tbuckley/cabot-search huggingface dataset:
Unexpected rapid weight gain in a patient with HIV and anorexia
Authors: Malika Mohabeer Hart, Marta Boffito, Anton Pozniak
Journal: BMJ (2015)

A 45 year old man presented to outpatients in January 2015 with unexplained weight gain and shortness of breath. He was HIV positive (diagnosed in the early 1990s) and was on combination antiretroviral therapy (tenofovir, emtricitabine, and darunavir boosted with ritonavir). His HIV infection was well controlled with an undetectable HIV viral load and a CD4 count of 497×106/L.

His medical history was complex, including depression, schizophrenia, anorexia, and epilepsy. He had been treated for adenocarcinoma of the lung and also had osteoporosis and hypertriglyceridaemia. He was therefore taking many drugs including pregabalin, omeprazole, gabapentin, clonazepam, lithium carbonate, loperamide, metoclopramide, zopiclone, and fenofibrate.

In October 2013 he was prescribed megestrol for anorexia and low body weight (64 kg), but this was stopped in May 2014 after he gained weight. Five months later, he gained another 10 kg and his blood pressure rose from 130/83 mm Hg to 163/97 mm Hg. He was breathless and developed a chronic cough in November 2014. Blood tests showed a rise in alanine aminotransferase from 65 IU/L (reference value <40) in August 2014 to 129 IU/L in November 2014.

In January 2015 he reported further weight gain (to 91 kg) and breathlessness. His abdominal girth had increased and he had developed purple abdominal striae (figure⇓). He had no intra-abdominal accumulation of fluid (confirmed by ultrasonography). His face was moon shaped. His morning serum cortisol was 32 nmol/L (130-690). On questioning he admitted that he used his partner’s fluticasone containing inhaler to alleviate his breathlessness.





### 1. What is the most likely diagnosis?

#### Short answer

Cushing’s syndrome due to excess …
Applicability of the global lung initiative (GLI) spirometric reference values for northern Sweden
Authors: Helena Backman, Anne Lindberg, Kjell Larsson, Bo Lundbäck, Eva Rönmark
Journal: European Respiratory Journal (2014)

Background The GLI reference values are currently endorsed by ERS, ATS and other respiratory societies, but evaluations from European countries of applicability are lacking for adults.

Aim To evaluate the applicability of the GLI, European Coal and Steel Community (ECSC) and Bergen reference values for adults in northern Sweden.

Methods A general population sample of subjects from northern Sweden was clinically examined by interviews and spirometry during 2008-2013. Healthy, non-smoking Caucasian subjects aged 22-91 years were included (n=501, 49% women). The GLI, ECSC and Bergen reference values, Z-scores and percentiles for FEV1, FVC and the FEV1/FVC ratio were analyzed. Airway obstruction was defined as FEV1/FVC ratio<lower 5th percentile.

Results The applicability of GLI and Bergen reference values was superior to that of ECSC (expressed as mean % of predicted in

![Figure][1] 



). Mean GLI Z-scores (SD) for women were 0.20 (0.89) for FEV1, 0.42 (0.91) for FVC and -0.38 (0.86) for the ratio, and for men: 0.22 (0.92) for FEV1, 0.29 for FVC and -0.12 (0.82) for the ratio. The proportion of airway obstruction based on the GLI reference values was 9.4% (5.7%-13.1%) among women and 2.7% (0.7%-4.7%) among men, which contrasts to the expected 5%.

Conclusions The use of the GLI reference values result in an overestimation of the prevalence of obstruction among women in northern Sweden. The ECSC values are not applicable.

 [1]: pending:yes
Megalin-Mediated Tubuloglomerular Alterations in High-Fat Diet–Induced Kidney Disease
Authors: Shoji Kuwahara, Michihiro Hosojima, Reika Kaneko, Hiroyuki Aoki, Daisuke Nakano, Taiji Sasagawa, Hideyuki Kabasawa, Ryohei Kaseda, Ryota Yasukawa, Tomomi Ishikawa, Akiyo Suzuki, Hiroyoshi Sato, Shun Kageyama, Takahiro Tanaka, Nobutaka Kitamura, Ichiei Narita, Masaaki Komatsu, Akira Nishiyama, Akihiko Saito
Journal: Journal of the American Society of Nephrology (2015)

Obesity, an important risk factor for metabolic syndrome (MetS) and cardiovascular disease, is often complicated by CKD, which further increases cardiovascular risk and causes ESRD. To elucidate the mechanism underlying this relationship, we investigated the role of the endocytic receptor megalin in proximal tubule epithelial cells (PTECs). We studied a high-fat diet (HFD)–induced obesity/MetS model using kidney-specific mosaic megalin knockout (KO) mice. Compared with control littermates fed a normal-fat diet, control littermates fed an HFD for 12 weeks showed autolysosomal dysfunction with autophagy impairment and increased expression of hypertrophy, lipid peroxidation, and senescence markers in PTECs of the S2 segment, peritubular capillary rarefaction with localized interstitial fibrosis, and glomerular hypertrophy with mesangial expansion. These were ameliorated in HFD-fed megalin KO mice, even though these mice had the same levels of obesity, dyslipidemia, and hyperglycemia as HFD-fed control mice. Intravital renal imaging of HFD-fed wild-type mice also demonstrated the accumulation of autofluorescent lipofuscin-like substances in PTECs of the S2 segment, accompanied by focal narrowing of tubular lumens and peritubular capillaries. In cultured PTECs, fatty acid–rich albumin induced the increased expression of genes encoding PDGF-B and monocyte chemoattractant protein-1 via megalin, with large (auto)lysosome formation, compared with fatty acid–depleted albumin. Collectively, the megalin-mediated endocytic handling of glomerular-filtered (lipo)toxic substances appears to be involved primarily in hypertrophic and senescent PTEC injury with autophagy impairment, causing peritubular capillary damage and retrograde glomerular alterations in HFD-induced kidney disease. Megalin could be a therapeutic target for obesity/MetS-related CKD, independently of weight, dyslipidemia, and hyperglycemia modification.
Safety of Hydroxyurea in Children With Sickle Cell Anemia: Results of the HUG-KIDS Study, a Phase I/II Trial
Authors: Thomas R. Kinney, Ronald W. Helms, Erin E. O’Branski, Kwaku Ohene-Frempong, Winfred Wang, Charles Daeschner, Elliott Vichinsky, Rupa Redding-Lallinger, Beatrice Gee, Orah S. Platt, Russell E. Ware
Journal: Blood (1999)
An Intervention to Reduce Use of Low-Value Imaging Tests
Authors: Kenneth E. Covinsky, Rita F. Redberg
Journal: JAMA Internal Medicine (2015)

Joshua J. Fenton, MD, MPH; Richard L. Kravitz, MD, MSPH; Anthony Jerant, MD; Debora A. Paterniti, PhD; Heejung Bang, PhD; Donna Williams, MD; Ronald M. Epstein, MD; Peter Franks, MD
Comparison of the pictorial Epworth sleepiness scale and the Epworth sleepiness scale in a sleep clinic population
Authors: Donna Fairley, Marjorie Vennelle, Raquel Azuaje-Borges, Renata Riha
Journal: European Respiratory Journal (2013)

Aims:  The main symptom of fragmented nocturnal sleep is excessive daytime sleepiness (EDS). The Epworth Sleepiness Scale (ESS) is one of the most commonly used questionnaires to measure EDS; a pictorial Epworth Sleepiness Scale (pESS) was developed to help people with diminished literacy (1). This study compared ease of use of the ESS and the pESS in a patient population referred to a specialist sleep centre.  Methods:  A questionnaire including the (pESS) and the (ESS) was given to 409 patients (irrespective of diagnosis) in randomised order to self-complete. Standard statistical analysis was undertaken using SPSS v. 19 (IBM).  Results:  Of 409 questionnaires, 338 (87%) were valid for analysis. Mean age of respondents was 50 ± 13 years (215 males; 123 females). The ESS had been previously completed by154 patients (46%) of whom 93 were males (60%) and 61 females (40%). Twenty-six percent of patients found the ESS and 28% the pESS very easy to do. Thirty-five patients (10.5%) required help filling out the questionnaire (28 males; 7 females), lack of literacy and disability being the major determinants.When questions on the ESS and the pESS were compared to each other, there was good correlation overall (κ=0.74). The lowest score for an individual question was for Q8-“in a car while stop for a few minutes in traffic” (κ=0.69) demonstrating differential interpretation of the written compared to the pictorial versions. Conclusion: We confirm previous work showing no significant differences between the pESS and the ESS in a general sleep population; most misunderstandings arise from the interpretation of Question 8 on the ESS.  (1) Ghiassi R, et al. Thorax. 2011;66:97-100.
Biomarker: Predictive or Prognostic?
Authors: Karla V. Ballman
Journal: Journal of Clinical Oncology (2015)

To demonstrate that a biomarker is predictive of treatment benefit, the study requires biomarker status on all patients as well as patients who were treated with the agent of interest and patients not so treated, preferably in the context of a randomized study. A formal statistical test of the treatment-by-biomarker interaction should be significant. To establish whether a marker is purely prognostic, it needs to be demonstrated that there is a significant association between the biomarker and outcome, regardless of treatment, and that treatment effects do not depend on the biomarker. Finally, a biomarker may have both predictive and prognostic implications. These concepts are summarized in Figure 2.
The generation and analysis of a novel combination of recombinant adenovirus vaccines targeting three tumor antigens as an immunotherapeutic
Authors: Kwong Y Tsang, Elizabeth S Gabitzsch, Claudia Palena, Justin M David, Massimo Fantini, Anna R Kwilas, Adrian E Rice, Yvette Latchman, James W Hodge, Caroline Jochems, Romaine I Fernando, James Gulley, Ravi A Madan, Christopher R Heery, Joseph P Balint, Frank R Jones, Jeffrey Schlom
Journal: Journal for ImmunoTherapy of Cancer (2015)

Meeting abstracts We have reported on a novel adenovirus serotype 5 (Ad5) vector gene delivery platform (Ad5 [E1-, E2b-]), in which regions of the early 1 (E1), early 2 (E2b), and early 3 (E3) genes have been deleted. The unique deletions in this platform result in a dramatic decrease in late gene
In healthcare, you get what you pay for
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2015)

Has the winter crisis hit yet? The reason I ask is that recently, in an unprecedented alignment of think tanks, the chief executives of the King’s Fund, Nuffield Trust and Health Foundation wrote to The Telegraph newspaper to highlight their concerns about the funding shortfall that made a NHS winter crisis inevitable.1 ‘In health care, you get what you pay for,’ warned Chris Ham, Nigel Edwards and Jennifer Dixon. And hardy Britons are getting some of the poorest care of any advanced nation according to the Organisation for Economic Co-operation and Development.

The Organisation for Economic Co-operation and Development needs to be taken seriously. These leaders of think tanks need to be taken seriously, especially when they speak with one voice. Their letter also made a case for investment based on facts. Eighty percent of English Trusts are in the red. The NHS in England is about to post a deficit of £2 billion for this year. These facts are worth repeating because England now spends less on health as a proportion of GDP than other major nations, and the rate of spending growth in terms of GDP is slower than it has ever been since the NHS was created. The numbers speak for themselves, say the think tankers, the state of the NHS and quality of care are in decline. ‘There is no quick fix’ and investment is required now.

These unfortunate developments lead us neatly to one of this month’s research papers. Sanjay Budhdeo and colleagues2 examine the effects of changes in government healthcare spending on health outcomes in all countries of the European Union from 1995 to 2010. The findings are disturbing. A 1% decrease in government healthcare spending is associated with an increase in several mortality indicators, from neonatal mortality to adult mortality. These detrimental effects are not only short-term, as increase in mortality was evident five years after the spending decrease.

A second research paper finds benefit in an ancient treatment for transphincteric fistula-in-ano. Cutting setons are an old treatment, retested by Soliman and colleagues, who make the case that there is ‘nothing new under the sun’.3 But old doesn’t necessary mean gold. The MRC’s Therapeutic Trials Committee of the early 20th century favoured studies that were physiological rather than clinical, single-centre instead of multicentre, and used controls to measure physiological changes in varying conditions when they might have been used to ensure a fair trial.4 The MRC today operates to different standards.

In healthcare, you get what you pay for. In research, you get what you design.
Long-Term Health Outcomes in Women With Silicone Gel Breast Implants
Authors: Ethan M. Balk, Amy Earley, Esther A. Avendano, Gowri Raman
Journal: Annals of Internal Medicine (2015)

Silicone gel breast implants were removed from the U.S. market for cosmetic use in 1992 owing to safety concerns. They were reintroduced in 2006, with a call for improved surveillance of clinical outcomes.To systematically review the literature regarding specific long-term health outcomes in women with silicone gel breast implants, including cancer; connective tissue, rheumatologic, and autoimmune diseases; neurologic diseases; reproductive issues, including lactation; offspring issues; and mental health issues (depression and suicide).MEDLINE, EMBASE, and Ovid Healthstar (inception through 30 June 2015), and the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the first quarter of 2015).4 researchers double-screened articles for longitudinal studies that compared women with and without breast implants and reported long-term health outcomes of interest.4 researchers extracted data on participant and implant characteristics, analytic methods, and results.32 studies (in 58 publications) met eligibility criteria. Random-effects model meta-analyses of effect sizes were conducted when feasible. For most outcomes, there was at most only a single adequately adjusted study, which usually found no significant associations. There were possible associations with decreased risk for primary breast and endometrial cancers and increased risks for lung cancer, rheumatoid arthritis, Sjögren syndrome, and Raynaud syndrome. Evidence on breast implants and other outcomes either was limited or did not exist.The evidence was most frequently not specific to silicone gel implants, and studies were rarely adequately adjusted for potential confounders.The evidence remains inconclusive about any association between silicone gel implants and long-term health outcomes. Better evidence is needed from existing large studies, which can be reanalyzed to clarify the strength of associations between silicone gel implants and health outcomes.The Plastic Surgery Foundation.
Molecular characterisation of PFGE non-typable methicillin-resistant Staphylococcus aureus in the Netherlands, 2007
Authors: X W Huijsdens, T Bosch, M G van Santen-Verheuvel, E Spalburg, G N Pluister, M van Luit, M E Heck, A Haenen, A  J de Neeling
Journal: Eurosurveillance (2009)

In 2007 in The Netherlands, 30% of all human isolates of methicillin-resistant Staphylococcus aureus (MRSA) sent to the National Institute for Public Health and the Environment could not be typed by pulsed-field gel electrophoresis (non-typable (NT)-MRSA). Molecular characterisation of the NT-MRSA isolates revealed 27 different spa types and two distinct SCCmec types, type IV and V. All NT-MRSA isolates were closely related based on spa and multi-locus sequence typing and belonged to the ST398 lineage. The rapid increase of NT-MRSA (ST398) isolates over the last years shows the importance of this relatively new clonal lineage.
Comparison of Intended Scope of Practice for Family Medicine Residents With Reported Scope of Practice Among Practicing Family Physicians
Authors: Anastasia J. Coutinho, Anneli Cochrane, Keith Stelter, Robert L. Phillips, Lars E. Peterson
Journal: JAMA (2015)

Narrowing of the scope of practice of US family physicians has been well documented. Proposed reasons include changing practice patterns as physicians age, employer restrictions, or generational choices. Determining components of care that remain integral to the practice of family medicine may be informed by assessing gaps between the intended scope of practice of residents and actual scope of practice of family physicians.To compare intended scope of practice for American Board of Family Medicine (ABFM) initial certifiers at residency completion with self-reported actual scope of practice of recertifying family physicians.Cross-sectional data were collected from a practice demographic questionnaire completed by all individuals applying to take the ABFM Maintenance of Certification for Family Physicians examination. Initial certifiers reported intentions and recertifiers reported actual provision of specific clinical activities. All physicians who registered for the 2014 ABFM Maintenance of Certification for Family Physicians examination were included: 3038 initial certifiers and 10,846 recertifiers.Initially certifying physicians vs recertifying physicians.The Scope of Practice for Primary Care score (scope score), a psychometric scale, was calculated for each physician and ranged from 0 to 30, with higher numbers equating to broader scope of practice. Recertifiers were categorized by decades in practice.The final sample included 13,884 family physicians and, because the questionnaire was a required component of the examination application, there was a 100% response rate. Mean scope score was significantly higher for initial certifier intended practice compared with recertifying physicians' reported actual practices (17.7 vs 15.5; difference, 2.2 [95% CI, 2.1-2.3]; P < .001). Compared with recertifiers, initial certifiers were more likely to report intending to provide all clinical services asked except pain management; this included obstetric care (23.7% vs 7.7%; difference, 16.0% [95% CI, 14.4%-17.6%]; P < .001), inpatient care (54.9% vs 33.5%; difference, 21.4% [95% CI, 19.4%-23.4%]; P < .001), and prenatal care (50.2% vs 9.9%; difference, 40.3 [95% CI, 38.5%-42.2%]; P < .001). Similar differences from initial certifiers were present when comparisons were limited to recertifiers in practice for only 1 to 10 years.In this study of family physicians taking ABFM examinations, graduating family medicine residents reported an intention to provide a broader scope of practice than that reported by current practitioners. This pattern suggests that these differences are not generational, but whether they are due to limited practice support, employer constraints, or other causes remains to be determined.
<i>Liber Divinorum Operum (Book of Divine Works)</i>
Authors: Thomas B. Cole
Journal: JAMA (2015)

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Genetic Testing for Melanoma—Where Are We With Moderate-Penetrance Genes?
Authors: Brigitte Bressac-de Paillerets, Pierre Vabres, Luc Thomas
Journal: JAMA Dermatology (2015)

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 Dermatology HomeNew OnlineCurrent IssueFor Authors Podcast 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) 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 Dermatology journal