tbuckley/cabot-search huggingface dataset:
Inhalation of the propeller from a spinhaler
Authors: R Polosa, JP Finnerty
Journal: European Respiratory Journal (1991)

A 39 yr old man with a 5 yr history of asthma opened his spinhaler to inspect it. He sucked at the capsule to see if its contents were damp. The capsule and propeller came off the spindle, and he aspirated them. He attended a casualty department. The chest radiogram was normal. Over the next three months he developed dypnoea and pain in his chest. He also noticed a whistling noise from his chest, more marked when he lay on his right side. On renewed examination, expiration was prolonged over the right side of the chest, and an occasional whistling wheeze could be heard on that side. A renewed chest radiogram was normal. By means of rigid bronchoscopy, the spindle was removed from its lodged position in the right intermediary bronchus just beyond the orifice to the right upper lobe.
Oral malodour (halitosis)
Authors: S R Porter, C Scully
Journal: BMJ (2006)

Oral malodour (halitosis) is common; most people have some element of transient unpleasant oral odour at some time.1 w1 In the developed world, 8-50% of people perceive that they have persistent recurrent episodes of oral malodour. This article provides a succinct review of oral malodour relevant to medical practitioners.

Oral malodour is common and can affect people of all ages. When severe or longstanding, it may decrease self confidence and social interactions.w2

Oral malodour on awakening is common and generally not regarded as halitosis. Longstanding oral malodour is usually caused by oral, or sometimes nasopharyngeal, disease (box 1). The most likely cause of oral malodour is the accumulation of food debris and dental bacterial plaque on the teeth and tongue, resulting from poor oral hygiene and resultant gingival (gingivitis) and periodontal (gingivitis/periodontitis) inflammation. Although most types of gingivitis and periodontitis can give rise to malodour, acute necrotising ulcerative gingivitis (Vincent's disease, trench mouth) causes the most notable halitosis. Adult periodontitis, characterised by gradual plaque related loss of periodontal attachment, can cause variable degrees of oral malodour.2 Aggressive periodontitis, typified by rapid loss of periodontal bone and resultant tooth mobility, can cause intense oral malodour.

Lack of oral cleansing because of xerostomia (dryness of the mouth) also has the potential to cause or enhance malodour,w3 and some evidence indicates that wearing dentures may sometimes cause oral malodour, possibly by virtue of increased tongue coat deposits.w4

Mild transient oral malodour often arises after sleep and is sometimes termed “morning halitosis.” This may be more likely in people with nasal obstruction—for example, due to upper respiratory tract infection—or when people sleep in a hot, dry atmosphere. Transient oral malodour can also arise after someone has eaten volatile foods such as garlic, onions, or spices (durian is reputed to …
Prevalence and characterization of neutrophil cytoplasmic antibodies in autoimmune liver diseases
Authors: A. H. Leontine Mulder, Gerda Horst, Elizabeth B. Haagsma, Pieter C. Limburg, Jan H. Kleibeuker, Cees G. M. Kallenberg
Journal: Hepatology (1993)

To evaluate the diagnostic significance of neutrophil cytoplasmic antibodies in chronic liver diseases, we assessed the prevalence of neutrophil cytoplasmic antibodies in autoimmune liver diseases, in particular in primary sclerosing cholangitis, autoimmune chronic active hepatitis and primary biliary cirrhosis, and we also determined the specificity of perinuclear-pattern neutrophil cytoplasmic antibodies for these autoimmune liver diseases by testing sera from patients with nonautoimmune chronic liver diseases. Neutrophil cytoplasmic antibodies were detected in 79% of sera from patients with primary sclerosing cholangitis (n = 24), in 88% of sera from patients with autoimmune chronic active hepatitis (n = 24) and in 28% of sera from patients with primary biliary cirrhosis (n = 25). The presence of neutrophil cytoplasmic antibodies in these diseases correlated significantly (p < 0.008) with the presence of cirrhosis. Neutrophil cytoplasmic antibodies were not detected in nonautoimmune liver diseases. All neutrophil cytoplasmic antibody-positive sera produced a perinuclear fluorescence pattern on ethanol-fixed granulocytes. On neutrophils fixed with paraformaldehyde, a granular cytoplasmic immunofluorescence pattern was observed, demonstrating the cytoplasmic nature of the antigen or antigens involved. Further characterization studies showed that neutrophil cytoplasmic antibodies in autoimmune liver diseases are not directed against myeloperoxidase, proteinase 3 or elastase, the neutrophil cytoplasmic antibody specificities associated with necrotizing vasculitis, glomerulonephritis or both. On Western blots neutrophil cytoplasmic antibodies in autoimmune liver diseases showed reactivity with either lactoferrin, a 67/66-kD protein combination or a 40-kD polypeptide. Reactivity with either of these proteins was observed in sera from patients with primary sclerosing cholangitis (38%), autoimmune chronic active hepatitis (17%) and primary biliary cirrhosis (20%).(ABSTRACT TRUNCATED AT 250 WORDS)
Management of common bile duct stones with a biliary endoprosthesis. Report on 40 cases.
Authors: R Peters, P Macmathuna, M Lombard, J Karani, D Westaby
Journal: Gut (1992)

Endoscopic placement of a biliary endoprosthesis has been proposed for the management of choledocholithiasis when stone extraction is difficult or considered hazardous. Over a two year period this approach was used in 40 such patients. There were 24 women and 16 men with a median age of 76 years. In seven patients with severe cholangitis no attempt was made to extract the stones. Twenty three (57.5%) patients underwent a sphincterotomy and four (10%) needle knife papillotomy. The endoprosthesis insertion was considered a temporary measure in 13 (32.5%) patients and definitive treatment in 27 (67.5%). Bile duct drainage was established in all patients. Early complications occurred in six patients (15%), but were without sequelae. Late complications developed in eight (20%) of the patients and included biliary colic (four), cholangitis (three), and cholecystitis (one). Two patients (one cholangitis and one cholecystitis) died as a consequence of the complication. Only patients without a sphincterotomy developed cholangitis. A total of eight patients (20%) underwent surgery (one as an emergency) and nine a repeat endoscopic retrograde cholangio pancreatography (two as an emergency) to clear the duct. The remaining 23 patients are asymptomatic at a median of 13 months (range five to 24 months). Biliary endoprosthesis insertion for choledocholithiasis is an important alternative means of establishing drainage in selected cases, and is probably the optimum method of management for the elderly and or debilitated patients with previous cholecystectomy. Caution must be exercised, however, in patients with an in situ gall bladder.
Pain rate and social circumstances rather than cumulative organ damage determine the quality of life in adults with sickle cell disease
Authors: Charlotte F.J. van Tuijn, Eduard J. van Beers, John‐John B. Schnog, Bart J. Biemond
Journal: American Journal of Hematology (2010)

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Persistent Cardiac Troponin I Elevation in Stabilized Patients After an Episode of Acute Coronary Syndrome Predicts Long-Term Mortality
Authors: Kai M. Eggers, Bo Lagerqvist, Per Venge, Lars Wallentin, Bertil Lindahl
Journal: Circulation (2007)

In patients with non-ST-elevation acute coronary syndrome, any troponin elevation is associated with an increased risk for cardiovascular events. However, the prevalence and prognostic importance of persistent troponin elevation in stabilized patients after an episode of non-ST-elevation acute coronary syndrome are unknown and were therefore assessed in this study.Cardiac troponin I (cTnI) was measured in 1092 stabilized patients at 6 weeks and 3 and 6 months after enrollment in the FRagmin and Fast Revascularization during InStability in Coronary artery disease (FRISC-II) trial. cTnI was analyzed with the Access AccuTnI assay with the application of different prognostic cutoffs. Outcomes were assessed through 5 years. Elevated cTnI levels >0.01 microg/L were found in 48% of the study patients at 6 weeks, in 36% at 6 months, and in 26% at all 3 measurements. cTnI elevation was associated with increased age and other cardiovascular high-risk features. The lowest tested cTnI cutoff (0.01 microg/L) was prognostically most useful and was independently predictive of mortality (hazard ratio, 2.1 [95% confidence interval, 1.3 to 3.3]; P=0.001) on multivariable analysis adjusted for cardiovascular risk factors and randomization to an invasive versus noninvasive treatment strategy, whereas it was related to myocardial infarction only on univariate analysis.Persistent minor cTnI elevation can be detected frequently in patients stabilized after an episode of non-ST-elevation acute coronary syndrome with the use of a sensitive assay. Elevated cTnI levels >0.01 microg/L predict mortality during long-term follow-up. Our results emphasize the importance of further troponin testing in non-ST-elevation acute coronary syndrome patients after hospital discharge.
Adherence to the recommendation of prescribing 4 drugs in the intensive phase of the standard treatment of tuberculosis in Spain
Authors: Jose-Maria Garcia-Garcia, Teresa Rodrigo, Martí Casals, Juan Ruiz-Manzano, Teresa Pascual, Joan Cayla, Grupo T.B. Trabajo
Journal: European Respiratory Journal (2014)

Aim   To analyse the differences between patients treated initially with four (HRZE) or three drugs (HRZ).   Methods   We studied 3.189 tuberculosis patients from all the Spanish Autonomous Regions. Frequency distributions for qualitative variables were calculated and proportions were compared between groups using X2 test. Factors associated with 3 or 4 drugs were analysed using logistic regression (backward method) including in the model the variables associated at the bivariate level.   Results    Conclusions   44,3% patients were treated with 3 drugs. Associated factors with the use of 4 drugs were: immigrants, living in a group, smear positive, HIV infection, being treated in 2009, employed, diagnosed in hospital, and men.
Optimalisation of the clinical pharmacogenetic model to predict methotrexate treatment response: the influence of the number of haplotypes of MTHFR 1298A-677C alleles on probability to respond
Authors: W M Kooloos, J A M Wessels, S M van der Kooij, C F Allaart, T W J Huizinga, H-J Guchelaar
Journal: Annals of the Rheumatic Diseases (2009)

Several single nucleotide polymorphisms (SNP) have been reported to be associated with the efficacy of methotrexate in the treatment of rheumatoid arthritis (RA).1 2 Subsequently, we developed a clinical model to predict the efficacy of methotrexate monotherapy in patients with recent-onset RA (N  =  205).3 The model consists of non-genetic factors, sex, rheumatoid factor and smoking status, disease activity score (DAS) before starting methotrexate and four genetic polymorphisms (MTHFD1 1958G>A, AMPD1 34C>T, ITPA 94A>C and ATIC 347C>G). Associations of these factors with the response to methotrexate were transformed into a scoring system ranging from 0 to 11.5 points. The predictive model showed a positive predictive value of 95% and a negative predictive value of 86% and was able to categorise 60% of …
Temporal relationship between air pollutants and hospital admissions for chronic obstructive pulmonary disease in Hong Kong
Authors: F. W S Ko, W. Tam, T. W. Wong, D. P S Chan, A. H Tung, C. K W Lai, D. S C Hui
Journal: Thorax (2007)

Aims: To assess any relationship between the levels of ambient air pollutants and hospital admissions for chronic obstructive pulmonary disease (COPD) in Hong Kong. Methods: A retrospective ecological study was undertaken. Data of daily emergency hospital admissions to 15 major hospitals in Hong Kong for COPD and indices of air pollutants (sulphur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), particulates with an aerodynamic diameter of <10 μm (PM10) and 2.5 μm (PM2.5)) and meteorological variables from January 2000 to December 2004 were obtained from several government departments. Analysis was performed using generalised additive models with Poisson distribution, adjusted for the effects of time trend, season, other cyclical factors, temperature and humidity. Autocorrelation and overdispersion were corrected. Results: Significant associations were found between hospital admissions for COPD with all five air pollutants. Relative risks for admission for every 10 μg/m3 increase in SO2, NO2, O3, PM10 and PM2.5 were 1.007, 1.026, 1.034, 1.024 and 1.031, respectively, at a lag day ranging from lag 0 to cumulative lag 0–5. In a multipollutant model, O3, SO2 and PM2.5 were significantly associated with increased admissions for COPD. SO2, NO2 and O3 had a greater effect on COPD admissions in the cold season (December to March) than during the warm season. Conclusion: Ambient concentrations of air pollutants have an adverse effect on hospital admissions for COPD in Hong Kong, especially during the winter season. This might be due to indoor exposure to outdoor pollution through open windows as central heating is not required in the mild winter. Measures to improve air quality are urgently needed.
The Prevalence of DSM-IV Personality Disorders in Psychiatric Outpatients
Authors: Mark Zimmerman, Louis Rothschild, Iwona Chelminski
Journal: American Journal of Psychiatry (2005)

The largest clinical epidemiological surveys of personality disorders have been based on unstructured clinical evaluations. However, several recent studies have questioned the accuracy and thoroughness of clinical diagnostic interviews; consequently, clinical epidemiological studies, like community-based studies, should be based on standardized evaluations. The Rhode Island Methods to Improve Diagnostic Assessment and Services project is one of the largest clinical epidemiological studies to use semistructured interviews to assess a wide range of psychiatric disorders conducted in general clinical outpatient practice. In the present report, the authors examined the frequency of DSM-IV personality disorders in a patient group and the comorbidity among them.Eight hundred fifty-nine psychiatric outpatients were interviewed with the Structured Interview for DSM-IV Personality upon presentation for treatment.Slightly less than one-third of the patients were diagnosed with one of the 10 official DSM-IV personality disorders (N=270, 31.4%). When the patients with personality disorder not otherwise specified were included, the rate of any personality disorder increased to almost half of the group (N=391, 45.5%). The majority of patients meeting criteria for one of the specific personality disorders were diagnosed with more than one. Avoidant, borderline, and obsessive-compulsive personality disorder were the most frequent specific diagnoses.Personality disorders, as a group, are among the most frequent disorders treated by psychiatrists. They should be evaluated in all psychiatric patients because their presence can influence the course and treatment of the axis I disorder that patients typically identify as their chief complaint.
Synthesis and activity of Helicobacter pylori urease and catalase at low pH.
Authors: P Bauerfeind, R Garner, B E Dunn, H L Mobley
Journal: Gut (1997)

Background-Helicobacter pylori pro- duces large amounts ofurease presumably to be prepared for the rare event of a sudden acid exposure.The hypothesis that Hpyloni is acid sensitive and protein pro- duction is inhibited by low pH was examined.Methods-H pyloni or its soluble enzymes were incubated buffered or unbuffered at a pH ranging from 2-7 in the presence of 5 mM urea for 30 minutes.After exposure, urease and catalase activities of whole cells, supernatants, and soluble enzyme preparations were measured at pH 6-8.Newly synthesised enzyme was quantified by immunoprecipitation of [35S]-methionine labelled protein.Results-Exposure to buffer below pH 4 resulted in loss of intracellular urease activity.In soluble enzyme preparations and supernatant, no urease activity was measurable after incubation at pH<5.In contrast, catalase in whole cells, supernatant, and soluble enzyme prep- arations remained active after exposure to pH>3.Exposure below pH 5 inhibited synthesis of total protein including nascent urease and catalase.At pH 6 or 7, urease represented 10% of total protein, catalase 1/5%.Exposure of H pylon to unbuffered HCI (pH>2) resulted in an immediate neutralisation; urease and catalase activities and synthesis were unchanged.Conclusion-Low surrounding pH reduces activity of urease and synthesis of nascent urease, catalase, and presumably of most other proteins.This suggests that Hpyloni is not acidophilic although it tolerates short-term exposure to low pH.
Pulmonary disease caused by non-tuberculous mycobacteria. Descriptive study and comparison with mycobacterium tuberculosis
Authors: Sandra Pedrero Tejada, Maria Alfonso Imizcoz, Begoña Vilar Achabal, Luis Miguel Soria Riendas, Nuria Marina Malanda, Ines Martinez Rienda, Israel Lopez Mirones, Jose Maria Antoñana, Elena Urra Zalbidegoitia, Rafael Zalacain Jorge
Journal: European Respiratory Journal (2011)

Aim:  To describe the epidemiological, clinical and radiological data of pulmonary disease (PD) caused by non-tuberculous mycobacteria (NTM) diagnosed in a period of 12 years in an area of Vizcaya, and to compare the incidence with the cases of M. tuberculosis (MT).   Material:  We reviewed all cases of PD caused by mycobacteria between 1997-2008 in our center, attending a population of 420,000. The diagnosis of NTM PD was conducted according to criteria of ATS.   Results:  We found 1019 cases of PD caused by mycobacterias,788 (77.3%) for MT and 231 (22.7%) NTM: 216 M. kansasii (MK), 11 M. avium complex (MAC), 2 M. abscessus, 1 M.xenopi and 1 M. celatum. NTM PD was more frequent in men (73.2%) and the mean age was 53.9. 2.8% of patients with MK and 9.1% of patients with MAC had extrapulmonary affection. 36 patients (15.6%) had HIV coinfection.Cavitary pulmonary infiltrates were the most common (56.1%), followed by reticulonodular infiltrates (31.9%). The location was unilateral in 54% and affection in upper lobes was observed in 82.6%.The mean age of patients infected by MT was 48.7 and was more frequent in men (60%). 53 patients (6.7%) had HIV coinfection. The annual incidence rate/100.000 of MT infection had the highest peak in 1999 with 22.8 and the lowest in 2008 with 11.9.The highest rate of NTM infection was in 1998 (7.4) and lowest in 2008 (1.2).   Conclusions:  1)The most common NTM specie in our area is M.Kansasii. The rest of NTM causes PD infrequently. 2) PD by NTM has a clinical and radiological presentation similar to tuberculosis. 3) The incidence of PD by NTM and MT had a descendant tendency in the 12 years studied, which is more remarkable since 2005.
Gonadotropin-Releasing Hormone Agonists for Ovarian Function Preservation in Premenopausal Women Undergoing Chemotherapy for Early-Stage Breast Cancer
Authors: Rodrigo R. Munhoz, Allan A. L. Pereira, André D. Sasse, Paulo M. Hoff, Tiffany A. Traina, Clifford A. Hudis, Ricardo J. Marques
Journal: JAMA Oncology (2015)

<h3>Importance</h3> Chemotherapy may result in a detrimental effect on ovarian function and fertility in premenopausal women undergoing treatment for early-stage breast cancer (EBC). To minimize risk of harm to ovarian function and fertility for patients in this setting, careful considerations should be made. Gonadotropin-releasing hormone agonists (GnRHa) have been suggested as an alternative to prevent the loss of ovarian function due to exposure to cytotoxic agents, but GnRHa use for ovarian protection in EBC patients is not fully resolved. <h3>Objective</h3> To determine the effectiveness of GnRHa administered concurrently with chemotherapy for ovarian function preservation. <h3>Data Sources</h3> PubMed, SCOPUS, and Cochrane databases were searched for studies published between January 1975 and March 2015. The abstracts of the American Society of Clinical Oncology Annual Meeting between 1995 and 2014 and the San Antonio Breast Cancer Symposium between 2009 and 2014 were searched as well. <h3>Study Selection</h3> Prospective, randomized, clinical trials addressing the role of ovarian suppression with GnRHa in preventing early ovarian dysfunction in premenopausal women undergoing treatment for EBC were selected. <h3>Data Extraction and Synthesis</h3> Data extraction was performed independently by 2 authors. The methodology and the risk of bias were assessment based on the description of randomization method, withdrawals, and blinding process. <h3>Main Outcomes and Measures</h3> Rate of resumption of regular menses after a minimal follow-up period of 6 months following chemotherapy was used as a surrogate to assess the incidence of ovarian dysfunction. Additional secondary outcomes included hormone levels and number of pregnancies. Risk ratio estimates were calculated based on the number of evaluable patients. Analyses were conducted using a random effect model. <h3>Results</h3> Seven studies were included in this analysis, totaling 1047 randomized patients and 856 evaluable patients. The use of GnRHa was associated with a higher rate of recovery of regular menses after 6 months (odds ratio [OR], 2.41; 95% CI, 1.40-4.15;<i>P</i> = .002) and at least 12 months (OR, 1.85; 95% CI, 1.33-2.59;<i>P</i> &lt; .001) following the last chemotherapy cycle. The use of GnRHa was also associated with a higher number of pregnancies (OR, 1.85; 95% CI, 1.02-3.36;<i>P</i> = .04), although this outcome was not uniformly reported and fertility or rate of pregnancy was not the primary outcome in any of the trials. <h3>Conclusions and Relevance</h3> Gonadotropin-releasing hormone agonists given with chemotherapy was associated with increased rates of recovery of regular menses in this meta-analysis. Evidence was insufficient to assess outcomes related to GnRHa and ovarian function and fertility and needs further investigation.