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[World Report] Treating and preventing cholera in Bangladesh
Cholera and diarrhoea remain major health problems in Bangladesh, but some effective, low-cost interventions are preventing the spread of the disease and saving lives. Sam Loewenberg reports. (Source: LANCET)
Source: LANCET - August 11, 2017 Category: General Medicine Authors: Sam Loewenberg Tags: World Report Source Type: research

[Comment] Born to run: our future depends on it
On May 6, 2017, a Kenyan distance runner ran the marathon in 2 h 25 s at the Monza racetrack in Italy. Although Eliud Kipchoge's time marks the fastest marathon ever run, his performance cannot be considered an official world record (currently at 2 h 2 min 57 s) because the race did not conform to rules required by the International Association of Athletics Federations.1 Yet, this astonishing performance suggests that a sub 2-h marathon under official conditions might not be far away and shows the remarkable capacity of the human body, as exemplified by Kipchoge's ability to endure a gruelling training regime (>120 mile...
Source: LANCET - August 11, 2017 Category: General Medicine Authors: Alejandro Santos-Lozano, Alejandro Lucia, Luis Ruilope, Yannis P Pitsiladis Tags: Comment Source Type: research

[Comment] Building virtual communities of practice for health
Advances in medical research and innovation mean little if they do not reach the patients who need them. Too often, specialised medical knowledge remains within the walls of academic and tertiary care centres in capitals and major cities, inaccessible to much of the world's population due to geographical distance and economic disparity. To “ensure healthy lives and promote well-being for all at all ages”, UN Sustainable Development Goal 3, a more efficient and equitable way to disseminate new scientific knowledge and evidence-based expertise is needed. (Source: LANCET)
Source: LANCET - August 11, 2017 Category: General Medicine Authors: Bruce Struminger, Sanjeev Arora, Sarah Zalud-Cerrato, David Lowrance, Tedd Ellerbrock Tags: Comment Source Type: research

[Editorial] Losing the fight against HIV in the Philippines
The Philippines is facing an unprecedented HIV crisis. New infections have doubled in the past 6 years to more than 10  000 new cases last year alone. Undoubtedly, stigma remains one of the major reasons for the spread of HIV in the Philippines, as Risa Hontiveros, Filipina Senator and Vice-Chairperson of the Senate Committee on Health, said on Aug 2, urging the Government to declare the HIV epidemic a national em ergency. (Source: LANCET)
Source: LANCET - August 11, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Yemen and cholera: a modern humanity test
Urgent warnings began in May as aid agencies called for an immediate response to the growing cholera outbreak in Yemen. By mid-July, over 330  000 cholera cases were reported, with 1700 deaths. Since 2015, a civil war has left 14·5 million people (half the country's population) without access to clean water and sanitation. The UN has called it the “world's worst cholera outbreak in the context of the world's worst humanitarian crisis ”. The war, unpaid worker salaries, a decimated health system, controversies around the undeployed cholera vaccine stockpile, and slow global funding efforts are all someh...
Source: LANCET - August 11, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Genome editing: science, ethics, and public engagement
Over the past 5 years, genome editing has been rapidly emerging in the biological sciences. In 2015, the American Association for the Advancement of Science chose the genome editing technique known as clustered regularly interspaced short palindromic repeats (CRISPR) as the most promising scientific advancement that year. CRISPR are short sequences that can be used as templates by the CRISPR-associated protein 9 (Cas9) or similar exogenous nucleases. When delivered to a cell, the CRISPR-Cas9 system can cut the genome to excise DNA sequences or introduce new ones. (Source: LANCET)
Source: LANCET - August 11, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Articles] Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial
We found no evidence that means reduction through improved household pesticide storage reduces pesticide self-poisoning. Other approaches, particularly removal of highly hazardous pesticides from agricultural practice, are likely to be more effective for suicide prevention in rural Asia. (Source: LANCET)
Source: LANCET - August 11, 2017 Category: General Medicine Authors: Melissa Pearson, Chris Metcalfe, Shaluka Jayamanne, David Gunnell, Manjula Weerasinghe, Ravi Pieris, Chamil Priyadarshana, Duleeka W Knipe, Keith Hawton, Andrew H Dawson, Palitha Bandara, Dhammika deSilva, Indika Gawarammana, Michael Eddleston, Flemming K Tags: Articles Source Type: research

[Comment] Learning from a negative trial of lockable pesticide storage
With a view to reducing pesticide self-poisoning in Sri Lanka, Melissa Pearson and colleagues1 did one of the largest community-based cluster-randomised controlled trials of the effectiveness of household lockable pesticide storage, reported in The Lancet. The effort is admirable, but unfortunately their results show that improved household pesticide storage did not reduce the incidence of pesticide self-poisoning. (Source: LANCET)
Source: LANCET - August 11, 2017 Category: General Medicine Authors: Paul Yip Tags: Comment Source Type: research

[Department of Error] Department of Error
Balar AV, Galsky MD, Rosenberg JE, et al, for the IMvigor210 Study Group. Atezolizumab as first-line treatment in cisplatin-ineligible patients with locally advanced and metastatic urothelial carcinoma: a single-arm, multicentre, phase 2 trial. Lancet 2017; 389: 67 –76—In figure 3 of this Article (published Online First on Dec 7, 2016), all patients should be grey in the key and IC0/1 should be green. These corrections have been made to the online version as of Aug 11, 2017. (Source: LANCET)
Source: LANCET - August 11, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Articles] Intrathecal 2-hydroxypropyl- β-cyclodextrin decreases neurological disease progression in Niemann-Pick disease, type C1: a non-randomised, open-label, phase 1–2 trial
Patients with NPC1 treated with intrathecal HP βCD had slowed disease progression with an acceptable safety profile. These data support the initiation of a multinational, randomised, controlled trial of intrathecal HPβCD. (Source: LANCET)
Source: LANCET - August 10, 2017 Category: General Medicine Authors: Daniel S Ory, Elizabeth A Ottinger, Nicole Yanjanin Farhat, Kelly A King, Xuntian Jiang, Lisa Weissfeld, Elizabeth Berry-Kravis, Cristin D Davidson, Simona Bianconi, Lee Ann Keener, Ravichandran Rao, Ariane Soldatos, Rohini Sidhu, Kimberly A Walters, Xin Tags: Articles Source Type: research

[Comment] A hopeful therapy for Niemann-Pick C diseases
Niemann-Pick C1 disease (NPC1) is a rare autosomal recessive lysosomal storage disease, which was separated from the sphinomyelinase-deficient NPCA and NPCB when cholesterol was found to be stored.1 No drugs for the disease are currently approved in the USA, although miglustat is approved in Europe. In The Lancet, Daniel Ory and colleagues2 report strong evidence that intrathecal delivery of hydroxypropyl-beta-cyclodextrin (HPBCD) slows the progression of NPC1. (Source: LANCET)
Source: LANCET - August 10, 2017 Category: General Medicine Authors: Robert P Erickson, Maria Teresa Fiorenza Tags: Comment Source Type: research

[Articles] Interim results from the CATNON trial (EORTC study 26053-22054) of treatment with concurrent and adjuvant temozolomide for 1p/19q non-co-deleted anaplastic glioma: a phase 3, randomised, open-label intergroup study
Adjuvant temozolomide chemotherapy was associated with a significant survival benefit in patients with newly diagnosed non-co-deleted anaplastic glioma. Further analysis of the role of concurrent temozolomide treatment and molecular factors is needed. (Source: LANCET)
Source: LANCET - August 8, 2017 Category: General Medicine Authors: Martin J van den Bent, Brigitta Baumert, Sara C Erridge, Michael A Vogelbaum, Anna K Nowak, Marc Sanson, Alba Ariela Brandes, Paul M Clement, Jean Francais Baurain, Warren P Mason, Helen Wheeler, Olivier L Chinot, Sanjeev Gill, Matthew Griffin, David G Br Tags: Articles Source Type: research

[Comment] Benefit with adjuvant chemotherapy in anaplastic astrocytoma
The role of chemotherapy for newly diagnosed anaplastic gliomas, particularly when combined with radiotherapy, has long been unresolved. Over the past few decades, despite no conclusive data, study findings have suggested that the addition of nitrosourea-based chemotherapy to radiotherapy could be beneficial. The NOA-04 trial1 revealed that initial treatment with chemotherapy (either temozolomide or procarbazine, lomustine, and vincristine [PCV]) or radiotherapy alone yielded similar results. Survival of patients with anaplastic glioma has been recognised as being strongly dependent on the presence or absence of the favour...
Source: LANCET - August 8, 2017 Category: General Medicine Authors: David Schiff Tags: Comment Source Type: research

[Articles] Trends in international asthma mortality: analysis of data from the WHO Mortality Database from 46 countries (1993 –2012)
The trend for reduction in global asthma mortality observed since the late 1980s might have stalled, with no appreciable difference in a smoothed LOESS curve of asthma mortality from 2006 to 2012. Although better implementation of established management strategies that have been shown to reduce mortality risk is needed, to achieve a further substantive reduction in global asthma mortality novel strategies will also be required. (Source: LANCET)
Source: LANCET - August 7, 2017 Category: General Medicine Authors: Stefan Ebmeier, Darmiga Thayabaran, Irene Braithwaite, Cl ément Bénamara, Mark Weatherall, Richard Beasley Tags: Articles Source Type: research

[Comment] Eliminating asthma deaths: have we stalled?
There has been a marked and progressive reduction in asthma mortality rates since the epidemic of deaths in many countries around the world that preceded major changes in the clinical and public health approaches to asthma in the late 1980s. The effort to turn around rising asthma mortality rates was broad —occurring globally, nationally, and at a local level, through health system change to individual advocacy and clinical leadership.1 Previous approaches to acute and long-term care of asthma, which did not recognise the risks associated with short-acting β2 agonists, were overhauled when it becam e evident tha...
Source: LANCET - August 7, 2017 Category: General Medicine Authors: Christine Jenkins Tags: Comment Source Type: research

[Department of Error] Department of Error
ATTEND Collaborative Group. Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial. Lancet 2017; 390: 588 –99—In the Summary of this Article, the number of patients lost to follow-up should have been 33. This correction has been made to the online version as of Aug 3, 2017, and the printed Article is correct. (Source: LANCET)
Source: LANCET - August 4, 2017 Category: General Medicine Tags: Department of Error Source Type: research

[Correspondence] Post-deployment screening for mental disorders and help-seeking in the UK military – Authors’ reply
Lyndsay Baines and colleagues suggest that our findings1 could jeopardise military post-deployment screening. The policy in this area is for others to decide; our task was to deliver the first randomised controlled trial to inform this decision, which we contend that we have done, even if some find the results uncomfortable. The UK Armed Forces do not implement post-deployment screening; however, for countries that do, a reassessment of their screening programmes is advised in light of this new information. (Source: LANCET)
Source: LANCET - August 4, 2017 Category: General Medicine Authors: Roberto J Rona, Howard Burdett, Neil Greenberg, Nicola T Fear, Simon Wessely Tags: Correspondence Source Type: research

[Correspondence] Post-deployment screening for mental disorders and help-seeking in the UK military
In their cluster randomised controlled trial, Roberto J Rona and colleagues (April 8, p 1410)1 found that post-deployment mental health screening of military personnel using tailored advice, neither reduced the prevalence of mental health disorders nor increased help-seeking behaviour. These findings could jeopardise post-deployment screening at a time when the North Atlantic Treaty Organisation has deployed the largest build-up of military personnel along Moscow's sphere of influence since the Cold War. (Source: LANCET)
Source: LANCET - August 4, 2017 Category: General Medicine Authors: Lyndsay S Baines, Lee Mitchell, Kevin Long, Caroline Abbot, Nicky Clarke, Domon Tyler, Daniel Ireton, Faria Khan Tags: Correspondence Source Type: research

[Correspondence] Dementia-friendly public toilets
Many older adults avoid travelling and social interaction because of the scarcity of public toilets or their inaccessibility. Furthermore, where public toilets are provided, poor design and signage can preclude independent use, particularly for people living with dementia. Urinary incontinence and faecal are common problems in older people and especially those with dementia, particularly at the moderate to severe stages. (Source: LANCET)
Source: LANCET - August 4, 2017 Category: General Medicine Authors: Andrea Tales, Vanessa Burholt, Paul Nash, Jo-Anne Bichard, Angela Clayton-Turner, on behalf of 16 signatories Tags: Correspondence Source Type: research

[Correspondence] The reality of the mortality statistics of the nurses ’ strike in Kenya
I was relieved to see the despondent situation currently crippling Kenya's health-care system brought to international attention in The Lancet's Editorial (June 17, p 2350).1 The nurses ’ strike, which began on June 5, follows closely on the back of a 90-day doctors’ strike that finished mere months ago and is rumoured to soon recur. As noted in the Editorial, the strike is a response to the government's failure to uphold a Collective Bargaining Agreement, while millions of shi llings are spent each day on campaigning for the upcoming presidential elections. (Source: LANCET)
Source: LANCET - August 4, 2017 Category: General Medicine Authors: Phoebe C M Williams Tags: Correspondence Source Type: research

[Correspondence] Venezuela's health-care crisis
We read with interest The Lancet's report (May 27, p 2095)1 on Venezuela's health-care system. As heart-breaking as the newly released data are, the true magnitude of the problem will remain obscure until a shift is made towards transparent use of data —which will also provide the indicators needed to chart possible solutions. (Source: LANCET)
Source: LANCET - August 4, 2017 Category: General Medicine Authors: Ricardo J Bello, Jos é J Damas, Francisco J Marco, Julio S Castro Tags: Correspondence Source Type: research

[Obituary] John Walley Littlefield
Physician-scientist, geneticist, and cell culture expert who championed clinical genetics and amniocentesis. Born in Providence, RI, USA, on Dec 3, 1925, he died on April 20, 2017, in Cockeysville, MD, USA, from complications of dementia, aged 91 years. (Source: LANCET)
Source: LANCET - August 4, 2017 Category: General Medicine Authors: Alison Snyder Tags: Obituary Source Type: research

[Perspectives] Police surgeons and sexual violence: a history
On June 12, 1993, the editors of the British Medical Journal (BMJ) published an personal account by a male doctor of being sexually assaulted by a colleague. In light of the sensitive nature of the account, the editors allowed the victim to remain anonymous. The doctor described how a medical friend had sexually abused him when they were sharing a room during a medical conference. Although the doctor was angry, he fretted about whether he was partly culpable for being assaulted. After all, he admitted, he had been drinking alcohol and, during the attack, had frozen instead of vigorously resisting. (Source: LANCET)
Source: LANCET - August 4, 2017 Category: General Medicine Authors: Joanna Bourke Tags: Perspectives Source Type: research

[Perspectives] The world of surrogacy
Surrogacy is a contentious issue that evokes strong reactions. The idea of a woman undergoing pregnancy to give birth to someone else's child challenges traditional notions of motherhood. For all those involved, surrogacy entails inherent emotional and ethical challenges. Bodies, a new play written by Vivienne Franzmann and directed by Jude Christian at the Royal Court in London, UK, explores the promise and pitfalls of surrogacy, taking the point of view of both wealthy parents-to-be and a surrogate Indian mother. (Source: LANCET)
Source: LANCET - August 4, 2017 Category: General Medicine Authors: Marco De Ambrogi Tags: Perspectives Source Type: research

[Perspectives] Al Gore's truth is still inconvenient
As the Donald Trump Administration punches holes in American democracy along its seemingly inevitable path to Nixonian demise, the man who should have taken the oath of Presidential office in 2001 stands in such stark contrast to the current residents of 1600 Pennsylvania Avenue as to seem from another age, place, and even country. Former Vice President Al Gore, who won the popular vote in 2000 but not the electoral college vote and was denied the office by a five-to-four partisan Supreme Court decision, is back in bookstores and movie theatres. (Source: LANCET)
Source: LANCET - August 4, 2017 Category: General Medicine Authors: Laurie Garrett Tags: Perspectives Source Type: research

[World Report] The Green Helmets: providing care in Venezuela's protests
Among increasing violence, doctors and medical students risk their safety to aid Venezuelans protesting against President Maduro's Government. Manuel Rueda reports from Caracas. (Source: LANCET)
Source: LANCET - August 4, 2017 Category: General Medicine Authors: Manuel Rueda Tags: World Report Source Type: research

[Comment] After Charlie Gard: ethically ensuring access to innovative treatment
July 24, 2017, marked the end of the long-running legal battle over treatment for UK infant Charlie Gard.1 International medical experts, invited by the High Court to examine Charlie, concluded that proposed innovative treatment could no longer offer even theoretical benefit. His parents accepted that it was time to allow Charlie to die, while bitterly lamenting that he had missed a potential window of opportunity for treatment.2 Charlie Gard died 4 days later, after withdrawal of intensive medical treatment. (Source: LANCET)
Source: LANCET - August 4, 2017 Category: General Medicine Authors: Dominic Wilkinson, Julian Savulescu Tags: Comment Source Type: research

[Editorial] Breastfeeding: a missed opportunity for global health
No country in the world meets the recommended standards for economic investment and implementation of policies supporting mothers to breastfeed. These are the stark findings of a new report, released on Aug 1, 2017, to mark World Breastfeeding Week. (Source: LANCET)
Source: LANCET - August 4, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Health providers —helping to disrupt human trafficking
In the early hours of July 23, 2017, a call to police led to the search of a tractor-trailer in a San Antonio, Texas, parking lot. 39 people, all undocumented immigrants, were found at the scene, ten died, and another 22 were hospitalised. Survivors reported a ghastly clandestine journey to cross the border from Mexico —no food, no water, in utter darkness, without air and cooling systems. Those who succumbed likely died of heat exposure and asphyxiation. One of the nation's deadliest human trafficking incidents in years, it serves as a grim reminder of the harrowing risks individuals take in search of a better life,...
Source: LANCET - August 4, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Editorial] Charlie Gard and the limits of medicine
The heartbreaking story of an 11-month-old baby boy, Charlie Gard, has dominated newspaper headlines in the UK, and more widely, over the past few months. Last week, Charlie's parents, Connie Yates and Chris Gard, ended their legal fight to transfer their son to the USA for experimental treatment. After further court hearings to decide where Charlie should die, he was transferred to a children's hospice. On July 28, Charlie died. (Source: LANCET)
Source: LANCET - August 4, 2017 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research

[Articles] Exenatide once weekly versus placebo in Parkinson's disease: a randomised, double-blind, placebo-controlled trial
Exenatide had positive effects on practically defined off-medication motor scores in Parkinson's disease, which were sustained beyond the period of exposure. Whether exenatide affects the underlying disease pathophysiology or simply induces long-lasting symptomatic effects is uncertain. Exenatide represents a major new avenue for investigation in Parkinson's disease, and effects on everyday symptoms should be examined in longer-term trials. (Source: LANCET)
Source: LANCET - August 3, 2017 Category: General Medicine Authors: Dilan Athauda, Kate Maclagan, Simon S Skene, Martha Bajwa-Joseph, Dawn Letchford, Kashfia Chowdhury, Steve Hibbert, Natalia Budnik, Luca Zampedri, John Dickson, Yazhou Li, Iciar Aviles-Olmos, Thomas T Warner, Patricia Limousin, Andrew J Lees, Nigel H Grei Tags: Articles Source Type: research

[Comment] Insulin signalling: new target for Parkinson's treatments?
Parkinson's disease is the second most common neurodegenerative disease, and affects 2 –3% of people aged 65 years and older.1 The number of affected people is expected to double between 2005 and 2030 as the world's population ages, which will further increase the societal and economic burdens of the disease.1 Although in the past 20 years understanding of the molecular mechanisms u nderlying neuronal dysfunction and cell death in Parkinson's disease has improved substantially and novel therapeutic targets have been identified, no treatments with proven disease-modifying efficacy have become available. (Source: LANCET)
Source: LANCET - August 3, 2017 Category: General Medicine Authors: Werner Poewe, Klaus Seppi Tags: Comment Source Type: research

[Articles] Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial
We showed non-inferiority of partial-breast and reduced-dose radiotherapy compared with the standard whole-breast radiotherapy in terms of local relapse in a cohort of patients with early breast cancer, and equivalent or fewer late normal-tissue adverse effects were seen. This simple radiotherapy technique is implementable in radiotherapy centres worldwide. (Source: LANCET)
Source: LANCET - August 2, 2017 Category: General Medicine Authors: Charlotte E Coles, Clare L Griffin, Anna M Kirby, Jenny Titley, Rajiv K Agrawal, Abdulla Alhasso, Indrani S Bhattacharya, Adrian M Brunt, Laura Ciurlionis, Charlie Chan, Ellen M Donovan, Marie A Emson, Adrian N Harnett, Joanne S Haviland, Penelope Hopwood Tags: Articles Source Type: research

[Comment] Early-stage breast cancer: falling risks and emerging options
Great improvements in the therapeutic ratio of cancer treatment can result from innovative approaches that maintain tumour control benefits while lowering treatment-associated morbidity. The IMPORT LOW trial by Charlotte Coles and colleagues1 in The Lancet is a high-quality randomised trial of treatment de-escalation in the multidisciplinary management of breast cancer. (Source: LANCET)
Source: LANCET - August 2, 2017 Category: General Medicine Authors: Reshma Jagsi Tags: Comment Source Type: research

[Articles] Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials
An early invasive strategy does not reduce mortality compared with a delayed invasive strategy in all patients with NSTE-ACS. However, an early invasive strategy might reduce mortality in high-risk patients. (Source: LANCET)
Source: LANCET - August 1, 2017 Category: General Medicine Authors: Alexander Jobs, Shamir R Mehta, Gilles Montalescot, Eric Vicaut, Arnoud W J van't Hof, Erik A Badings, Franz-Josef Neumann, Adnan Kastrati, Alessandro Sciahbasi, Paul-Georges Reuter, Fr édéric Lapostolle, Aleksandra Milosevic, Goran Stankovic, Dejan Mil Tags: Articles Source Type: research

[Comment] Timing of revascularisation for acute coronary syndrome
Acute coronary syndrome is predominantly caused by a luminal thrombus or a sudden plaque haemorrhage imposed on an atherosclerotic plaque with or without an accompanying vasospasm.1 A luminal thrombus forms as a direct consequence of plaque rupture or erosion (if plaque rupture is not identifiable on intracoronary imaging).2 Initial electrocardiography can be used to distinguish ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). (Source: LANCET)
Source: LANCET - August 1, 2017 Category: General Medicine Authors: Peter Damman, Robbert J de Winter Tags: Comment Source Type: research

[Seminar] Thalassaemia
Inherited haemoglobin disorders, including thalassaemia and sickle-cell disease, are the most common monogenic diseases worldwide. Several clinical forms of α-thalassaemia and β-thalassaemia, including the co-inheritance of β-thalassaemia with haemoglobin E resulting in haemoglobin E/β-thalassaemia, have been described. The disease hallmarks include imbalance in the α/β-globin chain ratio, ineffective erythropoiesis, chronic haemolytic anaemia, co mpensatory haemopoietic expansion, hypercoagulability, and increased intestinal iron absorption. (Source: LANCET)
Source: LANCET - July 31, 2017 Category: General Medicine Authors: Ali T Taher, David J Weatherall, Maria Domenica Cappellini Tags: Seminar Source Type: research

[Seminar] Polymyalgia rheumatica
Polymyalgia rheumatica is an inflammatory disease that affects the shoulder, the pelvic girdles, and the neck, usually in individuals older than 50 years. Increases in acute phase reactants are typical of polymyalgia rheumatica. The disorder might present as an isolated condition or in association with giant cell arteritis. Several diseases, including inflammatory rheumatic and autoimmune diseases, infections, and malignancies can mimic polymyalgia rheumatica. Imaging techniques have identified the presence of bursitis in more than half of patients with active disease. (Source: LANCET)
Source: LANCET - July 31, 2017 Category: General Medicine Authors: Miguel A Gonz ález-Gay, Eric L Matteson, Santos Castañeda Tags: Seminar Source Type: research

[World Report] Frontline: Support for breastfeeding in crisis
Brooke Bauer is an infant-feeding specialist and founder of Nurture Project International, an NGO that provides lactation support, reproductive care, and nutrition support to families in emergencies. She is interviewed in Erbil, after a training session in a primary health centre in east Mosul. (Source: LANCET)
Source: LANCET - July 31, 2017 Category: General Medicine Authors: Rebecca Holland Tags: World Report Source Type: research

[Series] Evolution, human-microbe interactions, and life history plasticity
A bacterium was once a component of the ancestor of all eukaryotic cells, and much of the human genome originated in microorganisms. Today, all vertebrates harbour large communities of microorganisms (microbiota), particularly in the gut, and at least 20% of the small molecules in human blood are products of the microbiota. Changing human lifestyles and medical practices are disturbing the content and diversity of the microbiota, while simultaneously reducing our exposures to the so-called old infections and to organisms from the natural environment with which human beings co-evolved. (Source: LANCET)
Source: LANCET - July 28, 2017 Category: General Medicine Authors: Graham Rook, Fredrik B äckhed, Bruce R Levin, Margaret J McFall-Ngai, Angela R McLean Tags: Series Source Type: research

[Series] Human reproduction and health: an evolutionary perspective
According to life history theory, increased investment in reproductive function (physiology and behaviour) at different times throughout the life course affects the risk of many diseases and, ultimately, longevity. Although genetic factors contribute to interindividual and interpopulation variation in reproductive traits, the dominant source of variability is phenotypic plasticity during development and adult life. Reproductive traits in both sexes evolved sensitivity to ecological conditions, as reflected in contemporary associations of hormone concentrations with geographical setting, nutritional status, and physical act...
Source: LANCET - July 28, 2017 Category: General Medicine Authors: Grazyna Jasienska, Richard G Bribiescas, Anne-Sofie Furberg, Samuli Helle, Alejandra N úñez-de la Mora Tags: Series Source Type: research

[Series] Evolutionary public health: introducing the concept
The emerging discipline of evolutionary medicine is breaking new ground in understanding why people become ill. However, the value of evolutionary analyses of human physiology and behaviour is only beginning to be recognised in the field of public health. Core principles come from life history theory, which analyses the allocation of finite amounts of energy between four competing functions —maintenance, growth, reproduction, and defence. A central tenet of evolutionary theory is that organisms are selected to allocate energy and time to maximise reproductive success, rather than health or longevity. (Source: LANCET)
Source: LANCET - July 28, 2017 Category: General Medicine Authors: Jonathan C K Wells, Randolph M Nesse, Rebecca Sear, Rufus A Johnstone, Stephen C Stearns Tags: Series Source Type: research

[Correspondence] Formulated data do not reflect facts – Authors' reply
We thank Pauline Hull for her interest in our Article.1 Hull criticises our emphasis on increased maternal mortality and severe morbidity although there have been no deaths or hysterectomies. We decided on the composite outcome before the analysis was done, and we have reported all individual endpoints for transparency. We maintain our position that admission to an intensive care unit and receiving blood transfusion are important events. We are also concerned about the rare events of only nine (0 ·6%) in the 1515 mothers with antepartum caesarean section without indication and the sparsity of events might affect the...
Source: LANCET - July 28, 2017 Category: General Medicine Authors: Pisake Lumbiganon, Malinee Laopaiboon, Ahmet Metin G ülmezoglu Tags: Correspondence Source Type: research

[Correspondence] Formulated data do not reflect facts
In their study, Pisake Lumbiganon and colleagues' (Feb 6, 2010, p 490)1 interpretation of antepartum caesarean section without indication —ie, it “should be done only when there is a medical indication”—is an imprecise effort by WHO to influence international maternity policy. (Source: LANCET)
Source: LANCET - July 28, 2017 Category: General Medicine Authors: Pauline M Hull Tags: Correspondence Source Type: research

[Correspondence] Hydration and contrast-induced kidney injury – Authors' reply
We thank Hitinder Gurm and Simon Dixon, Ivan Pavlov, Brian Weiner, and Viktoria Schwarz and colleagues for opening up the discussion and allowing us to clarify a few key points. Our aim in the AMACING trial1 was to evaluate current international and national guidelines for the use of intravascular iodinated contrast material, and the study was designed to that end. (Source: LANCET)
Source: LANCET - July 28, 2017 Category: General Medicine Authors: Estelle C Nijssen, Patty J Nelemans, Roger J Rennenberg, Vincent van Ommen, Joachim E Wildberger, CIN group MUMC+ Tags: Correspondence Source Type: research

[Correspondence] Hydration and contrast-induced kidney injury
Iodinated contrast is commonly used in gastroenterology practice and clinicians endeavour to avoid complications. The hypothesis tested by Estelle Nijssen and colleagues1 was whether hydration with saline might mitigate the complication of renal failure. However, the investigators did not measure or report the hydration status —as in preimaging urine osmolarity—of the patients before the intervention. (Source: LANCET)
Source: LANCET - July 28, 2017 Category: General Medicine Authors: Brian C Weiner Tags: Correspondence Source Type: research

[Correspondence] Hydration and contrast-induced kidney injury
Estelle Nijssen and colleagues1 found that in patients at high risk for contrast-induced nephropathy who had an elective procedure with contrast medium, contrast-induced nephropathy occurred at similar rates whether the patients were treated before with intravenous saline or not. How can this finding be reconciled with that of previous studies, which showed the benefit of volume expansion with intravenous fluids? (Source: LANCET)
Source: LANCET - July 28, 2017 Category: General Medicine Authors: Ivan Pavlov Tags: Correspondence Source Type: research

[Correspondence] Hydration and contrast-induced kidney injury
Estelle Nijssen and colleagues1 are to be commended for doing a randomised controlled trial to test the clinical use of hydration in patients undergoing intravascular contrast media exposure. As Nijssen and colleagues have highlighted, this practice is endorsed by guidelines, although based on consensus, and has important patient and practice implications. However, it might be premature to advocate for withholding prophylaxis for all high-risk patients with estimated glomerular filtration rates higher than 29 mL/min per 1 ·73 m2. (Source: LANCET)
Source: LANCET - July 28, 2017 Category: General Medicine Authors: Hitinder S Gurm, Simon Dixon Tags: Correspondence Source Type: research

[Correspondence] Hydration and contrast-induced kidney injury
We read with interest the randomised trial by Estelle Nijssen and colleagues (April 1, p 1312).1 Nijssen and colleagues found no hydration to be non-inferior to prophylactic hydration to protect renal function from intravascular iodinated contrast media. (Source: LANCET)
Source: LANCET - July 28, 2017 Category: General Medicine Authors: Viktoria Schwarz, Gunnar H Heine, Michael B öhm, Bruno Scheller Tags: Correspondence Source Type: research

[Correspondence] Collaborating to achieve Global Vaccine Action Plan goals
In their Comment, Margaret Chan and colleagues1 (Feb 25, p 777) highlight the progress being made to achieve the goals of the Global Vaccine Action Plan (GVAP)2 and the results of the mid-term review of progress issued by WHO's Strategic Advisory Group of Experts (SAGE) on immunisation.3 They also summarise the remaining challenges and call on all stakeholders to do more to achieve GVAP goals. (Source: LANCET)
Source: LANCET - July 28, 2017 Category: General Medicine Authors: Alan R Hinman, Walter A Orenstein Tags: Correspondence Source Type: research