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[Department of Error] Department of Error

Sa, 06/07/2019 - 00:00
Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet 2019; 393: 1505–16—In this Article, the data for the laser trabeculoplasty group and the eye drops group were incorrectly switched in several places. The third paragraph of the Results section should have begun: “At 36 months, the selective laser trabeculoplasty group had an average EQ-5D score of 0·90 (SD 0·16), compared with 0·89 (SD 0·18) in the eye drops group…”.

[Department of Error] Department of Error

Sa, 06/07/2019 - 00:00
Pratley R, Amod A, Hoff ST, et al. Oral semaglutide versus subcutaneous liraglutide and placebo in type 2 diabetes (PIONEER 4): a randomised, double-blind, phase 3a trial. Lancet 2019; 394: 39–50—In this Article, in panel C of figure 2, the p value for the proportion of patients achieving the HbA1c target of less than 7·0% for oral semaglutide versus liraglutide by use of the trial product estimand should have been “p=0·0620”; in table 2, the p value for the estimated odds ratio for HbA1c ≤·5% at 26 weeks for the liraglutide group by use of the trial product estimand should have been “p=0·1503”, the 95% CI range for the estimated odds ratio for bodyweight loss ≥10% at 26 weeks in the liraglutide group by use of the trial product estimand should have been “(1·52 to 5·05)”, and the estimated odds ratio for bodyweight loss ≥10% at 52 weeks in the placebo group by use of the trial product estimand should have been “8·39 (2·79 to 25·26); p=0·0002”.

[Clinical Picture] Gallstone causing gastric outlet obstruction 50 years after cholecystectomy

Sa, 06/07/2019 - 00:00
A 90-year-old woman was transferred to our hospital with a 7-day history of pain in the right upper quadrant of her abdomen, decreased appetite, and post-prandial vomiting. On examination, she was afebrile, mildly tachycardic, at 95 beats per min, and in atrial fibrillation. Her blood pressure was 125/75 mm Hg. Clinically, she looked dehydrated and had a scar over the right hypochondrium, which was slightly tender, with a palpable mass, but she had no peritonism. In her medical history, she had a cholecystectomy approximately 50 years ago.

[Comment] Nerve transfers to restore upper limb function in tetraplegia

Ve, 05/07/2019 - 00:30
“For those who have nothing, a little is a lot.”1 As Sterling Bunnell, a pioneer of tetraplegic extremity reconstruction observed, small gains in function for people with spinal cord injury can equate to enormous gains in independence. People with mid-cervical spinal cord injury usually retain volitional movement at the shoulder and some control of their elbows and wrists. Hand opening and closing, a capacity that patients rate as more important to regain than walking or sexual function, is often lost.

[Comment] International failure in northwest Syria: humanitarian health catastrophe demands action

Ve, 05/07/2019 - 00:30
The 9-year conflict in Syria has resulted in one of the worst humanitarian crises of our generation, with more than 11·7 million people in need of humanitarian assistance in Syria, 11·3 million in need of health assistance, and 6·2 million internally displaced within Syria.1 In one of the worst onslaughts of the conflict to date, Syrian Government and Russian forces have intensified their ground shelling and airstrikes in northwest Syria since early April, 2019. This area contains an estimated 3 million people of whom 1·3 million are internally displaced people,2 who have already been displaced from other parts of Syria such as Aleppo and Eastern Ghouta by previous government offensives; the most severely affected area is in the southernmost part of the demilitarised zone of Idlib province.

[Comment] Interleukin-23 blockade: another breakthrough in the treatment of psoriasis

Ve, 05/07/2019 - 00:30
Before risankizumab's introduction, there were ten biologic therapies approved for psoriasis, with two more in development. Do we really need all of these expensive therapies for this disease? A close look at the data shows that we do not have any treatments that reliably achieve complete clearing as evidenced by psoriasis area and severity index (PASI) 100, and only the newest treatments achieve PASI 90 in high proportions of patients. Moreover, many treatments require frequent injections or are less effective in patients who have not had success with other therapies.

[Articles] Expanding traditional tendon-based techniques with nerve transfers for the restoration of upper limb function in tetraplegia: a prospective case series

Ve, 05/07/2019 - 00:30
Early nerve transfer surgery is a safe and effective addition to surgical techniques for upper limb reanimation in tetraplegia. Nerve transfers can lead to significant functional improvement and can be successfully combined with tendon transfers to maximise functional benefits.

[Articles] Risankizumab compared with adalimumab in patients with moderate-to-severe plaque psoriasis (IMMvent): a randomised, double-blind, active-comparator-controlled phase 3 trial

Ve, 05/07/2019 - 00:30
Risankizumab showed significantly greater efficacy than adalimumab in providing skin clearance in patients with moderate-to-severe plaque psoriasis. No additional safety concerns were identified for patients who switched from adalimumab to risankizumab. Treatment with risankizumab provides flexibility in the long-term treatment of psoriasis.

[Comment] Appropriate excision margins for cutaneous melanomas

Ve, 05/07/2019 - 00:30
In an era when attempts to better understand the pathophysiology and treatment of melanoma are focused on complex genomics and proteomics, it is remarkable that fundamentally simple questions about surgical excision margins remain unanswered. Often overlooked is the important fact that most patients who present with a primary cutaneous melanoma can be cured by surgery alone. The extent of that surgery must clearly be sufficient to maximise the chance of cure, while minimising patient morbidity and health-care costs associated with the reconstruction of large excision defects.

[Articles] 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: long-term follow-up of a multicentre, randomised trial

Ve, 05/07/2019 - 00:30
A 2-cm excision margin was safe for patients with thick (>2 mm) localised cutaneous melanoma at a follow-up of median 19·6 years. These findings support the use of 2-cm excision margins in current clinical practice.

[Correspondence] Intrahepatic cholestasis: suggested future investigations

Ma, 02/07/2019 - 00:30
We read with great interest Caroline Ovadia and colleagues' Article.1 We congratulate the authors for aggregating such large-scale individual data to determine how perinatal outcomes are linked with bile acid concentrations. The authors focus on stillbirth but show another important finding. Iatrogenic preterm birth is a matter of concern (it occurred in 305 [11·8%] of 2576 women with intrahepatic cholestasis of pregnancy (ICP) vs 2440 [2·0%] of 121 011 women in the control group; odds ratio 3·65, 95% CI 1·94–6·85), and we noticed a significantly increased number of admissions to neonatal intensive care units (517 [23·7%] of 2175 women vs 3367 [12·9%] of 26 005; 2·12, 1·48–3·03), with most births close to term and no difference in birthweight centile (p 15 of the Article's1 appendix).

[Correspondence] Intrahepatic cholestasis: suggested future investigations – Authors' reply

Ma, 02/07/2019 - 00:30
We share the concerns of Alexandre Vivanti and colleagues about the high proportion of iatrogenic preterm births for women with intrahepatic cholestasis of pregnancy (ICP)identified in our study.1 These births occurred for women with bile acids at all concentrations, the overall proportion being 817 (19%) of 4316 women with singleton pregnancies included in the individual patient data analysis,1 which is much higher than the typical proportion of all-cause preterm births (the estimated global proportion of preterm births for 2014 was 10·6% [uncertainty interval 9·0–12·0]2).

[Department of Error] Department of Error

Ma, 02/07/2019 - 00:30
Nosten FH, Pyae Phyo A. New malaria maps. Lancet 2019; 394: 278–79—In this Comment, the spelling of author Aung Pyae Phyo's name was incorrect. This correction has been made to the online version as of July 1, 2019, and the printed version is correct.

[Department of Error] Department of Error

Ma, 02/07/2019 - 00:30
Cubaka VK, Schriver M, Uwizihiwe JP, Lygidakis C, Kallestrup P. The twin-PhD model contributes to knowledge production in Africa. Lancet 2019; 393: 2590—The title of this Correspondence contained a spelling mistake in the word “contributes”. This correction has been made to the online version as of July 1, 2019.

[Comment] UK consultation on pulse oximetry screening for critical congenital heart defects in newborns

Ma, 02/07/2019 - 00:30
Universal screening allows potentially life-threatening diseases to be detected while presymptomatic. UK neonatal mortality is rising and in 2015 was ranked 19th out of 28 European countries.1 Congenital anomalies and infections are the main causes of UK term neonatal mortality, and most deaths from congenital anomalies are from cardiac defects.2 Critical congenital heart defects (CCHD) occur in two per 1000 livebirths and, if undetected, can result in collapse and death following closure of the ductus arteriosus.

[Comment] Improving medication safety: focus on prescribers and systems

Lu, 01/07/2019 - 10:00
Health-care services around the world continue to struggle with safe and effective delivery of medication. Globally, it has been estimated that the cost associated with medication errors is US$42 billion each year.1 Patients in low-income countries lose twice as many disability-adjusted life-years due to medication-related harm than those in high-income countries.1 In England, there are an estimated 237 million medication errors annually, about half of which were administration errors with minimal or no potential for clinical harm.

[Correspondence] Pain relief during labour

Sa, 29/06/2019 - 00:30
Matthew Wilson and colleagues1 found that remifentanil patient-controlled analgesia halved the proportion of epidural conversions compared with intramuscular pethidine. We believe there was a flaw in this research because the study lacked data on birth order, and primigravidae report more pain than multiparous women.2 We believe that addressing this issue could further increase the value of their study.

[Correspondence] Pain relief during labour

Sa, 29/06/2019 - 00:30
Matthew Wilson and colleagues should be congratulated for their well designed and executed study.1 However, several findings were inadequately addressed and affect their conclusions.

[Correspondence] Pain relief during labour

Sa, 29/06/2019 - 00:30
Although we appreciate the value of the work by Matthew Wilson and colleagues1 on remifentanil patient-controlled analgesia (PCA) versus intramuscular pethidine for pain relief in labour, we have concerns about the study and its interpretation.

[Correspondence] Pain relief during labour

Sa, 29/06/2019 - 00:30
We read the Article by Matthew Wilson and colleagues1 with interest. Their study findings add weight to the argument that remifentanil is an increasingly preferable pharmacological alternative to pethidine for labour analgesia and that it reduces conversion rates to epidural analgesia. However, the investigators have overlooked the substantial staffing implications that the widespread adoption of remifentanil would have on maternity units.