Riviste scientifiche

[Comment] Haemostatic treatment for intracerebral haemorrhage

The Lancet - Me, 16/05/2018 - 12:00
Spontaneous intracerebral haemorrhage remains the only stroke subtype without a scientifically proven treatment. The baseline factors associated with intracerebral haemorrhage mortality and functional outcomes are volume of intracerebral or intraventricular haematoma, growth of intracerebral haematoma during first hours of onset, age, Glasgow Coma Scale, and infratentorial location.1–4 Of these factors, only the growth of intracerebral or intraventricular haematomas and their resulting volumes are biologically modifiable.

[Articles] Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial

The Lancet - Me, 16/05/2018 - 12:00
Functional status 90 days after intracerebral haemorrhage did not differ significantly between patients who received tranexamic acid and those who received placebo, despite a reduction in early deaths and serious adverse events. Larger randomised trials are needed to confirm or refute a clinically significant treatment effect.

The woman who laughs uncontrollably when others get tickled

New Scientist - Me, 16/05/2018 - 08:00
A woman has a type of synaesthesia that makes her experience huge seizures of uncontrollable laughter whenever she sees someone else getting tickled

Ibuprofen versus pivmecillinam for uncomplicated urinary tract infection in women—A double-blind, randomized non-inferiority trial

PLoS Medicine - Ma, 15/05/2018 - 23:00

by Ingvild Vik, Marianne Bollestad, Nils Grude, Anders Bærheim, Eivind Damsgaard, Thomas Neumark, Lars Bjerrum, Gloria Cordoba, Inge Christoffer Olsen, Morten Lindbæk

Background

Although uncomplicated urinary tract infections (UTIs) are often self-limiting, most patients will be prescribed antibiotic treatment. We assessed whether treatment with ibuprofen was non-inferior to pivmecillinam in achieving symptomatic resolution by day 4, with a non-inferiority margin of 10%.

Methods and findings

This was a randomized, controlled, double-blind non-inferiority trial. We recruited patients from 16 sites in a general practice setting in Norway, Sweden, and Denmark. Non-pregnant women aged 18–60 years presenting with symptoms of uncomplicated UTI were screened for eligibility from 11 April 2013 to 22 April 2016. Patients with informed consent were randomized (1:1 ratio) to treatment with either 600 mg ibuprofen or 200 mg pivmecillinam 3 times a day for 3 days. The patient, treating physician, and study personnel were blinded to treatment allocation. The primary outcome was the proportion of patients who felt cured by day 4, as assessed from a patient diary. Secondary outcomes included the proportion of patients in need of secondary treatment with antibiotics and cases of pyelonephritis. A total of 383 women were randomly assigned to treatment with either ibuprofen (n = 194, 181 analyzed) or pivmecillinam (n = 189, 178 analyzed). By day 4, 38.7% of the patients in the ibuprofen group felt cured versus 73.6% in the pivmecillinam group. The adjusted risk difference with 90% confidence interval was 35% (27% to 43%) in favor of pivmecillinam, which crossed the prespecified non-inferiority margin. Secondary endpoints were generally in favor of pivmecillinam. After 4 weeks’ follow-up, 53% of patients in the ibuprofen group recovered without antibiotic treatment. Seven cases of pyelonephritis occurred, all in the ibuprofen group, giving a number needed to harm of 26 (95% CI 13 to 103). Five of these patients were hospitalized and classified as having serious adverse events; 2 recovered as outpatients. A limitation of the study was the extensive list of exclusion criteria, eliminating almost half of the patients screened. We did not register symptoms in the screening process; hence, we do not know the symptom burden for those who declined to participate. This might make our results less generalizable.

Conclusions

Ibuprofen was inferior to pivmecillinam for treating uncomplicated UTIs. More than half of the women in the ibuprofen group recovered without antibiotics. However, pyelonephritis occurred in 7 out of 181 women using ibuprofen. Until we can identify those women who will develop complications, we cannot recommend ibuprofen alone as initial treatment to women with uncomplicated UTIs.

Trial registration

ClinicalTrials.gov NCT01849926EU Clinical Trials Register (EU-CTR), EudraCT Number 2012-002776-14

Injury and death during the ISIS occupation of Mosul and its liberation: Results from a 40-cluster household survey

PLoS Medicine - Ma, 15/05/2018 - 23:00

by Riyadh Lafta, Maha A. Al-Nuaimi, Gilbert Burnham

Background

Measurement of mortality and injury in conflict situations presents many challenges compared with stable situations. However, providing information is important to assess the impact of conflict on populations and to estimate humanitarian needs, both in the immediate and longer term. Mosul, Iraq’s second largest city, was overrun by fighters of the Islamic State of Iraq and Syria (ISIS) on June 4, 2014. In this study, we conducted household surveys to measure reported deaths, injuries, and kidnappings in Mosul, Iraq, both during the occupation of the city by fighters of ISIS and the months of Iraqi military action known as the liberation.

Methods and findings

Mosul was overrun by ISIS forces on June 4, 2014, and was under exclusive ISIS control for 29 months. The military offensive by Iraqi forces, supported by coalition artillery and airstrikes, began on October 17, 2016, in east Mosul and concluded in west Mosul with the defeat of ISIS on June 29, 2017. We conducted a 40-cluster population-based survey as soon as the security forces permitted access for the survey team. The objective of the survey was to measure reported deaths, injuries, and kidnappings in Mosul households during 29 months of ISIS-exclusive control (June 2014–October 2016) and the nine months of Iraqi military action known as the liberation (October 2016–June 2017). In east Mosul, the survey was conducted from March 23 to March 31, 2017, and in west Mosul from July 18 to July 31, 2017. Sampling was based on pre-ISIS population distribution, with revisions made following the extensive destruction in west Mosul. The 1,202 sampled households included 7,559 persons: 4,867 in east Mosul and 2,692 in west Mosul. No households declined to participate. During the time from June 4, 2014, to the time of the survey, there were 628 deaths reported from the sampled households, of which 505 were due to intentional violence, a mortality rate of 2.09 deaths per 1,000 person-months. Over the entire time period, the group with the highest mortality rates from intentional violence was adults aged 20 to 39: 1.69 deaths per 1,000 person-months among women and 3.55 among men. In the 29 months of ISIS-exclusive control, mortality rates among all males were 0.71 reported deaths per 1,000 person-months and for all females were 0.50 deaths per 1,000 person-months. During the nine months of the military liberation, the mortality rates jumped to 13.36 deaths per 1,000 person-months for males and 8.33 for females. The increase was particularly dramatic in west Mosul. The leading cause of reported deaths from intentional violence was airstrikes—accounting for 201 civilian deaths—followed by 172 deaths from explosions. Reported deaths from airstrikes were most common in west Mosul, while reported deaths from explosions were similar on both sides of Mosul. Gunshots accounted for 86 cases, predominantly in west Mosul where ISIS snipers were particularly active. There were 35 persons who were reported to have been kidnapped, almost entirely prior to the military offensive. By the time of the survey, 20 had been released, 8 were dead, and 7 still missing, according to household reports. Almost all of the 223 injuries reported were due to intentional violence. Limitations to population-based surveys include a probable large survivor bias, the reliance on preconflict population distribution figures for sampling, and potential recall bias among respondents.

Conclusions

Death and injuries during the military offensive to liberate Mosul considerably exceeded those during ISIS occupation. Airstrikes were the major reported cause of deaths, with the majority occurring in west Mosul. The extensive use of airstrikes and heavy artillery risks an extensive loss of life in densely populated urban areas. The high probability of survivor bias in this survey suggests that the actual number of injuries, kidnappings, and deaths in the neighborhoods sampled is likely to be higher than we report here.

Falling mini-moons may have created Earth’s first continents

New Scientist - Ma, 15/05/2018 - 20:00
The early Earth was likely orbited by lots of small moons, which rained down onto the surface and could have built up ancient continents

A new synthetic molecule may solve a paradox about life’s origin

New Scientist - Ma, 15/05/2018 - 19:45
Many scientists suspect life began with a molecule called RNA, but there has long been a big problem with this idea. Now there is a solution

We’ve only just realised the huge power and value of our data

New Scientist - Ma, 15/05/2018 - 19:40
People signup to Facebook personality apps for fun but few read the terms and conditions. Once, this may have seemed reasonable, but the climate has changed

Fertiliser feeds us but trashes the climate – now there’s a fix

New Scientist - Ma, 15/05/2018 - 18:00
The way we make ammonia for fertilizer was developed a century ago and produces more than 1 per cent of all carbon emissions. Now we may have a replacement

Hawaii’s erupting volcano may blast out ‘10-tonne cannonballs’

New Scientist - Ma, 15/05/2018 - 16:45
As Kilauea continues erupting, lava is mixing with water, creating steam that could trigger massive explosions and throw large rocks up to a kilometre away

We may finally be able to beat the common cold with a new drug

New Scientist - Ma, 15/05/2018 - 14:35
An experimental drug stops common cold viruses from building their protective outer armour, preventing them from replicating and spreading

The tides are getting stronger thanks to the shifting continents

New Scientist - Ma, 15/05/2018 - 14:30
The ocean tides are the strongest they have been for millions of years, and they will get stronger for several million years to come – because of the position of the continents

Let’s hear it for psychology, a better than average science

New Scientist - Ma, 15/05/2018 - 11:00
It’s often derided as a pseudoscience, but every once in a while experimental psychology delivers a result that changes the way we think about ourselves

We’ve lost track of more than 900 near-Earth asteroids

New Scientist - Lu, 14/05/2018 - 21:37
More than 900 asteroids hurtling close to Earth were seen just once and then lost. Some may be kilometres across, and they could be just about anywhere

Rich nations restore their own forests but trash those elsewhere

New Scientist - Lu, 14/05/2018 - 21:00
As countries get richer, they start replanting their forests – but this is not a big environmental gain because they “export” the deforestation to poor countries

We messed up our figures on how much carbon dioxide is too much

New Scientist - Lu, 14/05/2018 - 18:00
Climatologists have tried to set a “carbon budget” that tells us how much greenhouse gas we can emit and stay below 2°C, but their efforts have only caused confusion

Probe saw plumes on Europa 20 years ago – we just didn’t notice

New Scientist - Lu, 14/05/2018 - 18:00
We weren’t sure whether Jupiter’s moon Europa spews plumes of water, but evidence for them has just been found in 20-year-old data from the Galileo spacecraft

Huge new Facebook data leak exposed intimate details of 3m users

New Scientist - Lu, 14/05/2018 - 15:17
Data from millions of Facebook users, including their answers to intimate questionnaires, was left exposed online for anyone to access, a New Scientist investigation has found

Doing Dry January lowers cancer-promoting proteins in your blood

New Scientist - Lu, 14/05/2018 - 14:15
Stopping drinking for just one month is enough to dramatically lower the levels of hormone-like chemicals in your blood that help cancer to develop and spread

[Comment] REPLACE: a roadmap to make the world trans fat free by 2023

The Lancet - Lu, 14/05/2018 - 13:45
Cardiovascular disease is the leading cause of death globally, accounting for one in every three deaths,1 with nearly half of deaths in lower-income countries among people younger than 70 years.2 WHO has identified the elimination of industrially produced trans fat (an artificial product contained in partially hydrogenated oils) from the food supply as an effective and cost-effective intervention to prevent cardiovascular disease.3 Industrially produced trans fat causes an estimated 540 000 deaths each year worldwide.
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