tbuckley/cabot-search huggingface dataset:
IT and medicine
Authors: Sarah Aldington, Imogen Thompson, Geoffrey Robinson, Richard Beasley
Journal: BMJ (2007)

Getting acquainted with rapidly advancing information technology is a prerequisite for clinical competency, say Sarah Aldington and colleagues Advances in information technology (IT) have redefined the practice of medicine12. IT has become an integral part of all facets of medicine, and it is now essential that all junior doctors obtain the skills to use it. Junior doctors simply have no choice but to master computer skills, which are now a prerequisite for achieving and maintaining clinical competency. A command of IT also has the advantage of making the junior doctor's working life easier and provides a good basis for ongoing medical education and training3. The world of IT is developing at great speed, and competency in this area is crucial or doctors will get left behind. In hospitals throughout the world, patients' information and communication systems are becoming increasingly computerised in an attempt to use the latest technology to improve patient care. The application is wide ranging-from electronic medical records to digital radiography to intranets that give local clinical guidelines and policies. Investigations can be ordered and drugs prescribed electronically. Although a paperless hospital is probably a remote possibility, most things in a hospital system can be done electronically. The UK Academy of Medical Royal Colleges gives a practical list of core requirements for the provision of IT services in hospitals (box 1)4. Junior doctors should be familiar with these recommendations, which are considered essential to enable them to do clinical work. Junior doctors should bring this list of recommendations to the attention of management if hospitals do not provide adequate IT services. LPWoods ### Box 1: Core requirements for IT servicesRETURN TO TEXT
Personal View: Adapt and survive - don't give up
Authors: Rhona MacDonald
Journal: BMJ (2000)

Having just had my left index finger amputated and been appointed editorial registrar at the BMJ, I can say with confidence that life does not always work out the way you plan!

When I graduated in 1992 from Aberdeen, I had a vague idea of what I wanted to do. Paediatrics in a developing country was looking likely-I had worked in a nutrition centre in Bangladesh for my elective, and in an orphanage in Romania for consecutive summer holidays. Having survived my house jobs, I opted for a general practice vocational training scheme as I thought this would be a useful addition to paediatrics for working abroad. While I was doing my medical rotation, I became increasingly alarmed at the colour of my hands, which at times would be almost black. Not wanting to be a paranoid health worker (every sore head is a potential brain tumour), I waited for months before seeing a rheumatologist, who soon diagnosed me as having CREST syndrome, a rare connective tissue disease. Just to confuse matters this is now called scleroderma, and to confuse …
Rivaroxaban Plus Aspirin in Patients With Vascular Disease and Renal Dysfunction
Authors: Keith A.A. Fox, John W. Eikelboom, Olga Shestakovska, Stuart J. Connolly, Kaj P. Metsarinne, Salim Yusuf
Journal: Journal of the American College of Cardiology (2019)

Chronic kidney disease is associated with an increased risk of both bleeding and ischemic cardiovascular events.The purpose of this study was to determine the balance of risks and benefits from the dual pathway antithrombotic regimen (rivaroxaban 2.5 mg twice daily [bd] plus aspirin, compared with aspirin) in vascular patients with or without moderate renal dysfunction.This was a secondary analysis of the COMPASS (Cardiovascular OutcoMes for People using Anticoagulation StrategieS) trial involving 27,395 patients with chronic coronary or peripheral artery disease.In COMPASS, 21,111 patients had an estimated glomerular filtration rate (GFR) at baseline of ≥60 ml/min, 6,276 had a GRF of <60 ml/min. Both the primary efficacy outcome (cardiovascular death, myocardial infarction, or stroke) and major bleeding were more frequent in those with renal dysfunction, and the frequency of these outcome events was inversely related to GFR. However, the primary outcome was consistently reduced with rivaroxaban 2.5 mg bd plus aspirin, irrespective of GFR category (GFR ≥60 ml/min, 3.5% rivaroxaban plus aspirin, 4.5% aspirin alone, hazard ratio [HR]: 0.76, 95% confidence interval [CI]: 0.64 to 0.90; GFR <60 ml/min, 6.4% rivaroxaban plus aspirin, 8.4% aspirin alone, HR: 0.75; 95% CI: 0.60 to 0.94). Major bleeding was more frequent with rivaroxaban 2.5 mg plus aspirin versus aspirin alone in those with GFR ≥60 ml/min (2.9% rivaroxaban plus aspirin, 1.6% aspirin alone, HR: 1.81; 95% CI: 1.44 to 2.28) and similarly in those with GFR <60 ml/min (3.9% rivaroxaban plus aspirin, 2.7% aspirin alone, HR: 1.47, 95% CI: 1.05 to 2.07).The benefits of the dual pathway COMPASS regimen (rivaroxaban 2.5 mg bd plus aspirin), versus aspirin alone, are preserved in patients with moderate renal dysfunction without evidence of an excess hazard of bleeding.
Abstract 17156: JunD Cardiac-specific Overexpression Results in Larger Infarct
Authors: Alexander Akhmedov, Fabrizio Montecucco, Ariane Schaub Clerigue, Sarah Costantino, Giovanni G Camici, Francesco Paneni, François Mach, Thomas F Luescher
Journal: Circulation (2017)

Introduction: Myocardial injury during short-term ischemia (I) and reperfusion (R) has become clinically important with the use of primary PCI as a first-line strategy in patients with acute corona...
On the front line: Fighting AIDS in a conflict zone
Authors: Clare Taylor
Journal: BMJ (2006)

Clare Taylor is a British doctor who recently returned from working for a year in the Democratic Republic of Congo. It was her first mission with Medecins Sans Frontieres after several years of hospital medicine and training in tropical diseases

I was working in the city of Bukavu, on the shores of Lake Kivu, on the border with Rwanda. It's a beautiful, green, hilly area, still volatile with simmering conflict as the Democratic Republic of Congo tries to emerge from more than 10 years of war. Occasional bursts of fighting remind us of much worse situations in the past decade. For me and the other Medecins Sans Frontieres (MSF) staff, this meant curfews at times and having to be vigilant, but, for the most part, it's business as usual.



Sebastian bolesch/still pictures



Bukavu is a city of 600 000 people in the South Kivu province. Ninety per cent of people are unemployed, and 5-10% are HIV positive. Many people live a hand to mouth existence, and most struggle to feed their families. Transport is difficult along mostly unsealed roads-hot and dusty in the dry season and ankle deep in mud in the wet. The town is marked by the presence of United Nations peacekeepers and many armed Congolese soldiers, some …
Abstract 14519: Assessing Competing Risks for 30-Day Outcomes Following Acute Heart Failure Hospitalizations Using Real World Data
Authors: Ella Nkhoma, Cesare Russo, Zhenchao Guo
Journal: Circulation (2016)

Introduction: Individual risk factors may differentially predict outcomes following acute heart failure (HF) hospitalization. We assessed competing risks for 30-day outcomes using an approach that ...
Increasing incidence of sexually transmitted infections in UK
Authors: Kay Brennan
Journal: BMJ (2002)

A dramatic increase in sexually transmitted infections in the UK has created a desperate need for more sexual education in schools and specialist clinics for young people according to a new report.

The report, Sexually transmitted infections , from the BMA's board of science and education, says that the number of new episodes of sexually transmitted infections (STIs) has doubled in the past decade, with an increase of almost 300 000 cases between 1995 and 2000. This rise is partly attributable to unsafe sexual behaviour among young heterosexual adults …
Real-World Experience of Switching from Deferasirox Dispersible to Film-Coated Tablets: Impact on Adherence to Chelation Therapy, Iron Overload and Renal Function
Authors: Simon Cheesman, Raakhee Shah, Sara Trompeter, Perla Eleftheriou, Bernadette Hylton, Maciej W Garbowski, John Porter
Journal: Blood (2018)
Protein O-GlcNAcylation Is Essential for the Maintenance of Renal Energy Homeostasis and Function via Lipolysis during Fasting and Diabetes
Authors: Sho Sugahara, Shinji Kume, Masami Chin-Kanasaki, Issei Tomita, Mako Yasuda-Yamahara, Kosuke Yamahara, Naoko Takeda, Norihisa Osawa, Motoko Yanagita, Shin-ichi Araki, Hiroshi Maegawa
Journal: Journal of the American Society of Nephrology (2019)

Significance Statement Lipolysis is of particular importance for energy homeostasis in proximal tubular epithelial cells (PTECs), and it is dysregulated during the pathogenesis of diabetic kidney disease. In knockout mice lacking O-GlcNAc transferase specifically in PTECs, the authors demonstrated that protein O-GlcNAcylation, an intracellular nutrient sensing system, is essential for renal lipolysis and ATP production during prolonged fasting. They also found evidence that this novel regulatory mechanism of renal lipolysis involves farnesoid X receptor–dependent upregulation of carboxylesterase-1 and that deficiency of renal protein O-GlcNAcylation exacerbates tubulopathy in diabetic kidney disease. These findings suggest that manipulation of the renal lipolytic mechanism to overcome the effects of prolonged fasting might represent a novel therapeutic approach for diabetic kidney disease. Background Energy metabolism in proximal tubular epithelial cells (PTECs) is unique, because ATP production largely depends on lipolysis in both the fed and fasting states. Furthermore, disruption of renal lipolysis is involved in the pathogenesis of diabetic tubulopathy. Emerging evidence suggests that protein O-GlcNAcylation, an intracellular nutrient-sensing system, may regulate a number of metabolic pathways according to changes in nutritional status. Although O-GlcNAcylation in PTECs has been demonstrated experimentally, its precise role in lipolysis in PTECs is unclear. Methods To investigate the mechanism of renal lipolysis in PTECs—specifically, the role played by protein O-GlcNAcylation—we generated mice with PTECs deficient in O-GlcNAc transferase (Ogt). We analyzed their renal phenotypes during ad libitum feeding, after prolonged fasting, and after mice were fed a high-fat diet for 16 weeks to induce obesity and diabetes. Results Although PTEC-specific Ogt-deficient mice lacked a marked renal phenotype during ad libitum feeding, after fasting 48 hours, they developed Fanconi syndrome–like abnormalities, PTEC apoptosis, and lower rates of renal lipolysis and ATP production. Proteomic analysis suggested that farnesoid X receptor–dependent upregulation of carboxylesterase-1 is involved in O-GlcNAcylation’s regulation of lipolysis in fasted PTECs. PTEC-specific Ogt-deficient mice with diabetes induced by a high-fat diet developed severe tubular cell damage and enhanced lipotoxicity. Conclusions Protein O-GlcNAcylation is essential for renal lipolysis during prolonged fasting and offers PTECs significant protection against lipotoxicity in diabetes.
PCSK9 Inhibitor Use in the Real World: Data From the National Patient Centered Outcomes Research Network (PCORNet)
Authors: Rhonda M. Cooper-DeHoff, Yan Gong, Kathryn McAuliffe, Jiang Bian, Wenliang Song, MacRae Linton, Vivian Fonseca, Eboni Price-Haywood, Emily Guhl, Jordan B. King, Rashmee U. Shah, Jon Puro, Karen L. Margolis, Adrian Hernandez, Alanna M. Chamberlain
Journal: Circulation (2018)
Evaluation and Treatment of Patients With Bradycardia and Cardiac Conduction Delay
Authors: Keith Oken, Mark H. Schoenfeld, Fred Kusumoto
Journal: JAMA Cardiology (2019)

This Clinical Guidelines Synopsis summarizes the 2018 American College of Cardiology/American Heart Association/Heart Rhythm Society Guideline on Bradycardia and Conduction Delay and reviews recommendations for permanent pacing.
Breaking bad news
Authors: Michael Reschen
Journal: BMJ (2007)

A year or so ago, I was a house officer, busy scurrying around the wards taking blood, prescribing fluids, and stealing the odd moment for myself. One evening on ward cover, I was bleeped by a nurse, who asked me to certify a patient who had just died. The family was also about to arrive, but were not yet aware that their relative had died. Would I come and break the news? My answer came quickly: “No problem.”

I had been a house officer for about two months, and already I could feel …
Anaplastic gliomas: Is there a role for aggressive concomitant treatment?
Authors: Luiz Gustavo Sueth Berriel, Fábio Nasser Santos, Ana Carolina Sigolo Levy Diniz, Ludmilla Thome Chinen, Alexandre Andre Balieiro Anastacio da Costa
Journal: Journal of Clinical Oncology (2013)

e13050 Background: Anaplastic glioma is a rare type of glioma, therefore there is no standard treatment after surgery. Adjuvant treatment possibilities are monotherapy with radiotherapy or chemotherapy, or combination therapy done concomitantly or sequentialy. Methods: A comparison of adjuvant treatments in a retrospective analysis of 64 patients with the diagnosis of anaplastic glioma treated at A.C.Camargo Hospital, Sao Paulo-Brazil, from 1994 to 2012. Results: Fifty-eight percent were male, median age 42yo (16-79yo), 76,6% ECOG 0-1, Histopatology was 76,6% astrocytomas, 9,4% oligoastrocytomas and 14% oligodendrogliomas. Adjuvant treatment was concomitant radiochemotherapy in 45, 2%, sequential radiochemotherapy in 14,5%, radiotherapy-only in 16,1%, chemotherary-only in 9,7% and 14,5% received no adjuvant treatment. With a median follow up of 32,2mo (P25-P75 – 13, 3-62, 9mo), median progression free survival (mPFS) was 65mo (CI 29,2 – 100,7mo) and median overall survival (mOS) was 87mo (CI 26,3 – 147,7mo) in the whole group. There was a mOS of 31,4mo for astrocytomas, 89,2mo for oligoastrocytomas and not reached for oligodendrogliomas. Comparing with other treatments, the concomitant therapy group had a longer mPFS (124,8mo vs. 20mo, p: 0,016) and mOS (139,8mo vs. 27,9mo, p = 0.081). When only anaplastic astrocytoma where analyzed, treatment with concomitant radiochemotherapy had better mPFS (p = 0.01) and mOS (p = 0.033). On the other side, treatment with sequential radiochemotherapy didn’t have such impact in either mPFS (p: 0,22) or mOS (p: 0,27). Prognostic factors related with both mPFS and mOS in the whole group were astrocytic histology, multiple lesions and more than 50yo at diagnosis. Non-cortical lesions were also prognostic for mOS. In the multivariate analysis, treatment with concomitant radiochemotherapy had an impact at mPFS (HR 0,28, p = 0.006) and mOS (HR 0,44, p = 0.039). Conclusions: Since there is no standard adjuvant treatment for anaplastic gliomas, evidence for treatment is often taken from GBM studies. This study suggests that an aggressive strategy, like concomitant radiochemotherapy with temozolamide, is useful in grade 3 gliomas, specially in astrocystic histology.
What's on the web? volunteer opportunities
Authors: Irina Haivas
Journal: BMJ (2004)

When looking for a volunteer opportunity far from home, the web is one of the most helpful tools. There are many opportunities on the internet, and you get to specify all the details, from the type of work to the duration and location.

One of the most complete websites on volunteering is www.imva.org, hosted by the International Medical Volunteers Association. This site includes a specific area for students, containing an extensive list of organisations which offer volunteer positions. It also includes resources on international health, …
Modeling Reentry in the Short QT Syndrome With Human-Induced Pluripotent Stem Cell–Derived Cardiac Cell Sheets
Authors: Rami Shinnawi, Naim Shaheen, Irit Huber, Assad Shiti, Gil Arbel, Amira Gepstein, Nimer Ballan, Noga Setter, Anke J. Tijsen, Martin Borggrefe, Lior Gepstein
Journal: Journal of the American College of Cardiology (2019)
Picture Quiz: The genetics of cystic fibrosis
Authors: Bruno Rushforth, Usha Kini
Journal: BMJ (2003)

Mr and Mrs A attend your paediatric clinic with their 18 month old daughter. She has a history of repeated chest infections, failure to thrive, and steatorrhoea (fatty stools). As part of the consultation you take a family history and draw the pedigree (family tree) (fig 1).



Fig 1 
Family tree



1.  What does the double line between Mr and Mrs A represent?

2.  You suspect an inherited disorder. Examining the pedigree, what is the most likely pattern of inheritance--sex linked, autosomal dominant, or autosomal recessive?

3.  What is the most likely diagnosis?

4.  Given that Mr and Mrs A's first child--an 8 year old boy--is fit and well, what is the probability that he is a carrier of the inherited disorder?

5.  While at clinic, Mrs A tells you that she is pregnant and is worried that the child could also be affected by the same condition. Who would you refer her to and why?

1.  Consanguinity, which means “of the same blood.” Mr and Mrs A are genetically related as they share a common set of grandparents--they are first …
Resequencing of 429 chickpea accessions from 45 countries provides insights into genome diversity, domestication and agronomic traits
Authors: Rajeev K. Varshney, Mahendar Thudi, Manish Roorkiwal, Weiming He, Hari D. Upadhyaya, Wei Yang, Prasad Bajaj, Philippe Cubry, Abhishek Rathore, Jianbo Jian, Dadakhalandar Doddamani, Aamir W. Khan, Vanika Garg, Annapurna Chitikineni, Dawen Xu, Pooran M. Gaur, Narendra P. Singh, Sushil K. Chaturvedi, Gangarao V. P. R. Nadigatla, Lakshmanan Krishnamurthy, G. P. Dixit, Asnake Fikre, Paul K. Kimurto, Sheshshayee M. Sreeman, Chellapilla Bharadwaj, Shailesh Tripathi, Jun Wang, Suk-Ha Lee, David Edwards, Kavi Kishor Bilhan Polavarapu, R. Varma Penmetsa, José Crossa, Henry T. Nguyen, Kadambot H. M. Siddique, Timothy D. Colmer, Tim Sutton, Eric von Wettberg, Yves Vigouroux, Xun Xu, Xin Liu
Journal: Nature Genetics (2019)
Vladimir Horowitz (1903–1989)
Authors: Anne R. Hart, Charles H. Kellner
Journal: American Journal of Psychiatry (2019)

Among the many celebrities who have been treated with electroconvulsive therapy (ECT), Vladimir Horowitz stands out as the preeminent musician.Widely celebrated as the foremost concert pianist of the 20th century, Horowitz was a champion of the romantic repertoire, and he reimagined concepts of tone, color, and expression.Privately, however, he had a complicated psychiatric history.He had multiple phobias, paralyzing performance anxiety (which he tried to mitigate by bringing his own piano to every concert), and severe bouts of depression throughout his life.His most debilitating episodes of depression lasted for years on end and were so severe that he withdrew from playing the piano entirely.What is less widely known is that he was successfully treated with ECT on multiple occasions.Horowitz was born in Kiev in 1903, the youngest of four children in a Jewish family.His talents as a young pianist brought him to the West in 1925, where he lived for the rest of his life.He married Wanda Toscanini, the daughter of his mentor, conductor Arturo Toscanini, and they had one daughter, Sonia.His first episode of depression began in 1933, during which he retreated to Lucerne, Switzerland, for 2 years, away from public performance.During this time, he grappled with crippling low self-esteem about his musicianship and perhaps his sexuality as well.His psychoanalysis with Lawrence Kubie in the 1940s may have been, at least in part, an effort to alter his sexual orientation.His second and most severe episode of major depression started in 1953 and resulted in a 12-year retirement from the concert stage.This period was marked by the death of his father-in-law and a traumatic brain injury to his daughter Sonia.He received ECT in 1963 at Presbyterian Hospital in New York, which enabled him to return to his performance career.According to one of his biographers, Horowitz described ECT as a "wonderful treatment that healed his nerves" (1).His third and final depressive episode occurred in 1983, precipitated by a concert tour that was poorly reviewed by friends and critics alike, with the New York Times reporting "lots of wrong notes, clotted chords, and rhythmic distortions.The famous Horowitz precision was only intermittently in evidence" (2).His depression led to physical debility.Historical records hint that he may have had problems with overuse of prescribed barbiturates as well.Another course of ECT, at the Neurological Institute in New York City, resulted in complete recovery.He was subsequently able to perform in Russia for the first time in 61 years, for what would become his final, triumphant international tour.The New York Times raved, "Horowitz returned to the Soviet musical stage today, giving a recital that dazzled the audience and left many in tears.…The audience, applauding loudly and shouting cheers, brought Mr. Horowitz back on stage for six curtain calls after he had played three encores" (3).Horowitz died in 1989 in New York City and is buried in the Toscanini mausoleum in Milan.
Picture Quiz: Vaginal bleeding and vommiting in early pregnancy
Authors: Ebube Obi
Journal: BMJ (2003)

A 45 year old woman was in the 14th week of her second pregnancy. Fourteen years ago she gave birth to a normal baby at term. She now complained of heavy vaginal bleeding to her general practitioner. She missed her ultrasound scan at 12 weeks because she did not think that any information from her scan would make her change her decision to keep the baby. She had lost some weight, which she attributed to morning sickness, but her weight loss had been more severe than in her first pregnancy. She sometimes had abdominal pain.

1.  What is your differential diagnosis?

2.  What main aspects of a physical examination should be carried out?

3.  On examination the uterus is larger than that expected for a normal 14 week pregnancy. What would be the main investigation in this case?

4.  The figure shows her ultrasound scan. Which blood test may help with the diagnosis?

5.  If concentrations of serum s human chorionic gonadotrophin were high, what would the most likely diagnosis be?

6.  What could be the differential diagnosis if her concentrations of human chorionic gonadotrophin were normal?

1.  Threatened abortion, missed abortion, inevitable abortion, incomplete abortion, ectopic pregnancy, or molar pregnancy.

2.  Palpation--To ascertain abdominal distension (uterine enlargement)/fetal parts compatible with pregnancy. Fundal height--At 14 weeks the uterus should be felt per abdomen. Fetal heart sound--At 14 weeks should be audible using an ultrasound device. Speculum examination--To see …