tbuckley/cabot-search huggingface dataset:
Picture Quiz: Spinal cord compression
Authors: Deborah King, Barbara Hammer
Journal: BMJ (2003)

An 82 year old man was admitted to the emergency department with pain in his back. He had a past medical history of hypertension, which was well controlled, and he complained of nocturia--he got up four times a night for the last six months.

The initial physical examination including neurological examination was unremarkable. His full blood count, electrolytes, and liver function tests were normal. A plain x ray of his thoracic spine reveaved a vertebral collapse of T6. Six days after admission, he was unable to move his right leg and was catheterised because of urinary retention. Examination found reduced power in his right leg and decreased reflexes but no sensory deficit.

1.  What are the features seen on the magnetic resonance images (figs 1 and 2)?

2.  What is the probable diagnosis?

3.  How would you confirm the diagnosis?

4.  How would you treat this patient?

5.  What is the prognosis?



Figure 1 



Figure 2 

1.  Spinal cord compression caused by a tumour in the T6 vertebral body.

2.  The tumour is most likely to be secondary to another in the body. Primary tumours of the cord are uncommon. Given the patient's age and history of nocturia, it is likely that the primary tumour is prostatic in origin.

3.  Physical examination of the rectum may show an enlarged prostate with an irregular …
Hope for the globe
Authors: Tiago Villanueva
Journal: BMJ (2007)

<b>Rebecca Hope</b>, a medical student at Leeds, is coordinator of Alma Mata, a global health network for healthcare graduates (www.almamata.net). She has a bachelors degree in international health from University College London and is author of <i>The Elective Pack</i>, available on Student BMJ.com, a guide to international health and development for medical students. She spoke to <b>Tiago Villanueva</b> about the future for Alma Mata and global health
Global Snapshots: Brazil - a rich country full of poor people
Authors: Lalla McCormack
Journal: BMJ (2003)

It's Carnival time in Brazil; a time of year when practical realities such as the country's health policies take a backseat to the sun, samba, and sensationalism of the Mardi Gras festival. The thousands of tourists descending on the country, flocking to the tourist capital, Rio de Janeiro, will embrace the intoxicating hedonism of the spectacle. The few who actually encounter the Brazilian health service will probably do so as a result of excess Cachaca--an unbeleivably potent rum.

Unfortunately, postcards depicting the Cidade Maravilhosa of Rio are unrecognisable to most of the population. In stark contrast to its opulent carnival, …
The pharyngeal pouch
Authors: Gurdeep Singh Mannu, Tunde Odutoye
Journal: BMJ (2008)

A pharyngeal pouch is a pulsion diverticulum of the pharyngeal mucosa through a weakening between the cricopharyngeus and thyropharyngeus muscles at the top of the oesophagus.1 These muscles collectively form the upper oesophageal sphincter. The pressure generated by swallowing can over time result in an out-pouching of the underlying mucosa through this weakness in the muscles. The exact reason why some people get pharyngeal pouches and others do not is unknown, but several theories exist. The more well known include incoordination of the swallowing reflex, resulting in more pressure in the superior oesophageal sphincter, which results in a pulsion diverticulum forming.



Pharyngeal pouch affects about 1 in 200 000 people a year in the United Kingdom.2 It usually occurs in elderly people. The prevalence is greater in men than in women and is greater in the West and Europe than elsewhere. Because Asian emigrants to the West share the raised risk associated with the country in which they live this is most likely to be as a result of environmental factors.

The pharyngeal pouch was first described in 1784 in a letter from Mr A Ludlow, a surgeon in Bristol, to Dr William Hunter about the case of a 60 year old man who had dysphagia: “It was clear that the bag was formed of a dilatation of the entire substance of the posterior part of the pharynx, the uniformity and thickness of both being so exact that it was impossible to ascertain at what particular point the dilatation first began.”3

Two main types of diverticulums can occur in the oesophagus: traction diverticula and pulsion diverticulums. Traction diverticulums occur in the middle third of the oesophagus and are caused by a regional adhesion of the oesophagus to a localised structure such as the trachea or a lymph …
Clinical trials in Europe: less than a fifth report within 12 months
Authors: Lynn Eaton
Journal: BMJ (2019)

Universities across Europe are failing to meet EU rules on reporting clinical trial results within 12 months of the trial being registered, a survey shows.1

The results came just two weeks after a similar survey showed that, despite initial teething problems, UK universities were now ahead of other universities in the EU in filing their results.2

The latest analysis came from an alliance of four campaign groups calling for transparency in clinical trials: TranspariMED (UK), BUKO Pharma-Kampagne (Germany), Test Aankoop (Belgium), and Health Action International (Netherlands).

Rachel Cooper, director of the Transparency International Health Initiative, criticised the failure to report trial results …
Abstract 026: Eicosapentaenoic Acid is a Strong Predictor of Risk for Heart Failure in the Multi-ethnic Study of Atherosclerosis
Authors: Robert C Block, Linxi Liu, Michael Y Tsai, Timothy D O'Connell, Gregory C Shearer
Journal: Circulation (2018)

Introduction: In animal models of afterload stress, eicosapentaenoic acid (EPA) prevents interstitial myocardial fibrosis and preserves diastolic dysfunction. Hypothesis: We hypothesized that EPA is similarly protective in humans. Methods: In the Multi-Ethnic Study of Atherosclerosis, we tested for an effect of plasma phospholipid EPA percent of total fatty acids on primary heart failure incidence across heart failure types including, heart failure with reduced ejection fraction (HFrEF; &lt;45% EF), and with preserved ejection fraction (HFpEF) using Cox proportional hazards modeling in 6566 subjects. Results are mean [95% CI]. Results: A total of 6566 subjects had measured baseline EPA, including 1797 black, 794 Chinese, 1444 Hispanic, and 2531 white participants; 52% were female. Over a median follow-up of 13.0 years, 293 heart failure events occurred in subjects with measured EPA: 129 had HFrEF, 110 had HFpEF, and the remaining 54 had unknown ejection fraction status. Mean EPA in HF-free subjects was 0.77% (0.76 - 0.79), and was lower in heart failure subjects 0.70% (0.65 - 0.74), p=0.002. EPA was associated with lower incidence of HF, having a hazard ratio of 0.73 (0.60 - 0.89) per unit change in percentage of total fatty acids, p=0.001. Adjusting for age, sex, race, BMI, smoking, diabetes mellitus, blood pressure, lipids and lipid-lowering drugs, and albuminuria did not change this relationship. Sensitivity analysis showed no dependence on heart failure type. Adjusting for other fatty acids with clustering did not change hazards. In animals, &gt;2.5% EPA is required for prevention of HF, between 2.5% and 1% is marginal, and &lt;1% EPA is insufficient. Most subjects had insufficient EPA levels (n=4794), fewer had marginal levels (n=1471), and fewer still had sufficient levels (n=301). Subjects with sufficient EPA levels were at 0.40 (0.15 - 0.81) fold risk compared to insufficient EPA (p=0.008). Conclusion: High abundance of EPA is robustly associated with reduced risk for heart failure, independent of established risk factors and regardless of ejection fraction status.
Molecular identification of the source of an uncommon tularaemia outbreak, Germany, autumn 2016
Authors: Daniela Jacob, Kristin Köppen, Aleksandar Radonić, Berit Haldemann, Philipp Zanger, Klaus Heuner, Roland Grunow
Journal: Eurosurveillance (2019)

BackgroundIn 2016, an uncommon outbreak of oropharyngeal tularaemia involving six human cases occurred in Germany, caused by drinking contaminated fresh must after a grape harvest.AimWe describe the details of laboratory investigations leading to identification of the outbreak strain, its characterisation by next generation sequencing (NGS) and the finding of the possible source of contamination.MethodsWe incubated wine samples in different media and on agar plates. NGS was performed on DNA isolated from young wine, sweet reserve and an outbreak case's lymph node. A draft genome of the outbreak strain was generated. Vertebrate-specific PCRs using primers targeting the mitochondrial cytochrome b gene and product analyses by blast search were used to identify the putative source of must contamination.ResultsNo bacterial isolate could be obtained. Analysis of the draft genome sequence obtained from the sweet reserve attributed this sequence to Francisella tularensis subsp. holarctica, belonging to the B.12/B.34 phylogenetic clade (erythromycin-resistant biovar II). In addition, the DNA sequence obtained from the case's isolate supported our hypothesis that infection was caused by drinking contaminated must. The vertebrate-specific cytochrome b sequence derived from the young wine and the sweet reserve could be assigned to Apodemus sylvaticus (wood mouse), suggesting that a wood mouse infected with F. tularensis may have contaminated the must.ConclusionThe discovered source of infection and the transmission scenario of F. tularensis in this outbreak have not been observed previously and suggest the need for additional hygienic precautionary measures when processing and consuming freshly pressed must.
Go for it
Authors: Se Eon Jung
Journal: BMJ (2005)

The Student BMJ, in partnership with the IFMSA, has launched the new International Experiences section on Student BMJ.com, where students can post a report of their elective and IFMSA exchange experiences. Helen Gordon and Se Eun Jung explain what an IFMSA professional exchange is all about and what it takes to set up the programme in your medical school

Every year nearly 7000 medical students escape from the medical school they know so well to learn something new, which they cannot experience at home-a different healthcare system and a different life as a medical student. This programme is organised for students by students and has run successfully since 1951 and 6600 people world wide participated last year.

The exchanges are facilitated and organised through the Standing Committee on Professional Exchanges (SCOPE), which could be considered the backbone of the International Federation of Medical Students' Associations (IFMSA). Its aim is to promote and strengthen international understanding of medical students through international exchanges. These exchanges offer students a unique educational and cultural experience, and are an interesting addition to the traditional medical curriculum. The experience broadens students' knowledge of medical and social conditions in another country.

Each country has a national member organisation (NMO) that is affiliated to the IFMSA. For example, the United Kingdom's NMO is called Medsin-UK. The NMOs are ultimately responsible for the exchanges in their country and they oversee and facilitate the exchange process through the election of at least one national exchange officer, who signs contracts with other countries and looks after every exchange that takes place in their country. They also encourage new faculties to set up exchanges and train the local exchange officers. Each local committee at the respective medical school has local exchange officers, who organise the exchanges at local level. They explain the …
Medicine Man: the Forgotten Museum of Henry Wellcome
Authors: Julia Sarginson
Journal: BMJ (2003)

This exhibition is about a man who, from humble beginnings as a farmer's son in the American mid-west, became one of this countries foremost medical men despite never being a practising doctor. Henry Wellcome trained as a pharmacist and became a household name when he launched the pharmaceutical company Burroughs Wellcome and Company in London in 1880. On the death of his partner, Silas Burroughs, in 1895, Wellcome became the sole owner and used his rapidly increasing wealth to fund his passion for collecting and penchant …
Abstract 21293: Hypertension: Innovating Personalized Strategies for Excellent Results (HIPSTER)
Authors: Geoffrey H Tison, Rose Pavlakos, Tuhin K Sinha, Ian S Eslick, Rebecca Coelius, Hannah Gittelman, Nelson B Schiller, Marilyn R Stebbins, Lisa Kroon, Valerie Clinard, Jeffrey E Olgin, Donald Grandis, Rajni K Rao
Journal: Circulation (2017)

Introduction: In 2012, there were 39 million physician visits for hypertension (HTN), but only 53% of patients have hypertension under control. Remote management coupled with mobile health platforms may help improve communication, medication titration, care team feedback and patient experience. We conducted an observational study in order to evaluate the performance of mobile app-facilitated, team-based remote HTN management program on HTN control, time to control, and time spent under control. Methods: The HIPSTER study was an observational study conducted by the UCSF Division of Cardiology and School of Pharmacy in collaboration with Vital Labs Inc. We enrolled 120 consecutive patients from the UCSF Cardiology clinic who were aged ≥18 years with a diagnosis of essential or co-morbid HTN. Participants downloaded the Vital Labs smart phone application (app) and utilized a home blood pressure cuff to measure blood pressure at least once-daily. The app scheduled blood pressure reminders, allowed for virtual communication via direct messaging, and provided access to patient data. Based on the daily, remote BP measurements, pharmacists performed rapid-cycle medication management for patients remotely, in coordination with study cardiologists. Results: Of 120 patients enrolled, 59% were male, and 10% were between 18-35y, 43% between 36-64y, and 45% &gt;64y. At the time of enrollment, 17.5% of patients were not on any antihypertensive medication. After 6 month follow-up, 84% of patients met their JNC8 goal. Patients took an average of 17 days to achieve BP control, and patients remained under control for 74% of the study duration. Conclusions: Using a mobile-app facilitated remote HTN management protocol, 84% of patients met their JNC8 BP goal, versus an estimated 53% nationally. Compared to prior reports that cite an average of 3.2 months to reach BP goal in real-world practice-based settings, patients in our study achieved JNC8 BP goal within 17 days from enrollment. A mobile app-facilitated remote HTN management platform, coupled with team-based care, can be used to increase achievement of BP control and decrease the time required to achieve BP control. Future directions include examining the generalizability of these findings through randomized studies.
Abstract 21374: Adenovirus Targets Cardiac Gap Junctions to Facilitate Viral Replication
Authors: Patrick J Calhoun, Allen V Phan, Jordan Taylor, Michael J Zeitz, James W Smyth
Journal: Circulation (2017)

Myocarditis is a leading cause of sudden cardiac death in young adults, accounting for 20% of cases under 40 years of age in the United States. Adenovirus is a major etiological agent in this disease yet much remains unknown regarding pathogenesis and predisposition to infection. During adenoviral infection, viral proteins uncouple cell cycle checkpoints for viral DNA genome replication to occur. Connexin43 (Cx43) gap junctions play an essential role in propagation of action potentials to precipitate each heartbeat. Cx43 has also been implicated in cell cycle regulation, leading us to hypothesize that adenovirus targets Cx43 to facilitate viral replication, resulting in arrhythmogenic alterations in cardiac intercellular communication. We find reduced Cx43 expression at the mRNA and protein level within 24 hours of infection with adenovirus type 5 (Ad5) in human epithelial cells. Studies in human induced pluripotent stem cell-derived cardiomyocytes reveal alterations in calcium transient propagation and reduced Cx43 protein levels. Growth factor signaling is activated by early Ad5 proteins and is known to negatively regulate gap junction coupling. We performed genetic screens and have identified the viral protein E4-ORF1 as sufficient in suppression of Cx43 expression and modulation of cardiac transcription factors. siRNA-mediated knockdown of Cx43 protein enhances viral genome replication while transient overexpression of Cx43 significantly inhibits late viral protein synthesis and genome replication. Finally, using dominant-negative trafficking-dead and closed-channel Cx43 mutants, we conclude that inhibition of Ad5 replication by Cx43 is gap junction dependent. Together, these data provide novel insight into molecular mechanisms underlying arrhythmogenic viral myocarditis in addition to understanding the role of Cx43 in adenoviral pathogenesis. Revealing viral mechanisms of gap junction dissolution will contribute not just to the development of novel antiviral therapeutics, but will also provide insight into fundamental Cx43 biology relevant to other forms of heart disease.
Minerva - December 2001
Authors: Amar Alwitry, Iain Gardner, R Rawlins, C S Carr, K M Brown, C R Cameron, J E Dussek
Journal: BMJ (2001)

When patients are advised to visit the local genitourinary medicine clinic, the suggestion often doesn't go down well. A qualitative study of young women in Glasgow found that attending a genitourinary medicine clinic was a stressful event, but not as bad as they had expected. Family planning clinics were perceived as benign compared with genitourinary medicine clinics, which are still associated with people who hold unacceptable social and moral traits (Sexually Transmitted Infections 2001;77:340.3).

The contraceptive pill hits the headlines again. This time it's being linked with reduced bone density (Canadian Medical Association Journal 2001;165:1023.9). Data taken from a sample of 524 women enrolled in the Canadian multicentre osteoporosis study showed that premenopausal “ever users” of the oral contraceptive pill have lower bone densities than “never users.” The reduction in bone density could mean increased fracture risks of 20.30%.



A 64 year old woman at routine follow up for glaucoma reported a few months' history of visual deterioration of both eyes. She had been taking tamoxifen 20 mg daily for eight years …
Minerva: December 2000
Authors: Jonathan Sleath, Manda Crain
Journal: BMJ (2000)

A distinction needs to be made between ‘henna tattoo’ and ‘BLACK henna tattoo’. The injury seen on the 9 yr old boy was caused by ‘black henna’. Black henna contains little or no henna, instead it contains Paraphenaline-diamine, or PPD, a strong sensitizer which causes severe allergic reaction in a large percent of the population.

It's part of a vascular surgeon's job to advise smokers to stop smoking, and 98% of members of the Vascular Surgical Society of Great Britain and Ireland do give advice ( Annals of the Royal College of Surgeons of England 2000;82:424–7). Only a minority give out written information, however, and even fewer (11%) run an antismoking clinic or group. Over half of the surgeons in this survey also counsel their junior staff about smoking. Whether the juniors take any notice could be the subject of another investigation.

Researchers from Oklahoma took advantage of an “animal damage control” exercise to test 21 of the state's wild coyotes for infectious diseases ( Emerging Infectious Diseases 2000;6:477–9). Nearly three quarters carried Ehrlichia chaffeensis , the ricketsial pathogen responsible for human monocytotropic ehrlichiosis. White tailed deer are the best known carriers of E chaffeensis , which jumps to humans and domestic animals on board the lone star tick.

Digestive surgery has …
Premature birth is linked to increased risk of chronic kidney disease into later life
Authors: Elisabeth Mahase
Journal: BMJ (2019)

Babies born at less than 37 weeks have a nearly twofold increased risk of developing chronic kidney disease (CKD) from childhood into mid-adulthood, a new study suggests.1

The paper, published in The BMJ , found preterm and early term birth are strong risk factors for the development of CKD, with a threefold increased risk for those born at less than 28 weeks, and a small increased risk in those born before their due date but after 37 weeks.

Researchers said that the …
Abstract 15474: Loss of Wnt5a Disrupts Endothelial Pericyte Interaction in Pulmonary Arterial Hypertension
Authors: Ke Yuan, Mark Orcholski, Elya Shamskhou, Vinicio de Jesus Perez
Journal: Circulation (2017)

Introduction: Pulmonary arterial hypertension (PAH) is a life-threatening disorder of the pulmonary circulation associated with loss and impaired regeneration of microvessels. Pericytes are highly specialized cells that directly interact with endothelial cells in blood vessels to provide mural support and help promote angiogenesis. Hypothesis: The non-canonical Wnt/PCP pathway orchestrates cell movements during tissue morphogenesis, but whether Wnt5a production and release by PMVECs is required to recruit pericytes to the proximity of vessels is unknown. Methods: We co-cultured pericytes with PMVECs for 24 hours followed by qPCR profiling of Wnt genes. Wnt5a expression was measured in PAH tissues and PMVECs using qPCR, WB and IF. Pericyte motility and polarity were measured with Wnt5a stimulation. A novel conditional endothelial specific Wnt5a knockout (Wnt5aEC/EC) mouse model was generated to assess impact of Wnt5a deficiency on hypoxia induced PH. Results: Characterization of Wnt/PCP gene expression in ...
Ethics in medicine
Authors: Susmita Barman
Journal: BMJ (2004)

Is modern medicine, preoccupied with disease and treatment, undermining ethical concerns? Are our priorities misplaced? Are we leaning towards fame and fortune, rather than basic human disposition?

I set off for the ethical guided tour with the American Medical Association's virtual mentor (www.ama-assn.org/ama/pub/category/3040.html). The site familiarises young doctors with the law, humanities, and bioethics. Each month, the site deals with a “hot area” in medical ethics from all possible perspectives. For instance, the August 2003 issue was dedicated to problems in paediatrics. Cases are presented-one described how a specialist treated …
Bhlhe40 mediates tissue-specific control of macrophage proliferation in homeostasis and type 2 immunity
Authors: Nicholas N. Jarjour, Elizabeth A. Schwarzkopf, Tara R. Bradstreet, Irina Shchukina, Chih-Chung Lin, Stanley Ching-Cheng Huang, Chin-Wen Lai, Melissa E. Cook, Reshma Taneja, Thaddeus S. Stappenbeck, Gwendalyn J. Randolph, Maxim N. Artyomov, Joseph F. Urban, Brian T. Edelson
Journal: Nature Immunology (2019)