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[Perspectives] Désirée van der Heijde: a focus on outcomes in rheumatic diseases

Sa, 02/06/2018 - 00:00
When researching the progress of rheumatoid arthritis and related conditions, many rheumatologists will have used the Sharp/van der Heijde scoring system for measuring radiographically observed damage. The first half of that eponym denotes John Sharp, the American rheumatologist who devised and published the scale in 1985 with a view to measuring the effectiveness of disease-modifying drugs. Sharp died in 2008, but Désirée van der Heijde, the Dutch rheumatologist who modified Sharp's original system, is alive and well and Professor of Rheumatology at Leiden University Medical Centre (LUMC) in the Netherlands.

[Obituary] Arno Motulsky

Sa, 02/06/2018 - 00:00
Founder of medical genetics and creator of pharmacogenomics. Born on July 5, 1923, in Fischhausen, Germany, he died in Seattle, WA, USA, on Jan 17, 2018, aged 94 years.

[Correspondence] Consequence of reimbursement policy alteration for urgent PCI in Japan

Sa, 02/06/2018 - 00:00
Establishing timely coronary revascularisation (eg, percutaneous coronary intervention [PCI]) in acute coronary syndrome has become a distinctive performance measure worldwide. Clinical guidelines recommend a door-to-balloon time of 90 min or less for patients with ST-elevation myocardial infarction (STEMI).1 In light of these guideline recommendations, the Japanese Ministry of Health, Labour and Welfare introduced a new reimbursement policy in April, 2014, providing an additional hospital incentive of approximately US$3500 when patients with positive cardiac biomarkers (eg, troponins) achieved a door-to-balloon time of 90 min or less.

[Correspondence] Chagas disease cardiomyopathy treatment remains a challenge

Sa, 02/06/2018 - 00:00
Congratulations to José Pérez-Molina and Israel Molina for their Seminar (Jan 6, p 82)1 on Chagas disease. However, I believe that some points they raised should be revisited for clinical practice because they are not based on evidence.

[Correspondence] Chagas disease cardiomyopathy treatment remains a challenge – Authors' reply

Sa, 02/06/2018 - 00:00
We appreciate Edimar Bocchi's Correspondence on our Seminar1 on Chagas disease. We agree that the paucity of clinical trials for this disease prevents us from making firm recommendations on specific aspects of this parasitosis. Thus, more often than is desirable, we are obliged to base our practice on prospective observational studies or expert opinion. Unfortunately, this predicament is not unique to Chagas disease.

[Correspondence] Can deinstitutionalisation contribute to exclusion?

Sa, 02/06/2018 - 00:00
The Review in The Lancet by Serena Luchenski and colleagues (Jan 20, p 266)1 on effective health interventions for people who experience homelessness, substance use disorders, or imprisonment, or who work in the sex trade highlighted the need to tackle physical health, mental health, and addiction in these populations, and noted the importance of deinstitutionalisation.

[Correspondence] Can deinstitutionalisation contribute to exclusion? – Authors' reply

Sa, 02/06/2018 - 00:00
In their Correspondence, Tarun Bastiampillai and colleagues present their interpretation of the evidence on the effects of reduced numbers of psychiatric beds on people with severe mental illness. This issue was not addressed at any point in our Review.1 Instead, we examined effective interventions for inclusion health target populations, defined as people who experience homelessness, substance use disorders, imprisonment, or sex work. Most people in these heavily overlapping populations do not have severe mental illness.

[Department of Error] Department of Error

Sa, 02/06/2018 - 00:00
Wood AM, Kaptoge S, Butterworth AS, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet 2018; 391: 1513–23—In this Article, Makoto Daimon's affiliation was listed incorrectly and should have been: Global Center of Excellence Program Study Group, Yamagata University Faculty of Medicine, Yamagata, Japan. The online version has been corrected as of May 31, 2018.

[Articles] Efficacy and safety of guselkumab in patients with active psoriatic arthritis: a randomised, double-blind, placebo-controlled, phase 2 study

Sa, 02/06/2018 - 00:00
Guselkumab, a novel anti-interleukin 23p19 antibody, significantly improved signs and symptoms of active psoriatic arthritis and was well tolerated during 44 weeks of treatment. The results of this study support further development of guselkumab as a novel and comprehensive treatment in psoriatic arthritis.

[Articles] Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial

Sa, 02/06/2018 - 00:00
Hip arthroscopy and personalised hip therapy both improved hip-related quality of life for patients with femoroacetabular impingement syndrome. Hip arthroscopy led to a greater improvement than did personalised hip therapy, and this difference was clinically significant. Further follow-up will reveal whether the clinical benefits of hip arthroscopy are maintained and whether it is cost effective in the long term.

[Clinical Picture] Nail infestation: an atypical presentation of typical scabies

Sa, 02/06/2018 - 00:00
A 55-year-old man with a 2-year history of leucocytosis was diagnosed, 9 months ago, with non-Hodgkins lymphoma. He underwent combination chemotherapy, but unfortunately, despite these treatments his illness did not remit. In April, 2017, he was admitted for a fourth round of chemotherapy. At review, he complained that some of his finger and toe nails had become thick and dystrophic over the previous 8 weeks. He did not report any pruritus or pain. Consequently, he was seen by a dermatologist. Physical examination revealed eight thickened, yellowish, and dystrophic nails, with the surrounding area appearing red and puffy (figure).

[Series] The pathogenesis of psoriatic arthritis

Sa, 02/06/2018 - 00:00
Psoriatic arthritis is a chronic, immune-mediated, inflammatory arthropathy that presents with inflammation of the joints and entheses, including those of the axial skeleton, and is associated with increased mortality from cardiovascular disease. Diagnosis is primarily based on clinical phenotype because of the diversity of the associated features, which can include skin and nail disease, dactylitis, uveitis, and osteitis. Improved understanding of the pathogenesis of psoriatic arthritis has led to the development of effective biologics and small-molecular drugs targeting specific cytokines and signalling pathways, which can prevent disease progression and improve quality of life.

[Series] Clinical management of psoriatic arthritis

Sa, 02/06/2018 - 00:00
Psoriatic arthritis, or the broader term psoriatic disease, refers to an inflammatory disorder that affects multiple organs, including the skin and joints, and that also has related extra-articular manifestations and can have comorbidities. Patients with psoriatic disease have a substantial clinical burden. Early identification leading to timely diagnosis and treatment is crucial to prevent long-term structural damage and disability and the associated socioeconomic consequences. The increase in therapeutic options, such as disease-modifying anti-rheumatic drugs, both biological and targeted synthetic, has revolutionised the treatment of skin and joint disease, and has prompted clinicians to use the full clinical picture of an individual patient to make rational treatment decisions.

[Commission] Time to deliver: report of the WHO Independent High-Level Commission on NCDs

Ve, 01/06/2018 - 12:00
The 2030 Agenda for Sustainable Development, with its pledge to leave no one behind, is our boldest agenda for humanity. It will require equally bold actions from Heads of State and Government. They must deliver on their time-bound promise to reduce, by one-third, premature mortality from NCDs through prevention and treatment and promote mental health and wellbeing.

[Articles] Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial

Ve, 01/06/2018 - 00:30
In this trial, long-term HA administration prolongs overall survival and might act as a disease modifying treatment in patients with decompensated cirrhosis.

[Comment] Long-term albumin in cirrhosis: is it the ANSWER?

Ve, 01/06/2018 - 00:30
Ascites is the most frequent complication of cirrhosis and carries the worst prognosis.1 Although its development might be delayed by non-selective β-blockers,2 once ascites develops the patient progresses to refractory ascites, hyponatraemia, and renal dysfunction.3 This progression is due to worsening of portal pressure and worsening of the vasodilatory–hyperdynamic circulatory state, leading to progressive decrease in effective blood volume, cardiac dysfunction, and renal perfusion.4 Inflammation from overt or covert (bacterial translocation) infections is a major driver of progression.

[Department of Error] Department of Error

Ve, 01/06/2018 - 00:30
Sperber A. Health for migrants and Dominicans of Haitian descent. Lancet 2018; 391: 2093–94—In this World Report, the following phrase should have read: “…the 2010 earthquake that killed more than 300 000 and displaced 1·5 million people”. This correction has been made to the online version as of May 31, 2018.

[Comment] Sugar, tobacco, and alcohol taxes to achieve the SDGs

Me, 30/05/2018 - 00:30
More than a decade after the adoption of the WHO Framework Convention on Tobacco Control, there is compelling evidence that raising tobacco prices substantially through taxation is the single most effective way to reduce tobacco use and save lives.1 Similarly, alcohol taxation is a cost-effective way to reduce alcohol consumption and harm.2 With growing evidence, sugar taxes are another fiscal tool to promote health and nutrition.3 Mexico's sugar tax reduced sugar-sweetened beverage sales by 5% in the first year, with an almost 10% further reduction in the second year.

[Correspondence] Where is the official guidance on Ebola and surgery?

Me, 30/05/2018 - 00:30
A new outbreak of Ebola is underway in the Democratic Republic of the Congo (DRC).1 In the two years since the west African outbreak ended, we now have a vaccine, but still no official guidance on Ebola and surgical care.

[Correspondence] Beyond vaccines: improving survival rates in the DRC Ebola outbreak

Sa, 26/05/2018 - 00:30
Even as an experimental vaccine is being deployed to limit the ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC), provision of the clinical care necessary for improving survival among infected patients must also be prioritised. During the early part of the 2013–16 west African epidemic when intravenous fluids were not readily available, the nearly four–fold difference in mortality between patients treated in high–income countries (18·5%) compared with those managed in west Africa (70·8%) suggests that aggressive hydration, among other measures, could improve outcomes.