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The start-up aims to collect data from the African continent for better representation of genetic variability. Paul Adepoju reports.
Rupal Shah, John Launer
We belong to a group of medical educators who share a concern about pressures in our work that threaten our capacity for reflection and creativity. We meet regularly to discuss papers that might enhance our practice and recently came across one by Arthur Frank in which he outlines sociological influences on medical practice. Frank argues that sociologists have a duty to uncover the unexamined assumptions that underlie the discourses of today's society and to question these when needed. We were intrigued by Frank's use of the term “scarcity loop” to describe an assumption that he believes dominates health care.
In a background of renewed calls for malaria eradication, several endemic countries in sub-Saharan Africa are contemplating malaria elimination nationally or sub-nationally. In Mozambique, a strategy to eliminate malaria in the south is underway in the context of low endemicity levels and cross-border initiatives to eliminate malaria in South Africa and Eswatini. In this context, a demonstration project aiming to interrupt malaria transmission through mass antimalarial drug administrations and intensified vector control programmes accompanied by community engagement and standard case management was implemented in the Magude District. To ensure the necessary uptake of these interventions, formative qualitative research explored the perceptions, beliefs, attitudes, and practices related to malaria, its prevention and control. The current article describes the results of this study.
Seventeen focus group discussions were conducted between September and October of 2015 with the community leaders (6), adult men (5), women of reproductive age (5), and traditional healers (1) in Magude prior to the implementation of the project interventions. Respondents discussed perceptions around malaria symptoms, causes, preventions, and treatments.
Knowledge of malaria was linked to awareness of its clinical presentation, and on-going vector control programmes. Perceptions of malaria aetiology were fragmented but related mainly to mosquito-mediated transmission. Reported preventive measures mostly involved mosquito control although participants were aware of the protective limitations of vector control tools. Awareness of asymptomatic carriers and the risk of outdoor malaria transmission were varied. Fever and malaria-like symptoms triggered immediate care-seeking community at health facilities. The identified barriers to malaria treatment included fear/mistrust in Western medicine, distance to health facilities, and lack of transportation.
Several constraints and opportunities will potentially influence malaria elimination in Magude. Malaria awareness, trust in health institutions, and the demand for chemoprophylaxis could facilitate new interventions, such as mass drug administration. A lack of awareness of asymptomatic carriers, inadequate understanding of residual transmission, and barriers to care seeking could jeopardize uptake. Hence, elimination campaigns require strong community engagement and grassroots mobilization.
Artemether–lumefantrine (AL) and dihydroartemisinin–piperaquine (DHA/PPQ) are the recommended first- and second-line treatments, respectively, for uncomplicated falciparum malaria in Somalia. The studies reported here were conducted to assess the efficacy of these artemisinin-based combinations and the mutations in Plasmodium falciparum K13-propeller (Pfk13) domain and amplification in Pfplasmepsin 2 (Pfpm2) gene in Somalia.
One-arm prospective studies were conducted to assess the clinical and parasitological responses to DHA/PPQ and AL at two sites in 2016 and 2017, respectively, using the standard WHO protocol. The patterns of molecular markers associated with artemisinin and PPQ resistance were investigated for the first time in Somalia.
A total of 339 patients were enrolled with 139 for AL and 200 for DHA/PPQ. With AL, no parasite recurrence was observed among patients treated at either site, corresponding to 100% clinical and parasitological responses. For DHA–PPQ, an adequate clinical and parasitological response rate > 97% was observed. All study patients on both treatments at both sites were parasite-free on day 3. Of the 138 samples with interpretable results for the polymorphism in Pfk13, only one (0.7%), from Bosaso, contained a non-synonymous mutation (R622I), which is not one of the known markers of artemisinin resistance. No Pfpm2 amplification was observed among the 135 samples with interpretable results.
AL and DHA/PPQ were highly effective in the treatment of uncomplicated falciparum malaria, and there was no evidence of resistance to artemisinin or PPQ. These two combinations are thus relevant in the chemotherapeutic strategy for malaria control in Somalia.
Trial registration ACTRN12616001005448 (Jowhar DP study), ACTRN12616000553471 (Bosaso DP study), ACTRN12617001055392 (AL study in Bosaso and Jowhar)
Miriam Orcutt, Diana Rayes, Ahmad Tarakji, Mohamad Katoub, Paul Spiegel, Leonard Rubenstein, Samer Jabbour, Munzer Alkhalil, Mohammad Alabbas, Aula Abbara
The 9-year conflict in Syria has resulted in one of the worst humanitarian crises of our generation, with more than 11·7 million people in need of humanitarian assistance in Syria, 11·3 million in need of health assistance, and 6·2 million internally displaced within Syria.1 In one of the worst onslaughts of the conflict to date, Syrian Government and Russian forces have intensified their ground shelling and airstrikes in northwest Syria since early April, 2019. This area contains an estimated 3 million people of whom 1·3 million are internally displaced people,2 who have already been displaced from other parts of Syria such as Aleppo and Eastern Ghouta by previous government offensives; the most severely affected area is in the southernmost part of the demilitarised zone of Idlib province.
Subodh Verma, C David Mazer, Vlado Perkovic
Following the regulatory requirements of 2008, randomised trials of glucose-lowering therapies have demonstrated safety, and in some cases superiority, with respect to cardiorenal outcomes. Sodium-glucose co-transporter-2 (SGLT2) inhibitors have been shown to reduce cardiorenal outcomes across a broad spectrum of type 2 diabetes in the presence or absence of established vascular disease, and across a broad range of kidney function.1 These benefits appear independent of glycaemic control and are mediated through a range of mechanisms including effects on systemic and renal haemodynamics.
Surgeon, oncologist, and medical educator. Born in Tallahassee, FL, USA, on May 22, 1930, he died of cancer in Washington, DC, USA, on May 25, 2019, aged 89 years.
Shelagh B Coutts, Bijoy K Menon
Thrombolysis for ischaemic stroke is recommended up to 4·5 h from stroke onset.1 Beyond 4·5 h, endovascular clot retrieval2 is the standard of care in selected patients up to 24 h after the time they were last known to be well.3 However, immediate endovascular clot retrieval will not be available for all patients. In The Lancet, Bruce Campbell and colleagues4 report the findings of their meta-analysis of individual patient data from three intravenous thrombolysis trials (EXTEND,5 ECASS4-EXTEND,6 and EPITHET7) of late window (4·5–9 h) or wake-up stroke.
US Border Patrol has been releasing migrants in communities that have been struggling with providing health care. Bryant Furlow reports.
A white woman with her hair cropped short gazes directly into the camera. She's wrapped in a white sheet that's pinned across her chest and above her left breast is a large black cross. Jo Spence's iconic portrait in her series The Picture of Health, reacting to a doctor's revelation of her cancer diagnosis, forms a key part of a new Wellcome Collection exhibition, Jo Spence and Oreet Ashery: Misbehaving Bodies. Spence's work is presented in conversation with digital artist Oreet Ashery, who also explores issues of identity, self-care, and self-censorship.
How can it be that in the 21st-century European nations are debating the rise of antisemitism? On the continent torn apart by a fascism that quickly became a genocide, it seems barely credible that antisemitism not only survives but also flourishes in increasingly populist and nationalist democracies. But survive and flourish it does. The UK's Labour Party, proud of its anti-racist history, has been reputationally wounded by repeated failures to expel those responsible for anti-Jewish activities.
Hui Wang, a 32-year-old Chinese ophthalmologist, experienced sudden cardiac death on June 30, after working with fever for 6 days in Beijing. Hui was the father of a 1-year-old girl, and married to a doctor, who donated Hui's corneas to two patients after his death. The emotive circumstances of Hui's devotion to his work and his family's selfless donation have triggered an outpouring of grief and sympathy online, with many people expressing their condolences to his family, as well as raising concerns about physician burnout in China.
Kimberly M Thompson
The Global Polio Eradication Initiative (GPEI), which launched in 1988 with a mandate to eradicate polio by 2000,1 has maintained its mission to stop and prevent the transmission of all three serotypes (1, 2, and 3) of wild poliovirus (WPV). Ultimately, ending all cases of poliomyelitis requires successful cessation of the use of all live-attenuated oral poliovirus vaccines (OPV) after certification of WPV eradication. Global transmission of serotype-2 WPV ended before 2000; in September, 2015, the world certified serotype-2 WPV eradication;2 and in late April and early May, 2016, the GPEI globally coordinated the cessation of all use of serotype -2-containing OPV (OPV2), except for in emergency uses to respond to serotype-2 outbreaks.
Pierre Van Damme, Ilse De Coster, Hilde Revets, Ananda S Bandyopadhyay
Despite global withdrawal of monovalent oral live-attenuated type-2 polio vaccines (OPV2) in May, 2016, recent circulating vaccine-derived type-2 poliovirus (cVDPV2) outbreaks in Africa highlight the danger of polio re-emerging in high-risk populations with low levels of immunity because of poor vaccine coverage.1 The only appropriate countermeasure to control and minimise spread of such outbreaks is deployment of stockpiled monovalent OPV2 vaccine, but this approach could seed further cVDPV2 outbreaks.
On June 28, 2019, the National Institute for Health and Care Excellence (NICE) published draft guidance on indoor air quality at home, highlighting some perhaps unexpected sources of indoor air pollution. The Lancet has often spoken about indoor air pollution problems in countries where the burning of fuels inside the home is a common occurrence, but the NICE guidelines offer some thoughts on the sorts of pollution problems that can affect households worldwide.
Newly released documents reveal the extent of the research misconduct perpetrated over many years in the laboratory of a distinguished UK scientist—David Latchman, at the UCL Institute of Child Health, London. In response to three separate allegations of misconduct, relating to dozens of papers from Latchman's group published between 1990 and 2013, UCL initiated two formal investigations. And on July 1, after several Freedom of Information requests, UCL finally released the reports.
Sam Oddie, Ben Stenson, Jonathan Wyllie, Andrew K Ewer
Universal screening allows potentially life-threatening diseases to be detected while presymptomatic. UK neonatal mortality is rising and in 2015 was ranked 19th out of 28 European countries.1 Congenital anomalies and infections are the main causes of UK term neonatal mortality, and most deaths from congenital anomalies are from cardiac defects.2 Critical congenital heart defects (CCHD) occur in two per 1000 livebirths and, if undetected, can result in collapse and death following closure of the ductus arteriosus.
You are in bed, held in a loop of sheets, one arm flung to the ward's blue light. A few of us stand near you, and our words—bradycardia…lunch…resus—fall on you, like hail. When I saw you here last, it was for results, your husband's voice beating with fury and—was it?—hope: “We never know what you'll tell us each time, what words you'll say.”
Retningslinjer til sundhedsprofessionelle vedr. håndtering af infektion med zikavirus (2019)
Antiviral behandling af hiv smittede personer (2019)
Lumbalpunktur af patienter i blodfortyndende behandling (2019)
Reply to Barner and Bruno-Murtha
23.09.2019Clinical Infectious Diseases Advance Access
False-negative Results of Human Immunodeficiency Virus (HIV) Rapid Testing in HIV Controllers
21.09.2019Clinical Infectious Diseases Advance Access
Resistance of Influenza Virus to Antiviral Medications
20.09.2019Clinical Infectious Diseases Advance Access
Oseltamivir resistance in severe influenza A(H1N1)pdm09 pneumonia and acute respiratory distress syndrome: a French multicenter observational cohort study
20.09.2019Clinical Infectious Diseases Advance Access
Baloxavir marboxil in Japanese pediatric patients with influenza: safety and clinical and virologic outcomes
20.09.2019Clinical Infectious Diseases Advance Access
Hvad tænker Professor Thomas Benfield om"Oral versus Intravenous Antibiotics for Bone and Joint Infection."?
Hvorfor anbefaler Professor Niels Obel artiklen"Early, Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis."?
Hvorfor synes Professor Thomas Benfield, at du bør læse"Duration of Antibiotic Treatment in Community-Acquired Pneumonia: A Multicenter Randomized Clinical Trial."?
Hvorfor anbefaler Professor Morten Sodemann artiklen"Evidence-based clinical guidelines for immigrants and refugees."?
Hvorfor synes Professor Niels Obel, at du bør læse"Use of statins and risk of AIDS-defining and non-AIDS-defining malignancies among HIV-1 infected patients on antiretroviral therapy."?
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