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[Correspondence] Malaria eradication

Sa, 25/04/2020 - 00:00
The Lancet Commission on Malaria Eradication1 is funded by the Bill & Melinda Gates Foundation. Unsurprisingly, therefore, the Commission's report reflects the Foundation's approach to global health,2 presenting the three main challenges to eradication as operational, biological, and financial.1 However, deep-rooted political and economic factors are the key to understanding the global distribution of malaria: Nigeria (53·7 million cases, 25%) and DR Congo (25·0 million, 11%) account for over a third of the total burden of global malaria;1 and it is not a coincidence that Nigeria (95·9 million) and DR Congo (63·7 million) are also the two countries with the highest number of people living in extreme poverty—defined as living on under US$1·90 a day.

[Correspondence] Malaria eradication

Sa, 25/04/2020 - 00:00
The report of the Lancet Commission on Malaria Eradication1 outlines the case for eradication of the disease within a generation without providing specific timelines for this aspirational goal. The public health definition of eradication by WHO and the International Task Force for Disease Eradication is specific: “the permanent reduction to zero of the worldwide incidence of infection caused by a specific pathogen as a result of deliberate efforts with no risk of reintroduction.”2

[Correspondence] Malaria eradication

Sa, 25/04/2020 - 00:00
One could argue that, considering the proliferation of the Lancet Commissions, a commission about malaria eradication was inevitable. Still, it qualifies as classic bypassing that the Lancet Commission on Malaria Eradication1 worked in parallel to the pre-existing WHO Strategic Advisory Group on Malaria Eradication (SAGme).2 This duplication of efforts and findings has tilted the discussions around the Commission's report and manifesto1 towards two narrow issues. First, there was predominantly a sense of relief to see some degree of agreement between the Commission and SAGme.

[Correspondence] Malaria eradication – Authors' reply

Sa, 25/04/2020 - 00:00
We thank our colleagues for their thoughtful letters in response to the report of the Lancet Commission on Malaria Eradication.1,2

[Articles] Effectiveness of reactive focal mass drug administration and reactive focal vector control to reduce malaria transmission in the low malaria-endemic setting of Namibia: a cluster-randomised controlled, open-label, two-by-two factorial design tr

Sa, 25/04/2020 - 00:00
In a low malaria-endemic setting, rfMDA and RAVC, implemented alone and in combination, reduced malaria transmission and should be considered as alternatives to RACD for elimination of malaria.

[Articles] Clopidogrel versus ticagrelor or prasugrel in patients aged 70 years or older with non-ST-elevation acute coronary syndrome (POPular AGE): the randomised, open-label, non-inferiority trial

Sa, 25/04/2020 - 00:00
In patients aged 70 years or older presenting with NSTE-ACS, clopidogrel is a favourable alternative to ticagrelor, because it leads to fewer bleeding events without an increase in the combined endpoint of all-cause death, myocardial infarction, stroke, and bleeding. Clopidogrel could be an alternative P2Y12 inhibitor especially for elderly patients with a higher bleeding risk.

[Clinical Picture] Bilateral pseudohypopyon causing white eyes in a patient with lymphoma

Sa, 25/04/2020 - 00:00
A 48-year-old man came to our eye clinic because his vision had been deteriorating over the previous 3 weeks; he had no pain and no other eye symptoms.

[Comment] Timing of renal replacement therapy in acute kidney injury: case closed?

Ve, 24/04/2020 - 00:30
Acute kidney injury is a common syndrome defined by an acute deterioration in renal function, and affects a wide variety of patients. It encompasses a heterogeneous group of underlying causes and thereby variable pathophysiological processes.1 In high-income countries, acute kidney injury is frequently associated with multiple organ failure, as well as sepsis, use of nephrotoxic drugs, and major surgery. In low-income and middle-income countries (LMICs), however, it is more likely to be associated with a single disease.

[Articles] Delayed versus early initiation of renal replacement therapy for severe acute kidney injury: a systematic review and individual patient data meta-analysis of randomised clinical trials

Ve, 24/04/2020 - 00:30
The timing of RRT initiation does not affect survival in critically ill patients with severe acute kidney injury in the absence of urgent indications for RRT. Delaying RRT initiation, with close patient monitoring, might lead to a reduced use of RRT, thereby saving health resources.

[Clinical Picture] Myocarditis in a patient with COVID-19: a cause of raised troponin and ECG changes

Ve, 24/04/2020 - 00:30
A 69-year old man, from Lombardy, Italy, was admitted to our unit because of acute respiratory distress syndrome that required mechanical ventilation; he was in Nice, France, on holiday. He had previously been fit and well; he had a history of hypertension controlled with bisoprolol 2·5 mg/day. He initially reported vomiting and diarrhoea, and 7 days afterwards, he came to our emergency department with a cough, fever of 39°C, and dyspnoea. He was immediately transferred to our intensive care unit (ICU) because of the respiratory distress syndrome and severe hypoxia.

[Correspondence] Medical students for health-care staff shortages during the COVID-19 pandemic

Ve, 24/04/2020 - 00:30
Faced with medical health-care staff shortages as a result of the coronavirus disease 2019 pandemic in Denmark,1 colleagues at Aalborg University and Aalborg University Hospital were able to shift teaching of medical students to a digital platform, employ final year students as temporary residents, and plan and initiate course programmes in ventilator therapy assistance and nursing assistance within 2 days.

[Correspondence] Global call to action for inclusion of migrants and refugees in the COVID-19 response

Ve, 24/04/2020 - 00:30
Lancet Migration1 calls for migrants and refugees to be urgently included in responses to the coronavirus disease 2019 (COVID-19) pandemic.2 Many of these populations live, travel, and work in conditions where physical distancing and recommended hygiene measures are impossible because of poor living conditions3 and great economic precarity. This global public health emergency highlights the exclusion and multiple barriers to health care4 that are faced by migrants and refugees, among whom COVID-19 threatens to have rapid and devastating effects.

[Correspondence] COVID-19: a need for real-time monitoring of weekly excess deaths

Gi, 23/04/2020 - 00:30
The first-line epidemiological response to coronavirus disease 2019 (COVID-19) requires estimation of key parameters, including case fatality risk, and reproduction number, to monitor and predict the probable course of the pandemic. The challenge for public health scientists is that these data are partly a function of testing coverage. The number of deaths attributed to COVID-19 is problematic because the criteria for defining a death almost certainly depends on whether the death occurs in somebody who tested positive for severe acute respiratory syndrome coronavirus 2.

[Comment] The key role of palliative care in response to the COVID-19 tsunami of suffering

Gi, 23/04/2020 - 00:30
Coronavirus disease 2019 (COVID-19) has brought a tsunami of suffering that is devastating even well resourced countries. The disease has wreaked havoc on health systems and generated immense losses for families, communities, and economies, in addition to the growing death toll. Patients, caregivers, health-care providers, and health systems can benefit from the extensive knowledge of the palliative care community and by taking heed of long-standing admonitions to improve access to essential medicines, particularly opioids for the relief of breathlessness and pain.

[Correspondence] First experience of COVID-19 screening of health-care workers in England

Gi, 23/04/2020 - 00:30
Since March 10, 2020, the Newcastle upon Tyne Hospitals National Health Service (NHS) Foundation Trust has been screening symptomatic health-care workers for severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2). Our decision was based on the following rationale: to maintain the health and welfare of our staff; to enable rapid identification and isolation of infected health-care workers so as to protect patients and the wider community, given that nosocomial transmission has been recognised as an important amplifier in epidemics of both SARS and Middle East respiratory syndrome;1 and to enable more rapid return to work of staff during this challenging period for the NHS.

[Department of Error] Department of Error

Gi, 23/04/2020 - 00:30
Zakham F, Vapalahti O, Lashuel HA. Education and research are essential for lasting peace in Yemen. Lancet 2020; 395: 1114—In this Correspondence, the spelling of Hilal A Lashuel's name was incorrect. The correction has been made to the online version as of April 22, 2020.

[Correspondence] Neurosurgery in an infant with COVID-19

Gi, 23/04/2020 - 00:30
Administering general aneasthesia to infants with respiratory infections is a challenge because aneasthetic drugs suppress immunity and can thus contribute to intubation-related mechanical stress and inflammation. Neurosurgery in infants with coronavirus disease 2019 (COVID-19) therefore poses a dilemma because the infection is associated with relative immune suppression and a dysregulated inflammatory response, which act as drivers of the disease.1

[Correspondence] Ethnicity and COVID-19: an urgent public health research priority

Me, 22/04/2020 - 00:30
As the coronavirus disease 2019 (COVID-19) pandemic continues advancing globally, reporting of clinical outcomes and risk factors for intensive care unit admission and mortality are emerging. Early Chinese and Italian reports associated increasing age, male sex, smoking, and cardiometabolic comorbidity with adverse outcomes.1 Striking differences between Chinese and Italian mortality indicate ethnicity might affect disease outcome, but there is little to no data to support or refute this.

[Correspondence] Hospital-based use of thromboprophylaxis in patients with COVID-19

Me, 22/04/2020 - 00:30
Physicians are receiving a great deal of information regarding how to care for patients with coronavirus disease 2019 (COVID-19). We would like to offer further information about thromboprophylaxis that we believe is worth considering when treating patients who have been admitted to hospital with COVID-19.

[Correspondence] Endothelial cell infection and endotheliitis in COVID-19

Lu, 20/04/2020 - 13:41
Cardiovascular complications are rapidly emerging as a key threat in coronavirus disease 2019 (COVID-19) in addition to respiratory disease. The mechanisms underlying the disproportionate effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on patients with cardiovascular comorbidities, however, remain incompletely understood.1,2