tbuckley/cabot-search huggingface dataset:
The management of acute urinary retention in a district general hospital (DGH) emergency department: How safe and effective is our current practice?
Authors: G. Ibe, A. Sime, A. Choudhury
Journal: International Journal of Surgery (2015)

s / International Journal of Surgery 23 (2015) S15eS134 S46 We audited our preoperative maintence fluid prescribing against the guideline. Methods: 20 patients aged 18e65, operated on in February 2014 were randomly selected. Exclusion criteria: Complex fluid requirements/significant co-morbidities (renal impairment, shock, sepsis). Notes were examined documenting weights and fluids prescribed since being made NBM. The quantity of water & electrolytes prescribed was calculated. Weights were used to calculate the ‘ideal’ amount of each component according to the guideline and time frame. A fluid ‘flashcard’was produced to guide the prescribing. We re-audited in August 2014 Results: Initial audit demonstrated on average (mean) patients were prescribed 19.7% of the recommended potassium & 11.5% of glucose however 519.2% of sodium, 459.3% chloride and 155.9% of water. The reaudit showed improvements with increases in potassium and glucose prescribed, 31.9% and 62.3% respectively and decreases in sodium 450.5% and Chloride 423.3%. Water 157%. Conclusion: This audit shows that further education is required. Our flashcardmade improvements. Further dissemination& incorporation into a hospital protocol would be the ideal next step. 0730: THE SURGICAL ASSESSMENT UNIT: A SOLUTION TO EMERGENCY WAITING TIMES? M. Dunstan, K.W.J. Mok, U. Wali, I. Drami, S. Vig. Croydon University
THU0047 Carotid plaque characteristics are associated with disease activity in rheumatoid arthritis
Authors: A.G.P. Semb, S. Rollefstad, S. Provan, T.K. Kvien, E. Stranden, I. Olsen, J. Hisdal
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Carotid plaques (CP) in rheumatoid arthritis (RA) are predictive of acute coronary syndrome in RA patients, suggesting that atherosclerotic plaques in RA are vulnerable.(1) <h3>Objectives</h3> To characterize vulnerability of CP in RA patients compared to a control population and between RA patients with different levels of disease activity. <h3>Methods</h3> Ultrasound of carotid arteries was performed in 152 RA patients and 89 controls. The CP echolucency was evaluated by the Gray-Scale Median (GSM) technique. Lower GSM value indicates higher vulnerability of plaques. CP characteristics were compared between RA patients with active disease and remission, and between patients and controls. All analyses were performed with adjustment for sex, age, smoking and blood pressure. Poisson regression was used for count data, mixed modeling for GSM and area per plaque, and analysis of covariance (ANCOVA) for minimum GSM per patient. <h3>Results</h3> Patients with RA were older (p&lt;0.0001), had higher blood pressure (p&lt;0.0001) and had more diabetes (p=0.04) compared to controls. The RA patients also had more frequently CP compared to controls (p&lt;0.0001), after adjustment for confounding factors. Patients with active RA disease according to clinical disease activity index (CDAI) had lower GSM (p=0.03), minimum GSM (p=0.03) and a larger CP area, although not significantly (p=0.27), compared to RA patients in remission. <h3>Conclusions</h3> RA patients with active disease assessed by CDAI seem to have more vulnerable CP compared to those in remission, pointing to the importance of obtaining RA remission goals to reach the state of stable atherosclerotic disease. The increased extent of atherosclerosis with numerically more CP was associated with the disease RA and surprisingly not with RA disease activity. <h3>References</h3> Evans MR, Escalante A, Battafarano DF, et al. Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis. Arthritis Rheum 2011;63:1211-1220. <h3>Disclosure of Interest</h3> None Declared
THU0186 Infliximab VS Etanercept: the Importance of Immunogenicity and Serum Drug Monitoring in Clinical Practice
Authors: C. Gainaru, M. Diana, M. Iliuta, G. Luca, N. Apetrei, C. Constantinescu, L. Groseanu, V. Bojinca, I. Saulescu, A. Borangiu, A. Balanescu, D. Predeteanu, R. Ionescu, D. Opris
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> Treatment with tumor necrosis factor (TNF) inhibitors in rheumatoid arthritis (RA) patients is based on the principle 9one size fits all9, but different immunogenicity of these drugs has a profound effect on pharmacokinetics and clinical response [1]. <h3>Objectives</h3> To measure infliximab (INF) and etanercept (ETA) drug level and presence of antidrug antibodies (ADAb) and to investigate clinical response and its relationship to drug immunogenicity and disease modifying anti-rheumatic drug (DMARD) association. <h3>Methods</h3> Thirty nine patients with moderate or high disease activity RA, treated with INF or ETA were evaluated for 6 months. Their clinical characteristics, DMARD association and serum drug and ADAb level were measured at baseline. Clinical activity and improvement at 4 months were measured using DAS28 score and EULAR response criteria. <h3>Results</h3> Ninety percent of patients treated with INF had concomitant DMARD, compared to 73.6% in ETA group. Eleven (45%) out of 20 patients treated with INF had ADAb: 7 patients had undetectable INF level, and 2 patients - subtherapeutic INF drug level. The presence of ADAb has correlated negatively with DMARD association in INF group (r=-0.492, P=0.027). In ETA treated patients, no ADAb were found. For both biologics, detectable drug level correlated with EULAR response at 4 months (for INF: r=0.701, P=0.001; for ETA: r=0.550, P=0.018). The association of a DMARD correlated with detectable serum INF (r=0.459, P=0.042) and a better EULAR response in patients treated with INF (r=0.468, P=0.038). <h3>Conclusions</h3> Our study confirms the difference in anti TNF drug9s immunogenicity and the importance of adding a DMARD to INF therapy. Also, therapeutic drug monitoring can be used to predict further clinical response. <h3>References</h3> Meghna Jani, Anne Barton RBW et al. The role of DMARDs in reducing the immunogenicity of TNF inhibitors in chronic inflammatory diseases. Rheumatol. (Oxford, England) Augv14. 2013; <h3>Disclosure of Interest</h3> : None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.4828
Evidence against a direct cytotoxic effect of alpha interferon and zidovudine in HTLV-I associated adult T cell leukemia/lymphoma
Authors: A Bazarbachi, R Nasr, ME El-Sabban, A Mahé, R Mahieux, A Gessain, N Darwiche, G Dbaibo, J Kersual, Y Zermati, L Dianoux, MK Chelbi-Alix, H de Thé, O Hermine
Journal: Leukemia (2000)
Hypouricemia in the Syndrome of Inappropriate Secretion of Antidiuretic Hormone
Authors: Laurence H. Beck
Journal: New England Journal of Medicine (1979)

WHILE evaluating patients with the syndrome of inappropriate secretion of antidiuretic hormone, it became apparent to me that hypouricemia was common during the period of hyponatremia. Review of the literature showed only one report of hypouricemia associated with the syndrome,1 and in recent reviews of hypouricemia in hospital patients, the syndrome was either not mentioned2 , 3 or not found.4 Therefore, a retrospective study of serum levels of uric acid in hyponatremic patients was performed. The results indicate not only that hypouricemia is the rule in patients with inappropriate secretion of antidiuretic hormone but also that the serum concentrations of urate can . . .
Spiral enteroscopy: from “new kid on the block” to established deep small-bowel enteroscopy tool
Authors: P. Mensink
Journal: Endoscopy (2010)

During the past 10 years small-bowel diagnostics and endoscopic therapy have emerged from the technically rather challenging push-enteroscopy and the occasional perioperative enteroscopy in patients with severe persistent gastrointestinal bleeding, to generally available and advanced deep small-bowel enteroscopy. First, with the introduction of capsule endoscopy in the year 2000, a new era of small-bowel diagnostics was entered [1]. The introduction of capsule endoscopy was quickly followed in 2001 by the launch of the double-balloon enteroscopy (DBE) system [2]. DBE combines excellent small-bowel diagnostic performance and, more importantly and in addition to capsule endoscopy, the possibility to perform diagnostic tissue sampling and therapeutic through-the-endoscope interventions.
Synthetic Cannabinoid–Related Illnesses and Deaths
Authors: Jordan Trecki, Roy R. Gerona, Michael D. Schwartz
Journal: New England Journal of Medicine (2015)

Use of synthetic cannabinoids (SCs) in the United States is increasing, as are clusters of cases of serious adverse health effects, including death. Though SC intoxication can be difficult to identify, some steps can be taken to respond more quickly to future outbreaks.
AB0658 Low dose naltrexone in the treatment of fibromyalgia
Authors: S. Metyas, K. Yeter, J. Solyman, D. Arkfeld
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Fibromyalgia is a chronic pain disorder characterized by diffuse musculoskeletal pain, fatigue, sleep disturbance and cognitive impairment. A significant number of fibromyalgia patients do not respond adequately to the current drugs (pregabalin, milnacipran, duloxetine) approved for fibromyalgia treatment by the Food and Drug Administration (FDA). Thus, there is still a need for adjunctive therapies. Naltrexone is an opioid receptor antagonist used to treat alcohol and opioid dependence. It is hypothesized that low dose naltrexone causes transient blockade of opioid receptors centrally resulting in a rebound of endorphin function which may attenuate pain in fibromyalgia<sup>1</sup>. <h3>Objectives</h3> The aim of this study was to determine the effect of low dose naltrexone on symptoms in fibromyalgia. <h3>Methods</h3> This was a prospective, open label study carried out at a single center. Twenty-five patients diagnosed with fibromyalgia (according to the American College of Rheumatology criteria) participated. Naltrexone was started at a dose of 3 mg at night time and could be titrated up to a maximum of 4.5 mg at night time. Patients were permitted to continue pregabalin, milnacipran, or duloxetine. The primary outcome measure was the Revised Fibromyalgia Impact Questionnaire (FIQR) at month 3. Adverse reactions were also recorded. <h3>Results</h3> Twenty-four females and 1 male were enrolled. Twenty-two patients completed the study. Seven (32%) patients were on naltrexone monotherapy throughout the study. There was a 19.5% overall improvement in FIQR at month 3 with naltrexone therapy. Eleven (50%) had an average of a 41% improvement in the FIQR. The patients reported decreases in anxiety, pain and sleeping habits from baseline. Two patients discontinued the drug because they felt it was ineffective and 1 patient discontinued because of diarrhea. <h3>Conclusions</h3> Treatment with low dose naltrexone may be an effective, highly tolerable and inexpensive treatment for fibromyalgia. Further controlled trials are needed. <h3>References</h3> Ramanathan S, Panksepp J, Johnson B. Is fibromyalgia an endocrine/endorphin deficit disorder?Is it low dose naltrexone a new treatment option? <i>Psychosomatics</i> 2012;53:591-4. <h3>Disclosure of Interest</h3> None Declared
Case 3-1992
Authors: Richard C. Cabot, Robert E. Scully, Eugene J. Mark, William F. McNeely, Betty U. McNeely, J.M. Drazen, E.J. Mark
Journal: New England Journal of Medicine (1992)

Presentation of CaseA 40-year-old woman was admitted to the hospital because of a productive cough, intermittent hemoptysis, and nondiagnostic findings on bronchoscopic examination.The patient was well until 2 1/2 years earlier, when she experienced the onset of a persistent cough that was initially productive of small amounts of blood-streaked sputum. Thereafter the cough was intermittently productive of 5 to 10 ml daily of "white" sputum and was dry at other times. A year and a half before entry wheezing developed, with gradually increasing exertional dyspnea. Nine months before admission the patient consulted a physician, who detected the presence . . .
Neuromuscular Blocking Agents in ARDS
Authors: Arthur S. Slutsky
Journal: New England Journal of Medicine (2010)

In this issue of the Journal, Papazian and colleagues1 present intriguing results of their study examining neuromuscular blockade in patients with severe, early acute respiratory distress syndrome (ARDS). The investigators randomly assigned 340 patients to receive the neuromuscular blocking agent cisatracurium or placebo for a period of 48 hours. Both groups underwent mechanical ventilation according to a lung-protective strategy previously shown to decrease mortality.2 Both the adjusted 90-day survival rate and time off the ventilator were greater in the cisatracurium group as compared with the placebo group.ARDS is an inflammatory disease characterized by pulmonary edema, stiff lungs, and hypoxemia. . . .
OP0312 Association of Insuline Resistance and Hypertension with Renal Clearance of Uric Acid in Males with Gout and Normal Renal Function
Authors: F. Perez-Ruiz
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Genetic studies have associated the Glut9 renal transporter with hyperuricemia and gout. Insulin resistance has also been associated to hyperuricemia and gout due to a reduction of renal clearance of uric acid. A direct link between renal clearance of uric acid and insulin resistance is an attractive physiopathologic hypothesis. <h3>Objectives</h3> To study whether there is a correlation between clearance of urate and insulin resistance in gout patients with normal renal function. <h3>Methods</h3> Consecutive male patients with crystal-proven gout were evaluated if not on any drug with urate-lowering properties, show normal renal function (CKD 1 with no altered urine sediment), fasting glucose &lt; 120 mg/dl, normal diet and alcohol avoidance. HOMA-IR was calculated with fasting glucose and insulin determinations. Inefficient excretion of uric acid being defined as clearance of uric acid &lt; 6 ml/min/1.73 sqm. Hypertension, previous ethanol intake, body mass index, time from onset, age, vascular events, renal lithiasis, total cholesterol, HLD-cholesterol, LDL-cholesterol, triglycerides, glycosilated hemoglobin, number of flares, and presence of tophi were also recorded in the database. <h3>Results</h3> One hundred and twenty-nine male patients were included for analysis. Age was 53 years (28-60), time from onset 5.5 (3-11) years. Previous ethanol intake &gt; 15 g/day, hypertension, glycosilated hemoglobin, clearance of creatinine, and HOMA-IR were associated to clearance of uric acid in bivariate regression analysis. Multivariate regression analysis showed that HOMA-IR and hypertension were the only variables predictive of the model. HOMA-IR showed a R<sup>2</sup> 0.27. ROC area was 0.869 and a HOMA-IR cut-off &gt;2.7 showed 80% sensitivity ad 81% specificity. <h3>Conclusions</h3> Insulin resistance, but also hypertension, was associated with lower clearance of uric acid in a series of phenotype-selected male gout patients, showing a plausible link between glucose metabolism and sugar transporters of uric acid that deserves further investigation. <h3>Disclosure of Interest</h3> F. Perez-Ruiz Consultant for: Ardea, Savient, Menarini, Astra, Metabolex, Pfizer, Novartis, SOBI, Speakers bureau: Menarini
Case 2-1967
Authors: Irving P. Ackerman, Benjamin Castleman
Journal: New England Journal of Medicine (1967)

Presentation of Case First admission. A sixty-two-year-old woman was admitted to the hospital because of pain in the chest.For many years she had had diffuse aches and pains for which no cause was found on repeated examinations. Ten years previously peripheral edema developed. Five years before admission she was told by a physician that she had hypertension. Two years later she began to experience pain in the anterior portion of the chest, with radiation to the inner aspect of one or both arms; the pain occurred once or twice a week after exertion or exposure to a cold . . .
A6.10 A biomarker discovery approach for urinary cells in lupus nephritis
Authors: S Baumgart, M Bertolo, V Glatzel, A Peddinghaus, P Enghard, A Radbruch, F Hiepe, A Grützkau
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> 50–80% of SLE patients develop end-stage renal failure (lupus nephritis (LN)) that is one of major causes of morbidity and mortality. Taking renal biopsies is an invasive procedure not free from risk and it is not applicable to monitor LN activity over time. Therefore, the goal of this study was to detect and define cell-based urinary abnormalities and signatures circumventing a critical intervention. We applied mass cytometry to the multiparametric analysis of urine samples of LN patients. <h3>Methods</h3> Urine and heparin anti-coagulated blood samples were simultaneously collected from 7 LN patients and prepared for mass cytometry analysis. All patients had clinically active SLE and had already started an immunosuppressive therapy. Peripheral blood cells were obtained after erythrocyte lysis. Two panels including 54 surface markers in total were used. <h3>Results</h3> Mass cytometry allows a comprehensive immunophenotyping of immune cells washed out in urine circumventing problems regarding sample size, autofluorescence-induced artefacts and spectral overlap inherent in conventional flow cytometry. Neutrophils and monocytes/macrophages followed by T cells represent the dominant leukocytes populations in urine samples of SLE patients. The elevated CD8 T cell count was used as biomarker for proliferative LN among SLE patients. Although T cells were below 3% of CD45<sup>+</sup> cells, we were able to observe a decreased CD4/CD8 ratio as already described in the literature for LN blood. Additionally, a T cell subpopulation expressing the activation marker CD69 and CD38 was identified in urine but not in blood. Active LN patients show a raised urinary monocyte/macrophage population (CD14<sup>+</sup>CD36<sup>+</sup>HLA-DR<sup>++</sup>). <h3>Conclusion</h3> First patient data shown indicate that leukocytes detectable in urine of LN patients are promising biosensors reflecting chronic inflammation in the kidneys. Obviously, the LN histopathologic heterogeneity seems to be better reflected by urinary cell populations than by peripheral blood. Therefore, &nbsp;larger patient cohorts and additional epithelial markers will be analysed to identify robust biosignatures that can be used diagnostically for a classification of lupus nephritis.
OC-070 Dietary Supplementation With Fodmaps Increases Fasting Colonic Volume And Breath Hydrogen In Healthy Volunteers: A Mechanistic Study Using Mri
Authors: G Major, A Teale, S Pritchard, L Marciani, K Whelan, P Gowland, R Spiller
Journal: Gut (2014)

<h3>Introduction</h3> Indigestible fermentable carbohydrates, grouped as FODMAPs, have been proposed to induce gastrointestinal symptoms. Some, such as oligofructose (OF), are prebiotics and modify the microbiota. The metabolic activity of the microbiota affected transit time in a mouse model.<sup>1</sup> This study hypothesised that dietary supplementation with OF would shorten whole gut transit time (WGTT) and improve the capacity of the microbiota to metabolise a FODMAP challenge. <h3>Methods</h3> The study was an open-label case series. 16 healthy volunteers underwent fasting MRI to assess colonic volume<sup> [2]</sup> and the position of 5 transit markers ingested 24 h earlier from which WGTT could be calculated.<sup>3</sup> Breath hydrogen (H<sub>2</sub>) and methane (CH<sub>4</sub>) were also measured. Subjects then consumed an inulin challenge drink (ICD): 500 ml water containing 40 g inulin. Inulin is fermented in the colon and known to increase H<sub>2</sub> and colonic volume.<sup>4</sup> After ICD subjects could sip water and were given a low FODMAP lunch but no other food was allowed. 8 h post-ICD MRI was repeated. Breath measurements were repeated 4 and 8 h post-ICD. Subjects then supplemented their usual diet with OF (gift from BENEO, Germany), 5 g twice daily, for a week. Fasting and post-ICD measurements were then repeated. Dietary questionnaires were completed for the weeks preceding MRIs to assess dietary fructan intake. <h3>Results</h3> Median [IQR] given unless stated as mean [95% CI]. Fasting colonic volumes (510 ml [400–710]) increased by mean 94 ml [12 – 177, p = 0.03] after OF. Fasting H<sub>2</sub> (33 ppm [9–87]) increased by mean 39 ppm [6 – 71, p = 0.02]. WGTT (34 h [10 – 45]) increased by 19 h [-9 – 42] but this increase did not reach significance (p = 0.09, Wilcoxon). Colonic volumes post-ICD were similar across weeks (mean 726 ml [667–785]). The change from baseline was significant in week 1 but not week 2 due to the difference in fasting volumes. There was no difference between weeks 1 and 2 in H<sub>2</sub> at 4 or 8 h after ICD. CH<sub>4</sub> did not change. Dietary fructan intake was similar in both weeks (mean &lt; 8 g/ day). <h3>Conclusion</h3> OF increased fasting colonic volumes by 18%. H<sub>2</sub> also rose. This may reflect increased bacterial mass with increased capacity for fermentation. The suggestion that OF slows WGTT is surprising and warrants further investigation. MRI can complement research on the microbiota to describe its impact on gut physiology. <h3>References</h3> 1 Kashyap P <i>et al. Gastroenterology</i> 2013;144(5):967–77 2 Chaddock G <i>et al</i>. <i>Neurogastroenterology and Motility</i> 2013 3 Pritchard S <i>et al</i>. <i>Neurogastroenterol Motil</i> 2013 4 Murray K <i>et al</i>. <i>Am J Gastroenterol</i> 2013 <h3>Disclosure of Interest</h3> None Declared.
Varieties of Digital Ischemia and Their Management
Authors: Edward A. Edwards
Journal: New England Journal of Medicine (1954)

A CONSTANT or episodic lack of blood supply to the acral parts of the limbs is frequently encountered in clinical practice. The term "Raynaud's disease" is too often indiscriminately applied to such cases. Raynaud1 did describe a clinical entity. The disease properly known by his name is characterized by digital ischemia occurring in paroxysms occasioned by exposure to cold and sometimes by emotion, without evidence of obstruction of the large limb vessels, afflicting all four limbs to some extent and existing as a chronic disorder. Unfortunately, the title of Raynaud's report—"Local Asphyxia and Symmetrical Gangrene of the Extremities" was misleading, . . .