tbuckley/cabot-search huggingface dataset:
Helicobacter pylori (HP) serology: an audit of action on positive serology results
Authors: B. James, M. Srinivas, P. Willemse, P. Basumani, B. Hoeroldt, K. Bardhan
Journal: Gut (2011)

<h3>Introduction</h3> Hp causes peptic ulcer disease (PUD) and is potentially carcinogenic. Hp eradication is done in conditions like PUD, uncomplicated dyspepsia and persistent iron deficiency anaemia. ‘Test and treat’ implies testing specifically with intent to treat, if positive. CLO test is read in real time and acted on promptly. Hp serology is used in acute upper GI (UGI) bleed or endoscopy on PPI as CLO test is less sensitive. Results take 5–7 days by when in-patients have been discharged and positive Hp serology (Hp+ve) results overlooked. This audit was prompted by two such missed cases of Hp+ve PUD with rebleed in one. <h3>Aim</h3> To review action taken on Hp+ve results in our hospital, assess factors contributing to inaction, impact on patient care and remedial steps needed. <h3>Methods</h3> Retrospective study of all patients with Hp+ve requested by hospital clinicians in 12 months (1 April 2009 to 31 March 2010). Serology data from our microbiology department was matched with subsequent urea breath tests (UBT), our standard test to confirm eradication. Patients with sequential serology and UBT were deemed to have received eradication. Case notes of the others were reviewed for test indication, point of first contact, gastroscopy findings (if done), eradication recommendation by endoscopist, specialist nurse (SpN) contact, reason for non-eradication and any complications. <h3>Conclusion</h3> 1 in 6 Hp+ve not eradicated; 21/33 results not reviewed. Factors for inaction: multiple test sources (clinic, ward, endoscopy), lack of single contact of point (poor use of SpN support), unclear advice from endoscopists. <h3>Recommendations</h3> In routine clinical practice, test Hp serology only with intent to treat positives. SpN in endoscopy unit to be single point for contact, review of results and action on Hp+ve results: If +ve, initiate and ensure successful eradication where recommended; contact clinician to decide for eradication or not, in the rest. Local arrangements made for lab to send copy of all hospital initiated Hp+ve results to SpN for above action.
Severe Community-acquired Pneumonia
Authors: SANTIAGO EWIG, MAURICIO RUIZ, JOSEP MENSA, MARIA ANGELES MARCOS, JOSE ANTONIO MARTINEZ, FRANCISCO ARANCIBIA, MICHAEL S. NIEDERMAN, ANTONI TORRES
Journal: American Journal of Respiratory and Critical Care Medicine (1998)

The purpose of the study was to validate the criteria used in the guidelines of the American Thoracic Society (ATS) for severe community-acquired pneumonia (CAP). Severe pneumonia was defined as admission to the intensive care unit (ICU). Overall 331 nonsevere (84%) and 64 severe cases (16%) of CAP were prospectively studied. Mortality was 19 of 395 (5%) and 19 of 64 (30%), respectively. Single severity criteria as well as the ATS definition of severe pneumonia were assessed calculating the operative indices. A modified prediction rule including minor (baseline) and major (baseline or evolutionary) criteria was derived. Single minor criteria at admission had a low sensitivity and positive predictive value. Defining severe pneumonia according to the ATS guidelines had a high sensitivity (98%). However, specificity and positive predictive value were low (32% and 24%, respectively). A modified prediction rule (presence of two or three minor criteria [systolic blood pressure < 90 mm Hg, multilobar involvement, PaO2/FIO2 < 250] or one of two major criteria [requirement of mechanical ventilation, presence of septic shock]) had a sensitivity of 78%, a specificity of 94%, a positive predictive value of 75%, and a negative predictive value of 95%. The ATS definition of severe pneumonia was highly sensitive but insufficiently specific and had a low positive predictive value. Our suggested modified rule had a more balanced performance and, if validated in an independent population, may represent a more accurate definition of severe CAP.
Cerebral Vasculitis Associated With Cocaine Abuse or Subarachnoid Hemorrhage?
Authors: Steven R. Levine
Journal: JAMA (1988)

<h3>To the Editor.</h3> —Kaye and Fainstat<sup>1</sup>report a case of alleged cerebral vasculitis secondary to cocaine use. Their interpretation is difficult to accept. The patient experienced unilateral headache and blurred vision for six days, left hemiparesis, drowsiness, and fever for four days, and then a major motor seizure. The cerebrospinal fluid was bloody and did<i>not</i>clear from the first to the fourth tube; the supernatant apparently was not examined for xanthochromia. An angiogram showed irregular narrowing of the right supraclinoid internal carotid and proximal middle cerebral arteries and occlusion of the right anterior cerebral artery; the appearance of more distal vessels or of the left cerebral circulation was not described. A computed tomographic scan showed right cerebral infarction. It seems to us that this patient probably had a subarachnoid hemorrhage that was followed four days later by cerebral vasospasm and infarction. Lack of visible blood on the computed
Bacterial Infections in Drug Users
Authors: Rachel J. Gordon, Franklin D. Lowy
Journal: New England Journal of Medicine (2005)

There are an estimated 13 million injection-drug users worldwide, and infections are among the most serious complications of drug use. This article reviews the common problems associated with drug use, including skin and soft-tissue infections, septic arthritis, osteomyelitis, and endovascular infections. The authors describe the most common organisms and provide guidance on both treatment and prevention.
Obesity and the Right Brain
Authors: Keith H. Bachman, Trina M. Histon
Journal: JAMA (2007)

To the Editor: In their Commentary, Drs Alonso-Alonso and Pascual-Leone discussed the right brain hypothesis for obesity. We agree that there is a great deal of basic science research needed to understand the complex etiology of obesity and to untangle the biological, cognitive, psychological, and environmental issues that may contribute. However, we feel the authors are premature in linking right prefrontal cortex abnormalities and obesity. There are simpler and more practical reasons for the behaviors observed among obese persons than those the authors cite. It is unlikely that “deficits in decision making” underlie the difficulty obese patients have in committing to longterm weight loss strategies. More likely explanations of high attrition rates during behavioral treatment include program fatigue, discordance between treatment goals and treatment success, and the time needed for frequent group attendance. Poor adherence with breast cancer screening programs reflect barriers and stigmatization of obese persons that are common in health care settings, or the low specificity of mammography in this population. “Lack of embarrassment” from prefrontal cortex impairment seems an unlikely contributor to obesity because weight loss attempts correlate with increasing body mass index. Before adding the stigma of “brain damaged” to the high physical and social burden obese persons already bear, we would like to see more compelling data to support this conclusion.
Cortical Thickness Abnormalities in Cocaine Addiction—A Reflection of Both Drug Use and a Pre-existing Disposition to Drug Abuse?
Authors: Nikos Makris, Gregory P. Gasic, David N. Kennedy, Steven M. Hodge, Jonathan R. Kaiser, Myung Joo Lee, Byoung Woo Kim, Anne J. Blood, A. Eden Evins, Larry J. Seidman, Dan V. Iosifescu, Sang Lee, Claudia Baxter, Roy H. Perlis, Jordan W. Smoller, Maurizio Fava, Hans C. Breiter
Journal: Neuron (2008)
THE LEMPERT FENESTRATION OPERATION
Authors: George E. Shambaugh
Journal: JAMA (1949)

To the Editor:—  The editorial on the fenestration operation inThe Journalof June 25 requires clarification on a few points.  In the discussion of the results reported by Shambaugh and Juers and Shambaugh the statement is made that their estimate of prognosis has apparently been revised downward. This statement seems to be based on the 1946 report by these authors 1 of improvement in 92 per cent of cases in which audiometric measurements were made two years after operation, whereas in the 1947 and 1948 reports 2 two year successful results, with practical hearing to within 30 decibels loss for the speech frequencies, were obtained in 80 per cent of ideally selected cases.  These two reports of results are not comparable, since they referred to two different criteria of evaluation of results: the first referred to all patients operated on with respect to whether or not they showed a
THE IMMUNOLOGICAL SPECIFICITY OF STAPHYLOCOCCI
Authors: C. W. Wieghard, L. A. Julianelle
Journal: The Journal of Experimental Medicine (1935)

1. Two carbohydrates have been extracted from different strains of Staphylococcus which are immunologically and chemically distinct. 2. The chemical differences between the two types are manifested principally in optical rotation, and in the simple sugars resulting from hydrolytic cleavage of the specific carbohydrates. 3. The immunological specificity of both polysaccharides is dissipated as hydrolysis proceeds. 4. The results of the chemical reactions reported are discussed.
Hypoglycemia from the Inadvertent Use of Oral Hypoglycemic Agents
Authors: TERRY W. CROWSON, ROBERT L. KRIEL
Journal: Annals of Internal Medicine (1980)

Letters and Corrections1 January 1980Hypoglycemia from the Inadvertent Use of Oral Hypoglycemic AgentsTERRY W. CROWSON, M.D., ROBERT L. KRIEL, M.D.TERRY W. CROWSON, M.D.Search for more papers by this author, ROBERT L. KRIEL, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-92-1-134_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: The surreptitious use of insulin (1) and oral hypoglycemic agents (2, 3) are recognized causes of hypoglycemia. Recently, Aderka and Pinkhas (4) reported a case of hypoglycemia induced by the inadvertent use of chlorpropamide. We report here our experience with two cases of hypoglycemia induced by inadvertent ingestion of sulfonylurea compounds.An 84-year-old white woman was brought to the emergency room in 1977 after being found unconscious by relatives. Her blood glucose level was 45 md/dL. She became alert and oriented after receiving 50 mL of 50% dextrose solution intravenously. Four hours after admission, she became tremulous...References1. SCARLETTMAKORUBENSTEIN JMA. Factitious hypoglycemia. N Engl J Med. 1977;297:1029-32. CrossrefMedlineGoogle Scholar2. MILLERORSONWATSON DJD. Up John, down glucose. N Engl J Med. 1977;297:339. Letter. CrossrefMedlineGoogle Scholar3. JORDANKAMMERRIDDLE RHM. Sulfonylurea-induced factitious hypoglycemia: a growing problem. Arch Intern Med. 1977;137:390-3. CrossrefMedlineGoogle Scholar4. ADERKAPINKHAS DJ. Inadvertently induced hypoglycemia. JAMA. 1978;240:1140. Letter. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: St. Paul-Ramsey Medical Center St. Paul, MN 55101 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByA Novel Solution to a Case of Occult Drug-Induced HypoglycemiaProfound Hypoglycemia in a Mail-Order Pharmacy Customer as a Result of a Dispensing ErrorArzneimittelbedingte TodesfälleConfusion about Drug NamesDrug-Induced Hypoglycemia: A Review of 1418 CasesHypoglycemia due to inadvertent dispensing of chlorpropamideInadvertent Chlorpropamide Hypoglycemia — No Longer Once in a Blue Moon?Orinase® (Upjohn)Insulin, glucagon and oral hypoglycemic drugs 1 January 1980Volume 92, Issue 1Page: 134-134KeywordsBloodEmergency departmentGlucoseHypoglycemiaHypoglycemicsIngestionInsulin Issue Published: 1 January 1980 PDF DownloadLoading ...
RENAL CONCENTRATING MECHANISMS IN NEWBORN INFANTS. EFFECT OF DIETARY PROTEIN AND WATER CONTENT, ROLE OF UREA, AND RESPONSIVENESS TO ANTI-DIURETIC HORMONE *
Authors: C. M. Edelmann, H. L. Barnett, V. Troupkou
Journal: Journal of Clinical Investigation (1960)

Measurements of the concentration of osmoti- cally active solutes in the urine of dehydrated in- fants have demonstrated a gradual increase from birth through the first weeks of life, with adult levels being attained only after several months (1-13).The minimal response noted in infants to ad- ministration of vasopressin has led many ob- servers (2, 5, 8, 11, 12) to the conclusion that due to immaturity the renal tubules are relatively insensitive to antidiuretic hormone (ADH).However, failure to observe a decrease in rate of urine flow or an increase in urine osmolality in response to vasopressin cannot be interpreted simply as resistance to the hormone per se, since other aspects of the concentrating mechanism, quite distinct from the role of ADH (14-16),
Soft Water, Heart Attacks, and Stroke
Authors: Andrew G. Shaper
Journal: JAMA (1974)

HEART attacks and strokes are the major causes of death in the United States, as in most developed countries of the world. The search for factors that might be concerned with the causation of these diseases has been intense and has gone on for many years. Many elements have already been found to be closely associated with the risk of heart attacks or stroke, and examination of individuals or populations may reveal the presence of these "risk factors." High blood cholesterol levels, high blood pressure, cigarette smoking, and diabetes mellitus are well established as risk factors in cardiovascular disease. Obesity and lack of vigorous physical activity are certainly involved in determining who suffers and who does not. As if this list was not enough, there has been increasing evidence in the past 15 years of yet another factor that appears to play an important role in influencing cardiovascular disease:<i>the</i>
Riboflavin Is a Determinant of Total Homocysteine Plasma Concentrations in End-Stage Renal Disease Patients
Authors: Sonja Skoupy, Manuela Fo[Combining Diaeresis]dinger, Mario Veitl, Agnes Perschl, Heidi Puttinger, Claudia Ro[Combining Diaeresis]hrer, Karin Schindler, Andreas Vychytil, Walter H. Ho[Combining Diaeresis]rl, Gere Sunder-Plassmann
Journal: Journal of the American Society of Nephrology (2002)

The effect of thiamine (vitamin B(1)) or riboflavin (vitamin B(2)) availability on fasting total homocysteine (tHcy) plasma levels in end-stage renal disease patients is unknown. A cross-sectional study was performed in a population of non-vitamin supplemented patients maintained on continuous ambulatory peritoneal dialysis. Red blood cell availability of thiamine (alpha-ETK) and of riboflavin (alpha-EGR), along with other predictors of tHcy plasma levels, was considered in the analysis. There was a linear association of alpha-EGR with tHcy plasma concentrations (P = 0.009), which was not observed for alpha-ETK. Among red blood cell vitamins, alpha-EGR was the only predictor of tHcy levels (P = 0.035), whereas alpha-ETK, red blood cell pyridoxal-5-phosphate supply (alpha-EGOT) and red blood cell folate levels had no effect. The risk for having a high tHcy plasma levels within the fourth quartile (plasma tHcy >38.3 micromol/L) was increased by an alpha-EGR > median (odds ratio, 4.706; 95% confidence interval, 1.124 to 19.704; P = 0.026). By way of contrast, alpha-ETK had no effect in these analyses. Independent predictors of tHcy plasma levels were serum albumin, alpha-EGR, red blood cell folate, and certain MTHFR genotypes. A logistic regression analysis showed that the MTHFR genotype is a predictor for having a tHcy plasma concentration within the fourth quartile. In summary, riboflavin availability, as measured by alpha-EGR, is a determinant of fasting tHcy plasma levels in peritoneal dialysis patients. This finding may have implications for tHcy lowering therapy in individuals with end-stage renal disease.
The Pulmonary Surfactant: Quantity and Quality
Authors: Barry T. Smith
Journal: New England Journal of Medicine (1979)

THE evolution of life from an aquatic to a gaseous environment necessitated the emergence of specialized organs for respiration characterized by large areas for gas exchange. In the mammalian lung, this surface area is provided by the repeated branching of the bronchial tree ending in respiratory units (alveoli) in which the epithelium is overlaid by a thin film of fluid. Thus, the lung is characterized by an extensive air-liquid interface, and surface forces generated at this interface provide a major retractile force. If unopposed, their surface tension would promote alveolar collapse at the end of expiration, allowing perfusion of unaerated . . .
445 THE ACTIVATION OF THE HEPATIC IMMUNE SYSTEM BY SIRNAS IS DIFFERENTLY CONTROLLED BY CHEMICAL MODIFICATIONS AND MAY INVOLVE ENDOSOMAL TOLL-LIKE RECEPTORS
Authors: R. Broering, M. John, K. Kleinehr, J.-P. Sowa, A. Bucchi, G. Gerken, J. Schlaak
Journal: Journal of Hepatology (2010)
CMR Imaging With Rapid Visual T1 Assessment Predicts Mortality in Patients Suspected of Cardiac Amyloidosis
Authors: James A. White, Han W. Kim, Dipan J. Shah, Nowell Fine, Ki Young Kim, David C. Wendell, Wael Al-Jaroudi, Michele Parker, Manesh Patel, Femida Gwadry-Sridhar, Robert M. Judd, Raymond J. Kim
Journal: JACC. Cardiovascular imaging (2014)
The Death of Young King Edward VI
Authors: Grace Holmes, Frederick Holmes, Julia McMorrough
Journal: New England Journal of Medicine (2001)

Measles virus suppresses host immunity to tuberculosis, as may some types of live measles-virus vaccine.1 Tuberculosis and measles remain important factors in childhood morbidity and mortality, particularly in the developing world. The life of Edward VI, son of Henry VIII, was short, and his death in 1553 was untimely and tragic. The cause of his death has never been clearly understood. We believe that his death was due to rapidly progressive tuberculosis that developed after he had measles. This early case is of interest because it is illustrative of the association of measles with tuberculosis and because of its importance . . .
Innovative approaches to optimizing the delivery of vancomycin in individual patients
Authors: Manjunath P. Pai, Michael Neely, Keith A. Rodvold, Thomas P. Lodise
Journal: Advanced Drug Delivery Reviews (2014)

The delivery of personalized antimicrobial therapy is a critical component in the treatment of patients with invasive infections. Vancomycin, the drug of choice for infections due to methicillin-resistant Staphylococcus aureus, requires the use of therapeutic drug monitoring (TDM) for delivery of optimal therapy. Current guidance on vancomycin TDM includes the measurement of a trough concentration as a surrogate for achieving an AUC to minimum inhibitory concentration (MIC) by broth microdilution (AUC/MICBMD) ratio ≥ 400. Although trough-only monitoring has been widely integrated into clinical practice, there is a high degree of inter-individual variability between a measured trough concentration and the actual AUC value. The therapeutic discordance between AUC and trough may lead to suboptimal outcomes among patients with infections due to less susceptible pathogens or unnecessarily increase the probability of acute kidney injury (AKI) in others. Given the potentially narrow vancomycin AUC range for optimal effect and minimal AKI, clinicians need a "real-time" system to predict accurately the AUC with limited pharmacokinetic (PK) sampling. This article reviews two innovative approaches for calculating the vancomycin AUC in clinical practice based on one or two drug concentrations. One such approach involves the use of Bayesian computer software programs to estimate the "true" vancomycin AUC value with minimal PK sampling and provide AUC-guided dosing recommendations at the bedside. An alternative involves use of two concentrations (peak and trough) and simple analytic equations to estimate AUC values. Both approaches provide considerable improvements over the current trough-only concentration monitoring method.
Court ruling strengthens EU governments' power to demand prior authorisation for cross-border health care
Authors: R. Watson
Journal: BMJ (2010)

National health authorities are entitled to insist that patients wishing to be reimbursed for specialised medical treatment outside a hospital setting in another European Union country must first receive prior authorisation, says the European Court of Justice in a new ruling.

The judgment is a setback for the European Commission, which had taken France to court, arguing that the authorisation requirement violated European law and one of the EU’s basic principles: the freedom to provide services. The French government, supported by the United …
Health and Ways of Living: The Alameda County Study
Authors: Charles B. Arnold
Journal: JAMA (1985)

Want a sophisticated, handy reference for facts about some of the health impacts of life-style? This book might do nicely. It tidily documents a nine-year social and medical follow-up of 8,000 Alameda County (California) residents. The objective was to relate reported personal health practices in 1965 (and later) to mortality patterns in 1974. Many of the results have previously been published in refereed journals and as book chapters since 1970. The present volume, however, presents in a readable form the study's methodology and its major findings, if one wishes a comprehensive understanding. The entire study, although careful in its research execution, was designed with important limitations that affect its clinical inferences. It used a one-occasion, follow-back methodology; only retrospective, self-report, and death certificate data were available for the time interval studied (1965 to 1974). Morbidity (disease incidence) or case severity, unfortunately, could not be effectively examined. As a result we
Replacement of aortic valve combined with myocardial revascularization: determinants of early and late risk for 500 patients, 1967-1981.
Authors: B W Lytle, D M Cosgrove, F D Loop, P C Taylor, C C Gill, L A Golding, M Goormastic, L K Groves
Journal: Circulation (1983)

Five hundred consecutive patients underwent aortic valve replacement and coronary revascularization in the years from 1967 to 1981, with 29 (5.9%) in-hospital deaths. Current operative mortality (1978-1981) is 3.4%. Univariate and multivariate analyses were used to identify determinants of early and late risk. Female sex, aortic insufficiency, and advanced age increased in-hospital mortality, whereas use of cardioplegia decreased it. At follow-up of 471 patients who survived hospitalization for 1 to 135 months (mean 41) after surgery, 96 late deaths were documented. Survival rates were 87%, 80%, and 55%, and event-free survival rates were 80%, 65%, and 39% at 2, 5, and 10 years after surgery, respectively. The late survival rate was unfavorably influenced by the presence of moderately or severely impaired left ventricular function and double-vessel coronary disease; the rate was enhanced for patients in age group from 50 to 59 years old and was not influenced by the method of myocardial protection. The event-free survival rate decreased with the presence of moderately or severely impaired left ventricular function and was enhanced for patients with New York Heart Association class I or II symptoms before surgery. Patients with bioprostheses who did not receive anticoagulants had higher survival and event-free survival rates than did either patients with bioprostheses who received anticoagulants or patients with mechanical valves, whether they received anticoagulants or not.