tbuckley/cabot-search huggingface dataset:
Global Snapshots - Lebanon: healthcare advanced yet still inaccessible
Authors: Smitha Mundasad
Journal: BMJ (2003)

Before 1975, Lebanon boasted one of the region's most developed economies. Beirut was the financial centre of the Middle East and home to some of the region's leading health services and medical institutions. The violent civil war, which spanned 16 years, caused enormous problems. In addition was a 22 year occupation of the south by Israel, which ended only three years ago.

The war led to the closure of most state health centres and triggered the expansion of the private sector. The healthcare sector is now dominated by ambulatory care, mostly provided by private medical practitioners and to a small …
Could the menagerie of the gut microbiome really cure cancer? Hope or hype
Authors: Muhammad Bilal Abid
Journal: Journal for ImmunoTherapy of Cancer (2019)

The investigational scale of the gut microbiome is expanding rapidly. In 2018, the intersection of gut microbiota and immuno-oncology received much attention. While the impact of gut microbiota on the immune system was already established, the year received an exponential expansion of microbiome's role in the immunotherapy setting. The microbiome research pipeline is ripe for large-scale, prospective trials. Working knowledge of immune-based cancer treatments, heterogeneity in their responses and resistance mechanisms, relevant immunological and microbiological pathways and potential for gut microbiome in enhancing the responses, is critical.
Head injury and left sided weakness
Authors: Senthil K Selvanathan, Sundip D Udani, Rebecca D Udani, Tony Goldschlager, Jeffrey V Rosenfeld
Journal: BMJ (2008)

A 77 year old man fell on an icy pavement on to his left shoulder and cut his head. He did not lose consciousness. Six weeks later while watching television he noticed his left arm shaking. This lasted for about 50 seconds. In the next 10 days he kept dropping things when using his left hand. He also kept veering to the left while driving, coming close to parked cars. He noticed that he had been feeling increasingly drowsy and had some right sided headache. On examination he had a left hemiparetic gait. His right pupil was larger and less reactive to light. He had a noticeable facial weakness because of the left upper motor neurone; left sided pyramidal weakness; and a left extensor plantar. He had no sensory loss of note. A computed tomogram of the head was arranged. Computed tomogram of the head
Imperial War Museum North
Authors: Bruno Rushforth
Journal: BMJ (2003)

In 1915, Robert Jones, a surgeon from Liverpool, travelled to France to show how his newly designed splints could help secure compound fractures in British soldiers on the battlefields of the first world war. Jones became director of military orthopaedics and played a key role in reducing disability among men and women in the armed services.



An artificial limbPHIL SAYER



The recently opened Imperial War Museum North charts the impact of war through personal narratives. It describes how doctors and scientists were spurred on to develop innovative treatments by the urgency of war. We learn how orthopaedics, the use of penicillin and antimalarial drugs, and the prevention of sexually transmitted infections—“he picked up more than a girl”—were given fresh impetus in the drive to maximise …
Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) using electrocautery-enhanced lumen-apposing metal stent: the easiest way to perform EUS-CDS?
Authors: Marion Schaefer, Jérémie Albouys, Romain Legros, Denis Sautereau, Aurelie Charissoux, Hugo Lepetit, Jeremie Jacques
Journal: Endoscopy (2019)

Endoscopic ultrasound (EUS)-guided biliary drainage is an alternative to percutaneous transhepatic biliary drainage (PTBD) in patients with malignant biliary obstructions and those for whom endoscopic retrograde cholangiopancreatography (ERCP) fails or is impossible. Duodenal stenosis attributable to tumor overgrowth is a classic example of the latter situation. Although increasing evidence indicates that EUS-guided biliary drainage is superior to PTBD [1], only a few expert centers routinely perform the former procedure, which is technically challenging.
Abstract 128: Efficacy Of Plasma Exchange For Refractory Kawasaki Disease: The Earlier, The Better
Authors: Kunio Hashimoto, Hideki Motomura, Hiroyuki Moriuchi
Journal: Circulation (2015)

Background: Amelioration of systemic inflammatory changes during the acute phase of Kawasaki Disease (KD) is critical for preventing coronary artery lesions (CALs). Plasma exchange (PE) therapy has been applied to patients with severe KD in several medical facilities in Japan and been covered by health insurance since 2012. Methods: We reviewed medical records of five KD patients, aged 3 to 44 months, who were treated with PE in Nagasaki University Hospital from December 2012 to August 2015. Results: All patient were treated with two courses of intravenous immunoglobulin (IVIG). After IVIG that had offered little or no improvement, two of the five patients used infliximab and another used cyclosporine A before PE. PE was performed for the consecutive 3 or 5 days until defervescence and clinical improvement were obtained. Acute inflammatory changes were successfully ameliorated upon PE therapy in all five patients, although two patients who had already developed CALs before PE on days 20 and 21, respectively, residual CALs were confirmed one year after the treatment. No CALs had developed in the remaining three patients who started PE therapy within nine days after onset (days 8, 8 and 9, respectively). PE therapy was carefully performed in the intensive care unit, and no severe adverse events occurred. Discussion: PE therapy is able to ameliorate acute inflammation in most cases of severe KD refractory to standard IVIG therapy; however, it is critical to start PE therapy earlier than day-10 in order to prevent CALs. Thus, pediatricians have to make prompt decision on referral of their KD patient who did not respond IVIG to the institutions where PE is applicable in Japan.
Neurological examination: feel the fear, then do it anyway
Authors: Gavin Yamey
Journal: BMJ (1999)

<b>Gavin Yamey</b> presents a practical approach to a widely feared task Neurology has always had an image problem. It conjures up an arcane world where educated men in bow ties elicit startling diagnoses with a hat pin or a single glance. Lesser mortals can barely pronounce Gerstmann-Sträussler-Scheinker syndrome or Pelizaeus-Merzbacher disease (both true entities, I9m afraid). The result is that when we come to perform a neurological examination ourselves, we feel incompetent and afraid. This article makes only one claim - to give you some guidance through the thorny thicket so that you will hopefully emerge triumphant. Under exam conditions, being polite and courteous to patients will always score highly, so make sure that they are comfortable and always cover them once the exam is over.
Passing for Normal - a Memoir of Compulsion
Authors: Rhys Thomas
Journal: BMJ (2001)

You'll find Passing for Normal in the psychology section of your local bookshop. Really, it shouldn't be there. Perhaps there is no specific category into which this book fits comfortably, being relevant to both clinicians as well those who fancy a damn good read.

Amy Wilensky tells of her battles with the neurological disorder Tourette's syn. drome and how they shaped her childhood and adolescence. During this time they were dismissed …
All about chocolate
Authors: Alexandra Brooks
Journal: BMJ (2001)

A plain brown bean brought back to Europe by the Spanish conquistadors is now an almost indispensable part of the British diet. Whether you enjoy it plain, dark, or milk most would agree that chocolate is indeed a “food of the gods.”

The original South American “xocoatl” or “chocolatl” was a bitter drink enjoyed by the Aztec Elite. Its reputation as a sacred drink travelled to Europe with …
Minerva: Decemver 2002
Authors: Nitin Shastri, M Yadav
Journal: BMJ (2002)

Humans may have two nostrils, but these dont necessarily share the same sense of smell. Elusive scents may be detected by one nostril but not the other. According to a brief communication in Nature (2002;419:802) individual nostrils that are initially non-detectors can be trained through repeated exposure to pick up unusual odours. This implies that although separate nerve supplies connect the nostrils to the brain, there must be some exchange of information going on in the brains olfactory centre.

Myocardial injuries commonly happen when coronary stents are inserted. The extent of the damage depends on local platelet aggregation, inflammation, and increased oxidative stress. Because statins have an effect on these elements, in addition to their lipid lowering effects, cardiologists tested the idea that giving a statin before carrying out stenting procedures might reduce the extent of myocardial damage ( Circulation 2002;106:2180-3). Giving statins before the procedure was associated in this small study with a reduced incidence of larger infarctions related to stenting.

Some people believe that impaired circulation of cerebrospinal fluid has a role in the high incidence of Alzheimers disease in elderly people, by encouraging the deposition of amyloid and tau protein in the brain. Draining cerebrospinal fluid …
Abstract P220: Elevated De Novo Lipogenesis Fatty Acids and Lower Omega-6 Fatty Acids Are Associated With Markers of Insulin Resistance and Respond to Changes in Dietary Carbohydrate Intake in Overweight Individuals on Weight Loss Diets
Authors: Kristina H Jackson, William S Harris, Christopher D Gardner
Journal: Circulation (2018)

Background: High blood levels of certain fatty acids (FAs) in the de novo lipogenesis pathway (DNL; i.e., 16:0, cis-16:1n7) and low levels of omega-6 FAs (n-6 FA; i.e., 18:2n6) have been related to increased risk for type 2 diabetes. We hypothesized that individuals with insulin resistance (IR) would have higher DNL and lower n-6 FA plasma levels than insulin sensitive (IS) individuals, and that DNL FA levels would decrease on a low-carbohydrate (LC) diet and not change on a low-fat (LF) diet. Methods: Plasma FAs were measured as a % of total FA in subjects (n=61) with varying degrees of obesity and IR before and after 6 months of LF or LC weight loss diets. IR metrics were calculated pre- and post from oral glucose tolerance tests and fasting blood samples. FA medians (Interquartile Range), Spearman correlations (R) and Mann-Whitney test results are presented. Results: All differences shown are significant at P&lt;0.05 unless reported as not significant (NS). Compared to the IS group, IR individuals had higher 16:0 (IR: 22.9% [22.2, 24.3] vs IS: 21.7% [20.2, 22.5]) and 16:1n7 (IR: 1.8% [1.4, 2.2] vs IS: 1.3% [1.1, 1.6]), and lower 18:2n6 (IR: 30.8% [27.8, 31.6] vs IS: 32.5% [30.0, 34.6]) levels at baseline. 16:0 and 16:1n7 were directly related to BMI (0.40, 0.28), fasting insulin (0.40, 0.33), HOMA-IR (0.40, 0.43), TG:HDL (0.38, NS) and indirectly to Matsuda Index (-0.35, -0.34). 18:2n6 was directly related to the Matsuda Index (0.35) and indirectly to HOMA-IR (-0.37) and TG:HDL (-0.45). Diet x IR status analyses were not significant, thus FA changes on LC and LF diets were compared. 16:1n7 decreased on the LC diet and did not change on the LF diet (LC: -0.5% [-0.7, -0.3] vs LF: -0.1% [-0.3, 0.2]). 18:2n6 levels increased on the LC diet and decreased on the LF diet (LC: 0.9% [-0.3, 2.7] vs LF: -0.5% [-2.4, 0.6]). Changes in dietary carbohydrate (% of calories) correlated with changes in 16:1n7 directly (0.38) and 18:2n6 indirectly (-0.37). Changes in 16:1n7 were directly related to changes in weight (0.55) and TG:HDL (0.65), and changes in 18:2n6 were indirectly related to TG:HDL changes (-0.51). Conclusions: Elevated plasma DNL FA and lower 18:2n6 were evident in IR vs. IS individuals, and individual markers of IR were related to FA levels accordingly. DNL and 18:2n-6 responded to changes in carbohydrate intake. FA patterns may be a useful tool to identify IR individuals and track carbohydrate consumption.
An umbilical defect
Authors: Michael Curci, Talia Hoffsetin
Journal: BMJ (2005)

During their caesarean delivery, one of three triplet fetuses, aged 31 weeks and 2 days, was noted to have a clear shiny sac protruding from the base of the umbilical cord. The defect was immediately covered with moist dressings, which upon removal had some green-yellow staining. Physical examination showed an intact membranous sac containing what seemed to be several loops of bowel. Upon closer inspection of the sac, a small stoma was discovered (figure).

1.  What is your diagnosis?

2.  What additional diagnostic investigation could be useful in this case? Is it necessary?

3.  What is the treatment of choice?

1.  There is a protrusion of abdominal contents through a mid-line defect that involves the umbilicus and a surrounding sac. It is the presence of the surrounding sac that classifies this defect as an omphalocele rather than gastroschesis (see discussion).
        The stoma is the probable source of the fluid drainage and likely represents a patent persistent omphalomesenteric duct. A ruptured omphalocele can be ruled out by the …
Court overturns “designer baby” ban
Authors: Bruno Rushforth
Journal: BMJ (2003)

The Court of Appeal has ruled that the UK fertility treatment regulator, the HFEA (Human Fertilisation and Embryology Authority), can allow a Leeds couple to select tissue matched embryos to help save their son with thalassaemia.

The family hope that by choosing embryos for in vitro fertilisation that are both free of disease and offer …
A guide to medical etiquette: revealing yourself-the Do's and Don'ts
Authors: David McAllister
Journal: BMJ (2000)

Bruce Wayne, Clark Kent, and the experienced medical student all have something in common. Each has learned the value of not revealing themselves to others in public. Some of the inexperienced among you may be under the impression that it is fine to tell people that you are a medical student.

This may once have been the case. The medical profession worked long to establish the widespread regard and concomitant professional status we …
In charge of a nation's health
Authors: Thomas Jaconelli
Journal: BMJ (2007)

When New Labour came to power in the United Kingdom in 1997 <b>Frank Dobson</b>, member of parliament for Holborn and St Pancras, was appointed secretary of state for health, a post he held for more than two years. As a seasoned politician he is a frequent media commentator on the health service. When <b>Thomas Jaconelli</b> applied to Hull York Medical School he was interviewed by Dobson. Now the tables are turned
Surgical emergencies: acute abdominal pain
Authors: Kevin Turner, Adam Jones, Ashok Handa
Journal: BMJ (2000)

Adam Jones , Kevin Turner , and Ashok Handa guide you through the early management of abdominal pain Abdominal pain is common, accounting for around 1% of all admissions to hospital.1 The trouble with surgical textbooks is that abdominal pain is classified by system, which is fine for written exam answers but does not help much when you're faced with a patient, except to remind you of the many possible diagnoses in front of you. Many of these are not life threatening. In some, however, rapid diagnosis and treatment can save lives. In theory you will never have to face these serious cases alone as a house officer, but in practice you may have to. Do not panic - it is not as daunting as you may think if you follow a few basic principles. This article will tell you these basic principles that will get you through the initial presentation." It is not textbook stuff for written exams, as you can easily learn lists of symptoms and signs, but it is sound practical advice that is good for vivas and ward rounds, and may save your skin (and your patients). There are two things to remember as you make your way quickly to your patient. Firstly, remember the conditions that are less common but life threatening. Against this, do not forget that common things are common. When you first see the patient there are only three diagnoses: Very ill; ill; and reasonable/well. So ask yourself three questions.
<i>Notes from the Field:</i> Live Poultry Shipment Box Sampling at Feed Stores as an Indicator for Human <i>Salmonella</i> Infections — Michigan, 2016–2018
Authors: Jennifer L. Sidge, Kimberly Signs, Sally Bidol, Kelly Jones, Sheri Robeson, Marty Soehnlen, Mary Grace Stobierski
Journal: MMWR Morbidity and Mortality Weekly Report (2019)
Targeting Src/Stat-3/HIF-1α by soy isoflavones for radiosensitization of prostate cancer
Authors: Vinita Singh-Gupta, Hao Zhang, Sanjeev Banerjee, Julian Raffoul, Fazlul Sarkar, Gilda Hillman
Journal: Cancer Research (2008)

418  We have shown that soy isoflavones act as potent radiosensitizers of prostate cancer (PCa). Pre-treatment with soy isoflavones enhanced cell killing of PC-3 human PCa cells by radiation in vitro and in vivo in an orthotopic PC-3/nude mouse model leading to more effective prostate tumor growth inhibition than each modality alone. We found that soy isoflavones inhibit the radiation-induced DNA binding activity of the transcription factor NF-κB and apurinic/apyrimidinic (AP) endonuclease 1/redox factor-1 (APE1/Ref-1) expression, two major signaling molecules involved in cell survival signaling pathways. In addition to its role as a DNA repair enzyme, APE1/Ref-1 also functions as a redox activator of multiple cellular transcription factors, including NF-κB and HIF-1α. APE1/Ref-1, NF-κB and HIF-1α are upregulated by radiation and are all implicated in radioresistance of cancer cells. Initial studies in the orthotopic PC-3 tumor model showed that prostate tumors treated with radiation express HIF-1α but this expression is reduced following combined treatment with soy and radiation. Based on these findings, we explored the effect of soy isoflavones on HIF-1α and its upstream signaling molecules Src and Stat-3. We also tested whether alterations of the Src/Stat-3/HIF-1α signaling pathway by soy is involved in radiosensitization of PCa. PC-3 cells were pre-treated with soy isoflavones in vitro, then irradiated and processed for protein extraction to test for signaling molecule expression or NF-κB and HIF-1α DNA binding activity by western blot analysis and EMSA. We found that radiation induced phosphorylation of Src and Stat-3 leading to induction of HIF-1α whereas soy isoflavones did not activate this pathway. Furthermore, we demonstrated that activation of the Src/Stat-3/HIF-1α signaling pathway by radiation was inhibited by pre-treatment with soy isoflavones. These data correlated with decreased expression of APE1/Ref-1 and decreased DNA binding activity of NF-κB and HIF-1α resulting in increased cell killing by combined soy isoflavones and radiation treatment. Our studies suggest that soy isoflavones alter the Src signaling pathway and could enhance radiosensitivity of PCa cells by inhibiting radiation-induced HIF-1α expression and activity. Moreover soy isoflavones inhibition of expression of APE1/Ref-1 could lead to decreased redox activity of NF-κB and HIF-1α affecting their DNA binding activity, as demonstrated in our studies. Because both transcription factors are involved in transcription of genes essential for tumor growth, angiogenesis and invasion and are upregulated in response to radiation, soy isoflavones inhibition of these cell survival pathways could potentially radiosensitize cancer cells and increase cell killing. This novel approach using safe dietary agents to enhance the efficacy of radiotherapy is relevant for the design of new clinical strategies for prostate cancer.
NorthSouthEastWest—a360° view of climate change
Authors: Berislav Bulat
Journal: BMJ (2005)

In Tifaeus , Plato describes the dramatic cataclysm of Atlantis, when one complete civilisation was erased thus: “…and in a single day and night of misfortune all your warlike men in a body sank into the earth…” . How would this be described by today's media? Would it be as a humanitarian disaster, like the Asian tsunami or the hurricanes in the United States? But what if a complete indigenous civilisation's homeland is irreversibly wiped out, a scenario that is likely to happen to the people of small island states in the Pacific? This is just one of the aspects on the issues of climate changes that the North South East West exhibition, launched in March at the Science Museum in London, is trying to bring attention to. The exhibition will be touring the world during the next year to coincide with the British Council's Zero Carbon City initiative for raising awareness of the problems caused by climate changes (www.britishcouncil.org/zerocarboncity …
Helen Salisbury: Alone in a darkened room
Authors: Helen Salisbury
Journal: BMJ (2019)

In some general practices, patients seeking help or advice may be seen by a doctor but could equally be given an appointment with a nurse, paramedic, physician’s associate, or pharmacist. This may look like a sensible—and cost effective—solution to the current GP workforce crisis.

However, all patients still need a registered GP who ultimately bears responsibility for their care. In this new, multi-professional model, which is most evident in some of the more commercial practice chains, individual GPs can end up with list sizes of over 4000 patients.

When my last patient leaves the surgery at the …
The Chylomicronemia Syndrome Is Most Often Multifactorial
Authors: Alan Chait, Robert H. Eckel
Journal: Annals of Internal Medicine (2019)

The chylomicronemia syndrome occurs when triglyceride levels are severely elevated (usually >16.95 mmol/L [1500 mg/dL]) and is characterized by such clinical features as abdominal pain, acute pancreatitis, eruptive xanthomas, and lipemia retinalis. It may result from 1 of 3 conditions: the presence of secondary forms of hypertriglyceridemia concurrent with genetic causes of hypertriglyceridemia, termed multifactorial chylomicronemia syndrome (MFCS); a deficiency in the enzyme lipoprotein lipase and some associated proteins, termed familial chylomicronemia syndrome (FCS); or familial partial lipodystrophy. Most chylomicronemia syndrome cases are the result of MFCS; FCS is very rare. In all these conditions, triglyceride-rich lipoproteins accumulate because of impaired plasma clearance. This review describes the 3 major causes of the chylomicronemia syndrome; their consequences; and the approaches to treatment, which differ considerably by group.
Planning your elective--the Caribbean
Authors: Mark Wilson
Journal: BMJ (2002)

Mark Wilson gives handy hints on organising an elective in the Caribbean

An elective in the Caribbean will, not surprisingly, raise suspicions of a plan for a big holiday. A fascinating variety of medicine can, however, be found even within one island: because of its wide variation in wealth for example, Jamaica has both excellent private and severely underfunded public health care. Outside hospital work there is plenty to do on all the islands--diving, sailing, eating, drinking, dancing.

The Caribbean as a whole has a subtropical climate with very mild winters. It's hottest between June and September (30°C), but this is also when rainfall tends to peak.

This article will go through the islands from north to south, so look at the map.

The University of the West Indies, Faculty of Medical Sciences, The Registry, Kingston, Jamaica, WI (Tel: +1 876 927 1297, Fax: +1 876 927 2556) has affiliated hospitals on Antigua, Dominica, St Vincent, St Lucia, Grenada, Martinique, Jamaica, Guadeloupe, St Joseph, St Martin, and Barbados. You can apply for an elective by writing directly to the hospitals.



Island hopping - a map of the Caribbean



The Bahamas are a group of over 700 islands, although only 30 are inhabited. The main government hospitals are in Nassau and Freeport.

The Princess Margaret Hospital, Nassau--This 484 bed hospital …