tbuckley/cabot-search huggingface dataset:
Response by Lee et al to Letter Regarding Article, “Cardiovascular Risk of Isolated Systolic or Diastolic Hypertension in Young Adults”
Authors: Hokyou Lee, Yuichiro Yano, So Mi Jemma Cho, Donald M. Lloyd-Jones, Hyeon Chang Kim
Journal: Circulation (2021)

In his letter, Dr McEvoy has given thoughtful comments on quality of blood pressure (BP) measurements, validity of claim-based outcomes, and comparability with another study 2 using the National Health Insurance Service (NHIS) database.First, we agree with Dr McEvoy on the importance of high-quality BP measurements, especially for analyses of diastolic BP.We also acknowledge that routinely collected BPs, such as those in the NHIS data, may have certain limitations regarding variable adherence to standardized protocols.However, they also have advantages, such as the capability of obtaining measurements on a nationwide scale and reflecting how BP is measured in routine clinical practice.Furthermore, the prevalence of isolated diastolic hypertension (IDH) by 2017 American College of Cardiology/American Heart Association definition based on NHIS BP data concurs with the prevalence based on standardized research-grade BP measurements in the Korean National Health and Nutrition Examination Survey. 3e also agree that adjudicated events in well-designed prospective epidemiological studies are more valid, in general, than outcomes based on hospitalization codes.That said, universal single-payer health care programs, like the NHIS in Korea, often provide accurate and uninterrupted outcome ascertainment, especially for hard cardiovascular disease (CVD) outcomes that are subjected to further scrutiny by the Health Insurance Review and Assessment Service.For instance, the accuracy of hospitalization codes against adjudication from medical records was >90% for myocardial infarction and >80% for stroke, based on multiple validation studies in Korea. 4ast, the study by Choi et al, 2 in a 10% sample data set of NHIS health examinees aged 40 to 79 (n=290 600), reported no difference of CVD risk between diastolic BP <80 and 80 to 89 mm Hg within each 10 mm Hg stratum of systolic BP.However, that study also found that stage 1 IDH by 2017 American College of Cardiology/ American Heart Association definition (systolic BP <130 mm Hg and diastolic BP 80-89 mm Hg), a clinically more intuitive BP phenotype, was associated with a higher CVD risk (hazard ratio, 1.12 [95% CI, 1.05-1.19]) in comparison with no IDH.Several population-based studies, including but not limited to the Japan Medical Data Center study (hazard ratio, 1.17 [95% CI,), 5 reported similar point estimates for the association of IDH by 2017 American College of Cardiology/American Heart Association definition with CVD risk, although statistical significance may have varied by sample size.Given the high prevalence of IDH and prognostic importance of diastolic BP during young adulthood, 3 it is reasonable that the association between IDH and CVD is greater in a younger cohort 1 than in previous studies.Taken together, although it is important to acknowledge the limitations of routinely collected data, leveraging these data to fill knowledge gaps in
A lichenoid rash with hepatic origins
Authors: Leila Nemazee, Janice Ferguson
Journal: BMJ (2021)

A woman in her 70s presented with a widespread rash of three months’ duration. The rash had started on her arms and spread to the trunk and legs. She described severe itching and a burning sensation. She also had non-specific symptoms of heartburn, weight loss, and loss of appetite for a similar period.

On examination, her limbs and trunk had an extensive grey-brown rash with a hint of purple, composed of small papules and excoriated, lichenified (thickened and leathery) plaques (fig 1). She had no mucosal involvement.



Fig 1 
Grey-purple excoriated papules and plaques on upper back, and post-inflammatory pigmentation



Investigations showed a marginally raised alkaline …
SARS-CoV-2 vaccines in advanced clinical trials: Where do we stand?
Authors: Saborni Chakraborty, Vamsee Mallajosyula, Cristina M. Tato, Gene S. Tan, Taia T. Wang
Journal: Advanced Drug Delivery Reviews (2021)

The ongoing SARS-CoV-2 pandemic has led to the focused application of resources and scientific expertise toward the goal of developing investigational vaccines to prevent COVID-19. The highly collaborative global efforts by private industry, governments and non-governmental organizations have resulted in a number of SARS-CoV-2 vaccine candidates moving to Phase III trials in a period of only months since the start of the pandemic. In this review, we provide an overview of the preclinical and clinical data on SARS-CoV-2 vaccines that are currently in Phase III clinical trials and in few cases authorized for emergency use. We further discuss relevant vaccine platforms and provide a discussion of SARS-CoV-2 antigens that may be targeted to increase the breadth and durability of vaccine responses.
Elevated Troponin T is an Independent Predictor of Adverse Outcome in Hypertrophic Cardiomyopathy
Authors: Frank Gommans, Etienne Cramer, Michael Fouraux, Sanne Heijmans, Michelle Michels, Janneke Timmermans, Freek W. Verheugt, Rudolf A. De Boer, Marcel Kofflard, Marc Brouwer
Journal: Circulation (2019)
AB0069 Anti beta 2 glycoprotein antibodies and thrombosis in sle patients
Authors: MA Mansour, M Badr, H El Bebawi, A El Ghobarey
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> <h3>Objectives</h3> Beta 2 glycoprotein was identified as a cofactor for the binding of antiphospholipid antibodies. Anticardiolipin antibodies were found to correlate with thrombosis in SLE patients. We measured the subclasses of anti B2 GP1 in LSE patients with or without history of thrombosis. <h3>Methods</h3> Fourty four SIE patients with mean (± SD) age of 26.7 ± 9.9) years, nine of whom had a history of vascular thrombosis along with 30 healthy age and sex matched normal control subjects were studied. <h3>Results</h3> There was a correlation between the presence of IgG anti B2 GP I and the incidence of thrombosis (P &lt; 0.05), There was, also, a positive correlation between IgG anti B2 GPt and IgG aCL antibodies and a negative correlation between IgG anti B2 GP1 and thrombocytopenia. However, serum levels of IgG and 1 gM anti B2GPI were increased in patients who had positive LAC activity. This thesis confirm the pathologic role of IgG anti B 2 GP1 (and not 1gM) in the incidence of thrombosis in SLE patients. Also, its relationship to the presence of anti ds DNA antibodies, anti CLA and lupus anticoagulant in SIE is discussed. <h3>Conclusion</h3>
Providing care for liver transplant patients via video telehealth during the COVID-19 pandemic
Authors: D. Kumar, S. Sarvepalli, M. Lie, N. Wong, S. Madu, G. A. Ketwaroo, J. Hou, A. Flores, R. Hernaez
Journal: Hepatology (2020)

Background: The Houston Veterans Affairs (VA) Medical Center is one of six VA liver transplant centers and has typically brought patients to Houston for evaluation and follow-up During the coronavirus 2019 (COVID-19) pandemic, VA Video Connect (VVC) - a VA-specific HIPAAcompliant video telehealth portal - was pilot-tested to provide remote and socially-distanced care for transplant patients We assessed VVC implementation by measuring patient and provider satisfaction Methods: Pilot implementation of VVC between March 13 & May 27, 2020 was based on model for improvement and Plan-Do-Study-Act (PDSA) frameworks Patients opted into VVC visits Providers were surveyed on overall satisfaction, technical difficulties, and missed crucial physical exam findings  Patients were surveyed on overall satisfaction, quality of interface, and self-report of time- and money-savings All satisfaction scores were assessed using a 5-point Likert scale (1= least satisfied, 5=most satisfied or 1=very easy, 5=very difficult)  Demographic information was obtained via chart review Summary statistics were performed Results: There were 63 VVC liver transplant encounters with 2 providers  Technical difficulties occurred in 33 (53 2%) encounters, with 46 (74 2%) completed using VVC alone (8 1% switched to telephone;6 4% to other video modality) Average (standard deviation) provider satisfaction was 4 0 (1 2) No providers reported management would have changed if in-person physical exam were available Of 20 (32 3%) patients who responded to the telephone survey (95% male;average age 59 years), average patient satisfaction was 4 8 (0 7), quality of interface was 4 1 (1 3), and ease of technical set up was 1 6 (1 4] All patients would do a VVC visit again Overall, respondents lived a median of 219 miles away from the study site and reported a median time saving of 1 75 hours and median money saving of $50 Conclusion: Our pilot implementation demonstrated VVC encounters are feasible and acceptable to liver transplant patients and their providers We found substantial time and money savings for our patients Although this pilot occurred during restrictions of the COVID-19 pandemic, our findings hold promise to continue video visits beyond the pandemic and thus improve access to care for liver transplant patients who live far from transplant centers Notably, technical issues were common Further resources should be directed towards studying and improving video telehealth, especially among older populations
AB0021 Topiramate as suspicious cause of arthropathy- another case report
Authors: G Saviola, L Abdi Ali, S Avanzi, M Castagna, D Idone
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> One year ago we described the case of a 23 year old female suffering from idiopathic generalised epilepsy treated with valproate and topiramate. The patient developed a poliarthritis that improved after topiramate was discontinued.<sup>1</sup> <h3>Objectives</h3> <h3>Methods</h3> We present a 58 year old male suffering since 1996 from epileptic seizures and left hemiplegia secondary to subharachnoid haemorrhage; he had a history of hypertension, diabetes and cigarette smoke. <h3>Results</h3> Since September 1999 the patient was treated with phenobarbital at the dose of 100 mg per day, since January 2000 topiramate was added at the dose of 100 mg per day. He was admitted in our department in July 2000 because of worsening of the motor performance: due to myalgias of the limbs, arthralgyas to the left knee and hand, and a frozen left shoulder (it was impossible to obtain any passive movement of that joint). X-ray of the left shoulder showed Sudeck?s atrophy; rheumatological blood tests were negative. We stopped topiramate and substituted it with gabapentin at the dose of 100 mg t.i.d.. 3 months after suspension of topiramate, continuing the treatment with gabapentin and phenobarbital, the patient showed a marked improvement in the range of motion of the left shoulder (passive abduction of 45°; because of hemiplegia, active movements were impossible); moreover arthralgyas and myalgias at the limbs disappeared. <h3>Conclusion</h3> Topiramate, a new anti-epileptic drug, seems to have a potential arthropathic role which should be better studied. <h3>Reference</h3> Saviola G, Abdi Ali L, Avanzi S, Idone D. Poliartrite da Topiramato: caso clinic. Reumatismo 2000;52(3):627
Abstract 12938: An Unusual Case of Malignant Hypertension and Stress Cardiomyopathy Originating From the Urinary Bladder
Authors: Anjali Rao, Wanpen Vongpatanasin
Journal: Circulation (2020)

A 39-year-old man with hypertension presented for an elective knee surgery. Within 15 minutes of induction of anesthesia, he developed malignant hypertension and acute hypoxia. Surgery wasaborted and he was subsequently transferred to our facility. High-sensitivity troponin was elevated. Chest X-ray demonstrated bilateral hilar opacities, consistent with pulmonary edema.Transthoracic echocardiography demonstrated mildly depressed left ventricular function with hypokinesis of the septum and inferolateral wall. Cardiac catheterization showed normal filling pressures and no coronary artery disease. Initial work up for secondary hypertension, including Duplex Doppler ultrasonography of renal artery and serum aldosterone level were unrevealing. Because of high index of suspicion, additional workup was pursued for adrenal hypertension. Hewas found to have severely elevated plasma normetanephrine level (36 nmol/L) and 24-hrurinary normetanephrine of 8,990 mcg while plasma metanephrine and epinephrine levels were within normal limits. Computed tomography of abdomen showed no adrenal mass but revealed contrast-enhancing mass in the bladder wall with surrounding lymphadenopathy, suggestive of metastatic paraganglioma. He underwent genetic evaluation which identified a heterozy gouspathogenic variant in the succinate dehydrogenase subunit B (SDHB) gene. He was treated withalpha- and beta-blockade and underwent partial cystectomy with lymph node dissection. Follow-up Gallium-68 DOTATATE scan was positive for uptake in several lymph nodes withsubsequent successful lymph node dissection. He is now asymptomatic. Discussion: This case illustrates the importance of a complete history in the evaluation of hypertension inyoung people. The presence of labile hypertension and acute cardiomyopathy which isprecipitated by stress or noncardiac surgery should prompt an evaluation of pheochromocytoma.The isolated elevation in plasma and urinary normetanephrine with normal plasma/urinarymetanephrine level is consistent with extra-adrenal production of catecholamines, which iscommon in the presence of SDHB mutation.
Acute Arterial Occlusions in Patients with COVID-19: Results and Outcomes
Authors: Rafael Soares
Journal: Clinical Cardiology and Cardiovascular Interventions (2021)

In this paper, we aimed to describe a case series report of four patients that were admitted in the emergency room of our vascular and endovascular surgery department with acute arterial occlusion after a diagnosis of Covid-19 infection. The first patient was a male, 50 years, tobacco user, with arterial systemic hypertension and COVID-19 positive that was admitted with an acute arterial occlusion Rutherford IIb in the left lower limb. He was submitted to an arterial thromboembolectomy with Fogarty catheter and had a satisfactory evolution. CASE 2 was a female, 63 years, with arterial systemic hypertension, diabetes, esquizophrenia, that was admitted with acute limb ischemia (ALI) Rutherford III in the upper left limb. Despite attempts do revascularize the upper limb, the patient evolved with a hand amputation. CASE 3 was a Male patient, 49 years, HIV positive, diabetic with previous debridement in both feet due to diabetic foot infection, tobacco user and Rutherford IIb ALI in the right lower limb..The patient was submitted to an arterial thromboembolectomy with Fogarty catheter, however presented with fasciotomy infection and another post-operative complications that led him to die. Finally, CASE 4 was a female patient, 49 years, diabetic, admitted with COVID-19 infection that presented ALI during hospitalization on the right lower limb. She was submitted to proper thromboembolectomy, with a satisfactory evolution and limb salvage. COVID-19 pandemic crisis is a challenging situation that has increased the number of acute arterial thrombosis and embolism urgencies and emergencies surgeries in the vascular world. The four patients related in this paper bring valuable information regarding the impact of COVID-19 on micro and macrovascular system.
AB0015 Synovial fluid analysis: correlation between reagent strips analysis and white blood cell count
Authors: S Aloui, H Ben Frej, S Chatti, I Hadda, I Bouajina, MH Abdessalem, T Chekir
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> <h3>Objectives</h3> To determine if reagent test strips used to analyse inflammatory synovial fluid (SF) is as performing as white blood cell (WBC) count. <h3>Methods</h3> 100 synovial fluid specimens obtained were tested using two techniques: reagent strips used to test urine (multistix 8SG Bayerdiagnostics) to check the presence of leucocytes. An inflammatory SF was defined as a strip showing more than a trace for leucocytes. The analysis was performed by an investigator unaware of WBC count and of diagnosis. White blood cell count. An inflammatory SF was defined as WBC ³ 2000 cells/mm<sup>3</sup>. Specificity, sensitivity and like hood ratio (LR) of the reagent strip in diagnosing inflammatory SF were calculated. <h3>Results</h3> 100 samples SF were tested. The performance of reagent strip were: sensitivity: 82% (IC: 95%); specificity was 88% (IC: 95%) LR: 5.6. <h3>Conclusion</h3> Our study suggest that an evaluation of SF by reagent strips could be of interest to guide the diagnosis.
Prophylaxis for COVID-19: a systematic review
Authors: Mikaela Smit, Annalisa Marinosci, Thomas Agoritsas, Alexandra Calmy
Journal: Clinical Microbiology and Infection (2021)

BackgroundWhile the landscape of vaccine and treatment candidates against the novel coronavirus disease 2019 (COVID-19) has been reviewed systematically, prophylactic candidates remain unexplored.ObjectivesTo map pre- and postexposure prophylactic (PrEP and PEP) candidate for COVID-19.Data sourcesPubMed/Medline, Embase, International Committee of Medical Journal Editors and International Clinical Trials Registry Platform clinical trial registries and medRxiv.Study eligibility criteria and participantsAll studies in humans or animals and randomized controlled trials (RCTs) in humans reporting primary data on prophylactic candidates against COVID-19, excluding studies focused on key populations.InterventionsPrEP and PEP candidate for COVID-19.MethodsSystematic review and qualitative synthesis of COVID-19 PrEP and PEP studies and RCTs complemented by search of medRxiv and PubMed and Embase for studies reporting RCT outcomes since systematic review search completion.ResultsWe identified 13 studies (from 2119 database records) and 117 RCTs (from 5565 RCTs listed in the registries) that met the inclusion criteria. Non-RCT studies reported on cross-sectional studies using hydroxychloroquine (HCQ) in humans (n = 2) or reported on animal studies (n = 7), most of which used antibodies. All five completed RCTs focused on the use of HCQ as either PrEP or PEP, and these and the cross-sectional studies reported no prophylactic effect. The majority of ongoing RCTs evaluated HCQ or other existing candidates including non–severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines, anti(retro)virals or use of vitamins and supplements.ConclusionsThe key message from completed studies and RCTs seems to be that HCQ does not work. There is little evidence regarding other compounds, with all RCTs using candidates other than HCQ still ongoing. It remains to be seen if the portfolio of existing molecules being evaluated in RCTs will identify successful prophylaxis against COVID-19 or if there is a need for the development of new candidates.
Encorafenib Plus Cetuximab as a New Standard of Care for Previously Treated <i>BRAF</i> V600E–Mutant Metastatic Colorectal Cancer: Updated Survival Results and Subgroup Analyses from the BEACON Study
Authors: Josep Tabernero, Axel Grothey, Eric Van Cutsem, Rona Yaeger, Harpreet Wasan, Takayuki Yoshino, Jayesh Desai, Fortunato Ciardiello, Fotios Loupakis, Yong Sang Hong, Neeltje Steeghs, Tormod Kyrre Guren, Hendrik-Tobias Arkenau, Pilar Garcia-Alfonso, Elena Elez, Ashwin Gollerkeri, Kati Maharry, Janna Christy-Bittel, Scott Kopetz
Journal: Journal of Clinical Oncology (2021)

BEACON CRC evaluated encorafenib plus cetuximab with or without binimetinib versus investigators' choice of irinotecan or FOLFIRI plus cetuximab in patients with BRAFV600E-mutant metastatic colorectal cancer (mCRC), after progression on 1-2 prior regimens. In the previously reported primary analysis, encorafenib, binimetinib plus cetuximab (ENCO/BINI/CETUX; triplet) and encorafenib plus cetuximab (ENCO/CETUX; doublet) regimens improved overall survival (OS) and objective response rate (ORR; by blinded central review) versus standard of care. The purpose of this analysis was to report updated efficacy and safety data.In this open-label, phase III trial, 665 patients with BRAF V600E-mutant mCRC were randomly assigned 1:1:1 to receive triplet, doublet, or control. Primary end points were OS and independently reviewed ORR comparing triplet to control. OS for doublet versus control was a key secondary end point. Updated analyses include 6 months of additional follow-up and ORR for all randomized patients.Patients received triplet (n = 224), doublet (n = 220), or control (n = 221). Median OS was 9.3 months (95% CI, 8.2 to 10.8) for triplet and 5.9 months (95% CI, 5.1 to 7.1) for control (hazard ratio [HR], 0.60 [95% CI, 0.47 to 0.75]). Median OS for doublet was 9.3 months (95% CI, 8.0 to 11.3) (HR v control, 0.61 [95% CI, 0.48 to 0.77]). Confirmed ORR was 26.8% (95% CI, 21.1% to 33.1%) for triplet, 19.5% (95% CI, 14.5% to 25.4%) for doublet, and 1.8% (95% CI, 0.5% to 4.6%) for control. Adverse events were consistent with the prior primary analysis, with grade ≥ 3 adverse events in 65.8%, 57.4%, and 64.2% for triplet, doublet, and control, respectively.In the BEACON CRC study, encorafenib plus cetuximab improved OS, ORR, and progression-free survival in previously treated patients in the metastatic setting compared with standard chemotherapy. Based on the primary and updated analyses, encorafenib plus cetuximab is a new standard care regimen for previously treated patients with BRAF V600E mCRC.
Two-dimensional shear wave elastography predicts survival in advanced chronic liver disease
Authors: Jonel Trebicka, Wenyi Gu, Victor de Ledinghen, Christophe Aubé, Aleksander Krag, Michael Praktiknjo, Laurent Castera, Jerome Dumortier, David Josef Maria Bauer, Mireen Friedrich-Rust, Stanislas Pol, Ivica Grgurevic, Rongqin Zheng, Sven Francque, Halima Gottfriedovà, Sanda Mustapic, Ioan Sporea, Annalisa Berzigotti, Frank Erhard Uschner, Benedikt Simbrunner, Maxime Ronot, Christophe Cassinotto, Maria Kjaergaard, Filipe Andrade, Martin Schulz, Georg Semmler, Ida Tjesic Drinkovic, Johannes Chang, Maximilian Joseph Brol, Pierre Emmanuel Rautou, Thomas Vanwolleghem, Christian P Strassburg, Jerome Boursier, Philip Georg Ferstl, Ditlev Nytoft Rasmussen, Thomas Reiberger, Valerie Vilgrain, Aymeric Guibal, Olivier Guillaud, Stefan Zeuzem, Camille Vassord, Xue Lu, Luisa Vonghia, Renata Senkerikova, Alina Popescu, Cristina Margini, Wenping Wang, Maja Thiele, Chrisitan Jansen
Journal: Gut (2021)

Objective Liver stiffness measurement (LSM) is a tool used to screen for significant fibrosis and portal hypertension. The aim of this retrospective multicentre study was to develop an easy tool using LSM for clinical outcomes in advanced chronic liver disease (ACLD) patients. Design This international multicentre cohort study included a derivation ACLD patient cohort with valid two-dimensional shear wave elastography (2D-SWE) results. Clinical and laboratory parameters at baseline and during follow-up were recorded. LSM by transient elastography (TE) was also recorded if available. The primary outcome was overall mortality. The secondary outcome was the development of first/further decompensation. Results After screening 2148 patients (16 centres), 1827 patients (55 years, 62.4% men) were included in the 2D-SWE cohort, with median liver SWE (L-SWE) 11.8 kPa and a model for end stage liver disease (MELD) score of 8. Combination of MELD score and L-SWE predict independently of mortality (AUC 0.8). L-SWE cut-off at ≥20 kPa combined with MELD ≥10 could stratify the risk of mortality and first/further decompensation in ACLD patients. The 2-year mortality and decompensation rates were 36.9% and 61.8%, respectively, in the 305 (18.3%) high-risk patients (with L-SWE ≥20 kPa and MELD ≥10), while in the 944 (56.6%) low-risk patients, these were 1.1% and 3.5%, respectively. Importantly, this M10LS20 algorithm was validated by TE-based LSM and in an additional cohort of 119 patients with valid point shear SWE-LSM. Conclusion The M10LS20 algorithm allows risk stratification of patients with ACLD. Patients with L-SWE ≥20 kPa and MELD ≥10 should be followed closely and receive intensified care, while patients with low risk may be managed at longer intervals.