tbuckley/cabot-search huggingface dataset:
Abstract 13139: Antithrombotic Use at Time of Incident Stroke among Individuals With Recent Atrial Fibrillation
Authors: Jonathan Thigpen, Chrisly Dillon, Kristen B Forster, Lori Henault, Emily K Quinn, Yorghos Tripodis, Peter B Berger, Elaine M Hylek, Nita Limdi
Journal: Circulation (2013)

Introduction: Antithrombotic (AT) drugs including antiplatelet (AP) and oral anticoagulants (OAC) are used to mitigate stroke risk in AF. Although treatment with AP vs. OAC is guided by stroke risk-stratification, this strategy is debatable as AP therapy provides little to no risk reduction. We report the utilization of AT drugs in AF patients who present with an ischemic stroke and determine factors associated with AT use. Methods: Patients admitted with ischemic stroke were identified from 2006-2010 from 3 unique sites: Boston Medical Center (safety net hospital), Geisinger Health System (rural PA), and the University of Alabama (urban stroke belt). To be eligible, patients had to have ECG-confirmed AF during or within 6 months of admission. New AF patients were not eligible. Stroke events and ECGs were confirmed by study physicians. AT use at baseline and INR were determined from admission records. Results: Across the 3 sites, 760 patients were identified (mean age 78, 43% male, 19% black, mean CHADS2 ...
Clinical and virological findings in the ongoing outbreak of West Nile virus Livenza strain in northern Italy, July to September 2012
Authors: L Barzon, M Pacenti, E Franchin, T Martello, E Lavezzo, L Squarzon, S Toppo, F Fiorin, G Marchiori, G P Scotton, F Russo, M Cattai, R Cusinato, G Palù
Journal: Eurosurveillance (2012)

In July-September 2012, one month earlier than in previous years, 13 confirmed human cases of West Nile virus infection were diagnosed in northern Italy, including five with neuroinvasive disease, three with West Nile fever, and five West Nile virus (WNV)-positive blood donors. In nine cases, the presence of the WNV lineage 1a Livenza strain, characterised in 2011, was ascertained. Symptomatic patients had prolonged viruria with high viral load.
Abstract P121: Self-perceived Physical Health Predicts Cardiovascular Disease Incidence and Death among Postmenopausal Women
Authors: Nazmus Saquib, Robert Brunner, Jessica Kubo, Hillary Tindle, Candyce Kroenke, Manisha Desai, Martha L Daviglus, Norrina Allen, Lisa W Martin, Jennifer Robinson, Marcia L Stefanick
Journal: Circulation (2013)

Background: Physical and Mental Component Summary (PCS, MCS, respectively) scales of SF- 36 health-related-quality-of-life have been associated with all-cause and cardiovascular disease (CVD) morta...
Leishmaniasis
Authors: Philip D. Marsden
Journal: New England Journal of Medicine (1979)

AS Schultz1 has noted the incidence and prevalence of human leishmaniasis is unknown. It is an endemic, sporadic infection in Central and South America, Africa, southern Europe, Asia and the Orient. It has been neglected by investigators in infectious disease, and much clinical information is still based on impressions rather than on documented fact. Occasionally, military groups have encountered epidemics that have stimulated research — e.g., kala azar, a chronic infection, among British soldiers in India, and cutaneous leishmaniasis in American troops undergoing jungle training in Panama. All forms of leishmaniasis "travel well": kala azar has occurred in British children . . .
Abstract P81: Role of Mitochondrial Permeability Transition Pore (mPTP) in the Transition from Reversible to Irreversible Myocardial Ischemia and Reperfusion
Authors: Jean-C Bopassa, René Ferrera, Souhila Benhabbouche, Michel Ovize
Journal: Circulation (2008)

Introduction . The aim of this study was to evaluate the role of mitochondrial permeability transition in the transition from reversible to irreversible injury following increasing times of ischemia- reperfusion. Methods . Rat hearts (n=72) were perfused according to Langendorff technique, arrested and submitted to global warm ischemia during 0 (sham), 10, 20, 30, 40 or 60 minutes at 37°C, and 60 min of reperfusion. Infarct size was evaluated by TTC staining and CK and LDH release. Functional recovery was assessed by rate-pressure product (RPP). Mitochondria were isolated to assess Ca 2+ resistance capacity (CRC) of the MPTP. Results . a transition from reversible to irreversible ischemia occurred between 20 and 30 minutes of warm ischemia. Hearts ischemic for less than 20 minutes exhibited better functionnal recovery with RPP averaging 31264±1341 and 28578±2176 mmHg/beats/min, respectively. In contrast, hearts that underwent 30, 40 and 60 min of ischemia displayed dramatic RPP decrease, averaging 12183±1895, 7411±578 and 4916±698 mmHg/min, respectively (p&lt;0.001 vs 20 minutes ischemia). CK and LDH release and TTC staining confirmed absence of infarction with ischemia &lt; 20 min (Panel A). In line with this, mean CRC was significantly reduced when ischemia lasted more than 20 minutes (p&lt;0.001, Panel B). Conclusion . This study shows a parallel evolution between the alteration of mitochondrial calcium retention capacity of the appearance of irreversible damage in the reperfused heart.
The $2.6 Billion Pill — Methodologic and Policy Considerations
Authors: Jerry Avorn
Journal: New England Journal of Medicine (2015)

Interview with Dr. Jerry Avorn on a new estimate of the cost of bringing a drug to market. (12:09)Download An industry-supported center claims that it costs companies $2.6 billion to develop a new drug. But we need a broader-based and more transparent reckoning of research-and-development costs to inform discussions about fostering innovation and paying for medications.
General practitioners must educate patients in the appropriate use of services
Authors: N. Bottone
Journal: BMJ (1996)

EDITOR,—I get concerned about the picture painted of morale in general practice, particularly distressing examples such as that given in the recent anonymous personal view.1 I believe that, of all the areas of clinical medicine in which I have worked, general practice provides the greatest opportunity for clinicians to practise unfettered medicine. Some general practitioners may disagree with this view and will point to the 1990 contract for general practitioners as heavy handed interference by the government.

Morale is often mentioned to me …
Abstract 133: Pressure Overload-Induced Cardiac Hypertrophy and Dysfunction Are Exacerbated in Heterozygous Carnitine Palmitoyltransferase 1b--Deficient Mice
Authors: Lan He, Teayou Kim, Jian Liu, Peiyong Wang, Yiqun Zhou, Jeevan Prasain, Philip Wood, Qinglin Yang
Journal: Circulation (2011)

Carnitine palmitoyltransferase 1 (CPT1) is a primary rate-limiting enzyme that controls the entry of long-chain fatty acids into the mitochondrial matrix. CPT1b is the predominant isoform in the he...
Avoid subcutaneous or intramuscular adrenaline
Authors: R Alexander, J Pappachan, G B Smith, B L Taylor
Journal: BMJ (1995)

<h3>Background/aim</h3> To compare the rates of retinal nerve fibre layer (RNFL) thinning in subgroups of patients with glaucoma based on spherical equivalent (SE). <h3>Methods</h3> In this retrospective study, patients were classified into three subgroups, namely, non-myopic glaucoma (NMG, &gt;0 dioptres (D)), mild-to-moderate glaucoma (MMG, 0 to −6 D) and highly myopic glaucoma (HMG,&lt;−6 D), according to their SE. Linear mixed effects models were used to evaluate the rate of change of RNFL thickness determined by spectral domain optical coherence tomography, adjusting for potentially confounding factors. <h3>Results</h3> Among 231 glaucomatous eyes from 231 patients (mean followed up 4.5 years), 105 (45.5%) were classified as NMG, 100 (43.2%) as MMG and 26 (11.3%) as HMG. Baseline visual field mean deviation did not differ among the three subgroups (−4.15 vs −5.44 dB vs −4.38 dB, p=0.185). Thinning rate of average RNFL did not differ among the three subgroups (−0.58, −0.52 and −0.54 μm/year, p=0.931). However, RNFL thinning rate at temporal quadrant (−0.85 vs −0.23 μm/year, p=0.046) and eight o’clock sector was greater in the HMG than in the NMG subgroups (−1.72 vs −0.35 μm/year, p=0.003), while that of one o9clock sector was greater in the NMG than in the HMG subgroups (−0.93 vs 0.45 μm/year, p=0.009). <h3>Conclusion</h3> Overall rate of RNFL thinning was not different among the glaucoma subgroups based on refractive error. However, sectoral RNFL thinning showed significant difference.
Pilot scheme for monitoring sickness absence in schools during the 2006/07 winter in England: can these data be used as a proxy for influenza activity?
Authors: P Mook, C Joseph, P Gates, N Phin
Journal: Eurosurveillance (2007)

During influenza epidemics, school-aged children are amongst the first affected patients. They frequently then spread the virus within their families. Recognising influenza activity in schools may therefore be an important indicator of early activity in the wider community. During 2005/06, influenza B was associated with high levels of morbidity in school-children and over 600 schools outbreaks were reported to the Health Protection Agency by local Health Protection Units. While it is not possible to directly monitor influenza in schools, the feasibility and validity of using sentinel school absenteeism data, as a proxy for influenza in the community can be investigated. From week 02/07 to 20/07, eight primary and three secondary schools from five HPA regions were able, via the Department of Health-funded Health Protection Informatics website, to report daily electronic registration data, relating to absenteeism due to illness. Aggregated absenteeism data due to illness peaked the same week as indices for the age group comparable to that used by the Royal College for General Practitioners and NHS Direct schemes. When illness-defined absenteeism data was stratified into primary and secondary schools, absence in primary schools peaked one week before that in secondary schools and the established schemes for all ages. The start time of the study meant that initial increases in activity could not be measured. These encouraging results justify expanding this sentinel scheme to collect more rigorous evidence of the usefulness of absenteeism as a proxy for influenza activity and a tool to inform policy and trigger local responses.
Update On The Safety and Efficacy Of EXTENDed Treatment With Eltrombopag (EPAG) In Adults With Chronic Immune Thrombocytopenia (ITP)
Authors: James B. Bussel, Mansoor N. Saleh, Raymond S.M. Wong, Paul Burgess, Kalpana Bakshi, Geoffrey W. Chan, Christine K. Bailey
Journal: Blood (2013)
Molecular Characterization of PK-LR Gene in Pyruvate Kinase–Deficient Italian Patients
Authors: Alberto Zanella, Paola Bianchi, Luciano Baronciani, Manuela Zappa, Elena Bredi, Cristina Vercellati, Fiorella Alfinito, Giovanni Pelissero, Girolamo Sirchia
Journal: Blood (1997)
Soundings: Three Bs, please
Authors: Des Spence
Journal: BMJ (2006)

“If you've got any grade As at A level you shouldn't be allowed to do medicine. All you get is the neurotics or the `gifted' no-social-skills types. I would shoot all those sods on admission panels.” He glanced at me, and I nodded my approval.

I like drunken conversations. The self congratulation, back slapping, and unquestioned certainty of new political manifestos—for a few hours the world does seem brighter—until reality shakes you awake demanding breakfast.

How should we choose medical students? Should we select the “brightest”? The qualities needed in medical practice are often completely opposite to those needed to get three As at A level. Having a personality obsessed with detail means you miss the bigger picture and leads to queues of patients boarding the anxiety rollercoaster of needless investigation. Also many of the “brightest” end up hating the job because they never wanted to do the glorified social work that is medicine.

The gift of the gab, blarney, patter, or a silver tongue are what we need. A willingness to accept uncertainty and the ability to reassure. To see the person and not refer, knowing that “health seeking behaviour,” not illness, determines patients' use of the NHS. We need the judicious use of the “rubber ear”: ignoring spurious symptoms of frequent attendees who merely want to talk.

The A levels are out now and salivating admissions panels will take the usual cream of the crop. Should we shoot the admissions panels in a Stalinist purge and impose a panel of “workers” instead, marking down potential students who play a classical instrument, rejecting all those with Duke of Edinburgh awards, and burning all the applications from the puffed up private schools? Well probably not, for the attributes of a doctor have nothing to do with social class, nor whether your parents suffered the misery of paying for your education. But perhaps it is time for a rethink.

For admissions panels I have a few suggestions. More mature students (early 20s, ideally), more students from the allied professions, and—most importantly—more students with lower grades, which might see an increase from the state sector. Go easy on the “gifted,” for all our sakes. Finally, admissions panels need more plodding, jobbing consultants and general practitioners who might spot the gems interested in people and service.
Apolipoprotein E 4 Allele as a Genetic Risk Factor for Left Ventricular Failure in Homozygous β-Thalassemia
Authors: Effrosini Economou-Petersen, Athanassios Aessopos, Athina Kladi, Panagiota Flevari, Fotis Karabatsos, Christina Fragodimitri, Peter Nicolaidis, Helen Vrettou, Dimitris Vassilopoulos, Markissia Karagiorga-Lagana, Dimitrios Th. Kremastinos, Michael B. Petersen
Journal: Blood (1998)
Abstract 17542: Criteria for the CMR Diagnosis of Stress-induced (Takotsubo) cardiomyopathy: A Multicenter Series of 202 Patients in Europe and North America
Authors: Ingo Eitel, Florian von Knobelsdorff-Brenkenhoff, Peter Bernhardt, Iacobo Carbone, Kai Muellerleile, Annachiara Aldrovandi, Marco Francone, Gerhard Schuler, Matthias Gutberlet, Oliver Strohm, Jeannette Schulz-Menger, Matthias Friedrich, Holger Thiele
Journal: Circulation (2010)

Purpose:  Stress-induced (Takotsubo, TTC) cardiomyopathy is an increasingly recognized acute cardiac syndrome. Cardiovascular magnetic resonance (CMR) allows for assessing irreversible injury (late gadolinium enhancement [LGE]) and myocardial edema and contributes to our understanding and differential diagnosis of this new entity. So far, various CMR criteria have been used in rather small populations. We aimed to establish CMR criteria for the diagnosis of TTC in a large series of TTC patients recruited by 7 CMR centers in Europe and North America.   Methods:  Between 2005 and 2010, 203 patients (182 female, age 66±14 years) with acute cardiac symptoms and a LV dysfunction pattern not explained by coronary artery disease underwent CMR in a 1.5-T scanner. LV function, T2-weighted and LGE images after administration of gadolinium-DTPA were evaluated. In 89 patients, the recommended CMR criteria for acute myocarditis (Lake Louise Criteria) were analyzed. All patients had a clinical follow-up after 3–6 months including CMR in 103 (51%) patients.   Results:  In 189 (93%) patients, cine images revealed a typical apical ballooning pattern, in 12 (6%) a midventricular and in 2 patients (1%) an “inverted”, basal pattern with moderate-to-severe reduction of LV function in all patients (mean 45±10%). A transmural area of high T2 signal in the mid and apical regions was visible in 113 (72%) patients matching the distribution of LV dysfunction. In 11 patients (5%), focal or patchy LGE was detected with a signal intensity lower than that typically observed in myocardial infarction or myocarditis (   Conclusions:  In this largest CMR series to date in TTC patients, the main diagnostic criteria for TTC are: 1) Typical pattern of LV dysfunction; 2) Edema in the mid and apical myocardium 3) Absence of LGE >5 SD; 4) Myocardial inflammation values. Recovery of LV dysfunction, inflammatory parameters and LGE at CMR follow-up can be used to confirm the diagnosis retrospectively.
Racial/Ethnic Differences in B-Type Natriuretic Peptide Levels and Their Association With Care and Outcomes Among Patients Hospitalized With Heart Failure
Authors: Selim R. Krim, Rey P. Vivo, Nassim R. Krim, Feng Qian, Margueritte Cox, Hector Ventura, Adrian F. Hernandez, Deepak L. Bhatt, Gregg C. Fonarow
Journal: JACC Heart Failure (2013)
Abstract MP79: Association of Long-term Risk Factor Levels with Carotid Atherosclerosis: The Chicago Healthy Aging Magnetic Resonance Imaging Plaque Study (CHAMPS)
Authors: Jarett D. Berry, Kai Lin, Kiang Liu, Daniel Garside, Colby Ayers, Timothy J Carroll, Martha Daviglus, Donald M Lloyd-Jones
Journal: Circulation (2013)

Background: The absence of risk factors (RFs) in early middle-age is associated with a markedly lower risk for cardiovascular disease across the lifespan. However, the mechanism for this association is not fully understood. Methods: We performed carotid MRI on 440 randomly-selected participants of the Chicago Healthy Aging Study in 2009-11, whose RFs were measured in 1967-73. We examined association of the burden of RFs at baseline with measures of carotid atherosclerosis (i.e., wall thickness and lipid-rich necrotic core (LRNC)) at follow-up. High resolution carotid MR images were acquired (Siemens, 1.5T) using Time of Flight and standard, Turbo Spin Echo T1 and T2 sequences; 16 consecutive images were acquired, and centered on the bifurcation. Risk groups were defined according to RFs present ~40 years earlier (baseline examination): blood pressure, cholesterol, diabetes, and smoking. Participants were divided into 4 groups (See Table footnote for definitions). The association of wall thickness measures and LRNC with baseline low-risk status was assessed in models adjusted for age, current RF, and mean wall thickness. Results: Among 423 ppts with evaluable images, the mean age was 32±5 y at baseline and 71±5 y at follow-up; 65% were male, 84% white, and 37% were “Low Risk” at baseline. Higher risk status at baseline was associated with greater burden of carotid atherosclerosis as measured by mean and maximum wall thickness and LRNC, with the lowest burden among individuals with low-risk status (see Table). In age-adjusted models, low-risk status was associated with a lower risk for LRNC in older age [OR 0.58 (95% CI, 0.35-0.97)]. This association persisted after adjustment for current RF burden [0.59 (0.35-0.99)] and mean wall thickness [0.57 (0.33-0.99)]. Conclusions: The presence of low-risk status in early life is associated with a lower prevalence of carotid LRNC in older age. These findings suggest that the decades-long protective effect of low risk status might be mediated through a lower burden of high-risk plaque.
Soundings: Behind every great woman
Authors: Trisha Greenhalgh
Journal: BMJ (2000)

What I want for Christmas more than anything else is a wife. I'm only interested in the old fashioned sort, who would stay at home most of the time baking scones and ironing. If anyone's interested, here's the job description:

 1 Get up a few minutes before me, grind beans, and put coffee on. Tidy up kitchen and place any half abandoned piles of paper neatly on desk in my study.

 2 Mix usual quirky combination of ingredients in my cereal bowl and place on table with my favourite spoon.

 3 Administer goodbye kiss on doorstep, saying: “Have a good day, darling.” Give me 15 minutes head start before commencing school run.

 4 When it suits me, allow me to do school run on my way to work so I can feel good about helping out.

 5 Be available when I phone from office and describe approximate whereabouts of forgotten item needed urgently for important meeting. Locate item, transport to office, and leave in lobby with my secretary (no, really—I know several men who have this perk).

 6 Do school pick-up, supervise homework and fish fingers. Implement agreed rules for time limited use of Playstation. Transform kids into scrubbed angels in pyjamas before my return.

 7 Explain to neighbours on a regular basis why I am continually crabby. “She works so hard.”

 8 Arrange my social diary (including babysitting) to accommodate strategic dinner engagements with respect to forthcoming promotions round. Produce immaculate dinner party chez nous approximately every six months, keeping full records of what I wore to whose, and of who turned us down last time.

 9 Identify all dirty suits in my wardrobe, take to and fetch from dry cleaners, remove plastic covers, and replace in exactly the order they were in so that I don't notice the change.

10 Avoid burdening me with trivial emotional needs. No physical contact required except for (3). Discreet affair with milkman would be quite in order.

Application forms can be downloaded from my website on http://breakingthroughglassceiling.com
Abstract 17019: Age-Specific Trends in Acute Myocardial Infarction Hospitalization in Minneapolis/St. Paul
Authors: Lindsay G Smith, Alan K Berger, David R Jacobs, Russell V Luepker
Journal: Circulation (2011)

Background: Hospitalizations for acute myocardial infarction (AMI) declined during the past 40 years. However, some studies suggest rising rates of AMI in young adults associated with the increasing prevalence of obesity and diabetes, but there are few data in this group. We hypothesized an increase in the rate of AMI hospitalizations among young and middle-aged adults (&lt;50 years) and a decline among older adults. Methods: Data from the Minnesota Hospital Association (MHA) were utilized to identify patients hospitalized with a primary discharge diagnosis of AMI (ICD-9 410) at the 20 acute care hospitals within the Minneapolis-St. Paul metropolitan area (2.85 million) between 1999-2008. Results: From 1999 to 2008, there were 42,850 AMI hospitalizations (4507 in 1999, 3904 in 2008; 13.4% decline) among those aged ≥ 30 years. Among women, the age-standardized rate of AMI hospitalization declined from 239 in 1999 to 169 in 2008, representing an annual proportionate decline of 3.2% (p=0.01) [Table]. Despite the overall decline, the rates of hospitalization among women 30-39 and 40-49 increased during this period (by 1.9% and 2.3%, respectively). In 1999, women aged 30-49 accounted for 5.5% of AMI hospitalizations in all women. By 2008, this age group accounted for 9.2% of hospitalizations. Among men, the age-standardized rate of AMI hospitalizations declined from 506 to 351 during this period (annual proportionate decline of 4.8%, p=0.003). The proportionate decline was lowest among men aged 30-39 (2.7%). Conclusion: In an era of decreasing hospitalization for AMI, differences in trends exist by sex and age. AMI hospitalizations rates increased among young and middle-aged women between 1999 and 2008, potentially due to increased attention paid to heart disease among women, the use of more sensitive biomarkers or actual increase in risk. Despite the aging population, the overall AMI hospitalization case burden decreased by 13% between 1999 and 2008.
Nonmalignant disease associated with human herpesvirus 8 reactivation in patients who have undergone autologous peripheral blood stem cell transplantation
Authors: Mario Luppi, Patrizia Barozzi, Thomas F. Schulz, Raffaella Trovato, Amedea Donelli, Franco Narni, Julie Sheldon, Roberto Marasca, Giuseppe Torelli
Journal: Blood (2000)