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[Department of Error] Department of Error

Sa, 20/04/2019 - 00:00
Hanley DF, Thompson RE, Rosenblum M, et al. Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. Lancet 2019; 393: 1021–32—In the webappendix of this Article, Colin P Derdeyn's name was spelled incorrectly. This correction has been made to the online version as of April 18, 2019.

[Department of Error] Department of Error

Sa, 20/04/2019 - 00:00
Norman JE, Marlow N, Messow C-M, et al, for the OPPTIMUM study group. Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentre, randomised, double-blind trial. Lancet 2016; 387: 2106–16—In this Article, in table 2, the upper 95% CI of the unadjusted odds ratio for the primary outcome of neonatal morbidity or death should be 1·07; in table 3, the p value of the treatment effect in the neonatal outcome in women with history of spontaneous preterm birth should be 0·033.

[Department of Error] Department of Error

Sa, 20/04/2019 - 00:00
Adepoju P. Mali announces far-reaching health reform. Lancet 2019; 393: 1192—In this World Report, it was reported that a reform carried out by Mali will not be rolled out until 2020, but the reform is planned to begin in 2019 through a phased roll-out. The text now reads: “will not become fully effective until 2022 because of the numerous changes needed to ensure smooth roll-out”, and the title of the paragraph now reads: “Not fully rolled out until 2020”. These corrections have been made to the online version as of April 18, 2019.

[Clinical Picture] A kidney changes size: first increasing and then decreasing

Sa, 20/04/2019 - 00:00
A 39-year-old man was admitted to our department with a 1-day history of pain in his left flank and dizziness. His medical history included poorly controlled diabetes mellitus and a stone in the left upper ureter. On admission to the hospital, he appeared to be in septic shock. His temperature was 38·1°C and his blood pressure was 66/35 mm Hg. Laboratory investigations showed a leucocytosis of 16·58 × 109 per L with 93·6% neutrophils. His renal function was abnormal: blood concentrations of creatinine and urea nitrogen were 0·499 mg/dL and 15·4 mmol/L, respectively.

[Articles] Clinical outcomes after ABO-incompatible renal transplantation: a systematic review and meta-analysis

Ve, 19/04/2019 - 00:30
Despite progress in desensitisation protocols and optimisation of ABOi-rTx procedures, excess mortality and loss of kidney grafts was found compared with ABOc-rTx within the first 3 years after transplantation. Only long-term outcomes after 5 years yielded equivalent survival rates and organ function. Awareness of the increased risks of infection, organ rejection, and bleeding could improve care of patients and promote efforts towards paired kidney exchange programmes.

[Comment] Community-wide soil-transmitted helminth treatment is equity-effective

Ve, 19/04/2019 - 00:30
Among the 20 diseases included on the WHO list of neglected tropical diseases, the soil-transmitted helminths (Ascaris lumbricoides, hookworm, and Trichuris trichiura) are the most prevalent (>1 billion people infected) and the most burdensome (global burden of 3 million disability-adjusted life years).1,2 At the turn of the new millennium, preventive chemotherapy—the periodic administration of donated anthelmintic drugs to pre-school-age and school-age children—had been embraced as the global strategy for morbidity control of soil-transmitted helminths.

[Comment] ABO-incompatible renal transplantation

Ve, 19/04/2019 - 00:30
The shortfall between organ donors and a growing population with end-stage kidney disease has resulted in increased transplant waiting times for patients, with increased mortality as a consequence.1 Strategies to reduce this deficit include expanding the live donor pool by crossing the blood group barrier with ABO-incompatible live donor pairs. ABO-incompatible renal transplantation (ABOi-rTx) has been in practice worldwide for over three decades. Initially regarded as having similar outcomes to ABO-compatible renal transplantation (ABOc-rTx),2 more recent registry reports have suggested otherwise.

[Articles] Effects, equity, and cost of school-based and community-wide treatment strategies for soil-transmitted helminths in Kenya: a cluster-randomised controlled trial

Ve, 19/04/2019 - 00:30
Community-wide treatment was more effective in reducing hookworm prevalence and intensity than school-based treatment, with little additional benefit of treating every 6 months, and was shown to be remarkably equitable in coverage and effects.

[Comment] UK Public Health Science 2019: a call for abstracts

Gi, 18/04/2019 - 00:30
In the current climate of political uncertainty in the UK and abroad, public health voices that champion equity, sustainability, and the long-term view can struggle to make themselves heard. Generating and implementing evidence that draws on insights from a diversity of research disciplines and that is relevant to policy and practice across societies is more important than ever. We, therefore, welcome abstract submissions for Public Health Science 2019: A National Conference Dedicated to New Research in UK Public Health, to be held in London, UK, on Nov 29, 2019.

[Articles] Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial

Gi, 18/04/2019 - 00:30
Although levetiracetam was not significantly superior to phenytoin, the results, together with previously reported safety profiles and comparative ease of administration of levetiracetam, suggest it could be an appropriate alternative to phenytoin as the first-choice, second-line anticonvulsant in the treatment of paediatric convulsive status epilepticus.

[Comment] Levetiracetam no better than phenytoin in children with convulsive status epilepticus

Gi, 18/04/2019 - 00:30
Although frightening to watch, most generalised convulsive seizures in both adults and children stop within about 2 min with or without treatment. Seizures that last more than 5 min, however, usually do not stop without anticonvulsant treatment. Initial treatment for these patients in status epilepticus is rapidly and adequately dosed administration of a benzodiazepine. Guidelines for benzodiazepine dosing are based on high-quality data from randomised controlled trials.1–3 Status epilepticus, treated according to guidelines, can be expected to resolve in about 70% of patients after first-line treatment with benzodiazepines.

[Articles] Levetiracetam versus phenytoin for second-line treatment of convulsive status epilepticus in children (ConSEPT): an open-label, multicentre, randomised controlled trial

Gi, 18/04/2019 - 00:30
Levetiracetam is not superior to phenytoin for second-line management of paediatric convulsive status epilepticus.

[Comment] Population versus individual protection by pneumococcal conjugate vaccination

Ma, 16/04/2019 - 00:30
In The Lancet, Laura Hammitt and colleagues1 describe a reduction of pneumococcal disease burden in all ages by childhood immunisation with ten-valent pneumococcal conjugate vaccine (PCV) in Kenya, a low-income country (LIC), which adds to the body of evidence for this effect, which is well described to date only in high-income2 and middle-income3 countries.

[Articles] Effect of ten-valent pneumococcal conjugate vaccine on invasive pneumococcal disease and nasopharyngeal carriage in Kenya: a longitudinal surveillance study

Ma, 16/04/2019 - 00:30
Introduction of PCV10 in Kenya, accompanied by a catch-up campaign, resulted in a substantial reduction in PCV10-type IPD in children and adults without significant replacement disease. Although the catch-up campaign is likely to have brought forward the benefits by several years, the study suggests that routine infant PCV10 immunisation programmes will provide substantial direct and indirect protection in low-income settings in tropical Africa.

[Comment] A turning point for chronic kidney disease in diabetes

Lu, 15/04/2019 - 01:20
The worldwide prevalence of chronic kidney disease is one in seven to one in ten adults.1,2 This pandemic is closely linked to a global diabetes emergency.3 In 2017, 425 million adults had diabetes, with a projection for a 48% increase to 629 million by 2045.3 About half of those with diabetes develop chronic kidney disease.4 Progressive chronic kidney disease eventuates in end-stage kidney disease requiring dialysis or kidney transplantation to sustain life. However, only about 10% of patients survive to end-stage kidney disease because of premature death, predominantly from cardiovascular diseases and infections.

[Articles] Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Lu, 15/04/2019 - 01:20
Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease.

[Editorial] Post-Castro Cuba: new constitution expands health rights

Sa, 13/04/2019 - 00:00
2019 marks the 60th anniversary of the 26th of July Movement, which established Fidel Castro as the leader of the new Cuban Government. Decades later, Cuba is holding fast to its Communist ideology, even after revolutionary icon Fidel Castro's death in 2016 and his brother Raúl stepping down in 2018. Although the grip on power of the so-called historic generation is loosening, the new generation has “demonstrated capacity to uphold the banners of…Revolution and Socialism”, as Raúl Castro noted in 2013.

[Editorial] Best practice in managing postoperative pain

Sa, 13/04/2019 - 00:00
Controlling acute pain after surgery is important not only in the immediate postoperative phase but also to prevent chronic postsurgical pain, which can develop in as many as 10% of patients. A Series of three papers in this week's issue examines postoperative pain management, outlines how and why acute pain can become chronic, what can be done to lessen that risk, and the role of opioids.

[Editorial] Artificial intelligence in global health: a brave new world

Sa, 13/04/2019 - 00:00
Despite decades of progress in global health, many low and middle income countries are not reaching their health Sustainable Development Goals, creating a sense of urgency to prioritise health in resource-strained environments. The use of artificial intelligence (AI) is becoming increasingly attractive to the health-care industry. The accompanying enthusiasm remains awkwardly placed somewhere between aspiration and reality.

[Comment] Optimal postoperative pain management: redefining the role for opioids

Sa, 13/04/2019 - 00:00
Fear of pain is deeply rooted among patients who are about to have surgery.1 Satisfactory perioperative pain management is crucial to assuring a good patient experience, optimising postoperative outcomes, and enhancing functional recovery after surgery.2 Despite decades of research showing the benefits of various new analgesic strategies, many patients endure severe postoperative pain,3 and this holds true across all age groups and continents, even after surgery widely considered to be minor.4 A 2016 study from the USA, which enrolled 799 449 patients, showed that reliance on opioid analgesics as the mainstay for perioperative pain management is still widespread.