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[World Report] England and Wales see 20 000 excess deaths in care homes

Sa, 23/05/2020 - 00:00
PPE shortages, lack of testing, and a vulnerable population have seen care homes in England and Wales become hotspots of the COVID-19 epidemic. Talha Burki reports.

[Perspectives] Helena Legido-Quigley: proponent of health systems strengthening

Sa, 23/05/2020 - 00:00
As Associate Professor in Health Systems at Saw Swee Hock School of Public Health at the National University of Singapore, Helena Legido-Quigley was able to observe at first-hand how the country responded to its first COVID-19 outbreak earlier this year. “It was striking how well Singapore was prepared, a legacy from the SARS era, with a dedicated infectious diseases hospital and 6 months of supplies of personal protective equipment and ventilators. The public health response was fast and efficient with good governance and effective health-risk communication”, she says.

[Perspectives] Stereotype threat

Sa, 23/05/2020 - 00:00
Among the disturbing statistics to have emerged during the COVID-19 pandemic has been the disproportionate impact in terms of death and severe illness on ethnic minorities in the UK and the USA. On April 7, 2020, it was reported that in the US city of Chicago, where the black population is roughly 30%, nearly 70% of COVID-19 deaths were in this demographic. A report released by the UK Intensive Care National Audit and Research Centre on April 17, 2020, showed that 34% of patients in the UK receiving advanced respiratory support were non-white, despite the non-white population nationally being about 14%.

[Obituary] Robert McCredie May

Sa, 23/05/2020 - 00:00
Physicist turned ecologist and UK Chief Scientific Adviser. He was born in Sydney, NSW, Australia, on Jan 8, 1936, and died of pneumonia in Oxford, UK, on April 28, 2020, aged 84 years.

[Department of Error] Department of Error

Sa, 23/05/2020 - 00:00
Clark H, Coll-Seck A M, Banerjee A, et al. A future for the world's children? A WHO-UNICEF–Lancet Commission. Lancet 2020; 395: 605–58—In this Commission, the affiliation details for S Peterson, D B Hipgrave, and J Requejo were incorrect and have been changed to “UNICEF Headquarters, Programme Division, Health Section (S Peterson MD, D B Hipgrave PhD), and Division of Data, Analysis, Planning and Monitoring, Data and Analytics Section, New York, USA (J Requejo PhD)”. Affiliation details for ZA Bhutta (Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan) have been added.

[Articles] Regulatory cell therapy in kidney transplantation (The ONE Study): a harmonised design and analysis of seven non-randomised, single-arm, phase 1/2A trials

Sa, 23/05/2020 - 00:00
Regulatory cell therapy is achievable and safe in living-donor kidney transplant recipients, and is associated with fewer infectious complications, but similar rejection rates in the first year. Therefore, immune cell therapy is a potentially useful therapeutic approach in recipients of kidney transplant to minimise the burden of general immunosuppression.

[Clinical Picture] Alternative causes of ankle pain in a patient with enthesopathy and X-linked hypophosphataemia

Sa, 23/05/2020 - 00:00
A 43-year-old Australian-born, white man was referred to our unit because of increasing pain in both his ankles. The pain had developed approximately 7 days earlier. 3 days before the pain started, he had been admitted to hospital with cellulitis of his upper arm; he had been treated for septicaemia and acute kidney injury caused by an infection with Streptococcus pyogenes.

[Review] Urinary tract infections in children

Sa, 23/05/2020 - 00:00
Urinary tract infections (UTIs) in children are among the most common bacterial infections in childhood. They are equally common in boys and girls during the first year of life and become more common in girls after the first year of life. Dividing UTIs into three categories; febrile upper UTI (acute pyelonephritis), lower UTI (cystitis), and asymptomatic bacteriuria, is useful for numerous reasons, mainly because it helps to understand the pathophysiology of the infection. A single episode of febrile UTI is often caused by a virulent Escherichia coli strain, whereas recurrent infections and asymptomatic bacteriuria commonly result from urinary tract malformations or bladder disturbances.

[Correspondence] Electron microscopy of SARS-CoV-2: a challenging task – Authors' reply

Me, 20/05/2020 - 00:30
We thank Cynthia Goldsmith and colleagues for their interest in our recent Correspondence.1 We described autopsy findings from patients who had died from COVID-19 and showed a systemic endotheliitis with evidence of loss of integrity of the endothelial monolayer.1

[Correspondence] Electron microscopy of SARS-CoV-2: a challenging task

Me, 20/05/2020 - 00:30
We read with interest the Correspondence by Zsuzsanna Varga and colleagues1 on the possible infection of endothelial cells by SARS-CoV-2 using electron microscopic (EM) images as evidence. However, we believe the EM images in the Correspondence do not show coronavirus particles but instead show cross-sections of the rough endoplasmic reticulum (RER). These spherical structures are surrounded by dark dots, which might have been interpreted as spikes on coronavirus particles but are instead ribosomes.

[Correspondence] Use of herbal drugs to treat COVID-19 should be with caution

Sa, 16/05/2020 - 00:30
On April 14, 2020, a Chinese official announced at a press conference that indications of three patent herbal drugs were approved to be expanded to include COVID-19 symptoms.1 This included Lianhuaqingwen capsules and Jinhuaqinggan granules for mild conditions, and Xuebijing (injectable) for severe conditions.

[Correspondence] Steam inhalation and paediatric burns during the COVID-19 pandemic

Sa, 16/05/2020 - 00:30
Steam inhalation is traditionally used as a home remedy for common colds and upper respiratory tract infections. The evidence base of the practice is weak, with unproven theories that the steam loosens mucus, opens nasal passages, and reduces mucosal inflammation, or that the heat inhibits replication of viruses.1,2

[Public Health] Voluntary collective isolation as a best response to COVID-19 for indigenous populations? A case study and protocol from the Bolivian Amazon

Sa, 16/05/2020 - 00:30
Indigenous communities worldwide share common features that make them especially vulnerable to the complications of and mortality from COVID-19. They also possess resilient attributes that can be leveraged to promote prevention efforts. How can indigenous communities best mitigate potential devastating effects of COVID-19? In Bolivia, where nearly half of all citizens claim indigenous origins, no specific guidelines have been outlined for indigenous communities inhabiting native communal territories.

[Editorial] Reviving the US CDC

Sa, 16/05/2020 - 00:00
The COVID-19 pandemic continues to worsen in the USA with 1·3 million cases and an estimated death toll of 80 684 as of May 12. States that were initially the hardest hit, such as New York and New Jersey, have decelerated the rate of infections and deaths after the implementation of 2 months of lockdown. However, the emergence of new outbreaks in Minnesota, where the stay-at-home order is set to lift in mid-May, and Iowa, which did not enact any restrictions on movement or commerce, has prompted pointed new questions about the inconsistent and incoherent national response to the COVID-19 crisis.

[Comment] Immune checkpoint inhibition in urothelial carcinoma

Sa, 16/05/2020 - 00:00
Immune checkpoint inhibitors such as atezolizumab have had a major positive effect on the treatment of platinum-refractory advanced urothelial carcinoma.1 Non-randomised trials have shown efficacy in patients with front-line programmed cell death ligand 1 (PD-L1) biomarker-positive advanced urothelial carcinoma, but there has not yet been a transformative change to treatment because of insufficient randomised trial data.2–4 These insufficient data are not due to a lack of randomised studies—at least six are ongoing.

[Comment] Adjuvant nivolumab plus ipilimumab for resected stage IV melanoma

Sa, 16/05/2020 - 00:00
Combined immune checkpoint inhibitor therapy with monoclonal antibodies against the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death 1 (PD-1) is associated with high response rates and high toxicity in patients with unresectable stage III and stage IV melanoma (henceforth referred to as advanced melanoma).1 In the CheckMate-067 trial, previously untreated patients with advanced melanoma were randomly assigned to one of three groups: combination of ipilimumab (anti-CTLA-4) plus nivolumab (anti-PD-1) induction followed by nivolumab maintenance, nivolumab monotherapy, and ipilimumab monotherapy.

[Comment] Increasing the visibility of older women in clinical research

Sa, 16/05/2020 - 00:00
By 2024, more than 20% of Canada's population will be 65 years or older, joining other countries in becoming a super-aged society.1,2 The USA and the UK are also among the high-income countries that will soon follow in becoming super-aged nations.2 In all three countries, the majority of those in this older age group will be women, with their proportion increasing with advancing age (figure).

[Comment] Offline: Don't let COVID-19 divert us completely

Sa, 16/05/2020 - 00:00
Dr Robert Spencer, a trustee of Dr Edward Jenner's House, Garden and Museum in Berkeley, Gloucestershire, UK, wrote to me last week on the 40th anniversary of the eradication of smallpox (May 8). He was polite but disappointed: “On this day in 1980 the WHO announced the eradication of smallpox from the world. This infection, which probably caused more deaths than any other disease, was finally condemned to the history books. Sorry to see you had no space in this week's edition of The Lancet to commemorate this milestone, especially at a time of COVID-19 pandemic.” Dr Spencer was right to admonish me.

[World Report] In the aftermath: the legacy of measles in Samoa

Sa, 16/05/2020 - 00:00
As Samoa recovers from a devastating measles outbreak, Jacqui Thornton reports on how the epidemic is having long-lasting effects on the country's health system.

[Perspectives] Computer vision's potential to improve health care

Sa, 16/05/2020 - 00:00
Artificial intelligence (AI) research for medical applications has largely focused on image pattern recognition or electronic health record (EHR) data. EHR data inputs include what clinicians order and what they document that they did. But the physical actions that comprise what clinicians actually did for patients can differ: one study showed almost half of physician medical record entries documenting the extent of their physical examinations of emergency room patients were not substantiated by an independent physician observer.