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[World Report] Hysterectomies in Beed district raise questions for India

Sa, 20/07/2019 - 00:00
An anomalous number of hysterectomies among women working as sugarcane cutters in Beed, Maharashtra, raises suspicion of unscrupulous medical practices. Patralekha Chatterjee reports.

[World Report] The yellow fever vaccination certificate loophole in Nigeria

Sa, 20/07/2019 - 00:00
Nigeria has introduced an e-registry to prevent travel with counterfeit certificates. But it is still possible to obtain a government-issued certificate without vaccination. Paul Adepoju reports.

[Perspectives] Moon landing: space medicine and the legacy of Project Apollo

Sa, 20/07/2019 - 00:00
On July 20, 1969, after a fraught 13 minutes of final descent, Apollo 11's commander Neil Armstrong and lunar module pilot Edwin “Buzz” Aldrin Jr made their historic first landing on the surface of the Moon. The US National Aeronautics and Space Administration (NASA) estimates that all-told 400 000 people were involved in that effort. The Project Apollo workforce had laboured tirelessly to achieve the goal set by US President John F Kennedy in 1961 of getting a human crew to the surface of the Moon and back before the end of the decade.

[Perspectives] Taxidermy and the clinic

Sa, 20/07/2019 - 00:00
Derek Frampton is one of the UK's leading taxidermists. For years he was based at London's Natural History Museum and now he works freelance. Much of his work involves “setting up” animals from zoos or collections when they die. At other times, he works with museum specimens that need conservation or repair. Sometimes he recreates extinct animals, or imaginary creatures like dragons. And sometimes, he works for the sheer joy of his art.

[Perspectives] Richard Watt: time to tackle oral diseases

Sa, 20/07/2019 - 00:00
Richard Watt first became aware of the social roots of oral health inequalities more than 30 years ago when he was a dentist at Greaves Hall psychiatric hospital in Merseyside, UK. There, he witnessed “appalling” levels of oral disease. “The mouth really is a marker of people's social position and future disease risk”, he says, “and oral diseases are a canary in the coal mine for inequality”. Today, Watt is Professor and Chair of Dental Public Health at University College London (UCL) in the Department of Epidemiology and Public Health.

[Perspectives] Polished smiles and porcelain teeth

Sa, 20/07/2019 - 00:00
Perhaps the most famous set of false teeth in history rest on a brass cradle in a glass case at the Mount Vernon Estate in Virginia. In another setting, they could be a pair of castanets imagined by Francis Bacon—a ghastly, disembodied grin that might pursue you, gnashing, through your dreams. These dentures once belonged to George Washington, first President of the USA, and—as most writers on the subject have observed—they are not made of wood, but a mixture of human teeth, cow or horse teeth, and elephant ivory.

[Obituary] Teruko Ishizaka

Sa, 20/07/2019 - 00:00
Immunologist who co-discovered IgE and advanced allergy research. Born in Yamagata, Japan, on Sept 28, 1926, she died with Parkinsonism symptoms in Yamagata, Japan, on June 4, 2019, aged 92 years.

[Correspondence] When can heart failure treatment be stopped safely?

Sa, 20/07/2019 - 00:00
We have ethical concerns regarding the study by Brian Halliday and colleagues.1 As active practitioners, we have ample experience treating patients with heart failure with recovered left ventricular ejection fraction. Our experience includes individuals who stopped beta-blockers due to non-compliance or discontinuation by other health-care providers, subsequently deteriorating in their systolic function and clinical status. In the justification of the TRED-HF trial,1 the investigators provide three main arguments.

[Correspondence] When can heart failure treatment be stopped safely?

Sa, 20/07/2019 - 00:00
Brian Halliday and colleagues1 showed that the withdrawal of pharmacological treatment in patients with recovered dilated cardiomyopathy was associated with a high rate of relapse. While the study provides support for the ongoing use of medications for these patients,2 it should be noted that the study population consisted of a heterogeneous group, with almost half (48%) on three or more heart failure medications before withdrawal. The cohort included patients with atrial fibrillation, hypertension, diabetes, familial cardiomyopathy, or truncating variant in TTN.

[Correspondence] When can heart failure treatment be stopped safely? – Authors' reply

Sa, 20/07/2019 - 00:00
We thank Jennifer Thibodeau and Mark Drazner for their comments. As experienced clinicians, it is probable they have cared for patients with dilated cardiomyopathy who have made a full symptomatic recovery with apparent normalisation of cardiac function. Such patients frequently ask whether heart failure treatments can be stopped. What should we tell such patients? We do not think that anecdotes are the optimal basis for advising on treatment. Data from randomised trials provide objective evidence of risk and facilitate shared decision making.

[Correspondence] Closing the Aboriginal health gap

Sa, 20/07/2019 - 00:00
It is proper for your columns to express disappointment at the dismal results of the decade-long national Close the Gap Strategy directed towards giving Indigenous and non-Indigenous Australians equity in social wellbeing, including health.1 But it is naïve and misleading to blame the continuing failures on governmental hypocrisy and lip service.

[Department of Error] Department of Error

Sa, 20/07/2019 - 00:00
Macchiarini P, Jungebluth P, Go T, et al. Clinical transplantation of a tissue-engineered airway. Lancet 2008; 372: 2023–30—In this Article, the first sentence of the figure 3 legend should read, “Brown staining represents MHC II at low (A,C,E) and high magnification (B,E,F)” and the final sentences should read, “At implantation, only a few small areas of cartilage were weakly MHC II positive. No Class I staining was visible (images not shown)”. These corrections have been made to the online version as of July 18, 2019.

[Clinical Picture] Avoid making a mountain out of an invasive hydatidiform mole: do a pregnancy test!

Sa, 20/07/2019 - 00:00
A 28-year-old Egyptian woman was referred to our specialised gestational trophoblastic disease clinic for treatment. She explained that 2 years earlier, her menstrual cycle had changed and become irregular with prolonged heavy bleeding lasting between 15 and 20 days; before this, her periods had been regular, lasting 30 days with 5 days of bleeding. The woman had two children and no history of contraceptive use, hormonal therapy, or any other medications. 3 months after the irregular bleeding started, the patient visited her local gynaecologist, who reported no uterine or cervical disease and prescribed diosmin tablets.

[Series] Oral diseases: a global public health challenge

Sa, 20/07/2019 - 00:00
Oral diseases are among the most prevalent diseases globally and have serious health and economic burdens, greatly reducing quality of life for those affected. The most prevalent and consequential oral diseases globally are dental caries (tooth decay), periodontal disease, tooth loss, and cancers of the lips and oral cavity. In this first of two papers in a Series on oral health, we describe the scope of the global oral disease epidemic, its origins in terms of social and commercial determinants, and its costs in terms of population wellbeing and societal impact.

[Series] Ending the neglect of global oral health: time for radical action

Sa, 20/07/2019 - 00:00
Oral diseases are a major global public health problem affecting over 3·5 billion people. However, dentistry has so far been unable to tackle this problem. A fundamentally different approach is now needed. In this second of two papers in a Series on oral health, we present a critique of dentistry, highlighting its key limitations and the urgent need for system reform. In high-income countries, the current treatment-dominated, increasingly high-technology, interventionist, and specialised approach is not tackling the underlying causes of disease and is not addressing inequalities in oral health.

[Department of Error] Department of Error

Me, 17/07/2019 - 00:30
Reich K, Gooderham M, Thaçi D, et al. Risankizumab compared with adalimumab in patients with moderate-to-severe plaque psoriasis (IMMvent): a randomised, double-blind, active-comparator-controlled phase 3 trial. Lancet 2019; 394: 576–86—In this Article, part of the legend of figure 3 should read “*p=0·0142 versus adalimumab”. This corrections has been made to the online version as of July 16, 2019, and the printed version is correct.

[Department of Error] Department of Error

Ma, 16/07/2019 - 00:30
Yousuf H, Narula J, Zwetsloot P-P, et al. Using entertainment to improve lifestyles and health. Lancet 2019; 394: 119–20—In this Correspondence, the country in which the movie based on the 11th season of SpangaG will be distributed in has been changed from Germany to the Netherlands. This correction has been made to the online version as of July 15, 2019.

[Editorial] Physician burnout: a global crisis

Sa, 13/07/2019 - 00:00
Hui Wang, a 32-year-old Chinese ophthalmologist, experienced sudden cardiac death on June 30, after working with fever for 6 days in Beijing. Hui was the father of a 1-year-old girl, and married to a doctor, who donated Hui's corneas to two patients after his death. The emotive circumstances of Hui's devotion to his work and his family's selfless donation have triggered an outpouring of grief and sympathy online, with many people expressing their condolences to his family, as well as raising concerns about physician burnout in China.

[Editorial] Regulators must work on indoor air pollution

Sa, 13/07/2019 - 00:00
On June 28, 2019, the National Institute for Health and Care Excellence (NICE) published draft guidance on indoor air quality at home, highlighting some perhaps unexpected sources of indoor air pollution. The Lancet has often spoken about indoor air pollution problems in countries where the burning of fuels inside the home is a common occurrence, but the NICE guidelines offer some thoughts on the sorts of pollution problems that can affect households worldwide.

[Editorial] Research integrity: recognising the responsibilities of authors

Sa, 13/07/2019 - 00:00
Newly released documents reveal the extent of the research misconduct perpetrated over many years in the laboratory of a distinguished UK scientist—David Latchman, at the UCL Institute of Child Health, London. In response to three separate allegations of misconduct, relating to dozens of papers from Latchman's group published between 1990 and 2013, UCL initiated two formal investigations. And on July 1, after several Freedom of Information requests, UCL finally released the reports.