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[Obituary] Kenneth Forde

Sa, 27/07/2019 - 00:00
Surgeon and pioneer in diagnostic and surgical endoscopy. Born on July 6, 1933, in Manhattan, NY, USA, he died of heart failure on June 2, 2019, in Scarborough, NY, USA, aged 85 years.

[Correspondence] Preparing for emerging infections means expecting new syndemics

Sa, 27/07/2019 - 00:00
When several sources of morbidity come together to produce interlinked and worse health outcomes, they are sometimes called a syndemic. Research on syndemics explores how two or more diseases cluster together; how social, political, economic, and ecological factors drive those clusters; and how clustered conditions interact via biological, psychological, or social pathways.1 Syndemic interventions target underlying patterns of multidirectional causality to achieve better overall health in susceptible and often dispossessed populations.

[Correspondence] Multidrug-resistant tuberculosis

Sa, 27/07/2019 - 00:00
The ideal number of drugs needed and treatment duration are crucial issues in the management of multidrug-resistant tuberculosis (MDR-TB). Thus, we read with interest the Article by the Collaborative Group for the Meta-Analysis of Individual Patient Data in MDR-TB treatment–2017,1 the results of which support our proposal,2 from 2015, to classify anti-tuberculosis drugs on the basis of their toxicity, and sterilising or bactericidal activity.

[Correspondence] Multidrug-resistant tuberculosis

Sa, 27/07/2019 - 00:00
We commend the Collaborative Group for the Meta-Analysis of Individual Patient Data in MDR-TB treatment–20171 on their important findings but have questions about the analyses. We understand that individuals not given the drug under study were matched multiple times by propensity scoring to individuals to whom the drug was given. Did the investigators control for this multiple matching in their analyses? Some clarity on how the random effects used (described as a random intercept and random slope for matched pairs for the logistic, mixed-effects model) relates to random effect for the included studies would also be helpful.

[Correspondence] Multidrug-resistant tuberculosis

Sa, 27/07/2019 - 00:00
Management of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis has never been easy, mirrored by the low proportion of successfully treated patients with MRD-TB of just 55% globally. In 2018, WHO released a Rapid Communication1 recommending the use of levofloxacin (or moxifloxacin), bedaquiline, linezolid, clofazimine and cycloserine (or terizidone) in longer MDR-TB regimens, largely on the basis of findings of the Collaborative Group for the Meta-Analysis of Individual Patient Data in MDR-TB treatment–2017.

[Correspondence] Multidrug-resistant tuberculosis – Authors' reply

Sa, 27/07/2019 - 00:00
We thank José A Caminero and colleagues for their Correspondence. We agree that our findings1 leave uncertainty about optimal duration and number of drugs needed to treat patients with multidrug-resistant tuberculosis (MDR-TB). In our study,1 the optimal number of effective drugs (based on the maximal odds of success with lowest odds of mortality) was five in the initial phase and four in the continuation phase and the total optimal duration of treatment was 19–22 months. However, this analysis included all patients treated, many of whom did not receive the three drugs found most effective in our analyses: later-generation fluoroquinolones, linezolid, and bedaquiline, which are considered core drugs in the new recommendations by WHO.

[Correspondence] Tuberculosis elimination in Canada

Sa, 27/07/2019 - 00:00
We read with interest Paul Webster's World Report1 about the tuberculosis epidemic among Inuit people in Canada. Webster might have been overoptimistic in asserting that “Canada is on track to meet the eradication goals for tuberculosis set by the high-level meeting”.1 Eradication is defined as less than 0·1 tuberculosis cases per 100 000 population by 2050 for countries with a low incidence of tuberculosis.2 The incidence of tuberculosis in Canada has been stagnant for more than a decade (figure), and the incidence among First Nations people, Inuit people, and those born outside of Canada is still disproportionately high.

[Correspondence] The guidelines on infection control in prisons need revising

Sa, 27/07/2019 - 00:00
Owing to a series of environmental and individual risk factors within prisons worldwide, major infectious diseases have become substantially more prevalent.1 The proportion of prisoners in the world with HIV has been estimated at 3·8%, hepatitis C virus (HCV) at 15·1%, hepatitis B virus (HBV) at 4·8%, and tuberculosis at 2·8%.2 Since most prisoners will eventually be released back into their communities, these individuals have the potential to further spread these contagious diseases, presenting a risk to society.

[Clinical Picture] A recurrent lump in the groin poses a diagnostic problem

Sa, 27/07/2019 - 00:00
A 51-year-old man attended our outpatient clinic complaining of repeated bouts of pain in his left groin. He said he had a lump that appeared intermittently in the area, and because of this, he regularly wore firm underwear. In his medical history, it was noted that 9 years earlier he had undergone an open flat mesh repair of a left inguinal hernia. 14 months later, however, the problem had recurred; at this stage, he was managed by a different surgeon—who had not been involved in the original operation—who did a further open mesh repair.

[Department of Error] Department of Error

Gi, 25/07/2019 - 00:30
Beaglehole RH, Beaglehole R. Promoting radical action for global oral health: integration or independence? Lancet 2019; 394: 196–98—In this Comment, the sixth sentence of the fifth paragraph should read: “Despite the appointment in 2019 of a former executive director of the FDI to the Board of Directors of the NCD Alliance, there is a danger that oral health will continue to be neglected within this wider collaboration.” This correction has been made to the online version as of July 24, 2019.

[Comment] Global partnerships and the Chief Medical Officer's 2019 annual report

Lu, 22/07/2019 - 01:15
The Chief Medical Officer for England's 2019 annual report focuses on UK engagement with global health.1 The UK is a world leader in health, with an impressive track record of global collaboration, but there is no room for complacency. Globally, governments across the world are not on track to deliver the Sustainable Development Goals, and the UK must sustain its level of engagement in global health while being vigilant to the changing threats to health, abroad and at home. We as a global health community must also consider the commercial determinants of health and ill-health and the opportunities and challenges they present.

[Editorial] Prioritising disability in universal health coverage

Sa, 20/07/2019 - 00:00
Current health systems are failing the 1 billion people worldwide living with disabilities. Unless access to health care is dramatically improved for this marginalised group, the goal of universal health coverage will not be achieved. These are the stark conclusions of The Missing Billion, a report from the London School of Hygiene & Tropical Medicine and other partners, published on July 9, which shines a light on the barriers to health care and disparities in outcomes faced by people living with disabilities.

[Editorial] Oral health at a tipping point

Sa, 20/07/2019 - 00:00
What comes to mind when you think of dentistry? A luxury, a pain, excessive costs, the quest for straight, white teeth? Any way that dentistry is thought of, it's rarely as a mainstream part of health-care practice and policy, despite the centrality of the mouth and oral cavity to people's wellbeing and identity. The inattention to dental and oral health is concerning given the fact that oral diseases—tooth decay, gum disease, and oral cancers—are exceedingly common, affecting an estimated 3·5 billion people across the world.

[Editorial] A wake up call for the Ebola outbreak response

Sa, 20/07/2019 - 00:00
A 46-year-old pastor died from Ebola virus infection in Goma, DR Congo, this week. Nearly a year since the Ebola outbreak began, WHO convened a High-Level meeting to review the response and to call for a more system-wide coordinated approach with UN partners ahead of publication of the fourth strategic response plan (SRP4) by the government. The tone of the meeting was defiant and conveyed a definite change in narrative, at odds with those who claim the Ebola virus outbreak is under control. WHO Director-General, Tedros Adhanom Ghebreyesus, announced that he will reconvene the International Health Regulations Emergency Committee.

[Comment] Sphenopalatine ganglion stimulation after stroke, promising but not yet ready for adoption

Sa, 20/07/2019 - 00:00
Despite major advances in treatment of acute ischaemic stroke with reperfusion therapies—intravenous thrombolysis and mechanical thrombectomy1,2—most patients remain ineligible for these treatments. In many centres around the world, neither mechanical thrombectomy nor advanced brain imaging to identify patients who would benefit from reperfusion therapies in a later time window is available.3,4 Alternative treatment options are needed that improve outcome irrespective of time windows and imaging-defined salvageable tissue windows.

[Comment] Conflicts of interest between the sugary food and beverage industry and dental research organisations: time for reform

Sa, 20/07/2019 - 00:00
Prevention of dental caries (tooth decay), one of the most common chronic diseases globally,1 requires the global implementation of WHO's guideline on sugars intake.2,3 WHO recommends that individuals consume less than 10% of total energy intake from free sugars and that intake below 5% would be beneficial.3 The global dental research community, as the Lancet oral health Series1,2 argues, has an important role in the implementation of the WHO guideline by promoting research on public health and dietary interventions, among other actions.

[Comment] Promoting radical action for global oral health: integration or independence?

Sa, 20/07/2019 - 00:00
Globally, oral health has been neglected. The major global burden of oral health and its social and economic impacts are not disputed,1 and the deficiencies in oral health care and preventive services in all countries are apparent.2 But given that everyone experiences oral health problems at some stage of their life, it is surprising that the neglect of global oral health has not been seriously challenged.

[Comment] Understanding masculinities to improve men's health

Sa, 20/07/2019 - 00:00
While women and girls experience more disability in every region of the world, men and boys bear a greater share of the global mortality burden. The 2016 Global Burden of Disease data show age-standardised death rates per 100 000 population of 1002 for men and 690 for women.1 Many of the drivers of men's ill-health are linked to perceptions and attitudes about manhood and the overall structural organisation of men's lives and relationships.2 Furthermore, this public health challenge is intensified by insufficient attention to the intersections between masculine norms and men's health within public health systems.

[Comment] Offline: The ethical darkness of global health

Sa, 20/07/2019 - 00:00
Saudi Arabia. A country whose rulers ordered the murder and dismemberment of journalist Jamal Khashoggi. A nation whose armed forces have killed thousands of civilians in Yemen. The Philippines. A country whose President has led a violent “war on drugs”, with over 4000 extrajudicial executions since 2016. Myanmar. A nation whose abuses against the Rohingya people have been globally condemned. International action to hold Saudi Arabia, the Philippines, and Myanmar accountable has been weak. But there has, at least, been some action.

[World Report] Hungarian Government taking over science academy

Sa, 20/07/2019 - 00:00
A bill pending approval could allow the Hungarian Government to take over the Hungarian Academy of Sciences. Sharmila Devi reports.