Riviste scientifiche

[Correspondence] Managing late preterm pre-eclampsia

The Lancet - Sa, 01/08/2020 - 00:00
I read with particular interest Lucy C Chappell and colleagues'1 findings from the PHOENIX study, which clarifies issues about whether planned delivery or expectant management has better outcomes for mothers and their babies if the woman has pre-eclampsia or superimposed pre-eclampsia between 34 and 37 weeks' gestation.2 However, classical components of severe maternal morbidity, such as haemolysis elevated liver enzymes, and low platelets syndrome, are not specified or even mentioned in the primary outcome, which is a heterogeneous composite variable with both some obvious severe maternal complications and one isolated episode of severe hypertension.

[Correspondence] Managing late preterm pre-eclampsia

The Lancet - Sa, 01/08/2020 - 00:00
Lucy C Chappell and colleagues1 showed that, at the expense of increased neonatal unit admissions related to premature births, immediate planned delivery reduced maternal morbidity and severe hypertension compared with expectant management among women with late preterm pre-eclampsia. Although the authors conclude that their trial supports this strategy in favour of initiation of delivery in women with late preterm pre-eclampsia, we are concerned about the underestimation of long-term neonatal morbidities.

[Correspondence] Managing late preterm pre-eclampsia – Authors' reply

The Lancet - Sa, 01/08/2020 - 00:00
Lionel Carbillon queries the choice of composite maternal outcome in the PHOENIX trial,1 a Delphi consensus derived composite outcome reflecting the spectrum of pre-eclampsia multiorgan complications (including hepatic dysfunction typical of haemolysis, elevated liver enzymes, and low platelets syndrome),2 together with severe maternal hypertension (associated with maternal adverse cerebrovascular events). Hepatic dysfunction was more common in the PHOENIX expectant management group (63 [14%] of 451 participants) than the planned delivery group (44 [10%] of 448 participants), in keeping with the HYPITAT-II trial3 results cited by Carbillon.

[Correspondence] Cardiovascular risk in hypertension: open questions about HOPE 4

The Lancet - Sa, 01/08/2020 - 00:00
With great interest we read the encouraging results of the HOPE 4 trial by Jon-David Schwalm and colleagues.1 However, we agree with Tanzeen H Jafar and colleagues2 that the generalisability of the findings is limited because the non-physician health workers were privately paid by the study, and drugs were provided for free. Our work in Kenya shows that non-physician health workers are often overburdened, and that drugs are frequently out of stock in public facilities and pricey in private health facilities, leading to high out-of-pocket expenditure.

[Correspondence] Cardiovascular risk in hypertension: open questions about HOPE 4

The Lancet - Sa, 01/08/2020 - 00:00
Congratulations to Jon-David Schwalm and colleagues1 of the HOPE 4 study team for convincingly showing that a non-physician health worker care model reduces 10-year cardiovascular disease risk in middle-income countries. However, the reduction in risk attributable to the care model is almost certainly larger than the −6·40% points reported for the primary outcome for two reasons.

[Correspondence] Cardiovascular risk in hypertension: open questions about HOPE 4 – Authors' reply

The Lancet - Sa, 01/08/2020 - 00:00
We thank Marleen Hendriks and colleagues and Adam Richards for their comments regarding the HOPE 4 trial.1 Hendriks and colleagues draw attention to the generalisability of our findings as the non-physician health workers were paid by the project and the study medications were provided to the intervention group free of charge. Although working within the infrastructure of existing health-care systems might be theoretically optimal for uptake and sustainability, most health systems do not adequately address cardiovascular disease control.

[Correspondence] Individual patient risk assessment and cost–benefit analysis of patiromer in AMBER

The Lancet - Sa, 01/08/2020 - 00:00
We commend Rajiv Agarwal and colleagues1 for completion of the AMBER phase 2 trial. This is an important contribution to a habitually understudied patient population. However, their results raise challenging questions regarding both individual patient risk assessment and future cost–benefit analysis of patiromer use in this setting.1

[Correspondence] Individual patient risk assessment and cost–benefit analysis of patiromer in AMBER – Authors' reply

The Lancet - Sa, 01/08/2020 - 00:00
Eoin O'Sullivan and Iain MacIntyre raise important questions about the relevance of the AMBER study, relating to individual-level decision making and the cost–benefit of our approach.1

[Department of Error] Department of Error

The Lancet - Sa, 01/08/2020 - 00:00
Younossi ZM, Ratziu V, Loomba R, et al. Obeticholic acid for the treatment of non-alcoholic steatohepatitis: interim analysis from a multicentre, randomised, placebo-controlled phase 3 trial. Lancet 2019; 394: 2184–96—In this Article, the y-axis scale on the ALT panel in figure 4 has been corrected. Additionally, the declarations of interests statements have been corrected for Vlad Ratziu, Mary Rinella, Zachary Goodman, Pierre Bedossa, Andreas Geier, David Sheridan, Eric Lawitz, Manal Abdelmalek, Kris Kowdley, Jerome Boursier, Philippe Mathurin, Elisabetta Bugianesi, Antonio Olveira, Helena Cortez-Pinto, Lise Lotte Gluud, Jean-Francois Dufour, David Shapiro, Jason Campagna, Luna Zaru, Leigh MacConell, Reshma Shringarpure, and Stephen Harrison and the Acknowledgments section has been updated.

[Department of Error] Department of Error

The Lancet - Sa, 01/08/2020 - 00:00
Walli-Attaei M, Joseph P, Rosengren A, et al. Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet 2020; 396: 97–109—In this Article the Acknowledgments section has been added. This correction has been made to the online version as of July 30, 2020.

[Department of Error] Department of Error

The Lancet - Sa, 01/08/2020 - 00:00
Bradley BT, Maioli H, Johnston R, et al. Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington State: a case series. Lancet 2020; 396: 320–32—In this Article, the scale bars in figure 5 were incorrectly labelled. These corrections have made to the online version as of July 30, 2020, and the printed version is correct.

[Articles] Cytosponge-trefoil factor 3 versus usual care to identify Barrett's oesophagus in a primary care setting: a multicentre, pragmatic, randomised controlled trial

The Lancet - Sa, 01/08/2020 - 00:00
In patients with gastro-oesophageal reflux, the offer of Cytosponge-TFF3 testing results in improved detection of Barrett's oesophagus. Cytosponge-TFF3 testing could also lead to the diagnosis of treatable dysplasia and early cancer. This strategy will lead to additional endoscopies with some false positive results.

[Seminar] Atopic dermatitis

The Lancet - Sa, 01/08/2020 - 00:00
Atopic dermatitis is a common inflammatory skin disorder characterised by recurrent eczematous lesions and intense itch. The disorder affects people of all ages and ethnicities, has a substantial psychosocial impact on patients and relatives, and is the leading cause of the global burden from skin disease. Atopic dermatitis is associated with increased risk of multiple comorbidities, including food allergy, asthma, allergic rhinitis, and mental health disorders. The pathophysiology is complex and involves a strong genetic predisposition, epidermal dysfunction, and T-cell driven inflammation.

Sperm have a weird way of swimming and we only noticed after 300 years

New Scientist - Ve, 31/07/2020 - 21:00
For 300 years we’ve assumed sperm swim by beating their tails symmetrically, but in reality sperm rotate like a corkscrew while beating their tails asymmetrically

Changing how we make solar panels could reduce their carbon emissions

New Scientist - Ve, 31/07/2020 - 21:00
Although solar panels are a source of renewable energy, making them has an environmental impact. A new type of panel has a lower carbon footprint than traditional silicon ones

Covid-19 news: Rising cases in England delay easing of restrictions

New Scientist - Ve, 31/07/2020 - 19:30
The latest coronavirus news updated every day including coronavirus cases, the latest news, features and interviews from New Scientist and essential information about the covid-19 pandemic

Australia will use robot boats to find asylum seekers at sea

New Scientist - Ve, 31/07/2020 - 16:00
Five-metre-long uncrewed vessels that look like miniature sailing boats will be able to operate at sea for extended periods of time, but plans to look for asylum seekers have human rights groups concerned

Single particles of light can be used for remote 3D surveillance

New Scientist - Ve, 31/07/2020 - 14:00
Researchers have taken 3D images by bouncing individual photons from a laser off a building 45 kilometres away, more than 4 times farther than ever before

Electronic is an epic trip through the history of music

New Scientist - Ve, 31/07/2020 - 13:00
Electronic, an exhibition at London's Design Museum, evokes some of the experiences of being in a club. It is a trip through electronic music in all its guises and offers hope that things will be alright in the future
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