tbuckley/cabot-search huggingface dataset:
Occult manifestations of bacteraemia in an 82 year old woman
Authors: C. Gouldthorpe, D. Heseltine
Journal: BMJ (2014)

An 82 year old woman presented with breathlessness, increasing confusion, and a feeling of being generally unwell for the past two weeks. As well as a cough—productive of clear sputum—and dysuria, she also reported pain in her right rib on admission.

Her medical history included hypertension, osteoarthritis, hypothyroidism, and polymyalgia rheumatica, for which she was taking 10 mg prednisolone a day. Two years earlier she had been treated for venous leg ulcers, which were positive for meticillin resistant Staphylococcus aureus (MRSA).

On examination she did not have a fever, appeared pale, and had dry mucous membranes. Her respiratory rate was 18 breaths/min with oxygen saturations of 96% on air. Both lung bases were dull to percussion and reduced breath sounds were noted. No additional heart sounds were noted and nor were there any signs of infective endocarditis. Furthermore, she had no ulcers on presentation.

Initial investigations showed a raised white cell count (17.1×109/L; reference range 4.0-11.0), raised urea mmol/L (9.5; 2.5-7.8), raised creatinine (142 µmol/L; 49-90), and raised C reactive protein (2657 nmol/L; 0-76.2). A midstream urine specimen was negative for micro-organisms. and chest radiography showed no focal consolidation. Subsequent blood cultures were positive for S aureus , sensitive to flucloxacillin and resistant to penicillin. Paraspinal abscesses were detected on magnetic resonance imaging (fig 1⇓).





### 1. What are the common sources of S aureus bacteraemia?

#### Short answer

S aureus bacteraemia commonly arises from skin and soft tissue infections and indwelling venous catheters. It can also arise from pneumonia, endocarditis, or deep seated foci.

#### Long answer

S aureus commonly colonises the skin and mucous membranes. Although it is usually harmless, it can result in bacteraemia.1 The organism is …
The Golden Age of CME Is Yet to Come
Authors: David A. Fisher
Journal: JAMA (1988)

To the Editor.  —The excellent article by Drs Manning and Petit 1 about continuing medical education fails to address two important and salient problems that postgraduate education needs to attend to.  First, for those who attended undergraduate and medical school in the precomputer age, achieving computer literacy is an expensive and time-consuming problem. Second is the challenge of achieving proficiency and technical finesse in newly developed procedures. Some examples that come to mind are intraocular lens implantation in ophthalmology, coronary angiography and angioplasty in cardiology, and the use of lasers in a variety of medical disciplines.  Didactic courses provide only the base on which to build, analogous to the preclinical years at medical school. Methods must be devised whereby practitioners, in a structured manner and preferably at established teaching hospitals, can obtain hands-on experience in new procedures under the guidance of practiced physicians. Not only is this important for licensing,
Regulation of leucine catabolism by caloric sources. Role of glucose and lipid in nitrogen sparing during nitrogen deprivation.
Authors: J A Vazquez, H S Paul, S A Adibi
Journal: Journal of Clinical Investigation (1988)

Previously we showed that hypocaloric amounts of glucose reduce leucine catabolism while an isocaloric amount of fat does not (1985. J. Clin. Invest. 76:737.). This study was designed to investigate whether the same difference exists when the entire caloric need is provided either as glucose or lipid. Rats were maintained for 3 d on total parenteral nutrition (350 cal/kg per d), after which the infusion of amino acids was discontinued and rats received the same amount of calories entirely as glucose or lipid for three more days. A third group of rats was infused with saline for 3 d. In comparison to glucose, lipid infusion resulted in higher urinary nitrogen excretion (55 +/- 3 vs. 37 +/- 2 mg N/24 h, P less than 0.05), muscle concentrations of tyrosine (95 +/- 8 vs. 42 +/- 8 microM, P less than 0.01), and leucine (168 +/- 19 vs. 84 +/- 16 microM, P less than 0.01), activity of BCKA dehydrogenase in muscle (2.2 +/- 0.2 vs. 1.4 +/- 0.04 nmol/mg protein per 30 min, P less than 0.05), and whole body rate of leucine oxidation (3.3 +/- 0.5 vs. 1.4 +/- 0.2 mumol/100 g per h, P less than 0.05). However, all these parameters were significantly lower in lipid-infused than starved rats. There was no significant difference between leucine incorporation into liver and muscle proteins of lipid and glucose-infused rats. On the other hand, starved rats showed a lower leucine incorporation into liver proteins. The data show that under conditions of adequate caloric intake lipid has an inhibitory effect on leucine catabolism but not as great as that of glucose. The mechanism of this difference may be related to a lesser inhibition of muscle protein degradation by lipid than glucose, thereby increasing the leucine pool, which in turn stimulates leucine oxidation.
Tonsils and Adenoids
Authors: A. W. Franklin
Journal: BMJ (1957)

MEDICA,L JOURN~AL due to dissection. . . .This suggestion cannot be refuted, but I think toxicity of the medium when given in excessive doses is the major factor in such accidents."With this we are in agreement.For that very reason, in the Bristol Royal Infirmary we have reduced the concentration of diodone from 70% to 50% (25-30 ml.) for the last 18 months.
Electronic Patient–Physician Communication
Authors: Kenneth D. Mandl
Journal: Annals of Internal Medicine (1999)

Letters1 June 1999Electronic Patient–Physician CommunicationKenneth D. Mandl, MD, MPH and Isaac S. Kohane, MD, PhDKenneth D. Mandl, MD, MPHChildren's Hospital, Boston; Boston, MA 02115 (Mandl)Children's Hospital, Boston; Boston, MA 02115 (Kohane)Search for more papers by this author and Isaac S. Kohane, MD, PhDChildren's Hospital, Boston; Boston, MA 02115 (Mandl)Children's Hospital, Boston; Boston, MA 02115 (Kohane)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-130-11-199906010-00013 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We strongly agree with Dr. Wong that e-mail correspondence between patients and physicians must be both authenticated and archived in the patient's record. Indeed, some proprietary systems may fall short by leaving messages vulnerable to subsequent alteration. In our article, we suggested public key cryptography as one candidate technology for confirming the identity of the senders while protecting the content of the messages against unauthorized access. Following guidelines such as those set out by the American Medical Informatics Association (1) will help to avoid some of the potential pitfalls in electronic patient–physician communication.Reference1. Kane B, Sands DZ. Guidelines for the clinical use of electronic mail with patients. The AMIA Internet Working Group, Task Force on Guidelines for the Use of Clinic-Patient Electronic Mail. J Am Med Inform Assoc. 1998;5:104-11. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Kenneth D. Mandl, MD, MPH; Isaac S. Kohane, MD, PhDAffiliations: Children's Hospital, Boston; Boston, MA 02115 (Mandl)Children's Hospital, Boston; Boston, MA 02115 (Kohane) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEpinephrine and Outcome after Cardiac Arrest Robert E. Fromm Jr. and Joseph Varon Epinephrine and Outcome after Cardiac Arrest Fritz Sterz , Wilhelm Behringer , and Harald Kittler Metrics 1 June 1999Volume 130, Issue 11Page: 944KeywordsElectrode recordingFalls ePublished: 15 August 2000 Issue Published: 1 June 1999 Copyright & PermissionsCopyright © 1999 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Diagnosis of invasive amoebiasis: renaissance of the morphology era.
Authors: A Gonzalez-Ruiz, R P Bendall
Journal: Gut (1995)

of cytokines such as transforming growth factor ,B is likely to be an epiphenonemon of the inflammatory process.Finally, we support the view of Cavallini et al that while calcification might contribute to the pathogenesis of chronic pancreatitis in its later stages, there is no well documented evidence fulfilling Koch's postulates that it is probably a significant aetiological factor in the disease.Hence, we also cannot support the hypothesis of the Marseilles school.2We consider that the disease known as 'chronic pancreatitis' is not a single pathological entity but rather a group of different aetiologies and pathogenetic processes sharing a few common morphological end points.3Within this overall group, we anticipate that a predisposition based upon an identifiable genetic abnormality is the likely primary aetiological factor responsible for at least a proportion of cases of chronic pancreatitis.Whether this defect occurs within the pathway of alcohol metabolism or is responsible for promoting an inappropriate cell mediated cytotoxic response to some pancreatic cellular antigen is presently unknown.Nevertheless, answers to such questions are vital if biologically appropriate treatment regimens for different aetiologically and pathogenetically distinct types of 'chronic pancreatitis' are to be developed and affected patients treated more rationally than at present.
P297 Effect Of Bts-recommended Medical Leadership On The "door-to-mask" Time Of Acute Non-invasive Ventilation (niv) Set Ups
Authors: H. Boryslawskyj, F. Rauf, B. Beauchamp, A. Oakes, N. Santana-Vaz, B. Chakraborty, R. Mukherjee
Journal: Thorax (2014)

<h3>Introduction</h3> NIV is now part of standard acute care in the UK. "Door-to-mask" time has been discussed as a performance/quality indicator of acute NIV services [Mandal S <i>et al</i>. <i>Thorax, </i>66(4). A117]. We compare the "Door-to-mask" time by analysing the “% of patients receiving NIV within 3 h” of diagnosis of acute hypercapnic respiratory failure (AHRF) at two acute hospitals in central England: Hospital A, which appointed a Lead NIV consultant in 2009–10 as per BTS recommendations and Hospital B without a Lead consultant. Both hospitals are run by the same Trust and on call physiotherapy teams, with comparable acute catchment sizes. <h3>Methods</h3> The survey was approved as an audit by the Trust’s Clinical Standards Committee. Data was taken from the acute NIV database, maintained continuously since 2004 at HospitalA and since 2009 Hospital B as part of a drive to maintain built-in quality. All acute NIV episodes between 01/10/2010–01/04/2011 (period 1) and 01/10/2012–01/04/2013 (period 2) were included: 458 episodes (27 excluded – incomplete data). <h3>Results</h3> In period1, the “% of patients receiving NIV within 3 h” of diagnosis of AHRF were 69.9% at Hospital A and 69.49% at Hospital B. In period2, Hospital A improved to 82% with Hospital B at 71.1%. The most significant improvement, however, was in the reduction of variance around the median "Door-to-mask" time of 1.55 h at Hospital A and 1.83 h at HospitalB on the Probability Density curves, also seen over other periods outside the ones studied. <h3>Conclusions</h3> The service at Hospital B did not show any measurable improvement in ‘door-to-mask time’ between periods1 and 2 but Hospital A did. As there were no significant differences like the demography, work load, frequency of on calls or number/grades of staff between the periods 1 and 2, this improvement could be a reflection on the role of a Lead NIV consultant at Hospital A as per BTS recommendations. Furthermore, reduction of variance around the median "Door-to-mask" time is observed to be a consistent feature of the improvement, which needs evaluation as an independent performance/quality indicator of acute NIV services.
Chronic Tophaceous Gout
Authors: ELINOR GOSHEN, ARNON SCHWARTZ, S. TZILA ZWAS
Journal: Clinical Nuclear Medicine (2000)

A 79-year-old man with a documented history of gout and Paget's disease of the bone was referred for a whole-body bone scan as part of routine follow-up of his condition. Aside from obvious Paget's disease involving the skull, left humerus (with callus from a known fracture), and midthoracic vertebrae, the scan also indicated multifocal disease related to the known gout. These findings include diffuse markedly increased uptake in metacarpal and interphalangeal joints, expanding into the periarticular soft tissues, and focal pathologic uptake in the distal right leg and ankle. Radiologic correlation of the findings were consistent with chronic tophaceous gout. Because of the effective treatment of gout by colchicine, such tophi are rarely encountered. FIGURE 1Fig. 1: A dose of 25 mCi Tc-99m MDP was administered and a whole-body bone scan was acquired 2 hours later. The whole-body scan showed findings typical of Paget's disease of bone (skull, left humerus, and thoracic vertebrae). Increased uptake in the distal right leg and ankle are attributed to tophaceous gout.FIGURE 2Fig. 2: Images of the hands indicate dramatic multifocal uptake in most joints bilaterally, including the wrists and metacarpophalangeal and interphalangeal joints.FIGURE 3Fig. 3: A radiograph of the hand shows soft-tissue densities and subjacent bony erosions with sclerotic margins consistent with tophaceous gout.
Learning from low income countries: what are the lessons?: Hands on course may help deliver obstetric care
Authors: Peter Blackwell-Smyth, Michael Breen, Kim Hinshaw
Journal: BMJ (2004)

EDITOR—We are involved with a scheme in Zambia that has introduced a training programme in emergency skills in obstetrics and gynaecology based on the ALSO (advanced life support in obstetrics) course methods.

The programme, pioneered in the United States by the American Academy of Family Physicians to update practitioners (especially those working in remote areas), has now expanded not only into Europe—about 35 …
Talking trash: the economic and environmental issues of landfills.
Authors: D Taylor
Journal: Environmental Health Perspectives (1999)

The U.S. per-capita figure for garbage production has topped four pounds per person per day, and that amount is rising at roughly 5% per year. In the past, municipal solid waste was sent to the nearest local landfill or incinerator. But in 1988, the U.S. Environmental Protection Agency instituted the first federal standards for landfills, designed to make them safer. Over 10,000 small municipal landfills have since been consolidated into an estimated 3,500 newer, safer landfills, some of which are "megafills" that can handle up to 10,000 tons of waste a day. The new landfills are outfitted to prevent air and water pollution and limit the spread of disease by scavengers. Although the new landfills provide better controls against air and water pollution as well as an alternate source of municipal income, they are not entirely problem-free. Some experts believe the new landfill technology has not been properly tested and will therefore not provide protection in the long run. Others feel that poorer, less well-informed communities are targeted as sites for new landfills. In addition, many people that live near megafills, which may draw garbarge from several states, are unhappy about the noise, truck traffic, odors, and pests caused by the facilities.
Assessment of left ventricular end-systolic pressure-volume relations with an impedance catheter and transient inferior vena cava occlusion: Use of this system in the evaluation of the cardiotonic effects of dobutamine, milrinone, posicor and epinephrine
Authors: Raymond G. McKay, Michael J. Miller, James J. Ferguson, Shin-Ichi Momomura, Peter Sahagian, William Grossman, Richard C. Pasternak
Journal: Journal of the American College of Cardiology (1986)
Correlation between pre and intraoperative myocardial ischemia in patients undergoing major vascular surgery detected by dobutamine stress echocardiography and continuous 12-lead electrocardiography
Authors: D. Poldermans, S. Mey, A.M. Peterse, R.F. Veldkamp, K. Leendertse, H. van Urk, P. Klootwijk
Journal: Journal of the American College of Cardiology (1998)
Abstract C53: rVP1 inhibits prostate cancer metastasis via suppression of Jagged1
Authors: Jui-Ling Wang, Shao-Wen Hung, Chi-Ming Liang, Pei-Wen Hsiao, Shu-Mei Liang
Journal: Cancer Research (2013)

Abstract Jagged1, a NOTCH ligand, has been shown to correlate with poor prognosis and metastasis of prostate cancer (CaP). CaP is a leading cause of cancer death among men worldwide. There is currently no effective therapeutic strategy for patients with castration-resistant prostate cancer (CRPC) which is defined as continued growth of CaP despite the suppression of male hormones. We previously reported that recombinant capsid protein VP1 (rVP1) of foot-and-mouth disease virus causes cell apoptosis of PC-3, a CRPC, via integrin β1 in vitro. Herein, we demonstrate that rVP1 inhibited cell migration/invasion at a non-toxic concentration and reduced the expression level of Jagged1 and phosphorylation of Akt (Ser 473) and IKKα/β (Ser 176/180) of PC-3 cells in vitro. This inhibition was abolished by integrin β1 blocking antibody, knockdown of integrin β1, or a constitutively active Akt. Furthermore, intravenous administration of rVP1 induced tumor apoptosis, suppressed tumor Jagged1 expression level, reduced primary-tumor spread to lymph nodes and bone, and prolonged the survival time of tumor-bearing mice in an orthotopic PC-3 xenograft model. Recombinant VP1 retarded tumor expansion within the bone and tumor-induced osteolysis in an experimental model of bone metastasis made by injecting PC-3 cells carrying the luciferase gene into mouse left ventricle. Finally, in vivo vascular permeability analyses showed that rVP1 specifically targeted tumor cells by penetrating leaky tumor vasculature. Recombinant VP1 may thus suppress Jagged1 expression of CaP cells by inhibiting the integrin β1/Akt/NF-κB signaling pathway to attenuate expansion of bone metastases and tumor-induced osteolysis in CRPC. Citation Format: Jui-Ling Wang, Shao-Wen Hung, Chi-Ming Liang, Pei-Wen Hsiao, Shu-Mei Liang. rVP1 inhibits prostate cancer metastasis via suppression of Jagged1. [abstract]. In: Proceedings of the Third AACR International Conference on Frontiers in Basic Cancer Research; Sep 18-22, 2013; National Harbor, MD. Philadelphia (PA): AACR; Cancer Res 2013;73(19 Suppl):Abstract nr C53.
How Do Observational Studies Expand the Evidence Base for Therapy?
Authors: Martha J. Radford
Journal: JAMA (2001)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA HomeNew OnlineCurrent IssueFor Authors Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Podcasts Clinical Reviews Editors' Summary Medical News Author Interviews More JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA journal
Should we screen for coeliac disease? No
Authors: K. E Evans, R. McAllister, D. S Sanders
Journal: BMJ (2009)

Coeliac disease often goes undiagnosed. <b>Alessio Fasano</b> (doi:10.1136/bmj.b3592) argues that screening would prevent considerable morbidity, but <b>Kate Evans and colleagues</b> think we do not know enough about the effects on people without symptoms
A lesson learnt: An inspirational teacher
Authors: A. Douglas
Journal: BMJ (1999)

one with 45,X/46,XY (case 7); one with 46,XX; and one with 47,XYY.At surgery for cryptorchidism the risk of testicular neoplasia was 7/135 (5.2%) in patients with intraabdominal testis, abnormal external genitalia other than cryptorchidism, or diagnosed abnormal karyotype.In contrast, no case of testicular neoplasia occurred in 1114 patients without these characteristics.The figures are significantly different (Fischer's exact test, P < 0.001).At surgery the risk of testicular neoplasia was 4/286 (1.4%) in the 286 patients operated on for bilateral cryptorchidism, which is not significantly different from 3/963 (0.3%) in the 963 patients with unilateral cryptorchidism (P = 0.10).However, intra-abdominal testis, abnormal external genitalia, or abnormal karyotype were reported in 42 (14.7%)patients operated on for bilateral cryptorchidism, compared with 93 (9.7%) patients with unilateral cryptorchidism (P < 0.05).
Notch2 signaling promotes biliary epithelial cell fate specification and tubulogenesis during bile duct development in mice
Authors: Jan S. Tchorz, Jochen Kinter, Matthias Müller, Luigi Tornillo, Markus H. Heim, Bernhard Bettler
Journal: Hepatology (2009)

Abstract Intrahepatic bile duct (IHBD) development begins with the differentiation of hepatoblasts into a single continuous biliary epithelial cell (BEC) layer, called the ductal plate. During ductal plate remodeling, tubular structures arise at distinct sites of the ductal plate, forming bile ducts that dilate into the biliary tree. Alagille syndrome patients, who suffer from bile duct paucity, carry Jagged1 and Notch2 mutations, indicating that Notch2 signaling is important for IHBD development. To clarify the role of Notch2 in BEC differentiation, tubulogenesis, and BEC survival, we developed a mouse model for conditional expression of activated Notch2 in the liver. We show that expression of the intracellular domain of Notch2 (Notch2ICD) differentiates hepatoblasts into BECs, which form additional bile ducts in periportal regions and ectopic ducts in lobular regions. Additional ducts in periportal regions are maintained into adulthood and connect to the biliary tight junction network, resulting in an increased number of bile ducts per portal tract. Remarkably, Notch2ICD-expressing ductal plate remnants were not eliminated during postnatal development, implicating Notch2 signaling in BEC survival. Ectopic ducts in lobular regions did not persist into adulthood, indicating that local signals in the portal environment are important for maintaining bile ducts. Conclusion : Notch2 signaling regulates BEC differentiation, the induction of tubulogenesis during IHBD development, and BEC survival. (Hepatology 2009.)
Prediction of the solubility of cucurbitacin drugs in self-associating poly(ethylene oxide)-b-poly(α-benzyl carboxylate ɛ-caprolactone) block copolymer with different tacticities using molecular dynamics simulation
Authors: Sarthak K. Patel, Afsaneh Lavasanifar, Phillip Choi
Journal: Biomaterials (2009)