tbuckley/cabot-search huggingface dataset:
Treating hypertension: an evidence based case report
Authors: Rosemary Morgan
Journal: BMJ (2000)

A 66 year old retired publican, Mr C, was admitted to hospital with a sudden onset of weakness affecting his right arm and right leg. His wife had been unable to get her husband out of bed earlier that morning. She had noted that his speech was very slurred and initially had thought that he was very confused. The day before he had knocked his head against a car door but had seemed all right at the time. There was no history of transient ischaemic attacks. A diagnosis of essential hypertension had been made four years previously, and angina pectoris had been diagnosed two years previously. Although his general practitioner had prescribed antihypertensive treatment, Mr C did not like the side effects of the drug and stopped taking it three and half years ago. His only other current medication was sublingual glyceryl trinitrate as required. He smoked 20 cigarettes a day, having started at age of 20, and consumed 40 units of alcohol per week. Mr C's father had died of a myocardial infarction at age 69, and his mother had died of a stroke at age 70. He had no siblings.

Physical examination revealed power to be reduced at 3/5 in his right arm and right leg with an expressive dysphasia. Tone was increased on the right with a right extensor plantar response and hyperreflexia on the right compared to the left. He was continent and had reasonable sitting balance.

A 12 lead electrocardiogram confirmed him to be in sinus rhythm with left …
Medics worldwide: news and opportunities from the IFMSA
Authors: Jana Kammeyer
Journal: BMJ (2006)

Actions for life: towards a world free of tuberculosis - The IFMSA's Anti-TB campaign aims to draw attention to the global tuberculosis epidemic. As part of the global Stop TB Partnership, IFMSA will be promoting the World TB Day on 24 March 2006 with the theme “Action for life: towards a world free of tuberculosis.” Visit www.stoptb.org for campaign resources, or contact IFMSA's Anti-TB Campaign initiative coordinator (stoptb@ifmsa.org) for further details on medical students' activities.

Opportunity for IFMSA graduates - Have you recently graduated? All IFMSA graduates are eligible for the World Medical …
Obesity could be contagious
Authors: Jenny Blythe
Journal: BMJ (2000)

Obesity could be caused by a virus in some people, says a study published in last month's International Journal of Obesity (2000; 24: 989-96).

Human adenovirus-36 (Ad-36) may be responsible for fat accumulation in up to 30% of obese people. In the study, obese individuals with these viral antibodies also had lower cholesterol and triglyceride levels.

Dr Nikhil Dhuranda is one of the doctors behind the research. He originally injected mice and chickens with Ad-36 …
The Wrong Boy
Authors: Rebecca Monks
Journal: BMJ (2002)

Willy Russell has written some cracking plays—notably, Shirley Valentine and Educating Rita. He has a fine eye for human frailty and an ability to create humour out of the blackest, most miserable of situations. In The Wrong Boy, Russell's first novel, he continues to deliver the goods.

Raymond Marks was, by today's definition, an average lad. By his 18th year he is perceived as a social reject, a mental case, and a dirty “perv.” Raymond evolves from …
The CTLA-4 x OX40 bispecific antibody ATOR-1015 induces anti-tumor effects through tumor-directed immune activation
Authors: Anne Månsson Kvarnhammar, Niina Veitonmäki, Karin Hägerbrand, Anna Dahlman, Karin Enell Smith, Sara Fritzell, Laura von Schantz, Mia Thagesson, Doreen Werchau, Kristine Smedenfors, Maria Johansson, Anna Rosén, Ida Åberg, Magnus Winnerstam, Eva Nyblom, Karin Barchan, Christina Furebring, Per Norlén, Peter Ellmark
Journal: Journal for ImmunoTherapy of Cancer (2019)

<h3>Background</h3> The CTLA-4 blocking antibody ipilimumab has demonstrated substantial and durable effects in patients with melanoma. While CTLA-4 therapy, both as monotherapy and in combination with PD-1 targeting therapies, has great potential in many indications, the toxicities of the current treatment regimens may limit their use. Thus, there is a medical need for new CTLA-4 targeting therapies with improved benefit-risk profile. <h3>Methods</h3> ATOR-1015 is a human CTLA-4 x OX40 targeting IgG1 bispecific antibody generated by linking an optimized version of the Ig-like V-type domain of human CD86, a natural CTLA-4 ligand, to an agonistic OX40 antibody. In vitro evaluation of T-cell activation and T regulatory cell (Treg) depletion was performed using purified cells from healthy human donors or cell lines. In vivo anti-tumor responses were studied using human OX40 transgenic (knock-in) mice with established syngeneic tumors. Tumors and spleens from treated mice were analyzed for CD8<sup>+</sup> T cell and Treg frequencies, T-cell activation markers and tumor localization using flow cytometry. <h3>Results</h3> ATOR-1015 induces T-cell activation and Treg depletion in vitro. Treatment with ATOR-1015 reduces tumor growth and improves survival in several syngeneic tumor models, including bladder, colon and pancreas cancer models. It is further demonstrated that ATOR-1015 induces tumor-specific and long-term immunological memory and enhances the response to PD-1 inhibition. Moreover, ATOR-1015 localizes to the tumor area where it reduces the frequency of Tregs and increases the number and activation of CD8<sup>+</sup> T cells. <h3>Conclusions</h3> By targeting CTLA-4 and OX40 simultaneously, ATOR-1015 is directed to the tumor area where it induces enhanced immune activation, and thus has the potential to be a next generation CTLA-4 targeting therapy with improved clinical efficacy and reduced toxicity. ATOR-1015 is also expected to act synergistically with anti-PD-1/PD-L1 therapy. The pre-clinical data support clinical development of ATOR-1015, and a first-in-human trial has started (NCT03782467).
Picture quiz: Pitting oedema and recurrent pulmonary embolism
Authors: Benjamin Drew, Alexander Finlayson
Journal: BMJ (2008)

A 37 year old man presented with sudden onset, sharp pain across the left side of his chest. The pain was worse on deep inspiration and associated with shortness of breath. He had no history of recent surgery, no long journeys, and he had not been immobile. He reported a previous pulmonary embolism, two years ago. Examination findings include pitting oedema of the ankles and ascites.

He said that his parents noticed he looked “puffy” at the age of 4. This problem worsened, until his face became swollen, and resolved after a course of prednisolone. The swelling returned months later. Further steroids were prescribed, and the problem abated. The patient had experienced relapse throughout his life, each one characterised by generalised oedema, lethargy, and frothy urine.

Routine investigations (box 1) showed that he was hypoproteinaemic, with raised D-dimers. Computed tomography angiography showed a large filling defect in the left lower lobe pulmonary artery—that is, pulmonary embolism (fig 1). Could this man's pulmonary embolism be related to his protein status?



Fig 1 
Computed …
Abstract 17994: Different Effects of Lipophilic and Hydrophric Statin on Muscle Sympathetic Nerve Activity in Heart Failure With Preserved Ejection Fraction
Authors: Hideki Tokuhisa, Hisayoshi Murai, Takuto Hamaoka, Yoshitaka Okabe, Shinichiro Takashima, Takeshi Kato, Soichiro Usui, Hiroshi Furusho, Masayuki Takamura, Shuichi Kaneko
Journal: Circulation (2017)

Introduction: It has been proposed that increased sympathetic nerve play a role in pathogenesis of HFpEF. Recent study suggests that statin use is associated with improved mortality rates in HFpEF ...
Elect to teach
Authors: Eoin Young, Rob Melvin, John Coombes, Miriam Samuel
Journal: BMJ (2004)

Traditionally, medical students spend their electives practising clinical medicine. However, <b>Eoin Young</b>, <b>Rob Melvin</b>, <b>John Coombes</b>, and <b>Miriam Samuel</b> decided to use their basic computer knowledge to teach
Effect of Calcium-Channel Blocker Therapy on Radial Artery Grafts After Coronary Bypass Surgery
Authors: Mario Gaudino, Umberto Benedetto, Stephen E. Fremes, David L. Hare, Philip Hayward, Neil Moat, Marco Moscarelli, Antonino Di Franco, Giuseppe Nasso, Miodrag Peric, Ivana Petrovic, John D. Puskas, Giuseppe Speziale, Kyung Jong Yoo, Leonard N. Girardi, David P. Taggart, Mario Gaudino, David P Taggart, Umberto Benedetto, Brian Buxton, Antonino Di Franco, Stephen Fremes, Leonard N Girardi, Steven Goldman, David L Hare, William L. Holman, Robert Habib, Philip Hayward, Jialin Mao, Neil Moat, Giuseppe Nasso, Miodrag Peric, Ivana Petrovic, John D Puskas, Elfriede Ruttmann-Ulmer, Thomas A. Schwann, James Tatoulis, Robert Tranbaugh, Kyung Jong Yoo
Journal: Journal of the American College of Cardiology (2019)
Creepy crawly medicine--does it work?
Authors: Samena Chaudhry, Ardeshir Bayat
Journal: BMJ (2002)

There are some more unusual techniques used in medicine, and they can also be a little gruesome. The thought of maggots crawling around on your skin is pretty unpleasant, but it does apparently have some therapeutic basis…

Imagine going to a doctor for a leg wound that just won't heal. Instead of prescribing antibiotics, the doctor suggests a treatment of maggots. Sounds horrible? You may have read stories with concentrated close ups of huge numbers of scary and non- sterile looking creatures and wondered why anyone would even consider such a treatment. But, disgusting as it sounds, scientific research has shown that, in some cases, such creepy crawlies may heal a wound more quickly and efficiently than modern medicine. “Biosurgery” using larvae such as maggots for treatment of difficult wounds is now becoming an established discipline in the management of difficult wounds.



VOLKER STEGER/SPL



Maggot therapy (placing live sterile maggots on a wound, also known as larval therapy), in combination with surgery, was used during the early decades of the 20th century for treating osteomyelitis and purulent infections of the soft tissue.1 We have known for hundreds of years that soldiers whose wounds become infected with maggots are less likely to die from septicaemia than those who did not.2 Since the 1940s, when antibiotics became widely available, maggot therapy was used only as a last resort. But maggots have more recently again been used successfully in the treatment of various chronic soft tissue wounds, including neurovascular ulcers, venous stasis …
Development and validation of the Adolescent Asthma Self-Efficacy Questionnaire (AASEQ)
Authors: Simone Holley, Rebecca Knibb, Sue Latter, Christina Liossi, Frances Mitchell, Ruth Radley, Graham Roberts
Journal: European Respiratory Journal (2019)

Perceived self-efficacy is the belief that one can manage prospective situations. Good asthma self-management self-efficacy is associated with better asthma outcomes. However, a well-developed and validated tool to measure adolescent asthma self-management self-efficacy is lacking. Our objective was to develop and validate an Adolescent Asthma Self-Efficacy Questionnaire (AASEQ). The first stage of the study included a review of the literature, interviews with adolescents with asthma and consultations with parents and relevant healthcare professionals to develop a prototype scale. To assess reliability and validity, a further group of adolescents completed the prototype scale, the General Self-Efficacy Scale and KidCOPE (measures coping styles). Retesting was undertaken to assess longitudinal validity. Interviews with 28 adolescents and consultations with other stakeholders resulted in a 38-item prototype scale. Key themes were medication, symptom management, triggers, knowledge, attitude and beliefs around asthma, supportive relationships, schools and healthcare professionals. The prototype scale was completed by 243 adolescents. Factor and reliability analysis reduced it to a 27-item scale with four subsections: symptom management; medication; friends, family and school; and asthma beliefs. The 27-item scale had respectable to excellent internal consistency (α's 0.78–0.91) with results that were stable over time (intra-class correlation=0.82) in 63 subjects who completed it twice. Better adolescent asthma self-efficacy was associated with better general self-efficacy and indices of better asthma management. The AASEQ is a reliable and valid tool that is likely to aid future research and practice focused on adolescent asthma self-management and could be a useful intermediate outcome measure to assess the impact of behavioural interventions.
Sweaty palms could be inherited
Authors: Jamie Wilson
Journal: BMJ (2002)

The unfortunate affliction of a slimy handshake may be genetic and not--as previously thought--a sign of nervousness. American scientists from the University of California at Los Angeles found that people with sweaty plams have a 28% chance of passing their condition on to their children.1 Similarly, nearly two thirds of affected individuals identified a positive family history, …
The medical students' guide to medical terminology
Authors: Leyla Sanai
Journal: BMJ (2002)

Medicine is a strange business. On the one hand, people are always emphasising the importance of communication. On the other, the terms that are used are so opaque and cloaked in euphemisms that it takes a good few years to actually understand what is being said to you. Knowing what people are really talking about can save you a whole heap of trouble.
Revised Risk Stratification Criteria for Children with Newly Diagnosed Acute Myeloid Leukemia: A Report from the Children's Oncology Group
Authors: Todd M Cooper, Rhonda E. Ries, Todd A Alonzo, Robert B Gerbing, Michael R. Loken, Lisa E. Brodersen, Susana C. Raimondi, Betsy A Hirsch, Richard Aplenc, Alan S Gamis, Edward A Kolb, Soheil Meshinchi
Journal: Blood (2017)
Learning to work together
Authors: Marilyn Hammick
Journal: BMJ (2001)

He was going … they … gave him the last rites, but then ten minutes later, they came along and resuscitated him, I mean, that's the trouble with hospitals, no liaison.

Alan Bennett, eavesdropping on two northern women, captures the results of a team not working together.1 It could have happened anywhere. Many of us have found that the theoretical elements of interprofessional collaboration are often not achieved in practice.2 Enhanced collaboration needs to be meaningful and effective for patients and their carers.3 Effective teamwork that puts patients' needs at the centre of the care delivered is an essential constituent of future health and social care services.45 It needs …
Tumor-Derived LOXL2 Is Highly Expressed in Myelofibrosis and Activating Mesenchymal Stem Cells Differentiate into Cancer Associated Fibroblasts In Vitro
Authors: Na Xu, Chengyun Pan, Xuan Zhou, Jixian Huang, Yangqing Lan, Bolin He, Jing Sun, Liu Xiaoli
Journal: Blood (2017)
Sexism in the ’70s
Authors: Leone Ridsdale
Journal: BMJ (2009)

In the 1970s I chose to do an elective learning experience attached to a physician who worked at the general hospital. The hospital was on the east side of town, where the industrial workers lived. I had found he was an excellent doctor. I attached myself to him, and was following him as he went around the wards. He gave his opinion on the patients referred to him for specialist advice. Between wards he reflected ironically on the state of his family and the family generally in North America.

We were standing at the ward desk one day while he was writing down his opinion in a patient’s notes. A surgeon known for …
Minerva: May 2002
Authors: M Willet
Journal: BMJ (2002)

Dietary phytoestrogens, found in soya bean and linseed, are thought to help relieve vasomotor menopausal symptoms. A study of 939 women ( Journal of Nutrition 2002;132:276-82) found that a high intake is also associated with a favourable metabolic cardiovascular risk profile. As with hormone replacement therapy, waist:hip ratios and concentrations of triglyceride and low density lipoprotein cholesterol were lower in women with high intakes. Minerva was glad to read that small concentrations of phytoestrogens are also found in wine and beer.

Surgeons performing thyroid surgery may no longer tie the knot. In a case-control study of 86 patients undergoing lobectomy or total thyroidectomy, the harmonic scalpel, which works by using ultrasonic frictional heating to ligate vessels, shortened operative times by almost 30 minutes compared to the conventional “tie and clamp technique” time ( Archives of Surgery 2002;137:137-42).

Minerva bids farewell to the birthplace of the BMA. The Worcester Royal Infirmary, in the boardroom of which Sir Charles Hastings founded the BMA in 1832, closed last month. In its place opens the new PFI Worcestershire Royal Hospital. Progress?

Some things dont change. A GP wrote to point out that the BMJ has been delivered to one particular private address in England for 119 years. The span of years covers three different general practitioners who have lived in the same house, …
My experience of palliative care
Authors: Bindu Praveen
Journal: BMJ (2009)

Another day in another place as a junior doctor: this was my rather bleak view when I started as a foundation doctor in palliative medicine. On my first day I was greeted by the team, who explained their working pattern. As a hospital based liaison service, the patients were referred for their complex problems. Then one team member would visit the patient, assess, and give recommendations. It was a new experience not having a ward to look after, and initially I followed the specialist nurses in their visits to wards. I remember most, if not all, of my patients.

Often their physical health was lacking, …
Disaster and emergency response training
Authors: Amy Cheng
Journal: BMJ (2005)

Debra reid/ap/empics

Is the shell suit making a comeback?



Medical students haven't traditionally been trained to respond in disaster situations. Now a university in Canada is trying to establish an ambitious training programme that will cater for their training needs. Amy Cheng finds out if medical students are entering a new era of emergency response

The London tube bombings—52 dead. The Asian tsunami—220000 dead. The 11 September attacks—2986 dead. Hurricane Katrina—1163 dead. As these figures and images of devastation flashed across newspaper front pages and television screens, I wondered, as a senior medical student, what I could do to help?

I was travelling in South East Asia when the tsunami struck. As soon as I heard about it and the devastation it caused, I immediately submitted an application to volunteer for the Doctors Without Borders/Medecins Sans Frontieres' emergency relief projects in the affected regions. My enthusiasm was quickly met by disappointment when my application was rejected. According to the organisation, medical students are rarely accepted because we are more of a liability than an asset. Our insufficient medical training, in addition to our need for supervision, diverts the organisation's resources away from the people we are trying to help.

In fact, the literature shows that even experienced medical staff can become a burden, rather than a help at the scene of a disaster. Without sufficient training in emergency response and disaster relief, healthcare workers can become victims themselves, without changing the morbidity and mortality of the population they are trying to help.12

Ever since the attacks on September 11, there has been an explosion of papers that draw our attention to the scarce number of physicians who …
Reply to Hall <i>et al.</i>: Hypersensitivity Pneumonitis Mortality by Industry and Occupation
Authors: Evans R. Fernández Pérez, David Sprunger, Pailin Ratanawatkul, Lisa A. Maier, Tristan J. Huie, Jeffrey J. Swigris, Joshua J. Solomon, Michael Mohning, Rebecca C. Keith, Kevin K. Brown
Journal: American Journal of Respiratory and Critical Care Medicine (2019)
PTH-113 Disease activity affects response to enteral iron supplementation; post-hoc analysis of data from the aegis study
Authors: N Quraishi, S Smith, D Ward, N Sharma, M Sampson, C Tselepis, T Iqbal
Journal: Gut (2017)

Introduction  Iron deficiency is a common extra-intestinal complication of IBD and, as large doses of intestinal iron are poorly tolerated by patients with IBD [1] intravenous iron supplementation is often recommended [2]. It is also often stated that, in patients with chronic systemic inflammation, iron is poorly absorbed from the gut. This has been sparsely investigated although we have previously shown that patients with elevated CRP tend to absorb ferrous sulphate less well [3]. The hepatic peptide hepcidin is the master iron regulator. It is not known if hepcidin prevents iron uptake from the gut in practice in anaemic IBD patients.  Method  We measured serum hepcidin (using MALDI TOF mass spectrometry) in serum samples stored from a previously published phase III trial using ferric maltol to treat IBD patients with anaemia [4]. We then analysed data from this study retrospectively to assess whether baseline hepcidin or CRP would predict response to oral iron supplementation.  Results  The table below gives the baseline characteristics of the study cohort:   There was no correlation at baseline between CRP and hepcidin. Baseline hepcidin was not associated with response to iron replacement either at the primary endpoint (week 12) or at one year follow up. Neither CRP nor hepcidin was associated with haemoglobin response. However week 12 ferritin was inversely correlated to baseline CRP (p=0.004), and there was a trend for an association between TSAT at week 12 and baseline CRP which achieved statistical significance at 12 months (p=0.02).  Conclusion  In this study of factors predicting response to oral iron supplementation in IBD patients, the master iron regulator hepcidin did not seem to be a useful marker. However, there was a clear signal that CRP, as an indicator of chronic inflammation, did predict responsiveness of the body’s iron stores to replenishment with orally administered iron. The association between ferritin and CRP at week 12 and also between CRP and TSAT at 12 months but lack of association between CRP and haemoglobin suggests that, in the presence of elevated CRP, iron supplementation may need to be given for longer to replace iron stores. We suggest that the commonly available acute phase protein CRP should be measured in IBD patients with iron deficiency to help clinicians decide on the most appropriate route of iron supplementation  References  . Lugg S et al. JCC 2014;8:876–880.  . Dignass A et al. JCC 2015;9:211–222.  . Iqbal T et al. Dig Dis Sci 2015;60:1375–1381.  . Gasche C et al. IBD 2015;21:579–588.  Disclosure of Interest  N. Quraishi: None Declared, S Smith: None Declared, D Ward: None Declared, N Sharma: None Declared, M Sampson Conflict with: Shield Therapeutics, C Tselepis: None Declared, T Iqbal Conflict with: speaker fee from Shield