tbuckley/cabot-search huggingface dataset:
Yes, I'm Asian
Authors: Robin Som
Journal: BMJ (2007)

It's happened often enough to get slightly irksome. I meet someone new; I go through the formalities of small talk; and the question of what I study arises. I say that I'm a medical student. Then there it is-the smirk-followed by, “Oh, I should've guessed.”



Why don't they smirk at him?



This isn't because every time I meet someone I take their history. No, it's because I'm Asian. I'm not paranoid-press the irritant on their reasoning, and they'll honestly state that my ethnicity is the give away.

The assumption that a lot of Asians study medicine, though somewhat unreasonable, should be expected. In 2003, 22% of medical students accepted were Asian-that is, originally from the Indian sub-continent-according to a 2004 BMA discussion paper.

Talking to many medical students, it seems that the freedom to make the choice of medicine or not is race related. Non-Asian medical students normally say that their parents were happy for them to choose whatever course they wanted. The story is different for Asian medics. Those that I have spoken to state that it was medicine and nothing else for them-the consensus being that most courses are disapproved of while medicine is placed on a pedestal. “I wanted to be a teacher, but my parents said that wasn't good enough for me…….medicine would make me unique and better,” said a colleague, because “medicine gives you the respect of others; you'll have a job for life.” Job stability and respect are clearly valued in the Asian community.

There is a perceived hierarchy of subjects that exists in Asians-at the bottom lie …
Leg ulceration in a young woman
Authors: John Fleming, Louise Newell
Journal: BMJ (2007)

A 21 year old woman presented to her local emergency department with a painful necrotic blister on her left lower leg, which she thought might have followed an insect bite. Doctors diagnosed an abscess, which was treated with oral antibiotics. Three months later she presented with another presumed abscess in her right leg. Intravenous antibiotics were given and multiple surgical debridements were carried out over a two week period. Despite these interventions, the lesion rapidly advanced, and the patient became systemically unwell (fig 1). The admitting orthopaedic team suspected necrotising fasciitis and contemplated amputation of the leg below the knee.

Her C reactive protein concentration was 350 mg/l; white blood cell count 35×10/l; blood film, lymphocyte subsets, and serum protein electrophoresis were normal; and vasculitic and autoimmune screens and hepatitis serology were negative. Blood cultures and tissue microbiology for bacteria, fungi, and mycobacteria were also negative.

The extent of her deterioration required her to be transferred to the intensive care unit, where she was reviewed by dermatologists. They made an immediate diagnosis based on her clinical features and apparent lack of an infective cause.



Fig 1 
A large ulcer on the patient's right leg before a change of dressing. The well defined edges on the superior border reflect …
UK youth to be “most infertile in the history of mankind”
Authors: Ioana Vlad
Journal: BMJ (2004)

Young people in the United Kingdom are destroying their future health as a result of their alcohol drinking, drug taking, obesity, and sexual behaviour, says a new report. Speaking at the launch of the BMA's report on adolescent health, Russell Viner, a consultant in adolescent medicine, said, “The next generation will be the most infertile, obese, and suffer …
Scottish medical students accept acts of academic misconduct
Authors: Stephen Goldie
Journal: BMJ (2003)

Medical students think it is acceptable to forge signatures, pass off previous work as new, and falsify patients' information, researchers from the University of Dundee have found.

The study published in the Journal of Medical Ethics is based on data collected in 1999 at the University of Dundee. A total of 676 medical students representing all five years of medical school received questionnaires, and 461 (68%) completed the anonymous forms.

It assessed their attitudes to 14 scenarios in which fictitious student, “John,” engaged in dishonest behaviour. Students were asked whether they found John's actions to be wrong, answering …
Travellers put themselves at risk of hepatitis A
Authors: Helen Barratt
Journal: BMJ (2002)

Many people travelling to developing countries this summer could unwittingly put themselves in danger of infection with the hepatitis A virus, the European Travel Health Advisory Board has warned. Researchers interviewed 600 travellers at major European airports, and their findings, presented to the third European Conference on Travel Medicine, suggest that most people do not consider themselves at risk of contracting the virus. Also, …
Abstract 11462: The Clinical Significance of Pulse Pressure in Patients With Heart Failure With Preserved Ejection Fraction
Authors: Takanori Tokitsu, Eiichiro Yamamoto, Yoshihiro Hirata, Koichiro Fujisue, Koichi Sugamura, Megumi Yamamuro, Koichi Kaikita, Seiji Hokimoto, Seigo Sugiyama, Hisao Ogawa
Journal: Circulation (2015)

Background: Although pulse pressure (PP) has been recognized as a risk factor for various cardiovascular diseases, its association with cardiovascular outcomes in patients with heart failure (HF) with preserved ejection fraction (HFpEF) remains uncertain. This study aimed to assess the relationship between PP and cardiovascular outcomes in HFpEF patients. Methods: We enrolled 317 consecutive HFpEF patients, admitted to Kumamoto University Hospital from 2007 to 2013. We measured blood pressure (BP) by using ankle brachial index (ABI) form on admission. PP values higher than 65 mmHg were defined as high-PP as reported previously. Results: PP had a significant positive correlation with pulse wave velocity (PWV) (r=0.50, p&lt;0.001), and negative correlations with estimated glomerular filtration rate (eGFR) (r=0.32, p&lt;0.001) and hemoglobin levels (r=0.27, p&lt;0.01) in HFpEF patients. In multivariate logistic-regression analysis, age, hemoglobin, eGFR and the presence of diabetes mellitus were independently associated with high-PP. PP also had strong and significant correlations with eGFR, PWV and hemoglobin level. In multivariate-Cox-proportional hazard analysis, high-PP (p=0.01), the presence of ischemic heart disease (p=0.01), and B-type natriuretic peptide (BNP) values (p=0.01) were independently associated with the occurrence of cardiovascular events (CVE). In Kaplan-Meier analysis, HFpEF patients with high-PP had a significant higher risk of CVE and HF-related events (both, log-lank test, p&lt;0.01). Multivariate-Cox-hazard analysis identified that high-PP, but not high-systolic BP (SBP), as an independent predictor of both CVE (hazard ratio [HR]: 2.15, p=0.01) and HF-related events (HR: 4.37, p&lt;0.01).We further stratified patients into four groups combined with PP and BNP values, HFpEF patients with both high-PP and high-BNP(cutoff:100pg/dL) had the highest risk of HF-related events and CVE (both, log-rank test, p&lt;0.001), indicating their usefulness in risk prediction in HFpEF patients. Conclusion: High-PP, rather than high-SBP, was closely associated with the prognosis of patients with HFpEF. PP is the useful marker for risk stratification in HFpEF.
Picture quiz: Diabetes insipidus in a woman with breast cancer
Authors: Hassan Elasha, James E Fleet
Journal: BMJ (2007)

A 43 year old woman was admitted with a two week history of intermittent headache and a three month history of progressive malaise and headache. She had a history of node positive lobular breast cancer, treated with right mastectomy, chemotherapy, and tamoxifen eight years before.



Fig 1 
Postcontrast sagittal magnetic resonance imaging, showing suprasellar mass



Magnetic resonance imaging of the brain showed a large suprasellar mass (figure). Visual acuity was normal and visual fields were full.

Baseline and dynamic endocrine investigation confirmed anterior pituitary dysfunction affecting the glucocorticoid (morning cortisol low at 21 nmol/l, with adequate adrenal response to synthacten); growth hormone (no response to growth hormone after giving glucagon); and thyroid axis (inappropriately normal thyroid stimulating hormone at 2.76 mU/l with reduced thyroxine at 8.00 pmol/l). Prolactin concentrations were within the normal range at 132 mU/l. She was treated with replacement hydrocortisone and thyroxine.

A few weeks later she was admitted with polyuria and polydipsia. A paired serum concentration of 308 mmol/kg with …
Picture quiz: Cochlear bowel
Authors: Vibhore Gupta, D Sunderamoorthy
Journal: BMJ (2002)

A 72 year old man presented at the accident and emergency department with a one day history of diffuse colicky abdominal pain associated with abdominal distension and constipation. There was no associated vomiting. Abdominal examination revealed generalised distension without peritonism and increased bowel sounds. There was an operative scar in the right groin from a previous inguinal herniorraphy. The figure shows the abdominal x ray film.
Smoking related deaths expected to rocket
Authors: Anna Goldie
Journal: BMJ (2004)

The number of deaths related to smoking will increase to 10 million a year worldwide by 2030--more than the total number of deaths from malaria, maternal and serious childhood diseases, and tuberculosis combined, according to a World Health Organization report.

Seven in 10 of these deaths will occur in the developing world, where three quarters of the world's smokers live and where access to treatment remains low. Research has shown that the poorest households in Bangladesh were twice as likely to smoke as rich ones, with the average male smoker spending twice …
Picture quiz: A hairy problem in gynaecology
Authors: Nisha Lakhi, Abha Govind
Journal: BMJ (2007)

A 19 year old UK born Nigerian nursing student, with no important medical or surgical history and regular periods, presented to her general practitioner with a history of vaginal discharge and abdominal bloating of four to five months' duration. She was not taking any medication. On abdominal palpation an ill defined swelling in the right iliac fossa, which was not tender, was found. Her general practitioner arranged an abdominal ultrasound scan. It showed a normal uterus with a right multi-septate cyst measuring 8.2x4.9x7.8 cm. There was no free fluid in the pelvis. Her cancer antigen 125 was normal at 19 IU/ml (upper limit of reference range is 30 U/ml). The C19-9 was slightly raised at 118 IU/ml (cut off upper limit 37 IU/ml). She was referred to the gynaecology outpatient department. After counselling she underwent a laparotomy and right ovarian cystectomy. At laparotomy, a mass was found (figs 1 and 2). Fig 1 Fig 2
British Association of Dermatologists and British Photodermatology Group guidelines for the safe and effective use of PUVA therapy 2016.
Authors: Ling Tc, Clayton Th, Crawley J, Exton Ls, Goulden, Ibbotson S, McKenna K, Mohd Mustapa Mf, Rhodes Le, Sarkany R, Dawe Rs
Journal: British Journal of Dermatology (2016)
Scientific Issues Relevant to Improving the Diagnosis, Risk Assessment, and Treatment of Major Depression
Authors: Alan F. Schatzberg
Journal: American Journal of Psychiatry (2019)

Over the past two decades, research in the biology and treatment of major depression has led to advances in our understanding of the biology of the disorder and to the development of novel treatments. While progress has been made, a number of key issues have emerged regarding diagnosis of the disorder and how we develop and test new therapies. Among these are the potential need to include new dimensions in the diagnostic criteria, the limited utility of clinical predictors of response, the moving away from traditional blinded trials in major depression, and whether preclinical models tell us much about novel drug development. These issues need to be addressed to avoid the field's embarking on trails of research and treatment development that could actually mislead or misdirect our efforts to develop better diagnostic tools and more effective treatments. Possible solutions to these problems are proposed.
Talking About Aphasia
Authors: Marc Gutenstein
Journal: BMJ (1999)

“Language is what makes the world as it is If my arm was missing or my leg was, I would know that my arm was missing, and I would grieve about that. But when its your world … your sense of the world …”

Aphasia is a language impairment that may affect many aspects of communication including speech, writing, reading, gesture, and understanding of the spoken word. Every year in the United kingdom …
Associations between Maternal Tobacco Smoke Exposure and the Cord Blood CD4+ DNA Methylome
Authors: Caitlin G. Howe, Meng Zhou, Xuting Wang, Gary S. Pittman, Isabel J. Thompson, Michelle R. Campbell, Theresa M. Bastain, Brendan H. Grubbs, Muhammad T. Salam, Cathrine Hoyo, Douglas A. Bell, Andrew D. Smith, Carrie V. Breton
Journal: Environmental Health Perspectives (2019)

Background: Maternal tobacco smoke exposure has been associated with altered DNA methylation. However, previous studies largely used methylation arrays, which cover a small fraction of CpGs, and focused on whole cord blood. Objectives: The current study examined the impact of in utero exposure to maternal tobacco smoke on the cord blood CD4+ DNA methylome. Methods: The methylomes of 20 Hispanic white newborns (n=10 exposed to any maternal tobacco smoke in pregnancy; n=10 unexposed) from the Maternal and Child Health Study (MACHS) were profiled by whole-genome bisulfite sequencing (median coverage: 6.5×). Statistical analyses were conducted using the Regression Analysis of Differential Methylation (RADMeth) program because it performs well on low-coverage data (minimizes false positives and negatives). Results: We found that 10,381 CpGs were differentially methylated by tobacco smoke exposure [neighbor-adjusted p-values that are additionally corrected for multiple testing based on the Benjamini-Hochberg method for controlling the false discovery rate (FDR) (pFDR)<0.05]. From these CpGs, RADMeth identified 557 differentially methylated regions (DMRs) that were overrepresented (p<0.05) in important regulatory regions, including enhancers. Of nine DMRs that could be queried in a reduced representation bisulfite sequencing (RRBS) study of adult CD4+ cells (n=9 smokers; n=10 nonsmokers), four replicated (p<0.05). Additionally, a CpG in the promoter of SLC7A8 (percent methylation difference: −9.4% comparing exposed to unexposed) replicated (p<0.05) in an EPIC (Illumina) array study of cord blood CD4+ cells (n=14 exposed to sustained maternal tobacco smoke; n=16 unexposed) and in a study of adult CD4+ cells across two platforms (EPIC: n=9 smokers; n=11 nonsmokers; 450K: n=59 smokers; n=72 nonsmokers). Conclusions: Maternal tobacco smoke exposure in pregnancy is associated with cord blood CD4+ DNA methylation in key regulatory regions, including enhancers. While we used a method that performs well on low-coverage data, we cannot exclude the possibility that some results may be false positives. However, we identified a differentially methylated CpG in amino acid transporter SLC7A8 that is highly reproducible, which may be sensitive to cigarette smoke in both cord blood and adult CD4+ cells. https://doi.org/10.1289/EHP3398
Chest x rays made easy
Authors: Elizabeth Dick
Journal: BMJ (2000)

In the first of a five part series, Elizabeth Dick takes you through a normal chest x ray The aim of this five part series is to give you a basic system for looking at chest x ray films. They should enable you to say something sensible when presented with a film in your finals and be confident that you are not missing serious disease when you view a film on your own as a house officer. Looking at chest x ray films - the system By the time you do finals you will have learnt a system for examining the abdomen; you also need to develop a system for looking at x ray films. This will reduce your chances of missing abnormalities and it will provide a structured patter to come out with in exams when you are under pressure. Let's start by looking at a normal chest x ray film (fig 1). Use this film as a reference point during the rest of the article. Firstly, some technical details: Quickly look at the film to get some useful information about the patient: Fig 1 Normal chest x ray film
An easily overlooked cause of chronic lung disease
Authors: Dinusha Arulrajan, Stephen Harden, Julia Nightingale
Journal: BMJ (2008)

A 45 year old woman who did not work presented with a week's history of worsening breathlessness and productive cough. She was unable to complete sentences and her respiratory rate was 28 breaths/min, pulse 110 beats/min, and oxygen saturation 80% on air. She was too breathless for peak expiratory flow measurements. She had been treated for asthma for 12 years and was prescribed inhaled salbutamol and salmeterol and oral montelukast. This was her first hospital admission. She had smoked five cigarettes a day for 25 years.

On examination, she had finger clubbing and was cyanosed. Her chest was hyperexpanded and hyper-resonant to percussion. Widespread panexpiratory wheeze and inspiratory crepitations were audible. Chest radiography showed peribronchial thickening. Acute asthma was diagnosed, and she was managed accordingly. Once stable, concerns were raised about this diagnosis. Further history included longstanding breathlessness and recurrent respiratory infections. Lung function tests showed an obstructive defect (her forced expiratory volume in one second, FEV1, was 28% predicted and her ratio of FEV1 to forced vital capacity, FEV1/FVC was 25%), and she had a low transfer factor (30% predicted) (fig 1). A high resolution computed tomogram was requested (fig 2).



Fig 1 
Flow volume loop. In obstructive airways disease, the peak …
Revisiting Results on Use of Inferior Vena Cava Filters in Older Adults—Reply
Authors: Behnood Bikdeli, Yun Wang, Harlan M. Krumholz
Journal: JAMA Internal Medicine (2019)

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Jumping through hoops
Authors: Alan Woodall
Journal: BMJ (2000)

Last November I attended a science and medicine conference, held by the Royal College of Physicians, as a representative of my medical school. Listening to speakers at the forefront of their research fields was highly informative, as was reading many of the high quality poster presentations. It was a welcome change to be immersed back in the world of research. Before my four years of undergraduate teaching, I was a post-doctoral researcher at Berkeley university in the United States.

Some students read the conference posters with interest but did not feel confident enough to speak to the author. I know from past experience, however, that speaking with the author directly is often the most informative way to digest research findings. In my former life as a scientist, I had the chance to ask questions of some of the most eminent researchers in the world about their findings, and they …
Abstract O.07: The Clinical Risk Factors of Intravenous Immunoglobulin Resistance and Coronary Artery Lesion of Kawasaki Disease: Retrospective Analysis of 602 Cases
Authors: lijian xie, Cuizhen Zhou, Renjian Wang, Tingting Xiao, Jie Shen, Min Huang
Journal: Circulation (2015)

Introduction: The incidence of Kawasaki disease (KD) in China is increasing for years. The current coronary artery lesion (CAL) incidence is 5-10% in KD with intravenous immunoglobulin (IVIG) treatment. And the 10-20% KD patients still exhibit IVIG resistance. However, little clinical evidence on the occurrence of either CAL or IVIG resistance for big KD sample study in China during the past decade. Objective: In order to find clinical risk factors of CAL and IVIG resistance of KD in China. Methods: We retrospectively analyzed the clinical manifestations, laboratory results, treatment and complications of cardiac vascular of 602 KD cases from 2007 to 2012 admitted at Shanghai Children’s Hospital. The SAS 9.2 edition was used for statistical analysis. The mean ± standard deviation or the median were used for measurements. Case numbers and percentages were used for the count number. The t-test and the Mann-Whitney test were both used for mean comparisons. Single factor and multi-factor logistic regression analyses were used to analyze the risk factors. Results: 1. The KD gender male to female ratio was 1.85: 1. The KD median age was 2.0 years old (one month to 11.7 years old). 20.1% cases (121 of 602) exhibited CAL. There was no difference of CAL incidence between the gender (p=0.09). 2. The incidence of bright red cracked lips (p=0.001), peeling of the skin of the toes (p=0.021) and perianal skin peeling (p=0.031) are less in group with CAL. 3. Among the 602 cases, there were 525 cases that were sensitive to IVIG therapy. 100 of those cases had CAL with an incidence of 19.1%. Among the 26 IVIG resistance cases, there were 9 cases with CAL with an incidence of 34.6%, which was higher than the IVIG sensitive group (p=0.05). 4. ESR (p=0.014), CRP (p=0.017), PLT (p=0.003) and Hb (p=0.032) were much higher in the IVIG resistance group than the IVIG sensitive group, even though the IVIG resistance group started the IVIG treatment earlier (p=0.003). 5. Logistic regression analysis was conducted to show that GPT≥80IU/L was the independent risk factor of IVIG resistance, risk ratio was 2.945 (p=0.012) . Conclusion: This research suggests that risk factors of clinical evidence for IVIG resistance and CAL in KD.
Art against Stigma
Authors: Thomas Mac Mahon
Journal: BMJ (2004)

Its organisers describe Art against Stigma as the first programme in the world to introduce art created by people with psychiatric disorders on the same standing as professional artists. Until now, they maintain that collections of art by people with mental illnesses were kept in museums or hospitals and segregated from the mainstream. This exhibition integrates those two sectors and consists of 62 paintings, 52 of which were created by people with mental illnesses.

Launched in Copenhagen in October 2003, the programme has three main aims. Most importantly, it hopes to act as an alternative channel of communication for people who have difficulties expressing their feelings and inner thoughts, thereby building …
L3MBTL1 regulates ALS/FTD-associated proteotoxicity and quality control
Authors: Jiayin Lu, Goran Periz, Yu-Ning Lu, Qing Tang, Yang Liu, Tao Zhang, Yajas Shah, Ravi Thombre, Reham Aljumaah, Weixin Li, Jelena Mojsilovic-Petrovic, Yon Ji, Kenji Johnson, Robert Kalb, Jiou Wang
Journal: Nature Neuroscience (2019)