)

The scarce data published on mite sensitization and mite‐allergen levels in Norway indicate that the mites may not be of the same importance in allergic disease in Norway as in countries such as the UK and the rest of Europe. The problem also involves the low allergen levels and small amounts of dust collected for allergen determination, and when the level is to be expressed as mg/g, the lower detection limit will often vary from sample to sample, giving within the same investigation results such as &lt; 0.2 μg/g, &lt; 0.5 μg/g, and even &lt;2.0 μg/g. The use of allergen levels expressed instead per area (μg/m 2 ) at least results in a uniform lower detection limit, making statistical analysis easier.
Brain training, exercise, and healthy eating slow cognitive decline in elderly people at risk, study finds
Authors: S. Mayor
Journal: BMJ (2015)

A comprehensive programme incorporating individual support for healthy eating, regular exercise, and brain training in addition to managing metabolic and vascular risk factors reduced cognitive decline in older people at risk for dementia, results reported in the Lancet have shown.1

The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) screened 2654 people aged 60-77 and recruited 1260 people who had raised dementia risk and cognition at or slightly below the mean level expected for their age. Raised dementia risk was defined as scoring …
High-dose methotrexate for primary CNS lymphoma in the elderly
Authors: S. Ng, M. A. Rosenthal, D. Ashley, L. Cher
Journal: Neuro-Oncology (2000)

Primary central nervous system lymphoma (PCNSL) in the immunocompetent patient reaches a peak incidence in the sixth and seventh decades of life. This retrospective study reviewed the efficacy and tolerability of high-dose methotrexate (HDMTX) in an elderly patient population. Between May 1995 and September 1998, ten consecutive elderly patients with histologically proven PCNSL were treated with HDMTX. The median age was 72.5 years and eight patients (80%) were older than 70 years. HDMTX was well tolerated with no episodes of grade 4 toxicity nor febrile neutropenia. Toxicity included grade 3 nausea (1), grade 2 mucositis (2), and grade 2 asymptomatic elevation of liver transaminases (2). Grade 1 toxicity occurred in three patients with nausea, diarrhea, and mild reversible elevation in serum creatinine in one patient each. Six patients had a complete response and three patients achieved a partial response, giving an overall response rate of 90% (95% confidence interval, 56%-100%). The median overall survival for the cohort was 36 months (range 4-43 months). In summary, HDMTX is well tolerated in this elderly population with PCNSL and achieves response rates and median survival comparable with other chemotherapy or radiotherapy regimens.
High Court quashes GMC finding of serious professional misconduct
Authors: C. Dyer
Journal: BMJ (2002)

A hospital consultant has won a High Court ruling quashing a finding of serious professional misconduct against him by the General Medical Council on the grounds that it was irrational and perverse.

Mr Justice Turner ruled that Jeffrey Cream's decision to pass on concerns that a member of an appointments committee might be biased did not amount to misconduct at all. Nor had the GMC shown that the misconduct fell into the category “professional,” and even if it had been professional misconduct it fell short of “serious” by a wide margin.

Dr Cream, a consultant dermatologist …
Clinical Report.DISLOCATION OF THE CARTILAGE OF THE NOSE.
Authors: IRVING McNEIL
Journal: JAMA (1904)

The following unusual case seems of sufficient interest to deserve publication: <h3>Patient.</h3> —Mrs. W., Mexican, 30 years of age, came to me Aug. 1, 1904, complaining of a "sore nose." <h3>History.</h3> —About a year before she accidentally struck her nose violently against a door. There was no hemorrhage, nor even broken skin, but the blow was a severe one, and her nose had troubled her ever since, hurting severely one week, and appearing to get almost well another. <h3>Examination.</h3> —Inspection showed nothing abnormal except a little redness and swelling about the lower left ala. On palpating the nose lightly with my finger there was a most peculiar sensation of something slipping or giving way beneath. This also caused some pain. I diagnosed dislocation of the left lower lateral cartilage of the nose. Ordinarily there was no displacement because the elasticity of the surrounding tissues held it in place. Yet it
Macrophage Sortilin Promotes LDL Uptake, Foam Cell Formation, and Atherosclerosis
Authors: Kevin M. Patel, Alanna Strong, Junichiro Tohyama, Xueting Jin, Carlos R. Morales, Jeffery Billheimer, John Millar, Howard Kruth, Daniel J. Rader
Journal: Circulation Research (2015)

Rationale: Noncoding gene variants at the SORT1 locus are strongly associated with low-density lipoprotein cholesterol (LDL-C) levels, as well as with coronary artery disease. SORT1 encodes a protein called sortilin, and hepatic sortilin modulates LDL metabolism by targeting apolipoprotein B–containing lipoproteins to the lysosome. Sortilin is also expressed in macrophages, but its role in macrophage uptake of LDL and in atherosclerosis independent of plasma LDL-C levels is unknown. Objective: To determine the effect of macrophage sortilin expression on LDL uptake, foam cell formation, and atherosclerosis. Methods and Results: We crossed Sort1 −/− mice onto a humanized Apobec1 −/− ; hAPOB transgenic background and determined that Sort1 deficiency on this background had no effect on plasma LDL-C levels but dramatically reduced atherosclerosis in the aorta and aortic root. To test whether this effect was a result of macrophage sortilin deficiency, we transplanted Sort1 −/− ;LDLR −/− or Sort1 +/+ ;LDLR −/− bone marrow into Ldlr −/− mice and observed a similar reduction in atherosclerosis in mice lacking hematopoetic sortilin without an effect on plasma LDL-C levels. In an effort to determine the mechanism by which hematopoetic sortilin deficiency reduced atherosclerosis, we found no effect of sortilin deficiency on macrophage recruitment or lipopolysaccharide-induced cytokine release in vivo. In contrast, sortilin-deficient macrophages had significantly reduced uptake of native LDL ex vivo and reduced foam cell formation in vivo, whereas sortilin overexpression in macrophages resulted in increased LDL uptake and foam cell formation. Conclusions: Macrophage sortilin deficiency protects against atherosclerosis by reducing macrophage uptake of LDL. Sortilin-mediated uptake of native LDL into macrophages may be an important mechanism of foam cell formation and contributor to atherosclerosis development.
Septicemia after Endoscopic Retrograde Cholangiopancreatography
Authors: J. Devière, S. Motte, J. M. Dumonceau, E. Serruys, J. P. Thys, M. Cremer
Journal: Endoscopy (1990)

Clinical and bacteriological data from 55 patients who developed septicemia within 3 days after ERCP were collected. Forty-four patients presented with septicemia after therapeutic endoscopy, with incomplete drainage in forty, eight after diagnostic ERCP performed in obstructed bile ducts in another center and not followed by endoscopic therapy, and three with a normal common bile duct after diagnostic ERCP. The incidence of septicemia is significantly higher in cases of malignant obstruction than in benign obstruction (21 % vs 3 %; p < 0.01), due mainly to the problems of drainage associated with tumoral infiltration. Forty-eight patients (87 %) had incomplete bile duct drainage when they developed septicemia, and among the seven remaining cases, 3 had cholecystitis and 3 abscesses in the biliopancreatic area. Previous diagnostic ERCP without drainage was also clearly associated with septicemia after therapeutic ERCP. The most commonly isolated bacteria from blood and bile cultures were Pseudomonas aeruginosa and Escherichia coli. P. aeruginosa was observed mainly in patients referred from other centers after previous diagnostic ERCP, and was unusual in patients without previous ERCP. It is associated with problems in the disinfection of the scopes. Six deaths were attributed to sepsis, always in patients with incomplete biliary drainage which could not be improved. In most of the cases, septicemia after ERCP is related to incomplete bile duct drainage, and in some cases, to biliopancreatic infected collections. Careful disinfection of the endoscopes and other endoscopic devices is mandatory to avoid an unacceptably high rate of P. aeruginosa infection.
Venous Endothelium of Experimental Arteriovenous Fistulas in Rabbits
Authors: J. T. Fallon, W. E. Stehbens
Journal: Circulation Research (1972)

Since hemodynamic factors have been implicated in the localization and pathogenesis of atherosclerosis, the effect of hemodynamic stress on endothelium was investigated. The endothelium of the inferior vena cava of 24 rabbits with aortocaval fistulas was stained in situ and examined by the Hautchen technique at postoperative intervals ranging from 1 to 50 weeks. Cell counts revealed that, in the anastomosed vein of the fistula, an initially high frequency of abnormal cells decreased 3-12 weeks postoperatively but rose again within 20-50 weeks to levels significantly higher than those in either normal venous endothelium or sham-operated veins. An originally high mitotic index at 1-2 weeks decreased with time but still remained significantly larger than that observed in sham-operated rabbits. In most rabbits with arteriovenous shunts, a small area of the inferior vena cava near the fistula was devoid of endothelium, covered with a thin deposit of mural thrombi, and considered to be a jet lesion. The findings demonstrate that hemodynamic factors can cause endothelial injury, increased turnover of endothelial cells, and formation of multinucleated endothelial cells characteristic of regenerating endothelium.