tbuckley/cabot-search huggingface dataset:
Glucose tolerance during pulmonary exacerbations in children with cystic fibrosis
Authors: John Widger, Mark Oliver, Fergus Cameron, Sarath Ranganathan, Phil Robinson
Journal: European Respiratory Journal (2011)

Introduction: Patients with cystic fibrosis (CF) and normal glucose tolerance (NGT) may exhibit diabetic glucose tolerance during pulmonary exacerbations [1].

Aims: We examined glucose tolerance during exacerbations in children with CF and compared continuous glucose monitoring (CGM) with the gold standard oral glucose tolerance test (OGTT).

Methods: Children with CF aged at least 10 years hospitalised with an exacerbation were recruited. Those with diabetes and those on corticosteroids were excluded. On admission, patients had an OGTT and were fitted with a CGM for 3 days. Six weeks post discharge both tests were repeated.

Results: Ten patients (3 males), mean age 13.9 years, have completed the study. Two patients had CGM alone, 4 patients had OGTT alone and 4 patients had both tests. By OGTT criteria, 3 were diabetic, 3 had NGT and 2 had impaired glucose tolerance (IGT) during exacerbations. Glucose tolerance status did not change between exacerbation and follow-up although mean 2-hour glucose fell from 9.7 mmol/l to 8.6 mmol/l on repeat testing (p=0.012). For CGM (n=6), mean time spent with glucose > 7.8mmol/l fell from 7% during exacerbation to 4.3% when well (p=0.24). All 3 patients with NGT and 1 with IGT on OGTT had transient hyperglycaemia ≥11.1 mmol/l on CGM during exacerbations.

Conclusions: In contrast to previous published research, we found that glucose tolerance status, as determined by OGTT, remains unchanged during exacerbations. Patients with NGT and IGT had transient hyperglycemia on CGM.

Reference: 

*   1. Sc NN, Shoseyov D, Kerem E, Zangen DH. Patients with cystic fibrosis and normoglycemia exhibit diabetic glucose tolerance during pulmonary exacerbation. J Cyst Fibros May;9(3):199-204.
Website of the week: Reducing multiple births
Authors: Douglas Carnall
Journal: BMJ (2000)

Multiple pregnancies can be a disaster, both in human and financial terms. A set of premature triplets can tie up a special care baby unit for months, yet multiple pregnancy, once a curiosity, has become an epidemic. The causes of the epidemic are the various treatments for infertility, and one of the prime objectives of the latest guideline on the subject from the Royal College of Obstetricians and Gynaecologists is to reduce the number of multiple births that follow infertility treatments such as in vitro fertilisation.
New Interactive Effects Involving Factor XIII Gene Polymorphisms in Venous Thrombotic Disease.
Authors: Maria C. Pintao, Dayse M. Lourenço, Francisco H.A. Maffei, Vania M. Morelli, Amelia G. Araujo, Marli H. Tavella, Wilson A. Silva, Marco A. Zago, Rendrik F. Franco
Journal: Blood (2004)
Abstract 274: Primary Reasons Bystanders Do Not Perform CPR When Receiving Dispatcher Instructions
Authors: Ryan Anne Murphy, Aaron Dunham, Jeffrey Tully, Christian Dameff, Micah Panczyk, Doreen Wasick, Daniel Spaite, Bentley Bobrow
Journal: Circulation (2012)

Introduction: Dispatch-Assisted CPR (DACPR) has been shown to be an effective method of increasing bystander CPR (BCPR) rates and survival from out-of-hospital cardiac arrest (OHCA). Objective: No quantitative studies have specifically assessed why bystanders fail to perform CPR when offered pre-arrival CPR instructions from a dispatcher. We identified common reasons bystanders do not perform CPR when 9-1-1 emergency dispatchers offer CPR instructions. Methods: Review of suspected OHCA audio recordings from 3 regional 9-1-1 emergency dispatch centers for calls in which dispatchers offered CPR instructions. This study evaluated the subset where callers either verbally refused or were unable to perform CPR. The reasons for refusal or inability to perform CPR were categorized and recorded on a structured data form. Results: 555 total audio files between 04/11-01/12 were identified based upon dispatch center suspicion of OHCA. Upon review of calls, cases were excluded if: CPR was not indicated (111/555, 20.0%), CPR was already in progress (60/555; 10.8%), bystanders believed the victim to be deceased (59/555, 10.6%), audio was not clear (20/555, 3.6%), caller was not with victim (18/555, 3.2%) or EMS arrived before DACPR could be initiated (13/555, 2.3%). Bystanders performed CPR per dispatch instructions in 30.1% of cases (167/555). In the remaining cases (107/555, 19.3%; study group), BCPR was not performed because bystanders were either unwilling to perform CPR (58/107, 54.2%) or unable to attempt CPR (49/107, 45.8%). Conclusion: There are multiple reasons bystanders do not perform CPR, even when dispatcher instructions are offered. In this study, inability to move the arrest victim, fear of causing harm, and panic were the predominant reasons CPR was not initiated. An assertive dispatcher can help overcome these barriers.
THE DUAL NATURE OF THE ACTION OF INSULIN UPON THE HEART
Authors: Samuel Soskin, Louis N. Katz, Robert Frisch
Journal: Annals of Internal Medicine (1935)

Article1 February 1935THE DUAL NATURE OF THE ACTION OF INSULIN UPON THE HEARTSAMUEL SOSKIN, LOUIS N. KATZ, ROBERT FRISCHSAMUEL SOSKINSearch for more papers by this author, LOUIS N. KATZSearch for more papers by this author, ROBERT FRISCHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-8-8-900 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn a previous communication1it was shown that the characteristic electrocardiographic changes resulting from insulin hypoglycemia could be obtained in elderly diabetic patients with cardiovascular disease, by the use of therapeutic doses of insulin in amounts which did not cause hypoglycemia. Since similar results could be obtained in these patients by the use of low carbohydrate diets without insulin, and since in both insulin hypoglycemia and in our therapeutic experiments the insulin effects tended to be reversed upon the administration of carbohydrate, it seemed probable that the electrocardiographic distortions were secondary to the effects of the insulin on the available...Bibliography1. SOSKINKATZSTROUSERUBINFELD SLNSSH: Treatment of elderly diabetic patients with cardiovascular disease; available carbohydrate and blood sugar level, Arch. Int. Med., 1933, li, 122-142. CrossrefGoogle Scholar2. SOMOGYI M: Method for preparation of blood filtrates for determination of sugar, Jr. Biol. Chem., 1930, lxxxvi, 655-663. CrossrefGoogle Scholar3. SOSKIN S: Muscle glycogen as source of blood sugar, Am. Jr. Physiol., 1927, lxxxi, 382-391. CrossrefGoogle Scholar4. MARKOWITZYATERBURROWS JWMWH: Simple one-stage technic for hepatectomy in dog, with some remarks on clinical symptomatology of terminal hepatic insufficiency, Jr. Lab. and Clin. Med., 1933, xviii, 1271-1278. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Chicago, Illinois*Received for publication July 9, 1934.From the Metabolic and Cardiovascular Laboratories, Department of Physiology, Michael Reese Hospital, Chicago.Aided by the Max Pam Fund for Metabolic Research and the Emil and Fanny Wedeles Fund for the Study of Diseases of the Heart and Circulation. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCOMBINED SURGERY AND CHEMOTHERAPY FOR CARCINOMA OF THE BRONCHUSINSULIN AND THE HEARTTHE ASSOCIATION BETWEEN HYPOGLYCÆMIA AND MYOCARDIAL INFARCTIONCardiac complications of diabetes mellitusThe Effects of a Single Dose of 2000 Units of Protamine Zinc Insulin Taken by a Diabetic Patient with Suicidal Intent 1 February 1935Volume 8, Issue 8Page: 900-906KeywordsCarbohydratesElderlyElectrocardiographyHeartHeart diseasesHypoglycemiaInsulinLongitudinal studiesMetabolic disordersResearch funding ePublished: 1 December 2008 Issue Published: 1 February 1935 PDF downloadLoading ...
Abstract 4192: Unrecognized Myocardial Infarctions are Common in Cardiac Asymptomatic Subjects at High Vascular Risk
Authors: Matthijs F Meijs, Michiel L Bots, Maarten J Cramer, Evert J Vonken, Birgitta K Velthuis, Yolanda van der Graaf, Frank J Visseren, Willem P Mali, Pieter A Doevendans
Journal: Circulation (2008)

Unrecognized myocardial infarction (UMI), generally assessed by the presence of a Q-wave on the electrocardiogram, is commonly found. Furthermore, mortality associated with UMI appears to be similar as for recognized myocardial infarction. With delayed enhancement cardiac MRI (DE-CMR) both Q-wave and non-Q wave infarctions can be identified. The aim of this study was to investigate the prevalence and determinants of UMI in high risk subjects without symptomatic coronary artery disease using DE-CMR. A DE-CMR was performed in 502 subjects with clinically manifest non-coronary atherosclerotic disease or marked risk factors for atherosclerosis. As all subjects had no known history of coronary artery disease, subendocardial and transmural scar tissue on DE-CMR was considered an UMI. In all subjects information on atherosclerotic risk factors was collected. Multivariable logistic regression was used to study the relation of risk factors with UMI. DE-CMR was of sufficient image quality in 480 (95.6%) subjects. Interobserver agreement was excellent (weighted kappa = 95%). An UMI was present in 45 (9.4%) of all subjects, and in 38 (13.1%) of 291 men and in 7 (3.7%) of 189 women. The risk of UMI increased from 6.0% (95%CI 2.2 – 9.8%) in those with two risk factors up to 26.2% (95%CI 15.2 – 37.3%) in those with 4 or 5 risk factors (male gender, age above mean of 53 years, ever smoking, history of stroke, and history of aneurysm of the abdominal aorta (AAA)). In multivariable analysis the risk of UMI was related to male gender (OR 2.6 (95%CI 1.1– 6.3)), age (OR 1.0 (95%CI 1.0 –1.1) per year), ever smoking (OR 3.1 (95%CI 1.0 –9.0), history of stroke (OR 2.1 (95%CI 1.0 – 4.4)) and history of AAA (OR 2.3 (95%CI 0.9 –5.9)). In high risk cardiac asymptomatic subjects UMI is common. The risk of UMI increases with increasing presence of risk factors.
Minor physical anomalies in young psychotic children
Authors: M. Campbell, B. Geller, A. M. Small, Theodore Petti, S. H. Ferris
Journal: American Journal of Psychiatry (1978)

The authors examined three groups of children for minor physical anomalies: 52 autistic children, 34 nonautistic siblings of these patients, and 29 normal controls. The total number of anomalies and the weighted score were significantly higher in the autistic children. The formation of these anomalies in the first three months of fetal life may concur with the developmental deviation of the central nervous system in some of these individuals.
Abstract 13767: Comparison of the Intermountain Risk Score to Other Risk Prediction Models
Authors: Heidi T May, Jeffrey L Anderson, Joseph B Muhlestein, Tami L Bair, Brianna S Ronnow, Abdallah G Kfoury, Donald L Lappe, T. J Bunch, Benjamin D Horne
Journal: Circulation (2010)

Background: Risk stratification is essential for optimizing patient outcomes. Numerous risk prediction models have been developed to provide tools for clinicians to integrate a variety of factors t...
SAT0200 Abnormal Cardiac SPECT/CT in Newly Diagnosed, Untreated Patients with Idiopathic Inflammatory Myopathies
Authors: L. P. Diederichsen, J. A. Simonsen, A. C. Diederichsen, S. Hvidsten, M. V. Hougaard, P. Junker, L. E. Lundberg, S. Jacobsen
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Knowledge of cardiac involvement in idiopathic inflammatory myopathies (IIM) is limited and a matter of debate with reported frequencies between 6% and 75%. Although clinically overt disease is rare, cardiac events are the major cause of death in IIM. No studies of the heart by SPECT/CT in newly diagnosed, untreated adults with IIM have been performed. <h3>Objectives</h3> To examine cardiac involvement in newly diagnosed, untreated patients with IIM by cardiac SPECT/CT imaging compared to a gender- and age- matched control group. <h3>Methods</h3> In a cross-sectional, single-centre study of 14 untreated patients newly diagnosed with IIM (polymyositis 7, dermatomyositis 4, cancer-associated myositis 2, immune-mediated necrotizing myopathy 1) and of 14 gender- and age- matched healthy controls. <sup>99m</sup>technetium pyrophosphate (<sup>99m</sup>Tc-PYP) SPECT/CT imaging was performed and cardiac <sup>99m</sup>Tc-PYP uptake was correlated to blood <sup>99m</sup>Tc-PYP uptake and weight-adjusted. Cardiac <sup>99m</sup>Tc-PYP uptake was reported in kBq/ml with the following ranges; low uptake (&lt; 0 kBq/ml); normal uptake (0-12 kBq/ml); or high uptake (≥ 12 kBq/ml). Furthermore, disease activity was measured by Health Assessment Questionnaire (HAQ, range 0-3), myositis intention-to-treat activity index (MITAX, range 0-1), manual muscle test of 8 muscle groups (MMT8, range 0-80), serum levels of creatinine kinase (CK), C-reactive protein (CRP) and cardiac troponin I (TnI), a highly specific marker of myocardial injury. Also presence of circulating antinuclear antibodies (ANA) and myositis specific autoantibodies (MSA) was determined. <h3>Results</h3> The mean age of the patients was 59.5 years and 57% were women. Mean duration of disease symptoms was 2 years (range 0.1-10.1). At disease onset 14% had mild, 43% had moderate and 43% patients had severe or extremely severe myositis. At study entry mean HAQ was 1.2 (range 0.25 – 3), mean MITAX was 0.42 (range 0.17 -0.72), and mean MMT8 was 69 (range 52 – 80). Increased CRP levels was found in 6 (43%) patients and 12 (86%) had elevated levels of CK. ANA was found in 6 patients and 5 patients had one or more MSA. TnI was insignificantly increased in IIM compared to healthy controls (P &lt; 0.05). Abnormal cardiac <sup>99m</sup>Tc-PYP uptake was observed in 7 (50%) patients and no controls (P = 0.002). <h3>Conclusions</h3> Heart involvement, as detected by the presence of abnormal cardiac <sup>99m</sup>Tc-PYP uptake on SPECT/CT imaging, is more prevalent in untreated IIM patients than in age- and gender- matched healthy controls. These findings support the notion that heart involvement in IIM patients is common and that a comprehensive heart evaluation in IIM patients at disease onset is warranted. <h3>Disclosure of Interest</h3> None Declared
Concurrent chemo-radiotherapy for locally advanced cervical cancer: A prospective randomized trial comparing cis-platinum vs paclitaxel
Authors: A. Khalil, A. Shamseddine, F. Geara, M. Charafeddine, M. Seoud
Journal: Journal of Clinical Oncology (2005)

5163 Introduction: This study prospectively compares weekly Cis-platinum to weekly Paclitaxel as concurrent chemotherapy with radiotherapy in patients with locally advanced cervical cancer. Methods: 33 women (Stage IB2-IVA) were randomized to receive, on a weekly basis, either 40mg/m2 Cis-platinum or 50 mg/m2 Paclitaxel (TAXOLR) during radiotherapy. Response rate, progression free survival, Kaplan Meier survival, and toxicity were compared. p < 00.5 was considered significant. Results: 16 patients received Cis-platinum (group 1) and 17 patients Taxol (group 2). The age (54.4 ± 13.6 and 52.8 ± 13.3 yrs respectively), stage, mean diameter of the lesion (5.0 ± 1.4 Vs 5.5 ± 2.2 cm respectively), and performance status were similar. The mean number of chemotherapy cycles was also comparable [4.6 ± 0.9, (range: 3–6) Vs 4.3 ± 1.3 (range:1–6)] with 87.5 % and 80% of patient receiving ≥ 4 doses respectively. Two patients in group 1 had grade II transient peripheral neuropathy. In group 2, two patients had an allergic reaction. 36.6% Vs 54.0% in groups 1 and 2 respectively had grade 3 and 4 diarrhea. The mean dose of radiotherapy to point A was comparable in both groups (74.0 ± 11.3 and 71 ± 18.2 Gy respectively). The mean duration of treament was also similar (53.1 ± 9.9 Vs 55.8 ± 9.0 days respectively, p=0.56). In the Cis-platinum group, five patients (31.3%) recurred, four outside the pelvis (local control:75.0%)]. In the Taxol group eight patients had either progressive disease or recurrred (total 8/17 or 47%), two distally (local control:.11/17: 64.7%), with no signifcant differrence in the local control between the two groups (p= 0.52). The mean time to progression was comparable (31.0 Vs 26.1 months (p=0.64) respectively. The 2 and 3 years survival for Cisplatinum were 63% and 33.86% respectively while for the Taxol they were 71.50% and 53.63% respectively. The projected mean survival was also similar (41 and 36 months respectively, p=0.36). Conclusions: Both chemotherapy regimen provided a good local control with different toxicity profiles. Failure due to distant metastasis is still high. Consideration should be given to systemic adjuvant chemotherapy post concurrent chemoradiotherapy. No significant financial relationships to disclose.
Abstract 16544: The Evolution of Chemokine Release Supports a Bimodal Mechanism of Spinal Cord Ischemia and Reperfusion Injury
Authors: Phillip D Smith, Ferenc Puskas, Xianzhong Meng, Joon H Lee, Joseph C Cleveland, Michael J Weyant, David A Fullerton, T. Brett Reece
Journal: Circulation (2011)

Background: Paraplegia remains a significant complication of thoracic aortic surgery. The mechanism of the antecedent spinal cord ischemia and reperfusion injury (IR) is largely understudied. IR of...
Massachusetts Medical Society
Authors: John Figgis Jewett
Journal: New England Journal of Medicine (1974)

COMMITTEE ON MATERNAL WELFARERuptured Cornual PregnancyA 27-year-old gravida III, para II, was admitted at nine weeks' gestation after attending a banquet where she fainted and felt nauseated. She had had abdominal cramping for the last few days, with a loose stool on the prior day. The temperature on admission at 10:15 p.m. was 36.5°C, the pulse 80, the respirations 20, and the blood pressure 100/60. The uterus was questionably enlarged, but not tender, and the cervix was softened. A diagnosis of "intestinal grippe" was made. Orders included repeated doses of a combination of pectin and kaolin and meperidine, . . .
Contribution of Major Lifestyle Risk Factors for Incident Heart Failure in Older Adults
Authors: Liana C. Del Gobbo, Shadi Kalantarian, Fumiaki Imamura, Rozenn Lemaitre, David S. Siscovick, Bruce M. Psaty, Dariush Mozaffarian
Journal: JACC Heart Failure (2015)

The goal of this study was to determine the relative contribution of major lifestyle factors on the development of heart failure (HF) in older adults. HF incurs high morbidity, mortality, and health care costs among adults ≥65 years of age, which is the most rapidly growing segment of the U.S. population. We prospectively investigated separate and combined associations of lifestyle risk factors with incident HF (1,380 cases) over 21.5 years among 4,490 men and women in the Cardiovascular Health Study, which is a community-based cohort of older adults. Lifestyle factors included 4 dietary patterns (Alternative Healthy Eating Index, Dietary Approaches to Stop Hypertension, an American Heart Association 2020 dietary goals score, and a Biologic pattern, which was constructed using previous knowledge of cardiovascular disease dietary risk factors), 4 physical activity metrics (exercise intensity, walking pace, energy expended in leisure activity, and walking distance), alcohol intake, smoking, and obesity. No dietary pattern was associated with developing HF (p > 0.05). Walking pace and leisure activity were associated with a 26% and 22% lower risk of HF, respectively (pace >3 mph vs. <2 mph; hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.63 to 0.86; leisure activity ≥845 kcal/week vs. <845 kcal/week; HR: 0.78; 95% CI: 0.69 to 0.87). Modest alcohol intake, maintaining a body mass index <30 kg/m2, and not smoking were also independently associated with a lower risk of HF. Participants with ≥4 healthy lifestyle factors had a 45% (HR: 0.55; 95% CI: 0.42 to 0.74) lower risk of HF. Heterogeneity by age, sex, cardiovascular disease, hypertension medication use, and diabetes was not observed. Among older U.S. adults, physical activity, modest alcohol intake, avoiding obesity, and not smoking, but not dietary patterns, were associated with a lower risk of HF.
INDEPENDENT VS. INTERCONNECTED TIME MARKING SYSTEM EMPLOYED IN ELECTROCARDIOGRAPHS
Authors: Joseph B. Wolffe
Journal: Annals of Internal Medicine (1940)

Article1 January 1940INDEPENDENT VS. INTERCONNECTED TIME MARKING SYSTEM EMPLOYED IN ELECTROCARDIOGRAPHSJOSEPH B. WOLFFE, M.D.JOSEPH B. WOLFFE, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-13-7-1160 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptINTRODUCTIONIn spite of the fact that the electrocardiograph long ago attained its majority, there still appears to be a considerable amount of misunderstanding in the minds of physicians, including many who have had years of experience in the field of electrocardiography, as to what constitutes a reliable and accurate time marking system.In interpreting an electrocardiogram, if any thought at all is given to the matter, it is usually considered that if the time marks on the tracing are uniformly and evenly spaced, they must be correct, and conversely, if they are not even or uniform in their spacing,... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Philadelphia, Pennsylvania*Received for publication December 17, 1938.From the Department of Medicine and Cardiology, Temple University School of Medicine. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 1 January 1940Volume 13, Issue 7Page: 1160-1166KeywordsElectrocardiography ePublished: 1 December 2008 Issue Published: 1 January 1940 PDF downloadLoading ...
Abstract 2401: Endothelial Dysfunction and Oxidative Stress in Human Coronary Microvasculature Following Acute Exposure to AL Amyloid Light Chains: New Mechanism of Amyloid Injury
Authors: Raymond Q Migrino, Parameswaran Hari, Megan Bright, Shane Phillips, Seth Truran, April Wittenburg, Jingli Wang, David D Gutterman
Journal: Circulation (2008)

Light chain amyloidosis (AL), a plasma cell dyscrasia, is often fatal in patients with heart failure yet the mechanism of injury is unknown. We hypothesize that AL light chains (LC) acutely cause endothelial dysfunction in coronary arterioles. The aims are to measure endothelium-dependent and independent dilation and reactive oxygen species (ROS) in human coronary arterioles exposed to LC from AL subjects. Urine LC was isolated from 3 AL subjects by dialysis and lyophilization. Separately, 15 coronary arterioles were isolated from discarded atrial tissue from 12 non-AL subjects without significant vascular disease or diabetes undergoing open heart surgery (8 males, 70 ± 11 years). Arterioles were pressure-mounted and vessel diameter measured by videomicroscopy. Post-preconstriction with endothelin-1, vessels were exposed to vehicle and sequential doses of bradykinin (endothelium-mediated,10 −10 to 10 −6 M) then papaverine (endothelium-independent, 10 −4 M) were given and dilation was measured. Dilator response was again measured after 20 μg/mL of LC. Coronary arterioles were separately exposed to vehicle and LC and mitochondrial superoxide (MitoSox Red) and hydrogen peroxide (dichlorofluoroscein) were measured by fluorescence microscopy. see figure. Brief exposure to AL amyloid light chains impairs endothelium-dependent coronary vasodilation. This is associated with increased ROS production. This is the first human study demonstrating endothelial dysfunction in coronary microvasculature caused by AL LC. The vascular dysfunction and oxidative stress may be an important mechanism in the pathophysiology of this fatal disease.