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[Obituary] Lawrence Kaggwa

Ve, 05/10/2018 - 23:00
Ugandan surgeon and hospital director. Born in Kiryasaka, Uganda, on April 9, 1948, he died after a series of heart complications in Kampala, Uganda, on Nov 10, 2017, aged 69 years.

[Correspondence] Mitochondrial donation: from test tube to clinic

Ve, 05/10/2018 - 23:00
The first licences permitting mitochondrial donation were issued in late 2017 by the Human UK Fertilization and Embryo Authority (HFEA), the statutory authority charged with regulating human embryo research, representing a historic landmark in the quest to eradicate transmission of serious mitochondrial DNA (mtDNA) disease.1 We previously estimated2 the average number of births per year among women at risk for transmitting mtDNA disease to be 152 (95% CI 125–200) in the UK and 778 (636–944) in the USA; mitochondrial donation will have an immediate and direct effect on these births.

[Correspondence] The Global Fund as an ATM plus

Ve, 05/10/2018 - 23:00
In his Comment, Richard Horton (July 7, p 14)1 advocates for an expanded mandate of the Global Fund, with the inclusion of Universal Health Coverage (UHC) in addition to its support for the three global high-burden diseases (HIV/AIDS, tuberculosis, and malaria). This notion is welcome in an era in which poor reproductive, neonatal, mother, adolescent, and child health and catastrophic health expenditure for chronic (non-communicable) diseases still create considerable anguish and hardships for people in many countries.

[Correspondence] Directed organ donation and deceased donor-initiated kidney chains

Ve, 05/10/2018 - 23:00
In many instances, transplants cannot be performed because of incompatibility (such as incompatible blood type or crossmatch) among donors and recipients. A way to address this issue is by means of donor exchanges, in which incompatible pairs are enrolled in a registry. Registries can lead to paired exchanges or to donor chains. In chains, a non-directed (altruistic) donor initiates a sequence of transplants that culminates with a so-called bridge donor. Studies have estimated that a non-directed donor triggers on average 4·8–6 transplants (if donor is blood type O).

[Correspondence] Moving back in policy banning glyphosate use in Colombia

Ve, 05/10/2018 - 23:00
Colombia is a country of unique advances and setbacks. In May, 2015, the Ministry of Health banned the use of glyphosate for the eradication of coca and poppy crops, after 34 years of use in jungle territories inhabited by vulnerable populations.1 The decision to ban glyphosate was debated by both scientists and politicians, and, in the interest of public health, this precautionary measure was applied after the International Agency for Research on Cancer concluded that glyphosate is potentially carcinogenic for humans.

[Correspondence] The impact of preprint on media reporting of science

Ve, 05/10/2018 - 23:00
We note with interest that The Lancet has begun a trial of preprint submissions (June 23, p 2482).1 At the Science Media Centre we appreciate the potential benefits of preprint to the research process, but we are concerned about possible unforeseen effects on the public's understanding of science.

[Correspondence] Checkpoint blockade therapy resistance in Hodgkin's lymphoma

Ve, 05/10/2018 - 23:00
About 50 years ago, the enigma of Hodgkin's lymphoma was depicted as the Hodgkin maze in two editorials in The Lancet.1,2 The uncertainties of the time were expressed through two questions: “Infection or neoplasm?” and “One entity or two (or more)?”.2 Subsequently, advances in cell biology and molecular pathology provided answers to these questions. Substantial evidence now indicates that classical Hodgkin's lymphoma is a distinct neoplastic entity, with heterogeneous pathological features, which might be associated with Epstein-Barr virus infection.

[Correspondence] The myth that shames us all

Ve, 05/10/2018 - 23:00
Any aspect of care demands a wise balance between benefits and risks, but problems arise when these are exaggerated, minimised, ignored, or hidden. Although arguments over most drugs have been settled through evidence, the arguments over opioids have persisted despite half a century of evidence.

[Department of Error] Department of Error

Ve, 05/10/2018 - 23:00
Chang AB, Bush A, Grimwood K. Bronchiectasis in children: diagnosis and treatment. Lancet 2018; 392: 866–79—In figure 1 of this Series paper, “feedback breathing exercise” has been changed to “full blood count”. In the management section, under Monitoring treatment response, the interval with which to reassess children was incorrect and should have said “Regular and frequent reassessment (every 3–6 months) of the child is essential”. These corrections have been made to the online version as of Oct 4, 2018.

[Department of Error] Department of Error

Ve, 05/10/2018 - 23:00
Opoku NO, Bakajika DK, Kanza EM, et al. Single dose moxidectin versus ivermectin for Onchocerca volvulus infection in Ghana, Liberia, and the Democratic Republic of the Congo: a randomised, controlled, double-blind phase 3 trial. Lancet 2018; 392: 1207–16—In this Article (published online first on Jan 17, 2018), the number of people who received ivermectin in 2014 should have been more than 110 million, and George Olipoh and Asare Sampson should have been included as authors rather than listed in the Acknowledgments section.

[Clinical Picture] Stone in urethra causing chronic pelvic pain

Ve, 05/10/2018 - 23:00
A 50-year-old man presented to the hospital with perineal pain that had been troubling him for 5 years. He described it as a mild, dull ache that was aggravated by riding his motorcycle. The patient did not report any bothersome lower urinary tract symptoms. He was able to generate a reasonable urinary stream, and preoperative uroflowmetry showed a maximum flow rate of 11·2mL/s, a voided volume of 215 mL, and a post-void residual volume of 20 mL.

[Series] Current practice and future directions in the diagnosis and acute treatment of ischaemic stroke

Ve, 05/10/2018 - 23:00
Even though stroke presents as a variety of clinical syndromes, neuroimaging is the most important biomarker to help differentiate between stroke subtypes and assess treatment eligibility. Therapeutic advances have led to intravenous thrombolysis with tissue-type plasminogen activator and endovascular treatment for proximal vessel occlusion in the anterior cerebral circulation being standard care for acute ischaemic stroke. Providing access to this care has implications for existing systems of care for stroke and their organisation and has reintroduced the possibility of adjuvant and neuroprotective treatment strategies in acute ischaemic stroke.

[Series] Intracerebral haemorrhage: current approaches to acute management

Ve, 05/10/2018 - 23:00
Acute spontaneous intracerebral haemorrhage is a life-threatening illness of global importance, with a poor prognosis and few proven treatments. As a heterogeneous disease, certain clinical and imaging features help identify the cause, prognosis, and how to manage the disease. Survival and recovery from intracerebral haemorrhage are related to the site, mass effect, and intracranial pressure from the underlying haematoma, and by subsequent cerebral oedema from perihaematomal neurotoxicity or inflammation and complications from prolonged neurological dysfunction.

[Series] Prevention of stroke: a global perspective

Ve, 05/10/2018 - 23:00
Along with the rising global burden of disability attributed to stroke, costs of stroke care are rising, providing the impetus to direct our research focus towards effective measures of stroke prevention. In this Series paper, we discuss strategies for reducing the risk of the emergence of disease (primordial prevention), preventing the onset of disease (primary prevention), and preventing the recurrence of disease (secondary prevention). Our focus includes global strategies and campaigns, and measurements of the effectiveness of worldwide preventive interventions, with an emphasis on low-income and middle-income countries.

[Comment] Lipoprotein(a): lodestar for future clinical trials

Gi, 04/10/2018 - 23:30
Lipoprotein(a) is an LDL-like particle with a covalently bound, unique glycoprotein called apolipoprotein(a).1 Concentrations of lipoprotein(a) in plasma are under tight genetic control, and in the population these amounts can be skewed positively in distribution, with one in four individuals inheriting levels that increase their lifetime risk of atherosclerotic cardiovascular disease by more than 50%.2 Interest in lipoprotein(a) has been rekindled by findings of large epidemiological3 and Mendelian randomisation4 studies that confirm the causal role of lipoprotein(a) in the development of atherosclerotic cardiovascular disease and calcific aortic valve disease.

[Articles] Baseline and on-statin treatment lipoprotein(a) levels for prediction of cardiovascular events: individual patient-data meta-analysis of statin outcome trials

Gi, 04/10/2018 - 23:30
In this individual-patient data meta-analysis of statin-treated patients, elevated baseline and on-statin lipoprotein(a) showed an independent approximately linear relation with cardiovascular disease risk. This study provides a rationale for testing the lipoprotein(a) lowering hypothesis in cardiovascular disease outcomes trials.

[Department of Error] Department of Error

Me, 03/10/2018 - 23:30
Walker KF, Thornton JG. Encouraging awareness of fetal movements is harmful. Lancet 2018; published online Sept 27. http://dx.doi.org/10.1016/S0140-6736(18)31720-3—This Comment is eligible for Open Access. The copyright line has been added. This has been corrected online as of Oct 3, 2018, and is correct in the print Comment.

[World Report] UN High-Level Meeting to end tuberculosis disappointing

Me, 03/10/2018 - 16:22
A high-level meeting in which a political declaration to end tuberculosis was agreed upon fell short of expectations, experts say. Sophie Cousins reports.

[Comment] Enlarging the loop: closed-loop insulin delivery for type 1 diabetes

Me, 03/10/2018 - 09:15
A growing number of clinical trials have shown that home use of hybrid closed-loop insulin delivery systems reduces time spent in hypoglycaemia and improves time in target ranges for those with type 1 diabetes.1–6 In September, 2016, the first commercially available hybrid closed-loop insulin delivery system for management of type 1 diabetes was approved by the US Food and Drug Administration for patients aged 15 years and older. Approval of this system was supported by a non-randomised trial in which the primary outcome was safety.

[Articles] Closed-loop insulin delivery in suboptimally controlled type 1 diabetes: a multicentre, 12-week randomised trial

Me, 03/10/2018 - 09:15
Hybrid closed-loop insulin delivery improves glucose control while reducing the risk of hypoglycaemia across a wide age range in patients with suboptimally controlled type 1 diabetes.