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[Perspectives] Alberto García-Basteiro: seeking better TB control in Mozambique

Sa, 19/03/2022 - 01:00
“I always say that before I came to Mozambique my understanding of tuberculosis was not much more than you learn in med school”, says Alberto García-Basteiro, now Tuberculosis and HIV/AIDS Research Coordinator at the Manhiça Health Research Centre (CISM) in Mozambique. Working at CISM, some 80 km north of the country's capital, Maputo, provided him with a rapid, in-depth education in the disease. The research he has led since his arrival in Mozambique in 2013 has earned him the 2021 Stephen Lawn TB–HIV Research Leadership Prize, awarded for his innovative and high-quality research on tuberculosis diagnostics in an area of Africa with a high burden of HIV and tuberculosis.

[Perspectives] The misuse of race in the search for disease-causing alleles

Sa, 19/03/2022 - 01:00
In her influential 2000 paper, Levels of Racism: A Theoretic Framework and a Gardener's Tale, Camara Phyllis Jones presented a theoretical framework for understanding racism through an allegory about a gardener with two flower boxes, one with rich and the other with poor soil. The gardener, who prefers red flowers, plants red blossoming seeds in fertile soil but pink blossoming seeds in poor soil (structural racism) and plucks pink blossoming seeds blown into fertile soil (personally mediated racism).

[Obituary] Sarah Weddington

Sa, 19/03/2022 - 01:00
Lawyer, politician, and advocate for women's rights and reproductive health care. Born on Feb 5, 1945 in Abilene, TX, USA, she died on Dec 26, 2021 in Austin, TX, aged 76 years.

[Correspondence] Global mortality burden attributable to non-optimal temperatures

Sa, 19/03/2022 - 01:00
Katrin Burkart and colleagues1 present the results of an ambitious study on the global mortality burden attributable to non-optimal temperatures by the Global Burden of Diseases, Injuries,and Risk Factors Collaborators. They report that 2·98% of deaths globally could be attributed to non-optimal temperatures in 2019; 2·37% of deaths from low temperatures and 0·63% of deaths from high temperatures.

[Correspondence] Global mortality burden attributable to non-optimal temperatures – Authors’ reply

Sa, 19/03/2022 - 01:00
We are pleased to respond to Ana Vicedo-Cabrera and colleagues, who suggest we underestimated the mortality burden attributable to cold temperatures.1 We agree that, in explicitly restricting our analysis to same-day temperature effects, not considering lagged effects, we probably underestimated the temperature-attributable mortality, especially for cold temperatures. In asserting that season is a strong confounder, Vicedo-Cabrera and colleagues cite a simulation study that evaluates the role of season in air pollution assessment, which is fundamentally different because both air pollution and health are affected by season and meteorology.

[Correspondence] Is stenting equivalent to endarterectomy for asymptomatic carotid stenosis?

Sa, 19/03/2022 - 01:00
We read with interest the findings of the ACST-2 trial.1 However, some of the observations made us wonder whether it was accurate to conclude that carotid artery stenting (CAS) and carotid endarterectomy (CEA) were comparable.

[Correspondence] Is stenting equivalent to endarterectomy for asymptomatic carotid stenosis?

Sa, 19/03/2022 - 01:00
The ACST-2 trial1 is the largest randomised trial to date comparing carotid artery stenting (CAS) with carotid endarterectomy (CEA). The study involved 3625 patients with carotid stenosis and no previous or recent same-sided stroke or transient ischaemic attack. However, we feel it is important to counter the investigators’ conclusions that “serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable”.

[Correspondence] Is stenting equivalent to endarterectomy for asymptomatic carotid stenosis? – Authors’ reply

Sa, 19/03/2022 - 01:00
In the ACST-2 randomised trial1 we compared carotid endarterectomy (CEA) with carotid artery stenting (CAS). The discussion of its findings drew on two other sources of evidence; first, the procedural hazards seen in large population registries, and second, our meta-analysis of all the properly randomised trials. For in comparing these two procedures, the differences in their immediate hazards and the differences in their long-term effects on stroke incidence are both important. Hence, for both these outcomes the treatment differences should be assessed reliably.

[Department of Error] Department of Error

Sa, 19/03/2022 - 01:00
Ahsan S. Ukrainian health workers respond to war. Lancet 2022; 399: 896—In this World Report, the author's and Dr Bezuhlyy's names were misspelled. These corrections have been made to the online version as of Mar 17, 2022.

[Articles] Effectiveness of the Ad26.COV2.S vaccine in health-care workers in South Africa (the Sisonke study): results from a single-arm, open-label, phase 3B, implementation study

Sa, 19/03/2022 - 01:00
The single-dose Ad26.COV2.S vaccine shows effectiveness against severe COVID-19 disease and COVID-19-related death after vaccination, and against both beta and delta variants, providing real-world evidence for its use globally.

[Clinical Picture] Infective endocarditis and thromboses due to antiphospholipid syndrome following acute Q fever

Sa, 19/03/2022 - 01:00
A 38-year-old man, presented to our hospital emergency room with sudden onset of severe pain, weakness, and hypoesthesia in both legs.

[Correspondence] War surgery and transfusion in makeshift hospitals in beleaguered cities

Ve, 18/03/2022 - 01:30
In 1714, the satirist Jonathan Swift stated that the “blessing of liberty” must be paid for in “blood and treasure”.1 As we look to events in Ukraine, the terrible price of freedom again becomes apparent. Yet war has also been the impetus for improvements in medical care, from Jean-Louis Petit's screw tourniquet and Dominique Larrey's ambulance volante to the modern concept of damage control resuscitation (DCR). Contemporary DCR is characterised by haemostatic resuscitation, permissive hypotension, and damage control surgery,2 which originated on the battlefield and is now entrenched in civilian practice.

[Correspondence] The UN must provide secure medical and humanitarian assistance in Ukraine

Ve, 18/03/2022 - 01:30
We are calling for more involvement by the UN in the current conflict in Ukraine.1 Continuation of the health and humanitarian crisis will result in many deaths and much suffering unless there is safe delivery and implementation of humanitarian and medical aid, including secure humanitarian corridors and safe medical evacuation. Substantial international protection forces, able to ensure safe humanitarian work in Ukraine, are essential and urgently needed.

[Comment] Omicron: fewer adverse outcomes come with new dangers

Gi, 17/03/2022 - 01:30
With wave after wave of SARS-CoV-2 variants, COVID-19 patients filled the worlds' hospitals and morgues because not everybody had access to vaccines or were willing to be vaccinated.1,2 Omicron (B.1.1.529) is no different. Although most scientists were expecting an increase in cases during late 2021, it was surprising that vaccinated and previously infected people were contracting the novel omicron variant so easily and how fast it was transmitting,3 which raised several questions. Would existing vaccines still prevent SARS-CoV-2 infection?4 Was omicron more transmissible than previous variants?5 What were the consequences of omicron's wide and rapid spread infecting millions of people, including a high number of breakthrough cases? Would it have worse or better outcomes than the worst SARS-CoV-2 variant on record, the delta variant (B.1.617.2)? In The Lancet, Tommy Nyberg and colleagues report their findings about omicron for individuals who are vaccinated, previously infected, or unvaccinated.

[Articles] Comparative analysis of the risks of hospitalisation and death associated with SARS-CoV-2 omicron (B.1.1.529) and delta (B.1.617.2) variants in England: a cohort study

Gi, 17/03/2022 - 01:30
The risk of severe outcomes following SARS-CoV-2 infection is substantially lower for omicron than for delta, with higher reductions for more severe endpoints and significant variation with age. Underlying the observed risks is a larger reduction in intrinsic severity (in unvaccinated individuals) counterbalanced by a reduction in vaccine effectiveness. Documented previous SARS-CoV-2 infection offered some protection against hospitalisation and high protection against death in unvaccinated individuals, but only offered additional protection in vaccinated individuals for the death endpoint.

[Department of Error] Department of Error

Gi, 17/03/2022 - 01:30
Bagenal J, Baxter N. Sexual misconduct in medicine must end. Lancet 2022; 399: 1030–32—In this Comment, the authors of reference 1 have been corrected to read Fleming S, Fisher RA. This correction was made to the online version as of March 16, 2022.

[Comment] Two midwives during the second stage of labour to reduce severe perineal trauma

Me, 16/03/2022 - 01:30
The reported incidence of the most severe form of perineal trauma—obstetric anal sphincter injury—varies greatly; however, estimates from WHO suggest a global incidence of 4·0–6·6% from all vaginal deliveries.1,2 Obstetric anal sphincter injury is of major concern for women because it is associated with an increased risk of pelvic floor disorders, such as anal incontinence, urinary incontinence, pelvic organ prolapse, and sexual dysfunction. Pelvic floor disorders restrict women in their daily activities and have a negative impact on their quality of life.

[Comment] Evaluating COVID-19 vaccines in the real world

Me, 16/03/2022 - 01:30
The effectiveness of the mRNA vaccines in preventing COVID-19 disease progression in 2021 set new expectations about the role of prevention interventions for the disease. Efficacy observed in the trials was more than 90%.1,2 The efficacy of other vaccines evaluated in large randomised trials, such as the Oxford–AstraZeneca (70%) and Sputnik V (91%) vaccines, have been criticised for elements of the trial conduct and concerns about safety.3,4 For that reason, mRNA vaccines have been most widely distributed in wealthier settings while other vaccines, such as Sinopharm and Sinovac, with some exceptions,3 have been provided in low-income and middle-income countries.

[Articles] The effect of two midwives during the second stage of labour to reduce severe perineal trauma (Oneplus): a multicentre, randomised controlled trial in Sweden

Me, 16/03/2022 - 01:30
The presence of two midwives during the active second stage can reduce SPT in women giving birth for the first time.