tbuckley/cabot-search huggingface dataset:
Burden of allergy diets in Finnish day care reduced by change in practices
Authors: M. Erkkola, T. Saloheimo, H. Hauta‐alus, A. K. Kukkonen, S. Virta, C. Kronberg‐Kippilä, E. Vaara, A. S. Pelkonen, M. Fogelholm, M. J. Mäkelä
Journal: Allergy (2016)

Nonessential allergy diets in children with mild symptoms may harm the development of immunological tolerance and impose a burden on families and day care. We aimed to reduce the high prevalence of allergy diets in day care by reforming the practices for inquiring about need of special diets from parents.We developed a new special diet form and an information leaflet based on the new allergy guidelines. The new form was implemented into 40 Finnish day care centres in the capital region in 2013-2015. The questionnaires on practices concerning special diets in day care centres and allergy knowledge were collected from the personnel.After 2 years, the new special diet form was used by 64% of families with food-allergic children, and the prevalence of allergy diets in day care centres decreased by 43% to 4.3% (IQ range 3.05-5.96). A significant decrease was found in the prevalence of all basic (milk, grains, egg) and most other allergy diets (P for trend < 0.01). The new practice was well accepted by day care and kitchen personnel. Lack of updated allergy knowledge was noted among day care personnel.The burden of allergy diets in day care settings could be decreased by simple pragmatic changes based on current allergy guidelines. Old allergy attitudes persisted among day care personnel, indicating the need for continuous education.
Thrombotic Thrombocytopenic Purpura and Clopidogrel — A Need for New Approaches to Drug Safety
Authors: Alastair J.J. Wood
Journal: New England Journal of Medicine (2000)

In this issue of the Journal, Bennett et al. describe 11 cases of thrombotic thrombocytopenic purpura that occurred in patients during or shortly after they received clopidogrel.1 The evidence linking clopidogrel to the development of thrombotic thrombocytopenic purpura is strengthened by the finding that the disorder began within 14 days after the initiation of clopidogrel therapy in all but one patient.Thrombotic thrombocytopenic purpura is known to occur in patients who are treated with ticlopidine, a similar antiplatelet drug. The similarities between ticlopidine and clopidogrel extend beyond their mechanism of action. Both drugs inhibit platelet aggregation in response to adenosine . . .
P0396 : Emricasan, a potent pan caspase inhibitor, rapidly reduces caspase activity and biomarkers of apoptosis in patients with hepatic impairment but not in healthy volunteers: Implications for safety, selectivity and mechanism of action
Authors: A.P. Spada, P.C. Contreras, M.C. Huyghe, M. Morris, G.C. Burgess
Journal: Journal of Hepatology (2015)
Case 50-1983
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, Betty U. McNeely, Gustave A. Laurenzi, Eugene J. Mark
Journal: New England Journal of Medicine (1983)

Presentation of CaseA 72-year-old woman was admitted to the hospital because of a pulmonary infiltrate.She was well until two years earlier, when a cough productive of yellow sputum developed and resolved after the administration of penicillin. Four months later cough and sputum production recurred in association with fever. An x-ray film of the chest taken 18 months before admission (Fig. 1) showed nonhomogeneous consolidation in the right upper lobe associated with volume loss and retraction of the minor fissure; linear densities were visible in the lingula. Tomographic examination of the lungs disclosed no hilar or mediastinal mass. Cytologic . . .
Medicine and books: Principles and Practice of Critical Care
Authors: D W Ryan
Journal: BMJ (1998)

Ed C G Garrard, P Foex, S Westaby 

Blackwell Science, £149.50, pp 880 

ISBN 0632 032 839 

Textbooks on intensive care used to be pretty sparse, but they are now widely available. So why do we need another one? This book represents an attempt to provide a truly multidisciplinary approach to intensive care. It doubles as a reference book for the more experienced readers and a “look up and learn” guide for the uninitiated. 

In many respects it manages this balancing act well, but it has weaknesses. The short and readable chapters, written in a punchy style, are suddenly intersected by two incredibly complex dissertations on acid base and fluid balance by Palazzo. There is, in fact, nothing wrong with either of these, but they are in sharp contrast to the style of the rest of the book. There are conflicts—at least three different views on fluid replacement, repetition of and differences over trauma management, and the 1992 American guidelines on cardiopulmonary resuscitation but not the 1992 European recommendations. The divide between the United States and the rest of the world in these three areas is bewildering to the uninitiated, and the obvious differences could have been turned to an advantage if a critical commentary had been imposed with stronger editorial control. 

This is not to say that the senior editor has not pulled his weight—Dr Garrard writes well and is involved in about a third of the 69 chapters. There are some irritations—the term ARDS is used to mean both adult and (now renamed correctly) acute respiratory distress syndrome throughout the book, sometimes within the same chapter. The need to have a choice of similar puncture sites for central line insertion plus indigestible diagrams is unhelpful. 

The strengths of the book are that it is well written, very readable, and with clear tables and pictures. I am not sure the book will appeal to both American and European tastes, but that is what has been attempted and why differences of opinion and content are present. It is a comprehensive work, not over-referenced, and well presented. The market place for this type of book is overflowing—whether it sinks or sails, it’s a good read.
The effects of atamestane, toremifene, and atamestane plus toremifene compared to letrozole on bone, serum lipids and uterus
Authors: P. E. Goss, S. Qi, H. Hu, A. M. Cheung, W. Lang, D. G. Blanchett, P. J. Langecker
Journal: Journal of Clinical Oncology (2005)

600 Background: Aromatase inhibitors (AI) and anti-estrogens combined may more completely eliminate oestrogenic signaling than either compound alone. In contrast to earlier combinations the steroidal AI atamestane (ATA) and the anti-estrogen toremifene (TOR) have shown no PK interaction. We evaluated the effects of ATA and TOR alone or combined on bone, serum lipids and uterus in ovariectomized (OVX) rats, comparing them to the AI letrozole (LET). Methods: ATA 15 mg/kg BID; TOR 10 mg/kg and LET 1 mg/kg, O.D. were given by oral gavage to OVX rats for 16 weeks, after which uterine wet weight, femoral bone mineral density (BMD), serum cholesterol and low-density lipoprotein (LDL) were measured. Results: Compared to intact rats, femoral BMD decreased 12.9% 16 weeks after OVX (P < 0.0001). 1) Compared to OVX femoral BMD increased with ATA by 7.7%, TOR by 15.6%, and TOR + ATA by 17.5% (Ps < 0.001) without increase of body weight. This effect was not reversible with the anti-androgen flutamide. 2) ATA had no stimulatory effect on uterine weight compared to OVX indicating absence of an intrinsic estrogenic signal. 3) Uterine weight compared to the OVX increased 69% with TOR (P 0.0001) and did not differ with TOR + ATA. 4) OVX rats given TOR and TOR + ATA had 58.8% and 56.5% reduction, respectively, in serum cholesterol compared to OVX controls (Ps < 0.0001). 4) OVX rats given TOR and TOR + ATA had 83.5% and 80.2% reduction, respectively, in serum LDL compared to the OVX controls (Ps < 0.0001) while ATA had no significant effects. 5) TOR caused a significant less body weight gain compared to OVX controls (P < 0.0001). 6) OVX rats treated with LET had femoral BMD, lipid levels, uterine weight and body weight gain similar to those of OVX controls. Conclusions: Unlike LET, ATA significantly prevents bone loss in OVX rats but this effect is not blocked by flutamide and appears to be non-estrogenic. TOR prevents bone loss, lowers serum cholesterol and LDL levels in OVX rats, but increases uterine weight. LET does not prevent bone loss and has no effect on serum lipids and uterus. Because of ATA’s non-estrogenic and non-androgenic bone-sparing effect a reversal of a decrease in BMD by ATA with TOR was not testable by this model. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Intarcia Therapeutics Intarcia Therapeutics Intarcia Therapeutics Intarcia Therapeutics
Progression of Mesangial and Focal to Diffuse Lupus Nephritis
Authors: Ellen M. Ginzler, Anthony D. Nicastri, Chun-Kuo Chen, Eli A. Friedman, Herbert S. Diamond, David Kaplan
Journal: New England Journal of Medicine (1974)

The finding of a focal glomerular lesion in systemic lupus erythematosus has been considered a good prognostic sign because the disease rarely progresses to a more severe histologic lesion and renal insufficiency. In 7.5 years, 110 of 165 such patients evaluated had clinical renal involvement, with biopsy in 69; 31 had a mesangial or focal lesion, 24 diffuse nephritis, and 14 membranous nephritis. The renal status of nine patients with an initial mesangial or focal lesion deteriorated one to 12 years later and progressed to diffuse nephritis. There was no difference between the groups with and without histologic progression in clinical severity of disease at the time of first biopsy, nor in the initial pattern of immunofluorescent or electron microscopical deposits within the glomerulus. It appears that mesangial, focal, and diffuse nephritis represent a continuum of increasingly advanced renal disease in systemic lupus erythematosus. (N Engl J Med 291:693–696, 1974)
Randomized, double-blind, phase 2, study evaluating same-day vs next-day administration of pegfilgrastim with R-CHOP in non-Hodgkin’s lymphoma patients
Authors: A. Saven, L. Schwartzberg, P. Kaywin, N. Bartlett, L. Dean, S. Shahin, L. Dreiling
Journal: Journal of Clinical Oncology (2006)

7570 Background: R-CHOP is associated with a high risk of febrile neutropenia (FN). Pegfilgrastim is indicated to lower infection incidence, manifested by FN, when administered once-per-cycle 24 hrs after chemotherapy (CT). However, eliminating an office visit the day after CT is desirable. Methods: Pts ≥ 18 years with previously untreated non-Hodgkin’s lymphoma (NHL) who received R-CHOP (rituximab 375 mg/m 2 , C 750 mg/m 2 , H 50 mg/m 2 , O 1.4 mg/m 2 , prednisone 100 mg; for 6 cycles Q21D) were randomized 1:1 to pegfilgrastim 6mg within 4 hours or ∼24hrs after CT. The primary endpoint was the duration of severe (grade 4) neutropenia (DSN) in cycle 1. Same-day administration was considered noninferior to next-day if the upper limit of the 2-sided 95% CI for the difference in mean cycle 1 DSN (same day - next day) was &lt;2 days. Results: 77 pts (8 mantle-cell, 69 diffuse large B-cell) were enrolled of 90 planned (due to slow accrual). 75 pts (36 same-day, 39 next-day) received CT and pegfilgrastim. Most pts had stage 3/4 disease (69% same-day, 74% next-day), no bone marrow involvement (75% same-day, 69% next-day) and ECOG status 0 or 1 (94% same-day, 97% next-day). Difference in mean cycle 1 DSN was 0.9 days (95% CI: 0.3–1.4) longer in the same-day than the next-day group (mean [SD]: 2.1 [1.22] vs 1.2 [1.20] days; grade 4 neutropenia incidence: 86% vs 64%). In cycle 1, more pts had a DSN ≥ 3 days in the same-day (36%) than the next-day group (15%). In cycle 4, mean DSN was longer in the same-day than the next-day group (mean [SD] 1.4 [1.40] vs 0.7 [0.94] days; grade 4 neutropenia incidence: 57% vs 42%). Pts in the 2 groups had similar occurrence of FN (17% vs 15%) and serious adverse events (33% vs 36%) across the study. Full dose on schedule, and the incidence of IV anti-infective use or hospitalization due to FN were also similar between groups. Conclusions: In cycles 1 and 4, the mean DSN was nearly 1 day longer for pts in the same-day group compared with the next-day group. Although the protocol-specified 2-day non-inferiority margin for DSN was met, for pts with NHL receiving R-CHOP, we recommend administering pegfilgrastim 24 hours after CT per labeling guidelines. [Table: see text]
The Effect of Preoperative Chemotherapy with S-1 Alone for Oral Squamous Cell Carcinoma Patients
Authors: M. Nakazawa, T. Imai, I. Kato, M. Ohmae, T. Sumi, A. Niki, M. Suematsu, Y. Matsumoto, K. Amino
Journal: Annals of Oncology (2014)
Guided duration of anticoagulation after unprovoked venous thromboembolism using D-dimer testing
Authors: Francis Couturaud
Journal: European Respiratory Journal (2016)

Venous thromboembolism (VTE) is a frequent, multifactorial and potentially life-threatening disease [1–3]. When VTE occurs in the absence of any major risk factor ( i.e. surgery, prolonged immobilisation or trauma of the lower limb), the risk of recurrent VTE is high ( i.e. about 10% at 1 year and 30% at 5 years) after anticoagulation therapy is stopped, and current guidelines recommended indefinite anticoagulation once a first episode of unprovoked VTE has occurred [1–8]. However, only one-third of these patients will benefit from indefinite anticoagulation whereas, in the others, the risk of anticoagulant therapy-related bleeding probably outweighs any risk of recurrent VTE after stopping anticoagulation therapy. Therefore, the determination of the individual risk of recurrent VTE among patients with unprovoked VTE remains a major issue. In this setting, Palareti et al . [9] report, in this issue of the European Respiratory Journal , the results of a subanalysis of the “DULCIS” study, a large prospective cohort of 1010 patients with unprovoked VTE [10]; the main aim was to evaluate the accuracy of serial D-dimer assessment to predict the risk of recurrent VTE according to whether patients had unprovoked pulmonary embolism (PE) or deep vein thrombosis (DVT) [9]. D-dimer testing after venous thromboembolism is helpful to identify patients eligible for indefinite anticoagulation <http://ow.ly/ZluRz>
Case 20-1996
Authors: T.B. Kinane, E.J. Mark
Journal: New England Journal of Medicine (1996)

Presentation of CaseA three-hour-old boy was admitted to the newborn intensive care unit after a premature delivery.The infant was born of a 35-week triplet gestation to a 25-year-old primipara, who had received Rh0(D) immune globulin at 28 weeks. A prenatal screening test revealed that the mother's blood group was A, Rh-negative; vaginal cultures for gonococci and chlamydia were negative. She was immune to rubella virus, and a test for hepatitis B surface antigen and a serologic test for syphilis were negative. The mother was admitted several days before delivery, and the fetuses were monitored with serial . . .
Prognostic significance of a low number of blasts in the cerebrospinal fluid (CSF) or a traumatic lumbar puncture (TLP) in children with acute lymphoblastic leukemia (ALL): The Dutch Pediatric Oncology Group experience
Authors: D. M. M. Te Loo, W. A. Kamps, A. Van Der Does-Van Den Berg, E. R. Van Wering, S. S. N. De Graaf
Journal: Journal of Clinical Oncology (2004)

8501 Background: The prognostic significance of a low number of blasts in the CSF (leukocytes <5/mm3) in childhood ALL is controversial. Also, it has been reported that a TLP at diagnosis has prognostic implications. Therefore, we retrospectively studied both aspects in ALL patients who were treated according to Dutch Pediatric Oncology Group protocols ALL-7/8 (1988–1996) that were identical to contemporary BFM protocols except that Dutch patients only received cranial irradiation if they had overt meningeal leukemia. Methods: 526 evaluable patients were classified into five groups according to the following criteria: CNS1 (no blasts in the CSF, n= 304), CNS2 (blasts in the CSF, but leukocytes < 5/mm3, n=111), CNS3 (overt meningeal leukemia, n=10), TLP+ (>15/mm3 erythrocytes and blasts in the CSF, n=39), TLP- (TLP but no blasts, n=62). All CSF samples were centrally reviewed by two experienced cytologists. In addition to conventional morphology, TdT staining was done. Results: Median duration of follow up was 10.8 years, range 6.9–15.5 years. Actuarial survival percentages at 5 year were as follows: Overall event-free survival (EFS) was 72%. EFS for CNS1 patients was 74% and for CNS2 patients 71% (not significant). EFS for CNS3 patients was 67%. Probability of CSF relapse (isolated or combined) was 5.1% in CNS1 and 6.2% in CNS2 patients (N.S.). EFS in TLP- patients was 82% and in TLP+ patients 59% (p < 0.01, log rank test). Probability of CSF relapse in TLP+ patients was 9.7% and in TLP- patients 1.6% (p < 0.001). When TdT positivity was used as an additional criterion for leukemic blasts, these conclusions remained unchanged. Conclusions: We were unable to show prognostic significance of a low number of blasts in the CSF. Our data do not support the administration of additional CNS therapy in ALL patients with a low number of CSF blasts at diagnosis. However, patients with a traumatic LP and blasts in the CSF at diagnosis have an inferior outcome and should probably receive additional treatment. No significant financial relationships to disclose.
<i>Escherichia coli</i>and the Hemolytic–Uremic Syndrome
Authors: Eric Rondeau, Marie-Noëlle Peraldi
Journal: New England Journal of Medicine (1996)

The hemolytic–uremic syndrome is characterized by nonimmune hemolytic anemia, thrombocytopenia, and acute renal failure.1 Extrarenal manifestations, particularly neurologic signs, may be present, indicating that the disease process is not limited to the kidney. As in the closely related disorder of thrombotic thrombocytopenic purpura, the pathologic hallmark of the disease is thrombotic microangiopathy. The hemolytic–uremic syndrome is the leading cause of acute renal failure in young children, but it occurs in adults as well, sometimes together with gastrointestinal infection and bloody diarrhea. Other forms of the syndrome in adults are related to pregnancy, the postpartum state, oral-contraceptive use, malignant hypertension, cancer . . .
Efficacy and long‐term toxicity of the rituximab‐fludarabine‐cyclophosphamide combination therapy in Waldenstrom's macroglobulinemia
Authors: Laetitia Souchet, Vincent Levy, Maya Ouzegdouh, Jérôme Tamburini, Alain Delmer, Jehan Dupuis, Steven Le Gouill, Brigitte Pégourié‐Bandelier, Olivier Tournilhac, Marouanne Boubaya, Jacques Vargaftig, Sylvain Choquet, Véronique Leblond
Journal: American Journal of Hematology (2016)

Waldenstrom's macroglobulinemia is generally treated with alkylating agents, purine analogs and monoclonal antibodies, alone or in combination. We report the outcomes of 82 patients (median age 61 years) treated with the RFC combination. Twenty-five patients were treatment-naive. RFC was administered every 4 weeks, for a median of five cycles. At treatment discontinuation, the overall response rate was 85.4%. The responses improved after treatment discontinuation in 25 patients, with a median time to best response achievement of 10.8 months, raising the major response rate (PR, VGPR and CR) from 64.6% to 76.8%. With a median follow-up of 47 months, the median progression-free survival time had not been reached (67% PFS at 48 months) and was influenced by age and treatment status before RFC. Likewise, the median time to next therapy had not been reached. Two cases of myelodysplastic syndrome/AML and 3 cases of transformation to aggressive lymphoma occurred. Thirteen patients died. The 3-year overall survival rate was 90%. Long-lasting cytopenias occurred in 19 patients. The RFC combination thus gave a high response rate and durable responses, even in heavily treatment-experienced patients. The high incidence of long-lasting cytopenia might be reduced by giving fewer courses and thereby minimizing myelotoxicity. Am. J. Hematol. 91:782-786, 2016. © 2016 Wiley Periodicals, Inc.
From the gut to the strut: where inflammation reigns, bone abstains
Authors: Jameel Iqbal, Tony Yuen, Li Sun, Mone Zaidi
Journal: Journal of Clinical Investigation (2016)

In this issue of the JCI, Li et al. show that germ-free mice, when chemically castrated, do not lose bone - a finding that unequivocally establishes a role of gut microbiota in mediating hypogonadal bone loss. Additionally and not unexpectedly, probiotics reversed hypogonadal osteopenia in sex steroid-deficient mice by preventing the disruption of gut barrier function and dampening cytokine-induced inflammation. The authors propose that TNFα is a key mediator; however, it is very likely that other molecules - including IL-1, IL-6, IL-17, RANKL, OPG, and CCL2 - modulate probiotic action. The results of this study highlight the potential for repurposing probiotics for the therapy of osteoporosis. Future placebo-controlled clinical trials will be required to establish safety and efficacy of probiotics in reducing fracture risk in people.
Multimedia: WEBSITE OF THE WEEK
Authors: Marcus Müllner
Journal: BMJ (1999)

The Female Genital Mutilation Homepage http://www.fgmnetwork.org/ At this very moment about 8 to 10 million women and girls in the Middle East and in Africa are at risk of undergoing one form or another of genital mutilation.

Even though there is increasing awareness for this topic, we may not realise the magnitude of this problem: the number of affected women is vast; pathophysiological understanding is low, as female genital mutilation is often compared to male circumcision, but in fact, it is far more drastic and damaging (a more appropriate analogy would be between clitoridectomy and removal of the entire penis); sociocultural differences are hard to assess and understand.

This website presents information concerning female genital mutilation from a variety of perspectives: psychological, cultural, sexual, human rights, just to name a few. Even though medical problems such as wound infections, transmission of infectious diseases, and long term sexual health and obstetric problems are only briefly addressed, the information provided is important to all health professionals. Of particular interest is the introduction, which explains what female genital mutilation is and where it is practised.

Because of the simple structure, navigating this site is easy, but unfortunately, several of the links are inaccessible. Some of those accessible are worth a visit, especially a particular case study: a transcript of a hearing concerning a 19 year old woman from Togo, seeking political asylum in the United States to escape from ritual female genital mutilation. Even though lengthy, this protocol provides a good example of the problems in understanding between different cultures and social structures. Fortunately, all links to advocacy groups and organisations working on the issue of eradication are functioning.

Not surprisingly, this website would benefit from regular maintenance and update (on 31 December 1998 a conference from August 1998 was still being announced). Serious readers may be happy with what they get. However, an occasional visitor may miss this issue’s importance because of these shortcomings, together with a rather dull presentation.