tbuckley/cabot-search huggingface dataset:
Student editors: what happened next?
Authors: Pritpal Tamber, Jessica Buchan (née Westall), Simon Kirwin, Sian Knight, Jason O'Neale Roach, Navin Chohan
Journal: BMJ (2002)

What happens after editing the Student BMJ? Did the student editors go on to take over the world, or did they vanish into obscurity? We tracked down those who have been at the helm to find out what they went on to do.
15 minute interview: The new president of the Medical Women's Federation
Authors: Karen Hebert
Journal: BMJ (2005)

<b>Bhupinder Sandhu</b> is the president of the Medical Women9s Federation. Combining a career as a high flying professor of paediatric gastroenterology with family life, she epitomises everything that the federation stands for. <b>Karen Hebert</b> spent 15 minutes with her and found out all about smallpox, DIY, and her involvement in the Medical Women9s Federation.
Assessment of the Development of New Regional Dermatoses in Patients Treated for Atopic Dermatitis With Dupilumab
Authors: Gefei Alex Zhu, Jennifer K. Chen, Albert Chiou, Justin Ko, Golara Honari
Journal: JAMA Dermatology (2019)

This cohort study describes the epidemiology, clinical features, and treatment of patients with moderate-to-severe atopic dermatitis and the association of developing new regional dermatoses with dupilumab treatment.
Drug rape test ‘buys you false confidence’
Authors: Nadeeja Koralage, Chibuzo Odigwe
Journal: BMJ (2004)

A drink testing device to be on sale “in every place where condoms are sold” has been criticised by experts for promoting a false sense of security. The matchbox sized Drink Detective, priced at £3.95 ($7.10; €5.90), detects ketamine; benzodiazepines, such as flunitrazepam (Rohypnol); and * hydroxy-butyrate (GHB), which marketers Bloomsbury Innovations, say are associated with drug rape.

The user puts a droplet of the suspect drink on to each of three sensitive patches, before waiting about 20 seconds for a result. The test works on most drinks, but not those containing orange juice, tomato juice, or milk, where it …
Stem cells: a biological repair kit
Authors: Lucy Modra
Journal: BMJ (2006)

### Star rating:

\**\*|\*: Don't miss

*: Don't bother

Have you ever looked down a microscope and wanted to frame the image for your bedroom wall? “Stem cells: a biological repair kit” is an exhibition of the photographs usually only found in research reports. These pictures are magnified images of stem cells produced by scientists around Australia. The photos are all entries in the Australian Stem Cell Centre's national photographic competition, which is believed to be the first of its kind in the world.



Up Close and Endodermal



The exhibition comprises more than 20 photos of magnified stem cells, including human embryonic stem cells, adult human stem cells, and animal stem cells in various stages of differentiation. Many of the images feature immunofluorescent labelling, making for a stunning technicolour display. Although some of the photos seem better suited to the pages of a histology textbook than a gallery wall, demonstrating biological features with little artistic flair, many entrants have realised the aesthetic potential of highly magnified cells to evoke a variety of forms. In Lincon Stamp and Joan …
Uterovaginal prolapse: a protruding mass
Authors: Mathumai Kanthasamy, Lauren Miguel, Wai Yoong
Journal: BMJ (2009)

An overweight 69 year old woman presented to her general practitioner with a recent feeling of “something bulging” between her legs and a pulling sensation in her pelvis. Notable obstetric, gynaecological, and medical history included three normal vaginal deliveries, the heaviest of which weighed 4200 g; total abdominal hysterectomy five years ago for uterine fibroids; and chronic constipation. Pictures were taken in theatre (figs 1⇓ and 2⇓).



Fig 1





Fig 2





(1) An enterocele. This was confirmed when omentum was seen when the enterocele sac was opened, as shown in fig 2⇑.

(2) Any factor that causes damage to, and break down in, the normal function of ligaments, fascia, and the levator ani muscles (the primary support elements of pelvic structures), can predispose to prolapse. Specific to developing an enterocele is weakening of connective tissue and ligaments that support the uterus. Key factors include ageing, hysterectomy, menopause, childbirth, and multiparity (giving birth …
Woman of 46 wins place to study medicine
Authors: Helen Barratt
Journal: BMJ (2002)

A 46 year old mature student has been given a place at one of the country's newest medical schools, at the University of East Anglia (UEA) in Norwich. Unusually, 57% of the first intake will be mature students; seven of the 110 students starting this autumn are over 40 and a further 22 are over 30. Only 33 are school leavers.

Admissions staff at UEA decided that they could not justify taking an applicant's age into account when considering offering them a place. Although medical schools are technically not allowed to …
One Man's Medicine
Authors: Upasana Tayal
Journal: BMJ (2003)

Cosmetics, that most female of indulgences, are tested in tissue culture obtained from the foreskins of newly circumcised baby boys. This seems odd at the best, embarrassingly inadequate at the worst, especially set against a backdrop of known physiological differences between men and women. Women come out of anaesthesia quicker than men, their hearts beat faster, and their stomachs empty slower, for example.

Yet we persist in a one size fits all approach …
Should I do what they say to secure that grade A?
Authors: Alan Woodall
Journal: BMJ (2001)

It was four weeks before my finals and I, like all my colleagues, was feverishly trying to grab what clinical experience I could get. I was on a busy geriatric firm, and I had plenty of opportunity to practise the invasive procedures that a house officer needs to survive on the wards. The elderly patients were mostly willing to “let the student have a go” and I made the most of the sessions to advance my skills. It was only when I was asked to perform a femoral arterial stab (a painful procedure) on patients who could not give consent that I began to wonder if what I was being asked to do was ethical.

One patient was comatose and the other had advanced dementia, but the doctor encouraged me to “have a go.” My mind raced at this point, torn between the conflict I felt: my natural desire to acquire clinical skills was balanced by an uncomfortable feeling that neither …
MTAS is a joke
Authors: Daniel M Henderson
Journal: BMJ (2009)

Distinctly average. That is the underlying message of my score from the medical training application service (MTAS). Am I proud of it? No, not really. Was I phenomenally disappointed by it? No, not really. Did I harbour any vestige of emotion to what in essence is an arbitrarily formulated number? No, not really. And then there was the score breakdown. Maybe this would shed some light onto my shortcomings and pinpoint exactly where I lost those highly sought after marks. Unfortunately, no such luck. It did tell me more numbers, however.

As you may have guessed by now, the MTAS experience didn’t exactly leave me wanting for more. In all honesty it left a feeling of emptiness. Throughout …
Road traffic accidents: to stop, or not to stop?
Authors: Georgia Ingram
Journal: BMJ (2001)

Picture yourself driving down a long, monotonous stretch of dual carriageway at the weekend. Ahead in the road you become aware that the traffic stream is slowing, and then you see before you the twisted outline of three vehicles that have come off the road ahead. There are a few people milling about outside the cars but no evidence of any organised police or ambulance activity. This is a very “fresh” road accident, and your reaction to coming across it is a tight knot in the stomach, a rising sense of adrenaline, and your inner voice groaning “Oh no …” as you pull over.

You may decide not to pull over. Unless you have the misfortune to be around a road traffic accident you will never need to make that decision. But it is worth thinking about your attitude to good Samaritan acts in advance. It is, after all, much easier to rationalise about whether you would try to help, and what you might achieve, with a clear head than in the thick of disrupted traffic.

In the United Kingdom there is no legal obligation for anyone to stop and help at a road accident. Ethically and morally the General Medical Council encourages trained doctors to provide “anyone at risk with the treat. ment you can be reasonably expected to give.” …
Picture quiz: renal impairment
Authors: Menelaos Philippou, Richard Napier-Hemy
Journal: BMJ (2003)

A 68 year old man with renal impairment was referred to a urology department. He had traces of blood and protein in his urine. He was clinically well and the examination was unremarkable.

The radiographs in figs 1, 2, and 3 were taken.

1.  What are the investigations shown in figs 1 and 2?

2.  What abnormality is seen in figs 1 and 2?

3.  Fig 3 is an oblique view of the above investigation. What can you see?

1.  Fig 1 shows kidneys, ureters, and bladder film (KUB); fig 2 shows an intravenous urogram (IVU).

2.  Fig 1 shows a radio-opaque mass at the level of the left proximal ureter. Whether the mass is in the ureter or overlying it is not clear. Fig 2 shows the same radio-opaque mass in addition to the outline of the renal tract. The left renal tract proximal to the mass appears to be dilated.

3.  The oblique view shows an mass 8 mm across in the left ureter causing partial obstruction. The calcified mass seen above is a mesenteric lymph node overlying the ureter.



From left to right: Fig1, Fig2 & Fig3.



Renal stone disease has been affecting human beings for as long as records exist, and, in fact, much of the early history of surgery deals with stone disease and its disastrous consequences. The Hippocratic …
UK to gain two new medical schools
Authors: Carolyn Edwards
Journal: BMJ (2000)

The UK will have two new medical schools by 2002, the Higher Education Funding Council of England (HEFCE) announced last month. The development is part of a joint HEFCE and Department of Health programme to increase the number of medical students by 1100 each year by 2005. The increase is needed to counter a growing shortage of NHS doctors.

The new medical schools will be based at the University of East Anglia and in the south west …
Thioredoxin-1 confines T cell alloresponse and pathogenicity in graft-versus-host disease
Authors: M. Hanief Sofi, Yongxia Wu, Steven D. Schutt, Min Dai, Anusara Daenthanasanmak, Jessica Heinrichs Voss, Hung Nguyen, David Bastian, Supinya Iamsawat, Shanmugam Panneer Selvam, Chen Liu, Nilanjana Maulik, Besim Ogretmen, Junfei Jin, Shikhar Mehrotra, Xue-Zhong Yu
Journal: Journal of Clinical Investigation (2019)

Oxidative stress is elevated in the recipients of allogeneic hematopoietic transplantation (allo-HCT) and likely contributes to the development of graft-versus-host disease (GVHD). GVHD is characterized by activation, expansion, cytokine production and migration of alloreactive donor T cells, and remains a major cause of morbidity and mortality after allo-HCT. Hence, strategies to limit oxidative stress in GVHD are highly desirable. Thioredoxin1 (Trx1) counteracts oxidative stress by scavenging reactive oxygen species (ROS) and regulating other enzymes that metabolize H2O2. The present study sought to elucidate the role of Trx1 in the pathophysiology of GVHD. Using murine and xenograft models of allogeneic bone marrow transplantation (allo-BMT) and genetic (human Trx1-transgenic, Trx1-Tg) as well as pharmacologic (human recombinant Trx1, RTrx1) strategies; we found that Trx1-Tg donor T cells or administration of the recipients with RTrx1 significantly reduced GVHD severity. Mechanistically, we observed RTrx1 reduced ROS accumulation and cytokine production of mouse and human T cells in response to alloantigen stimulation in vitro. In allo-BMT settings, we found that Trx1-Tg or RTrx1 decreased downstream signaling molecules including NFκB activation and T-bet expression, and reduced proliferation, IFN-γ production and ROS accumulation in donor T cells within GVHD target organs. More importantly, administration of RTrx1 did not impair the graft-versus-leukemia (GVL) effect. Taken together, the current work provides a strong rationale and demonstrates feasibility to target the ROS pathway, which can be readily translated into clinic.
Extract from Clinical Evidence: Diarrhoea
Authors: Guy de Bruyn
Journal: BMJ (2000)

Interventions Trade off between benefits and harms Empirical antibiotic treatment in travellers' diarrhoea Empirical antibiotic treatment in community acquired diarrhoea

Summary points RCTs have found that empirically treating travellers' diarrhoea with antibiotics reduces the length of illness by one to two days. In community acquired diarrhoea, RCTs have found that ciprofloxacin reduces the duration of diarrhoea by one to two days. Trials of other antibiotics have found no evidence of benefit or have not reported on time to cure. Some RCTs found that treatment prolonged excretion of organisms and was associated with the development of resistant organisms.

### Definition

Diarrhoea is defined as watery or liquid stools, usually with an increase in stool weight above 200 g per day and an increase in daily stool frequency.

Incidence/prevalence An estimated 4000 million cases of diarrhoea occurred worldwide in 1996, resulting in 2.5 million deaths.1 In developing countries, diarrhoea is reported to cause more deaths in children aged under five years than any other condition.1 In the United States, which has a low incidence, the estimated incidence for infectious intestinal disease is 0.44 episodes per person per year, or one episode per person every 2.3 years, resulting in about one consultation with a doctor per person every 28 years.2 The epidemiology of travellers' diarrhoea (people who have crossed a national boundary) is not well known. Incidence is higher in travellers going to developing countries but varies widely by location and season of travel. 3

### Aetiology

The cause depends on geographic location, standards of food hygiene, sanitation, water supply, and …
Risk for Major Hemorrhages in Patients Receiving Clopidogrel and Aspirin Compared With Aspirin Alone After Transient Ischemic Attack or Minor Ischemic Stroke
Authors: Holly Tillman, S. Claiborne Johnston, Mary Farrant, William Barsan, Jordan J. Elm, Anthony S. Kim, Anne S. Lindblad, Yuko Y. Palesch, J. Donald Easton
Journal: JAMA Neurology (2019)

<h3>Importance</h3> Results show the short-term risk of hemorrhage in treating patients with acute transient ischemic attack (TIA) or minor acute ischemic stroke (AIS) with clopidogrel plus aspirin or aspirin alone. <h3>Objective</h3> To characterize the frequency and kinds of major hemorrhages in the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial. <h3>Design, Setting, and Participants</h3> This secondary analysis of the POINT randomized, double-blind clinical trial conducted in 10 countries in North America, Europe, and Australasia included patients with high-risk TIA or minor AIS who were randomized within 12 hours of symptom onset and followed up for 90 days. The total enrollment, which occurred from May 28, 2010, through December 17, 2017, was 4881 and constituted the intention-to-treat group; 4819 (98.7%) were included in the as-treated analysis group. The primary safety analyses were as-treated, classifying patients based on study drug actually received. Intention-to-treat analyses were performed as secondary analyses. Data were analyzed in April 2018. <h3>Interventions</h3> Patients were assigned to receive clopidogrel (600 mg loading dose on day 1 followed by 75 mg daily for days 2-90) or placebo; all patients also received open-label aspirin, 50 to 325 mg/d. <h3>Main Outcomes and Measures</h3> The primary safety outcome was all major hemorrhages. Other safety outcomes included minor hemorrhages. <h3>Results</h3> A total of 269 sites worldwide randomized 4881 patients (median age, 65.0 years [interquartile range, 55-74 years]; 2195 women [45.0%]); the primary results have been published previously. In the as-treated analyses, major hemorrhage occurred in 21 patients (0.9%) receiving clopidogrel plus aspirin and 6 (0.2%) in the aspirin alone group (hazard ratio, 3.57; 95% CI, 1.44-8.85;<i>P</i> = .003; number needed to harm, 159). There were 4 fatal hemorrhages (0.1%; 3 in the clopidogrel plus aspirin group and 1 in the aspirin alone group); 3 of the 4 were intracranial. There were 7 intracranial hemorrhages (0.1%); 5 were in the clopidogrel plus aspirin group and 2 in the aspirin plus placebo group. The most common location of major hemorrhages was in the gastrointestinal tract. <h3>Conclusions and Relevance</h3> The risk for major hemorrhages in patients receiving either clopidogrel plus aspirin or aspirin alone after TIA or minor AIS was low. Nevertheless, treatment with clopidogrel plus aspirin increased the risk of major hemorrhages over aspirin alone from 0.2% to 0.9%. <h3>Trial Registration</h3> ClinicalTrials.gov identifier:NCT00991029
Interindividual and Intraindividual Responses to PCSK9 Inhibition
Authors: Paul D. Thompson
Journal: JAMA Cardiology (2019)

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Addition of Low-Dose Decitabine to Anti–PD-1 Antibody Camrelizumab in Relapsed/Refractory Classical Hodgkin Lymphoma
Authors: Jing Nie, Chunmeng Wang, Yang Liu, Qingming Yang, Qian Mei, Liang Dong, Xiang Li, Jiejie Liu, Wenjing Ku, Yan Zhang, Meixia Chen, Xiaojing An, Lu Shi, Malcolm V. Brock, Jie Bai, Weidong Han
Journal: Journal of Clinical Oncology (2019)

Anti-programmed death-1 (PD-1) monotherapy induces a high response rate in patients with relapsed/refractory classic Hodgkin lymphoma (cHL), but complete remission (CR) is infrequently observed. As decitabine is known to boost T-cell function, we assessed the safety and efficacy of anti-PD-1 camrelizumab alone versus decitabine-primed camrelizumab in patients with relapsed/refractory cHL.This two-arm, open-label, phase II study enrolled patients with relapsed/refractory cHL who had received at least two lines of previous therapy. Anti-PD-1 treatment-naïve patients were randomly assigned (1:2) to camrelizumab (200 mg) monotherapy or decitabine (10 mg/d, days 1 to 5) plus camrelizumab (200 mg, day 8) combination therapy every 3 weeks. Patients who were previously treated with anti-PD-1 were assigned combination therapy. Primary end point was CR rate and safety.Overall, 86 patients were enrolled and evaluated for response, with a median follow-up of 14.9 months. In anti-PD-1-naïve patients, CR rate was 32% (six of 19 patients) with camrelizumab monotherapy versus 71% (30 of 42 patients) who were administered decitabine plus camrelizumab (P = .003). At the time of analysis, the response duration rate at 6 months was 76% on camrelizumab monotherapy versus 100% on decitabine plus camrelizumab. For patients who were previously treated with anti-PD-1, 28% achieved CR and 24% partial response after decitabine plus camrelizumab. Ten patients maintained a response at more than 6 months and 81% of responders were estimated to have a response at more than 1 year. For both treatments, the most common adverse events were clinically inconsequential cherry hemangiomas and leukocytopenia that were self-limiting.CR rate in patients with relapsed/refractory cHL who were clinically naïve to PD-1 blockade was significantly higher with decitabine plus camrelizumab than with camrelizumab alone. Decitabine plus camrelizumab may reverse resistance to PD-1 inhibitors in patients with relapsed/refractory cHL.
Relationship Among Diabetes Distress, Decisional Conflict, Quality of Life, and Patient Perception of Chronic Illness Care in a Cohort of Patients With Type 2 Diabetes and Other Comorbidities
Authors: Brigida A. Bruno, Dorothy Choi, Kevin E. Thorpe, Catherine H. Yu
Journal: Diabetes Care (2019)

OBJECTIVE The primary outcome is to evaluate the relationship between diabetes distress and decisional conflict regarding diabetes care in patients with diabetes and two or more comorbidities. Secondary outcomes include the relationships between diabetes distress and quality of life and patient perception of chronic illness care and decisional conflict. RESEARCH DESIGN AND METHODS This was a cross-sectional study of 192 patients, ≥18 years of age, with type 2 diabetes and two or more comorbidities, recruited from primary care practices in the Greater Toronto Area. Baseline questionnaires were completed using validated scales: Diabetes Distress Scale (DDS), Decisional Conflict Scale (DCS), Short-Form Survey 12 (SF-12), and Patient Assessment of Chronic Illness Care (PACIC). Multiple linear regression models evaluated associations between summary scores and subscores, adjusting for age, education, income, employment, duration of diabetes, and social support. RESULTS Most participants were &amp;gt;65 years old (65%). DCS was significantly and positively associated with DDS (β = 0.0139; CI 0.00374–0.0246; P = 0.00780). DDS–emotional burden subscore was significantly and negatively associated with SF-12–mental subscore (β =−3.34; CI −4.91 to −1.77; P &amp;lt; 0.0001). Lastly, DCS was significantly and negatively associated with PACIC (β = −6.70; CI −9.10 to −4.32; P &amp;lt; 0.0001). CONCLUSIONS We identified a new positive relationship between diabetes distress and decisional conflict. Moreover, we identified negative associations between emotional burden and mental quality of life and patient perception of chronic illness care and decisional conflict. Understanding these associations will provide valuable insights in the development of targeted interventions to improve quality of life in patients with diabetes.
Living in blisters and pain
Authors: Samena Chaudhry
Journal: BMJ (2002)

Assya is almost 15 years old and has junctional epidermolysis bullosa, an autosomal recessively inherited condition. A defect caused by gene mutations within the components of the skin allows tissue to separate and blisters to form whenever there is friction or trauma to an area. In many instances, the blistering is spontaneous.

Each day begins painstakingly unwrapping the bandages that have been protectively enveloping Assyas blisters for the past day. Stuck to the weeping skin beneath, the last layer is stripped off while she grits her teeth. As I try to imagine a well adhered plaster being ripped from a partial thickness burn, Im surprised she makes no sound or mention of pain. Its difficult to imagine what the experience of pain might be for someone who has been experiencing it almost continually since birth, and even Assya finds it hard to find a description that fits:

“I met a man once, who wanted me to try laughing gas for pain relief. He kept questioning me on whether I felt like I had been burnt everywhere, but I just burst out laughing in annoyance. I …