tbuckley/cabot-search huggingface dataset:
fMRI for vegetative and minimally conscious states
Authors: L. Turner-Stokes, J. Kitzinger, H. Gill-Thwaites, E. D. Playford, D. Wade, J. Allanson, J. Pickard
Journal: BMJ (2012)

A more balanced perspective

The BBC’s Panorama programme The Mind Reader: Unlocking My Voice broadcast on 13 November 2012 provided important insights into the devastating experience of patients who live in vegetative or minimally conscious states and the families who support them. It also provided useful information on the use of functional magnetic resonance imaging (fMRI) to explore evidence of localised brain activity that might indicate underlying awareness. However, the programme failed to distinguish clearly between the two states and gave the impression that 20% of patients in a vegetative state show cognitive responses on fMRI. This claim needs to be clarified and put into perspective.

There are important differences between the two states. Patients in a vegetative state have no discernible awareness of self and no cognitive interaction with their environment. Patients in a minimally conscious state show evidence of interaction through localising or discriminating behaviours, although such interactions occur inconsistently. It is clinically important to make this distinction, for prognostic reasons and because some evidence suggests that patients in a minimally conscious state experience symptoms (such as pain) in a manner indistinguishable from non-brain injured patients.1 2

The programme presented two patients said to be in a “vegetative state” who showed evidence of cognitive interaction on assessment using fMRI in Ontario, Canada. The clinical methods used for the original diagnosis …
Torture continues in Algeria
Authors: M. Peel
Journal: BMJ (1996)

EDITOR,—Having recently published the results of a study on Zairean asylum seekers,1 the Medical Foundation for the Care of Victims of Torture has done a similar study on asylum seekers from Algeria. Algeria was chosen because it is a country in which there is a little known civil war2 and severe abuses of human rights,3 yet the Home Office is deporting asylum seekers back to the country.

In Algeria civilians are trapped between the security forces and armed Islamic groups.3 Teachers are targeted, often by both sides: by …
Enjoy your fruits and vegetables
Authors: M. W Gillman
Journal: BMJ (1996)

developed countries; and in many of these countries-for example, Malaysia, Indonesia, and Bangladesh-the private sector is expanding.The "old reason" for favouring public rather than private health care was, said Choksi, equity; but in most public systems inequalities remain extreme, and, particularly because health spending has been concentrated in city hospitals, the rural poor have often been subsidising the urban wealthy.The World Bank is now concentrating on pub- lic and primary health care for the poor.It believes in increased private health care for the wealthy in order to release public money for the poor and to raise efficiency and quality in the private sector.There are, Choksi concluded, big opportunities: "Managed care holds the biggest hope for developing health services in the developing world."So perhaps managed health care-which has emerged from a country with one of the world's most irrational health care systems-will end up being exported around the world.Just as more and more of us are fed by American fast food chains, so many of us may receive our health care in some way through American managed health care plans.
Lithium in Felty's Syndrome
Authors: ROY A. KAPLAN
Journal: Annals of Internal Medicine (1976)

Comments1 March 1976Lithium in Felty's SyndromeROY A. KAPLAN, M.D.ROY A. KAPLAN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-84-3-342_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: In their recent review on lithium salts, Baldessarini and Lipinski (1) mentioned leukocytosis as a side effect of therapy. They commented, "The leukocytosis is often persistent, but is fully reversible and is not known to be of any particular clinical significance at the present time." However, a recent report (2) suggests that lithium is helpful in patients with Felty's syndrome.In their study, Gupta, Robinson, and Smyth (2) treated 10 patients with Felty's syndrome with lithium carbonate, Li2CO3, orally for 6 weeks in doses of either 600 mg/day or 900 mg/day. All patients on the higher...References1. BALDESSARINI R and LIPINSKI J. Lithium salts: 1970-1975. Ann Intern Med 83:527-533, 1975 LinkGoogle Scholar2. GUPTA R, ROBINSON W, and SMYTH C: Efficacy of lithium in rheumatoid arthritis with granulocytopenia (Felty's syndrome). Arthritis Rheum 18:179-184, 1975 CrossrefMedlineGoogle Scholar3. HOLLINGSWORTH J: Local and Systemic Complications of Rheumatoid Arthritis. Philadelphia, W. B. Saunders Company, 1968, p. 105 Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: ROY A. KAPLAN, M.D.Affiliations: Division of Rheumatology University of Kentucky Medical Center Lexington, Kentucky 40506 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byLithiumeffekte auf das hämatopoetische SystemFelty's syndrome: long-term followup after treatment with auranofinLithium counteracts carbamazepine-induced leukopenia while increasing its therapeutic effectChronische Polyarthritis und Felty-SyndromA review of clinical trials of lithium in medicineTreatment of Neuroleptic-Induced Leukopenia with Lithium CarbonateLithiumLithium Treatment of Cyclic Hematopoiesis in the Gray Collie 1 March 1976Volume 84, Issue 3Page: 342-342KeywordsCarbonatesFelty syndromeLeukocytosisSalts ePublished: 1 December 2008 Issue Published: 1 March 1976 PDF downloadLoading ...
Carpal Tunnel Syndrome During Pregnancy
Authors: Mark G. Lazansky
Journal: JAMA (1964)

<h3>To the Editor:—</h3> The pregnant patients with upper extremity paresthesias described in the Aug 17 Questions and Answers section have the typical symptom complex now recognized as the result of median nerve compression in the carpal tunnel. Pain and numbness, often nocturnal, sometimes spreading proximally to the elbow and shoulder, precede thenar muscle weakness, which may rarely progress to severe atrophy. Phalen's sign (exacerbation of symptoms produced by hyperflexing the wrist for two or three minutes with the elbow extended) is helpful in differentiating carpal tunnel syndrome from other entrapment neuropathies. Most patients benefit from injection of 1 or 2 cc of corticosteroid suspension (hydrocortisone acetate or prednisolone tertiary-butylacetate) into the carpal tunnel, just medial to the palmaris longus at the level of the proximal wrist crease. In more severe or stubborn cases, surgical division of the deep transverse carpal ligament produces uniformly gratifying results. The pathological cause is still
HLA class II genotype influences the type of liver injury in drug-induced idiosyncratic liver disease
Authors: Raúl J. Andrade, Isabel M. Lucena, Anabel Alonso, Miren García-Cort'es, Elena García-Ruiz, Rafael Benitez, Carmen M. Fernández, Gloria Pelaez, Manuel Romero, Raquel Corpas, José Antonio Durán, Manuel Jiménez, Luis Rodrigo, Flor Nogueras, Rafael Martín-Vivaldi, José María Navarro, Javier Salmerón, Felipe Sánchez de la Cuesta, Ramón Hidalgo
Journal: Hepatology (2004)

Drug-induced idiosyncratic liver disease (DIILD) depends largely on host susceptibility factors. Small studies support the genetic influence of human leukocyte antigen (HLA) class II molecules on the predisposition to DIILD. We sought associations between HLA-DRB and -DQB alleles and DIILD considered collectively or according to the biochemical expression of liver damage. We studied a total of 140 patients with a definitive or probable diagnosis of DIILD, as assessed with the Council for International Organizations of Medical Sciences scale, with 635 volunteer bone marrow and blood donors serving as controls. HLA-DRB1* and -DQB1* genotyping was performed by hybridization with sequence-specific oligonucleotides after genomic amplification. The group with DIILD did not differ from control subjects with regard to the distribution of HLA-DRB and -DQB antigens. The frequencies of alleles DRB1*15 (35.4% vs. 18.6% of controls; P = .002; odds ratio [OR] 2.31) and DQB1*06 (61.5% vs. 40.8%; P = .001; OR 2.32) were significantly increased in patients with the cholestatic/mixed type of liver damage in comparison to healthy subjects. By contrast, frequencies of alleles DRB1*07 (16.9% vs. 35.4%; P = .003; OR 0.37) and DQB1*02 (32.3% vs. 55.8%; P = .0003; OR 0.39) were significantly decreased. In conclusion , there is no association between any specific HLA allele and the propensity to develop DIILD. However, the genetic influence associated with HLA class II alleles appears to play a role in the biochemical expression of liver injury in cholestatic/mixed hepatotoxicity and may explain why a given drug may cause different patterns of liver damage. (Hepatology 2004;39:1603-1612.)
The impact of providing rapid diagnostic malaria tests on fever management in the private retail sector in Ghana: a cluster randomized trial
Authors: E. K. Ansah, S. Narh-Bana, H. Affran-Bonful, C. Bart-Plange, B. Cundill, M. Gyapong, C. J. M. Whitty
Journal: BMJ (2015)

<b>Objective</b> To examine the impact of providing rapid diagnostic tests for malaria on fever management in private drug retail shops where most poor rural people with fever present, with the aim of reducing current massive overdiagnosis and overtreatment of malaria. <b>Design</b> Cluster randomized trial of 24 clusters of shops. <b>Setting</b> Dangme West, a poor rural district of Ghana. <b>Participants</b> Shops and their clients, both adults and children. <b>Interventions</b> Providing rapid diagnostic tests with realistic training. <b>Main outcome measures</b> The primary outcome was the proportion of clients testing negative for malaria by a double-read research blood slide who received an artemisinin combination therapy or other antimalarial. Secondary outcomes were use of antibiotics and antipyretics, and safety. <b>Results</b> Of 4603 clients, 3424 (74.4%) tested negative by double-read research slides. The proportion of slide-negative clients who received any antimalarial was 590/1854 (32%) in the intervention arm and 1378/1570 (88%) in the control arm (adjusted risk ratio 0.41 (95% CI 0.29 to 0.58), P&lt;0.0001). Treatment was in high agreement with rapid diagnostic test result. Of those who were slide-positive, 690/787 (87.8%) in the intervention arm and 347/392 (88.5%) in the control arm received an artemisinin combination therapy (adjusted risk ratio 0.96 (0.84 to 1.09)). There was no evidence of antibiotics being substituted for antimalarials. Overall, 1954/2641 (74%) clients in the intervention arm and 539/1962 (27%) in the control arm received appropriate treatment (adjusted risk ratio 2.39 (1.69 to 3.39), P&lt;0.0001). No safety concerns were identified. <b>Conclusions</b> Most patients with fever in Africa present to the private sector. In this trial, providing rapid diagnostic tests for malaria in the private drug retail sector significantly reduced dispensing of antimalarials to patients without malaria, did not reduce prescribing of antimalarials to true malaria cases, and appeared safe. Rapid diagnostic tests should be considered for the informal private drug retail sector. <b>Registration</b> Clinicaltrials.gov NCT01907672
Understanding Geographic Variations in Health Care Delivery
Authors: John E. Wennberg
Journal: New England Journal of Medicine (1999)

Geographic variations in health care delivery have been widely documented in the United States, Canada, Europe, and Australia. Most studies have concentrated on cross-sectional variations in the rates of surgical procedures. The study by Ashton et al. in this issue of the Journal is one of the few to analyze variations in the rates of hospitalization for groups of patients with chronic conditions.1 The introduction of the issue of variations in practice patterns into the debate on medical quality and efficiency in the Department of Veterans Affairs (VA) health care system comes at a time of unusual commitment to action . . .
The greatest emergency of all
Authors: Seye Abimbola
Journal: BMJ (2008)

> The peculiar character of an idea [is that] . . . no one possesses the less because everyone possesses the whole of it. He who receives an idea from me receives [it] without lessening [me], as he who lights his [candle] at mine receives light without darkening me.
> 
> Thomas Jefferson (1743-1826)
I once read of a man, Belding Scribner, in my favourite medical school textbook, the Oxford Handbook of Clinical Medicine . He invented the Scribner shunt. I had heard the eponym mentioned many times but never had I ventured to find out its origin, until I chanced upon it in the handbook, on one of the several interesting and inspiring pages that discussed sociological and ethical issues, interspersed between the pages of serious medical stuff. These pages easily won the book its well deserved place as the favourite textbook of several generations of students in my medical school. However, as many of us could not afford the sleek leatherbound edition of the book, we opted for a readily available third world alternative, the much cheaper Indian paperback reprints.

Like every inventor, Belding Scribner, a US physician, saw a problem in need of a solution. Patients with chronic renal failure could have dialysis for just five to seven times during a painful operation; damage to blood vessels would make further treatments impossible. A caring and passionate physician, and himself a lifelong patient, Scribner was inspired to invent the shunt, haunted by a patient who had made a startling recovery through dialysis but died soon after. Allowing haemodialysis to be repeated as often as needed, the shunt transformed chronic renal failure from a disease that was 100% …
Differences in electrocardiographic response to exercise of women and men: a non-Bayesian factor.
Authors: S M Barolsky, C A Gilbert, A Faruqui, D O Nutter, R C Schlant
Journal: Circulation (1979)

We evaluated the ability of ST-segment analysis during submaximal exercise tolerance testing (85% predicted age-adjusted heart rate) to diagnose the presence of significant coronary artery stenosis (2 75% cross sectional area narrowing) in a group of 85 men and 92 women with chest pain syndromes and no previously documented myocardial infarctions.Disease prevalence by selective coronary angiography was 36% for men and 33% for women (NS).Predictive value of a positive exercise test (PV(+ET)) as defined by 1 mm ST-segment depression 0.08 second after the J point was significantly higher for men than for women (77% vs 47%, p < 0.05).Predictive value of a negative test (PV(-ET)) was not significantly different for men (81%) and women (78%).Analysis of the 66 men and 66 women not taking digitalis preparations again showed that PV(+ET) was significantly higher for men than for women (90% vs 45%, p < 0.01).Multivariate analysis showed that patients with angiographically significant coronary disease had significantly lower attained heart rates and shorter exercise duration than those without significant stenosis, independent of ST-segment responses.A discriminant function using ST-segment response, attained heart rate and a sex-dependent ST-segment response factor was developed.Duration of exercise was not an independent predictor by our analysis.This function improved the PV(+ET) and PV(-ET) for the total group and for the women; for men, the PV(-ET) improved, while the PV(+ET) fell slightly.This function has not yet been used prospectively.In patients with chest pain and no previously documented myocardial infarction, men have a significantly higher PV( + ET) than women, which cannot be accounted for simply by a difference in disease prevalence (i.e., Bayes' theorem).EXERCISE TESTING has been a commonly used tool for the evaluation of cardiac status for over 20 years.Despite its extensive use as a screening test for asymptomatic patients, a diagnostic test for patients with symptoms of ischemic heart disease, and as a functional test for patients with known cardiac disease, the usefulness, accuracy, and even basic methods for interpretation of the test remain controversial.Proper use of any test involves definition of the patient populations in which the diagnostic yield will be greatest.The use of exercise testing for diagnosis of coronary atherosclerotic heart disease in women with chest pain has also been controversial.Some authors'-5 have found that women have a higher rate of-false-positive exercise tests than men, while others6 feel that there is no difference between the sexes in the exercise electrocardiographic response.We examined the electrocardiographic response to exercise of symp- tomatic men and women with regard to the diagnosis of coronary atherosclerotic heart disease.Methods Study GroupThe records of the cardiac catheterization and cardiac function laboratories at Grady Memorial
EXPERIENCES OF THE NATIONAL HEALTH INSURANCE ACT
Authors: E. F. Pratt
Journal: BMJ (1914)

MARCT-1 2Ij 191411 '~~~~~~~~~~~~~~~~~~~~~~~~ILIDICAL JOURNAL t this miietlhod of detectioni earlier and( more frequenitly.It putts it also within the imeans of every patient to obtain -a colmipetent histological relport in any case in wlhicll there is tlle least suspicion of ctalncer whlelnever thie situation of the disease renders this possible.It puts th-e patieit, howvever p.oor, on ani ejual footingi witlh his riclher
Prognostic Value of Microvascular Obstruction and Infarct Size, as Measured by CMR in STEMI Patients
Authors: Matthijs van Kranenburg, Michael Magro, Holger Thiele, Suzanne de Waha, Ingo Eitel, Alexandre Cochet, Yves Cottin, Dan Atar, Peter Buser, Edwin Wu, Daniel Lee, Vicente Bodi, Gert Klug, Bernhard Metzler, Ronak Delewi, Peter Bernhardt, Wolfgang Rottbauer, Eric Boersma, Felix Zijlstra, Robert-Jan van Geuns
Journal: JACC. Cardiovascular imaging (2014)
Response to Scheen and Buchanan
Authors: Mark E. Molitch
Journal: Diabetes Care (2003)

We appreciate the comments of Drs. Scheen (1) and Buchanan (2) regarding our article (3), which described the effects of withdrawal of metformin on diabetes status in the Diabetes Prevention Program (DPP). As Dr. Scheen comments, and as we pointed out in our article, clearly part of the effect of metformin was due to an acute pharmacological effect of metformin, but the great majority of the effect persisted beyond this period of washout. As he notes, the washout …
Cancer and Intestinal Pseudo-Obstruction
Authors: F. LHERMITTE
Journal: Annals of Internal Medicine (1982)

Letters and Corrections1 April 1982Cancer and Intestinal Pseudo-ObstructionF. LHERMITTE, M.D., F. GRAY, M.D., O. LYON-CAEN, M.D., B. F. PERTUISET, M.D., P. BERNARD, M.D.F. LHERMITTE, M.D.Search for more papers by this author, F. GRAY, M.D.Search for more papers by this author, O. LYON-CAEN, M.D.Search for more papers by this author, B. F. PERTUISET, M.D.Search for more papers by this author, P. BERNARD, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-96-4-535_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: We read with interest the editorial on the idiopathic intestinal pseudo-obstruction (1). Snape emphasized the importance of "a careful histologic examination of the intestinal smooth muscle and neural tissue."We have reported recently (2) a case of paralysis of digestive tract. The striking feature was the association of undifferentiated carcinoma and polyradiculoneuritis with a complete alimentarytract palsy of rapid onset and lesions restricted to the myenteric plexuses. The small bowel showed hyperplasia of the smooth muscle, and the myenteric plexuses were enlarged by marked proliferation of Schwan cells. Severe neuronal loss and nodules of Nageotte were also...References1. SNAPE W Taking the idiopathic out of intestinal pseudo-obstruction. Ann Intern Med. 1981;95:646-7. LinkGoogle Scholar2. LHERMITTEGRAYLYON-CAENPERTUISETBERNARD FFOBP. Paralysie du tube digestif avec lésions des plexus myentériques. Nouveau syndrôme paranéoplasique possible. Rev Neurol. 1980;136:825-36. MedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: F. LHERMITTE, M.D.; F. GRAY, M.D.; O. LYON-CAEN, M.D.; B. F. PERTUISET, M.D.; P. BERNARD, M.D.Affiliations: Hôpital de la Salpêtrière 77651 Paris Cedex 13, France PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 April 1982Volume 96, Issue 4Page: 535-535KeywordsCarcinomaCellsGastrointestinal tractLesionsParalysisSmooth muscles ePublished: 12 March 2020 Issue Published: 1 April 1982 PDF downloadLoading ...
Vascular Occlusion of the Colon and Oral Contraceptives
Authors: Zachary M. Kilpatrick, James F. Silverman, Edgardo Betancourt, Jack Farman, J. P. Lawson
Journal: New England Journal of Medicine (1968)

THE most frequently described complications of oral contraceptive therapy have been occlusive disease of the vessels supplying the brain and thrombophlebitis with pulmonary embolism. Vascular occlusion of the bowel rarely occurs in young adults, and to our knowledge only one case associated with oral contraceptive therapy has been reported.1 We report the cases of two young women in whom reversible vascular damage of the colon occurred while they were taking oral contraceptive drugs.Case ReportCase 1. A 29-year-old woman awoke 2 days before admission with dull, mildly cramping pain in the lower abdomen. She began to vomit 18 hours . . .
Occupational asthma in nurses caused by chlorhexidine and alcohol aerosols.
Authors: E. R. Waclawski, L. G. McAlpine, N. C. Thomson
Journal: BMJ (1989)

over the two days.She was extremely anxious about being left alone, but once the analgesia was withdrawn all symptoms disappeared.Case 3-A 58 year old woman underwent fusion of the posterior lumbar bodies with fusion of the alar transverse processes at L5-S 1.On the third postopera- tive day the became convinced that her leg was black despite reassurances to the contrary.A total dose of buprenorphine of 1150 tg had been given.When the drug was withdrawn the symptoms disappeared.Cases 4 and 5-Two further cases occurred (table).Symptoms did not develop until the third postopera- tive day.Patients with psychotomimetic symptoms after epidural buprenorphine Sex and Presenting Case age hallucinatory Total dose of No (years) Operation symptoms buprenorphine 1 F 40 Fusion of lumbar Saw horrifying 900 [tg bodies posteriorly creatures in wall 2 F 38 Fusion of spine Dreamt of frightening 750 [sg between transverse episode of her processes youth posteriorlv 3 F 58 Fusion of lumbar Believed her leg to be 1159 Ftg bodies between black alar transverse processes 4 M 42 Fusion of lumbar Thought that there 1000 Itg bodies posteriorly were people in (L4-5) room talking about him 5 M 55 Repair of Thought that objects 1200 Fig pseudoarthrosis in room were falling (L3-4) on top of him CommentNeither of our patients had a history of asthma or increased airways responsiveness to histamine when