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Clinicians and health-care managers displayed “a capacity for wilful blindness” that allowed Ian Paterson to hide in plain sight—that is the uncomfortable opening statement of the independent inquiry into Paterson's malpractice, published on Feb 4, 2020. Paterson worked as a consultant surgeon from 1993 to 2011 in both private and National Health Service hospitals in West Midlands, UK. During that period, he treated thousands of patients, many of whom had surgery. Paterson demonstrated an array of abhorrent and unsafe activities over this time, including exaggerating patients' diagnoses to coerce them into having surgery, performing his own version of a mastectomy, which goes against internationally agreed oncological principles, and inappropriate conduct towards patients and staff.
Last week, a campaign was jointly launched by the Brazilian Ministry of Health and the Ministry of Women, Family and Human Rights to reduce the country's high teenage pregnancy rate. Under the slogan “adolescence first, pregnancy later”, the campaign aims to make adolescents and their parents aware, via television, billboards, and social media, of the risks and consequences of teenage pregnancies. One of the messages emphasised by Damares Alves, an evangelical pastor who leads the Ministry of Women, Family and Human Rights, is to delay the start of sexual relationships—an approach that is widely regarded as completely ineffective.
On Feb 10, new WHO guidelines were released for the management of pregnant and breastfeeding women in the context of Ebola virus disease, outlining appropriate steps for clinicians to take in DR Congo. The country has had 3428 confirmed cases of Ebola over the past 18 months, the second worst outbreak after the 2014–16 west Africa outbreak of around 28 000 cases.
David L Heymann
The current outbreak of the 2019 novel coronavirus (2019-nCoV) is yet another example of the importance of infections at the animal–human interface, and the concerns that arise from the emergence of a newly identified organism as it spreads through human populations and across national and international borders.
Chen Wang, Peter W Horby, Frederick G Hayden, George F Gao
In December, 2019, Wuhan, Hubei province, China, became the centre of an outbreak of pneumonia of unknown cause, which raised intense attention not only within China but internationally. Chinese health authorities did an immediate investigation to characterise and control the disease, including isolation of people suspected to have the disease, close monitoring of contacts, epidemiological and clinical data collection from patients, and development of diagnostic and treatment procedures. By Jan 7, 2020, Chinese scientists had isolated a novel coronavirus (CoV) from patients in Wuhan.
Clark D Russell, Jonathan E Millar, J Kenneth Baillie
The 2019 novel coronavirus (2019-nCoV) outbreak is a major challenge for clinicians. The clinical course of patients remains to be fully characterised, little data are available that describe the disease pathogenesis, and no pharmacological therapies of proven efficacy yet exist.
Kabir Sheikh, Irene Agyepong, Manoj Jhalani, Walid Ammar, Assad Hafeez, Sushil Pyakuryal, Seye Abimbola, Abdul Ghaffar, Soumya Swaminathan
Institutions in high-income countries (HICs) are the main funders and generators of academic knowledge on health systems in low-income and middle-income countries (LMICs), and much too often this knowledge reflects their priorities rather than the needs of health systems in LMICs.1,2 This power imbalance between HICs and LMICs has been the focus of calls for reforms to global and HIC institutions.3,4 However, change must also come from within LMICs. To address this power imbalance, learning must be prioritised as a core part of strengthening health systems in LMICs.
Adnan A Hyder
The 3rd Global Ministerial Conference on Road Safety will be held in Stockholm, Sweden, on Feb 19–20, 2020, as the Decade of Action 2011–20 for global road safety comes to an end. Such summits are important for global road safety in many ways. First, they can bring political attention to road traffic injuries. Second, they can provide a stimulus for countries to assess their own situations and take action. Finally, they present an opportunity for the global community to track progress of road safety efforts over time.
Here is US President Donald Trump last week in his State of the Union Address: “A good life for American families also requires the most affordable, innovative, and high-quality healthcare system on Earth...Over 130 legislators in this chamber have endorsed legislation that would bankrupt our nation by providing free taxpayer-funded healthcare to millions of illegal aliens, forcing taxpayers to subsidise free care for anyone in the world who unlawfully crosses our borders...If forcing American taxpayers to provide unlimited free healthcare to illegal aliens sounds fair to you, then stand with the radical left.
Pharmacists across Europe have seen patients affected by shortages of hundreds of medicines. Rob Hyde reports.
With cases of novel coronavirus spreading worldwide, governments and institutions are getting ready for the first cases in Africa. Munyaradzi Makoni reports from Cape Town.
The two agencies have announced plans to work together to expand services, train health workers, and raise awareness. Talha Burki reports.
Tyler M Berzin, Eric J Topol
Today gastroenterologists face the challenge of how to perceive and interpret the high volume—about 30 high-definition frames per s—of rich visual data presented in real time during an endoscopy. Unlike many other medical image scenarios, gastroenterologists must make diagnostic decisions in real time since procedures, such as taking a biopsy or removing a polyp, are immediately influenced by the visual findings. Computer vision applied to endoscopy has the potential to improve interpretation of images.
When it comes to research, Giovanna Mallucci, an Associate Director of Cambridge University's UK Dementia Research Institute (DRI) and van Geest Professor of Clinical Neuroscience, has a guiding maxim: let the data speak to you. “You might start with one idea”, she says. “But when the data don't agree with it, that's the truth and that's what you have to follow.” If this means a change of direction, with new thinking, so be it. A lot of what Mallucci herself has come up with, she admits, started out as an attempt to answer a different question.
Menopause sits at the intersection of ageism, ableism, and misogyny, which is why, particularly in western culture, it is still held in shadow, and treated as comedic and shameful. The cartoonish portrayal of the menopausal woman is typically someone who is overweight, sweaty, raging, and desexed, segueing from pitiful to invisible (particularly to men) in a few short years. In this well written memoir, Flash Count Diary: A New Story About the Menopause, Darcey Steinke states: “Many online essays urge me to laugh at myself more and complain less.
Losing any loved one is painful. Part, taught the Buddha, of the inescapable fate of us all. But losing a spouse, a life partner, is different—these are the people with whom we are most intimate, who we've chosen, who have chosen us to share the joys and burdens of life's journey. And, if we are blessed with mutual long lives, to share the wisdom, the pleasures and pains of ageing together. Medicine has known since antiquity that the loss of a spouse can have profound consequences for the surviving member of a couple.
Medical epidemiologist and Executive Director of WHO's Division for Universal Health Coverage. Born in Melbourne, VIC, Australia, on Dec 22, 1968, he died of a suspected heart attack in Geneva, Switzerland, on Jan 23, 2020, aged 51 years.
Anna E Thorson, Megan Foeller, Pura Rayco-Solon, Zita Weise Prinzo, João Paulo Souza, Juan Pablo Peña-Rosas
We commend Mija Ververs and Akanksha Arya1 for highlighting an urgent need for evidence-based breastfeeding guidance in the context of Ebola virus disease. In response to the ongoing Ebola outbreak, WHO assembled an expert panel to create recommendations and implementation guidance on breastfeeding, as informed by a systematic review of evidence. On Feb 10, 2020, WHO published recommendations for the management of pregnant and breastfeeding women in the context of Ebola virus disease.2
Shaohua Guo, Gary Tse, Tong Liu
We read with great interest the outcomes of the PERSEPHONE trial by Helena Earl and colleagues,1 reporting less cardiotoxicity in 6-month treatment with adjuvant trastuzumab than in 12-month treatment. The cardiotoxicity of trastuzumab has been evaluated in several studies. Chang and colleagues2 summarised that 1·7–4·1% of patients treated with trastuzumab developed heart failure when anthracycline was not part of the therapeutic regimen. In the clinical setting, trastuzumab provides substantial benefit to survival and reduction of cancer recurrence in patients with HER2-positive breast cancer.
Helena M Earl, Louise Hiller, Chris Plummer, David Miles, Andrew M Wardley, David A Cameron, Janet A Dunn
We thank Tong Liu and colleagues for their interest in our publication of the primary endpoint results of the PERSEPHONE trial.1 Liu and colleagues draw attention to reports of prophylactic cardiac medication to modify reductions in left ventricular ejection fraction (LVEF) from anthracyclines2 and trastuzumab3 therapy. These drugs will remain standard for many patients with HER2-positive, early breast cancer. Therefore, the possibility of cardioprotection with prophylactic cardiac medication is an important development.
Machteld MHT van Egmond, Maroeska M Rovers, Gerjon Hannink, Carine TM Hendriks, Niels van Heerbeek
We thank Alfonso Pendolino and colleagues, Neil Tan and Samuel Leong, and Basile Landis and Abel-Jan Tasman for the interest in our study, and welcome the opportunity to reply.
Barbara Gomes, Maja de Brito, Ana Forjaz de Lacerda, Duarte Soares
End-of-life care is one of the most neglected areas in Portugal's health system.1 In adults and children, deaths caused by conditions requiring palliative care are rising,2,3 and this aligns with global projections.4 Portugal has the fourth highest aged population in the world, and is predicted to have the third by 2050.5 There is a continuing trend towards dying in hospital,2,3 which is often against people's preferences.6 Falling investment in end-of-life care will diminish the chances of reversing this trend and affect the conditions in which people die in hospitals.
Hélène Mascitti, Ruxandra Calin, Aurélien Dinh, Sabrina Makhloufi, Benjamin Davido
Toscana virus (TOSV) belongs to the arthropod-borne virus. It is a common cause of meningitis or meningo-encephalitis in Mediterranean area, typically reported in Southern Europe (Cusi et al., 2010) (see Fig. 1). In the literature, numerous TOSV meningitis have been described, including complicated neurological disorders (Sanbonmatsu-Gámez et al., 2009; Baldelli et al., 2004). Only rare publications reported extra-meningeal involvement (Charrel et al., 2005), particularly two cases which reported a testicle pain (Baldelli et al., 2004; Zanelli et al., 2013).
Xiaosong Song, Lan Wen, Maolin Li, Xinyuan Yu, Lijun Wang, Kunyi Li
This study aimed to determine the characteristics and risk factors of adult new-onset seizure patients with tuberculous meningitis (TBM) during long-term follow-up.
Qinqin Yan, Shuyi Yang, Jie Shen, Shuihua Lu, Fei Shan, Yuxin Shi
Z. Du et al.
Hyeri Seok, Juhyun Song, Ji Hoon Jeon, Hee Kyoung Choi, Won Suk Choi, Sungwoo Moon, Dae Won Park
We evaluated the effect of timing and appropriateness of antibiotics administration on mortality in patients diagnosed with sepsis according to the Sepsis-3 definition.
Henan Xin, Xuefang Cao, Haoran Zhang, Jianmin Liu, Shouguo Pan, Xiangwei Li, Ling Guan, Fei Shen, Zisen Liu, Dakuan Wang, Xueling Guan, Jiaoxia Yan, Hengjing Li, Boxuan Feng, Mingxia Zhang, Qianting Yang, Qi Jin, Lei Gao, for the LATENTTB-NSTM study team
Using QuantiFERON-TB Gold In-Tube (QFT-GIT) for monitoring tuberculosis (TB) and latent TB infection (LTBI) treatment effect is controversial. The present study aims to evaluate the dynamic changes of interferon gamma (IFN-γ) levels along with LTBI treatment based on a randomized controlled study.
Marcellin F, Miailhes P, Santos M, et al.
Wiesenfeld H, Meyn L, Darville T, et al.
AbstractBackgroundAnaerobic organisms are important pathogens in acute pelvic inflammatory disease (PID). The currently recommended PID regimen of a single dose of ceftriaxone and doxycycline for 14 days has limited anaerobic activity. The need for broader anaerobic coverage is unknown and concerns have been raised about metronidazole tolerability.MethodsWe conducted a randomized, double-blind placebo-controlled trial comparing ceftriaxone 250 mg IM single dose and doxycycline for 14 days, with or without 14 days of metronidazole in women with acute PID. The primary outcome was clinical improvement at 3 days following enrollment. Additional outcomes at 30 days following treatment were the presence of anaerobic organisms in the endometrium, clinical cure (absence of fever and reduction in tenderness), adherence and tolerability.ResultsWe enrolled 233 women (116 to metronidazole and 117 to placebo). Clinical improvement at 3 days was similar between the two groups. At 30 days following treatment, anaerobic organisms were less frequently recovered from the endometrium in women treated with metronidazole than placebo (8% vs 21%, p
Loh K, Zhong Y, Lin L, et al.
Satlin M, Lewis J, II, Weinstein M, et al.
AbstractRecent data on polymyxin pharmacokinetics (PK), pharmacodynamics (PD), toxicity and clinical outcomes suggest these agents have limited clinical utility. PK-PD data show a steady state concentration of 2 ug/mL is required for killing bacteria with colistin minimum inhibitory concentrations (MICs) of 2 ug/mL. Less than 50% of patients with normal renal function achieve this exposure and it is associated with high risk of nephrotoxicity. This exposure does not achieve bacterial stasis in pneumonia models. Randomized and observational studies consistently demonstrate increased mortality for polymyxins compared to alternative agents. CLSI and EUCAST are two global organizations that establish interpretive criteria for in vitro susceptibility data. CLSI has recently taken the step to eliminate the “susceptible” interpretive category for the polymyxins, whereas EUCAST maintains this interpretive category. This viewpoint describes the opinions of the two organizations and the data that were used to inform their perspectives.
McCreery R, Cawcutt K, Cortes-Penfield N, et al.
To the Editor—Johnson, Brown, and Priest recently reported a randomized, open-label study of oral vancomycin prophylaxis (OVP) for hospitalized patients at elevated risk of healthcare facility–onset (HCFO) Clostridioides difficile infection (CDI) . Randomizing 106 such patients to receive either OVP or no prophylaxis for the duration of systemic antibiotic therapy plus an additional 5 days, the authors reported that OVP reduced the frequency of HCFO-CDI (0% vs 12% among the 100 evaluated patients; P = .03). They conclude that “once-daily oral vancomycin was a clinically efficacious, well-tolerated, cost-effective option for patients at risk for developing HCFO-CDI while hospitalized.”
Scrub typhus is an acute febrile illness caused by the obligate intracellular bacterium, Orientia tsutsugamushi. Immunochromatography (ICT) and IgM ELISA are two of the routinely employed antibody based assays for diagnosis of Scrub typhus fever in Nepal, although the recommended gold standard diagnostic test is IgM Immunofluorescence assay (IFA). This study evaluated InBios Scrub Typhus Detect™ Immunoglobulin M (IgM) ELISA and IgM Immunofluorescence assays in single serum sample at the time of admission.
Study participants (1585 suspected cases), were enrolled based on acute febrile illness with suspected scrub typhus cases in central Nepal. Blood sample was collected from the suspected patients of scrub typhus, presenting with acute febrile illness. IgM antibody to Orientia tsusugamushi was detected by using Scrub Typhus Detect™ Kit and an in-house IgM IFA. The IFA assay was performed with the Gilliam, Karp, Kato strains and O. chuto antigens following the ARRL protocol.
Statistical analysis of IgM ELISA results when compared to reference test, IgM IFA results demonstrated the following characteristics, sensitivity 84.0% (95%CI: 79.73–87.68%), specificity 94.82% (95% CI: 93.43–95.99%), positive likelihood ratio 16.21% (95% CI: 12.71–20.67%), negative likelihood ratio 0.17% (95% CI: 0.13–0.21%), disease prevalence 22.08% (95% CI: 20.06 -24.21%), positive predictive value 82.12% (95% CI: 78.28–85.42%) and negative predictive value 95.44% (95% CI: 94.27–96.38%) respectively.
Although IgM IFA is considered the gold standard test for the diagnosis of scrub typhus cases, it is relatively expensive, requires trained personal and a microscope with fluorescence filters. Scrub typhus IgM ELISA may be the best alternative test and possible viable option for resource limited endemic countries like Nepal.
Currently, Staphylococcus aureus is one of the most important pathogens worldwide, especially for methicillin-resistant S. aureus (MRSA) infection. However, few reports referred to patients’ MRSA infections in Yunnan province, southwest China.
In this study, we selected representative MRSA strains from patients’ systemic surveillance in Yunnan province of China, performed the genomic sequencing and compared their features, together with some food derived strains.
Among sixty selective isolates, forty strains were isolated from patients, and twenty isolated from food. Among the patients’ strains, sixteen were recognized as community-acquired (CA), compared with 24 for hospital-acquired (HA). ST6-t701, ST59-t437 and ST239-t030 were the three major genotype profiles. ST6-t701 was predominated in food strains, while ST59-t437 and ST239-t030 were the primary clones in patients. The clinical features between CA and HA-MRSA of patients were statistical different. Compared the antibiotic resistant results between patients and food indicated that higher antibiotic resistant rates were found in patients’ strains. Totally, the average genome sizes of 60 isolates were 2.79 ± 0.05 Mbp, with GC content 33% and 84.50 ± 0.20% of coding rate. The core genomes of these isolates were 1593 genes. Phylogenetic analysis based on pan-genome and SNP of strains showed that five clustering groups were generated. Clustering ST239-t030 contained all the HA-MRSA cases in this study; clustering ST6-t701 referred to food and CA-MRSA infections in community; clustering ST59-t437 showed the heterogeneity for provoking different clinical diseases in both community and hospital. Phylogenetic tree, incorporating 24 isolates from different regions, indicated ST239-t030 strains in this study were more closely related to T0131 isolate from Tianjin, China, belonged to ‘Turkish clade’ from Eastern Europe; two groups of ST59-t437 clones of MRSA in Yunnan province were generated, belonged to the ‘Asian-Pacific’ clone (AP) and ‘Taiwan’ clone (TW) respectively.
ST239-t030, ST59-t437 and ST6-t701 were the three major MRSA clones in Yunnan province of China. ST239-t030 clonal Yunnan isolates demonstrated the local endemic of clone establishment for a number of years, whereas ST59-t437 strains revealed the multi-origins of this clone. In general, genomic study on epidemic clones of MRSA in southwest China provided the features and evolution of this pathogen.
International Congress on Infectious Diseases (ICID) 2020
Kuala Lumpur, Malaysia
20.02.2020 - 23.02.2020
Dansk Selskab for Intern Medicin (DSIM) årsmøde og overrækkelse af Hagedorn prisen 2020
Novo Nordisk Fonden, Tuborg Havnevej 19, 2900 Hellerup
Conference on Retroviruses and Opportunistic Infections (CROI) 2020
Boston, Massachusetts, USA
8.03.2020 - 11.03.2020
Når CROI går i fisk - med transmissioner fra CROI 2020
10.03.2020 - 11.03.2020
World TB day 2020
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Yield, Efficiency and Costs of Mass Screening Algorithms for Tuberculosis in Brazilian Prisons
17.02.2020Clinical Infectious Diseases Advance Access
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Hvad mener Professor Jens Lundgren om artiklen"Dolutegravir plus Two Different Prodrugs of Tenofovir to Treat HIV."?
Hvad tænker Professor Troels Lillebæk om"The global prevalence of latent tuberculosis: a systematic review and meta-analysis."?
Hvad synes Professor Lars Østergaard om"Efficacy of antibiotic treatment in patients with chronic low back pain and Modic changes (the AIM study): double blind, randomised, placebo controlled, multicentre trial."?
Hvad synes Professor Thomas Benfield om"Oral versus Intravenous Antibiotics for Bone and Joint Infection."?
Hvad tænker Professor Niels Obel om"Early, Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis."?
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