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Journal Cover The Lancet
  [SJR: 14.638]   [H-I: 600]   [2247 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
   Published by Elsevier Homepage  [3118 journals]
  • Tranexamic acid: is it about time'
    • Authors: David J Dries
      Pages: 97 - 98
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): David J Dries


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)32806-4
       
  • Nutrition in the ICU: sometimes route does matter
    • Authors: Lisa Van Dyck; Michael P Casaer
      Pages: 98 - 100
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Lisa Van Dyck, Michael P Casaer


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)32815-5
       
  • Scaling up integration of health services
    • Authors: Erin K Ferenchick; Kumanan Rasanathan; Nuria Toro Polanco; Olga Bornemisza; Edward Kelley; Viviana Mangiaterra
      Pages: 102 - 103
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Erin K Ferenchick, Kumanan Rasanathan, Nuria Toro Polanco, Olga Bornemisza, Edward Kelley, Viviana Mangiaterra


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30020-5
       
  • Chronic liver disease: scavenger hunt for novel therapies
    • Authors: Daniel A Patten; Shishir Shetty
      Pages: 104 - 105
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Daniel A Patten, Shishir Shetty


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)32671-5
       
  • Offline: Time to act on minimum unit pricing of alcohol
    • Authors: Richard Horton
      First page: 106
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Richard Horton


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30059-x
       
  • Malaysia: a refugee conundrum
    • Authors: Adam Bemma
      Pages: 107 - 108
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Adam Bemma


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30052-7
       
  • Iranian protests and Rouhanicare
    • Authors: Sharmila Devi
      First page: 109
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Sharmila Devi


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30053-9
       
  • Doctors disagree with proposed medical bill in India
    • Authors: Patralekha Chatterjee
      First page: 110
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Patralekha Chatterjee


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30054-0
       
  • A literary pain scale
    • Authors: Ann Jurecic
      First page: 111
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Ann Jurecic


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30022-9
       
  • Truth and information
    • Authors: Marco De Ambrogi
      First page: 112
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Marco De Ambrogi


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30023-0
       
  • Man-made disaster
    • Authors: Michael Marmot
      Pages: 113 - 114
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Michael Marmot


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)33322-6
       
  • Natalia Kanem: lifelong advocate for women's health and rights
    • Authors: John Zarocostas
      First page: 115
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): John Zarocostas


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)33323-8
       
  • Changing minds about changing behaviour
    • Authors: Theresa M Marteau
      Pages: 116 - 117
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Theresa M Marteau


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)33324-x
       
  • Shila Kaur
    • Authors: Andrew Green
      First page: 118
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Andrew Green


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)33325-1
       
  • Saving the Joint Comprehensive Plan of Action: full of hope or just
           hopeless'
    • Authors: Masoud Mozafari
      First page: 119
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Masoud Mozafari


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30011-4
       
  • Treaty to prohibit nuclear weapons and Germany's global health
           responsibility
    • Authors: Kayvan Bozorgmehr; Eva-Maria Schwienhorst-Stich
      Pages: 119 - 120
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Kayvan Bozorgmehr, Eva-Maria Schwienhorst-Stich


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30012-6
       
  • Singapore should play a strong leadership role in global health
    • Authors: Tikki Pang
      First page: 120
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Tikki Pang


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30013-8
       
  • Questions regarding the CONCERN trial
    • Authors: Ricky D Turgeon
      First page: 121
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Ricky D Turgeon


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)32450-9
       
  • Questions regarding the CONCERN trial – Authors' reply
    • Authors: Francis K L Chan; Jessica Y L Ching; Yee Kit Tse; Moe H Kyaw
      First page: 121
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Francis K L Chan, Jessica Y L Ching, Yee Kit Tse, Moe H Kyaw


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)32428-5
       
  • Translation of the link between cancer and obesity to patients
    • Authors: Dalia Abdulhussein; Elham Amin
      Pages: 121 - 122
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Dalia Abdulhussein, Elham Amin


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30014-x
       
  • GRECCAR2 trial: details worthy of more attention
    • Authors: Huixun Jia; Yun Guan; Ji Zhu
      First page: 122
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Huixun Jia, Yun Guan, Ji Zhu


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30015-1
       
  • GRECCAR2 trial: details worthy of more attention – Authors' reply
    • Authors: Eric Rullier; Véronique Vendrely; Quentin Denost; Julien Asselineau; Adélaïde Doussau
      Pages: 122 - 123
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Eric Rullier, Véronique Vendrely, Quentin Denost, Julien Asselineau, Adélaïde Doussau


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30016-3
       
  • Pitfalls of the healthy vaccinee effect
    • Authors: Salaheddin M Mahmud; Christiaan H Righolt
      First page: 123
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Salaheddin M Mahmud, Christiaan H Righolt


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30017-5
       
  • Pitfalls of the healthy vaccinee effect – Authors' reply
    • Authors: Helen Petousis-Harris; Janine Paynter; Jane Morgan; Peter Saxton; Felicity Goodyear-Smith; Steven Black
      Pages: 123 - 124
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Helen Petousis-Harris, Janine Paynter, Jane Morgan, Peter Saxton, Felicity Goodyear-Smith, Steven Black


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30018-7
       
  • Effect of treatment delay on the effectiveness and safety of
           antifibrinolytics in acute severe haemorrhage: a meta-analysis of
           individual patient-level data from 40 138 bleeding patients
    • Authors: Angèle Gayet-Ageron; David Prieto-Merino; Katharine Ker; Haleema Shakur; François-Xavier Ageron; Ian Roberts; Aasia Kayani; Amber Geer; Bernard Ndungu; Bukola Fawole; Catherine Gilliam; Cecelia Adetayo; Collette Barrow; Danielle Beaumont; Danielle Prowse; David I'Anson; Eni Balogun; Hakim Miah; Haleema Shakur; Ian Roberts; Imogen Brooks; Julio Onandia; Katharine Ker; Kiran Javaid; Laura Suncuan; Lauren Frimley; Mia Reid; Monica Arribas; Myriam Benyahia; Olujide Okunade; Phil Edwards; Rizwana Chaudhri; Sergey Kostrov; Sneha Kansagra; Tracey Pepple
      Pages: 125 - 132
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Angèle Gayet-Ageron, David Prieto-Merino, Katharine Ker, Haleema Shakur, François-Xavier Ageron, Ian Roberts
      Background Antifibrinolytics reduce death from bleeding in trauma and post-partum haemorrhage. We examined the effect of treatment delay on the effectiveness of antifibrinolytics. Methods We did an individual patient-level data meta-analysis of randomised trials done with more than 1000 patients that assessed antifibrinolytics in acute severe bleeding. We identified trials done between Jan 1, 1946, and April 7, 2017, from MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, PubMed, Popline, and the WHO International Clinical Trials Registry Platform. The primary measure of treatment benefit was absence of death from bleeding. We examined the effect of treatment delay on treatment effectiveness using logistic regression models. We investigated the effect of measurement error (misclassification) in sensitivity analyses. This study is registered with PROSPERO, number 42016052155. Findings We obtained data for 40 138 patients from two randomised trials of tranexamic acid in acute severe bleeding (traumatic and post-partum haemorrhage). Overall, there were 3558 deaths, of which 1408 (40%) were from bleeding. Most (884 [63%] of 1408) bleeding deaths occurred within 12 h of onset. Deaths from post-partum haemorrhage peaked 2–3 h after childbirth. Tranexamic acid significantly increased overall survival from bleeding (odds ratio [OR] 1·20, 95% CI 1·08–1·33; p=0·001), with no heterogeneity by site of bleeding (interaction p=0·7243). Treatment delay reduced the treatment benefit (p<0·0001). Immediate treatment improved survival by more than 70% (OR 1·72, 95% CI 1·42–2·10; p<0·0001). Thereafter, the survival benefit decreased by 10% for every 15 min of treatment delay until 3 h, after which there was no benefit. There was no increase in vascular occlusive events with tranexamic acid, with no heterogeneity by site of bleeding (p=0·5956). Treatment delay did not modify the effect of tranexamic acid on vascular occlusive events. Interpretation Death from bleeding occurs soon after onset and even a short delay in treatment reduces the benefit of tranexamic acid administration. Patients must be treated immediately. Further research is needed to deepen our understanding of the mechanism of action of tranexamic acid. Funding UK NIHR Health Technology Assessment programme, Pfizer, BUPA Foundation, and J P Moulton Charitable Foundation (CRASH-2 trial). London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation (WOMAN trial).

      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)32455-8
       
  • Enteral versus parenteral early nutrition in ventilated adults with shock:
           a randomised, controlled, multicentre, open-label, parallel-group study
           (NUTRIREA-2)
    • Authors: Jean Reignier; Julie Boisramé-Helms; Laurent Brisard; Jean-Baptiste Lascarrou; Ali Ait Hssain; Nadia Anguel; Laurent Argaud; Karim Asehnoune; Pierre Asfar; Frédéric Bellec; Vlad Botoc; Anne Bretagnol; Hoang-Nam Bui; Emmanuel Canet; Daniel Da Silva; Michael Darmon; Vincent Das; Jérôme Devaquet; Michel Djibre; Frédérique Ganster; Maité Garrouste-Orgeas; Stéphane Gaudry; Olivier Gontier; Claude Guérin; Bertrand Guidet; Christophe Guitton; Jean-Etienne Herbrecht; Jean-Claude Lacherade; Philippe Letocart; Frédéric Martino; Virginie Maxime; Emmanuelle Mercier; Jean-Paul Mira; Saad Nseir; Gael Piton; Jean-Pierre Quenot; Jack Richecoeur; Jean-Philippe Rigaud; René Robert; Nathalie Rolin; Carole Schwebel; Michel Sirodot; François Tinturier; Didier Thévenin; Bruno Giraudeau; Amélie Le Gouge; Hervé Dupont; Marc Pierrot; François Beloncle; Danièle Combaux; Romain Mercier; Hadrien Winiszewski; Gilles Capellier; Gilles Hilbert; Didier Gruson; Pierre Kalfon; Bertrand Souweine; Elizabeth Coupez; Jean-Damien Ricard; Jonathan Messika; François Bougerol; Pierre-Louis Declercq; Auguste Dargent; Audrey Large; Djillali Annane; Bernard Clair; Agnès Bonadona; Rebecca Hamidfar; Christian Richard; Mathieu Henry-Lagarrigue; Ahiem Yehia Yehia; Johanna Temime; Stephanie Barrailler; Raphaël Favory; Erika Parmentier-Decrucq; Mercé Jourdain; Loredana Baboi; Marie Simon; Thomas Baudry; Mehran Monchi; Jérôme Roustan; Patrick Bardou; Alice Cottereau; Philippe Guiot; Noelle Brule; Mickael Landais; Antoine Roquilly; Thierry Boulain; Dalila Benzekri; Benoit Champigneulle; Jalel Tahiri; Gabriel Preda; Benoit Misset; Virginie Lemiale; Lara Zafrani; Muriel Fartoukh; Guillaume Thiéry; Delphine Chatellier; Rémi Coudroy; Renaud Chouquer; Samuel Gay; Christine Brasse; Arnaud Delahaye; Gabriel Preda; Luis Ferreira; Régine Vermesch; Stéphanie Chevalier; Charlotte Quentin; Quentin Maestraggi; Francis Schneider; Ferhat Meziani; Charles Cerf; Grégoire Trebbia; Charlotte Salmon-Gandonnière; Laetitia Bodet-Contentin
      Pages: 133 - 143
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Jean Reignier, Julie Boisramé-Helms, Laurent Brisard, Jean-Baptiste Lascarrou, Ali Ait Hssain, Nadia Anguel, Laurent Argaud, Karim Asehnoune, Pierre Asfar, Frédéric Bellec, Vlad Botoc, Anne Bretagnol, Hoang-Nam Bui, Emmanuel Canet, Daniel Da Silva, Michael Darmon, Vincent Das, Jérôme Devaquet, Michel Djibre, Frédérique Ganster, Maité Garrouste-Orgeas, Stéphane Gaudry, Olivier Gontier, Claude Guérin, Bertrand Guidet, Christophe Guitton, Jean-Etienne Herbrecht, Jean-Claude Lacherade, Philippe Letocart, Frédéric Martino, Virginie Maxime, Emmanuelle Mercier, Jean-Paul Mira, Saad Nseir, Gael Piton, Jean-Pierre Quenot, Jack Richecoeur, Jean-Philippe Rigaud, René Robert, Nathalie Rolin, Carole Schwebel, Michel Sirodot, François Tinturier, Didier Thévenin, Bruno Giraudeau, Amélie Le Gouge
      Background Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition. Methods In this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20–25 kcal/kg per day), within 24 h after intubation. Randomisation was stratified by centre using permutation blocks of variable sizes. Given that route of nutrition cannot be masked, blinding of the physicians and nurses was not feasible. Patients receiving parenteral nutrition could be switched to enteral nutrition after at least 72 h in the event of shock resolution (no vasopressor support for 24 consecutive hours and arterial lactate <2 mmol/L). The primary endpoint was mortality on day 28 after randomisation in the intention-to-treat-population. This study is registered with ClinicalTrials.gov, number NCT01802099. Findings After the second interim analysis, the independent Data Safety and Monitoring Board deemed that completing patient enrolment was unlikely to significantly change the results of the trial and recommended stopping patient recruitment. Between March 22, 2013, and June 30, 2015, 2410 patients were enrolled and randomly assigned; 1202 to the enteral group and 1208 to the parenteral group. By day 28, 443 (37%) of 1202 patients in the enteral group and 422 (35%) of 1208 patients in the parenteral group had died (absolute difference estimate 2·0%; [95% CI −1·9 to 5·8]; p=0·33). Cumulative incidence of patients with ICU-acquired infections did not differ between the enteral group (173 [14%]) and the parenteral group (194 [16%]; hazard ratio [HR] 0·89 [95% CI 0·72–1·09]; p=0·25). Compared with the parenteral group, the enteral group had higher cumulative incidences of patients with vomiting (406 [34%] vs 246 [20%]; HR 1·89 [1·62–2·20]; p<0·0001), diarrhoea (432 [36%] vs 393 [33%]; 1·20 [1·05–1·37]; p=0·009), bowel ischaemia (19 [2%] vs five [<1%]; 3·84 [1·43–10·3]; p=0·007), and acute colonic pseudo-obstruction (11 [1%] vs three [<1%]; 3·7 [1·03–13·2; p=0·04). Interpretation In critically ill adults with shock, early isocaloric enteral nutrition did not reduce mortality or the risk of secondary infections but was associated with a greater risk of digestive complications compared with early isocaloric parenteral nutrition. Funding La Roche-sur-Yon Departmental Hospital and French Ministry of Health.

      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)32146-3
       
  • Oral fexinidazole for late-stage African Trypanosoma brucei gambiense
           
    • Authors: Victor Kande Betu Ku Mesu; Wilfried Mutombo Kalonji; Clélia Bardonneau; Olaf Valverde Mordt; Séverine Blesson; François Simon; Sophie Delhomme; Sonja Bernhard; Willy Kuziena; Jean-Pierre Fina Lubaki; Steven Lumeya Vuvu; Pathou Nganzobo Ngima; Hélène Mahenzi Mbembo; Médard Ilunga; Augustin Kasongo Bonama; Josué Amici Heradi; Jean Louis Lumaliza Solomo; Guylain Mandula; Lewis Kaninda Badibabi; Francis Regongbenga Dama; Papy Kavunga Lukula; Digas Ngolo Tete; Crispin Lumbala; Bruno Scherrer; Nathalie Strub-Wourgaft; Antoine Tarral
      Pages: 144 - 154
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Victor Kande Betu Ku Mesu, Wilfried Mutombo Kalonji, Clélia Bardonneau, Olaf Valverde Mordt, Séverine Blesson, François Simon, Sophie Delhomme, Sonja Bernhard, Willy Kuziena, Jean-Pierre Fina Lubaki, Steven Lumeya Vuvu, Pathou Nganzobo Ngima, Hélène Mahenzi Mbembo, Médard Ilunga, Augustin Kasongo Bonama, Josué Amici Heradi, Jean Louis Lumaliza Solomo, Guylain Mandula, Lewis Kaninda Badibabi, Francis Regongbenga Dama, Papy Kavunga Lukula, Digas Ngolo Tete, Crispin Lumbala, Bruno Scherrer, Nathalie Strub-Wourgaft, Antoine Tarral
      Background Few therapeutic options are available to treat the late-stage of human African trypanosomiasis, a neglected tropical disease, caused by Trypanosoma brucei gambiense (g-HAT). The firstline treatment is a combination therapy of oral nifurtimox and intravenous eflornithine that needs to be administered in a hospital setting by trained personnel, which is not optimal given that patients often live in remote areas with few health resources. Therefore, we aimed to assess the safety and efficacy of an oral regimen of fexinidazole (a 2-substituted 5-nitroimidazole with proven trypanocidal activity) versus nifurtimox eflornithine combination therapy in patients with late-stage g-HAT. Methods In this randomised, phase 2/3, open-label, non-inferiority trial, we recruited patients aged 15 years and older with late-stage g-HAT from g-HAT treatment centres in the Democratic Republic of the Congo (n=9) and the Central African Republic (n=1). Patients were randomly assigned (2:1) to receive either fexinidazole or nifurtimox eflornithine combination therapy according to a predefined randomisation list (block size six). The funder, data management personnel, and study statisticians were masked to treatment. Oral fexinidazole was given once a day (days 1–4: 1800 mg, days 5–10: 1200 mg). Oral nifurtimox was given three times a day (days 1–10: 15 mg/kg per day) with eflornithine twice a day as 2 h infusions (days 1–7: 400 mg/kg per day). The primary endpoint was success at 18 months (ie, deemed as patients being alive, having no evidence of trypanosomes in any body fluid, not requiring rescue medication, and having a cerebrospinal fluid white blood cell count ≤20 cells per μL). Safety was assessed through routine monitoring. Primary efficacy analysis was done in the modified intention-to-treat population and safety analyses in the intention-to-treat population. The acceptable margin for the difference in success rates was defined as 13%. This study has been completed and is registered with ClinicalTrials.gov, number NCT01685827. Findings Between October, 2012, and November, 2016, 419 patients were pre-screened. Of the 409 eligible patients, 14 were not included because they did not meet all inclusion criteria (n=12) or for another reason (n=2). Therefore, 394 patients were randomly assigned, 264 to receive fexinidazole and 130 to receive nifurtimox eflornithine combination therapy. Success at 18 months was recorded in 239 (91%) patients given fexinidazole and 124 (98%) patients given nifurtimox eflornithine combination therapy, within the margin of acceptable difference of −6·4% (97·06% CI −11·2 to −1·6; p=0·0029). We noted no difference in the proportion of patients who experienced treatment-related adverse events (215 [81%] in the fexinidazole group vs 102 [79%] in the nifurtimox eflornithine combination therapy group). Treatment discontinuations were unrelated to treatment (n=2 [1%] in the fexinidazole group). Temporary nifurtimox eflornithine combination therapy interruption occurred in three (2%) patients. 11 patients died during the study (nine [3%] in the fexinidazole group vs two [2%] in the nifurtimox eflornithine combination therapy group). Interpretation Our findings show that oral fexinidazole is effective and safe for the treatment of T b gambiense infection compared with nifurtimox eflornithine combination therapy in late-stage HAT patients. Fexinidazole could be a key asset in the elimination of this fatal neglected disease. Funding Drugs for Neglected...
      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)32758-7
       
  • Thalassaemia
    • Authors: Ali T Taher; David J Weatherall; Maria Domenica Cappellini
      Pages: 155 - 167
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): Ali T Taher, David J Weatherall, Maria Domenica Cappellini
      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, compensatory haemopoietic expansion, hypercoagulability, and increased intestinal iron absorption. The complications of iron overload, arising from transfusions that represent the basis of disease management in most patients with severe thalassaemia, might further complicate the clinical phenotype. These pathophysiological mechanisms lead to an array of clinical manifestations involving numerous organ systems. Conventional management primarily relies on transfusion and iron-chelation therapy, as well as splenectomy in specific cases. An increased understanding of the molecular and pathogenic factors that govern the disease process have suggested routes for the development of new therapeutic approaches that address the underlying chain imbalance, ineffective erythropoiesis, and iron dysregulation, with several agents being evaluated in preclinical models and clinical trials.

      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)31822-6
       
  • Hyperparathyroidism
    • Authors: John P Bilezikian; Leonardo Bandeira; Aliya Khan; Natalie E Cusano
      Pages: 168 - 178
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): John P Bilezikian, Leonardo Bandeira, Aliya Khan, Natalie E Cusano
      Primary hyperparathyroidism is a common endocrine disorder of calcium metabolism characterised by hypercalcaemia and elevated or inappropriately normal concentrations of parathyroid hormone. Almost always, primary hyperparathyroidism is due to a benign overgrowth of parathyroid tissue either as a single gland (80% of cases) or as a multiple gland disorder (15–20% of cases). Primary hyperparathyroidism is generally discovered when asymptomatic but the disease always has the potential to become symptomatic, resulting in bone loss and kidney stones. In countries where biochemical screening tests are not common, symptomatic primary hyperparathyroidism tends to predominate. Another variant of primary hyperparathyroidism has been described in which the serum calcium concentration is within normal range but parathyroid hormone is elevated in the absence of any obvious cause. Primary hyperparathyroidism can be cured by removal of the parathyroid gland or glands but identification of patients who are best advised to have surgery requires consideration of the guidelines that are regularly updated. Recommendations for patients who do not undergo parathyroid surgery include monitoring of serum calcium concentrations and bone density.

      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)31430-7
       
  • Last nail in the coffin for PCI in stable angina'
    • Authors: David L Brown; Rita F Redberg
      Pages: 3 - 4
      Abstract: Publication date: 6–12 January 2018
      Source:The Lancet, Volume 391, Issue 10115
      Author(s): David L Brown, Rita F Redberg


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)32757-5
       
  • A SENIOR moment' Bare-metal stents in elderly patients
    • Authors: Robert T Gerber; Anthony H Gershlick
      Pages: 4 - 6
      Abstract: Publication date: 6–12 January 2018
      Source:The Lancet, Volume 391, Issue 10115
      Author(s): Robert T Gerber, Anthony H Gershlick


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)32803-9
       
  • Surgery versus endoscopy for patients with infected pancreatic necrosis
    • Authors: Douglas G Adler
      Pages: 6 - 8
      Abstract: Publication date: 6–12 January 2018
      Source:The Lancet, Volume 391, Issue 10115
      Author(s): Douglas G Adler


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)32344-9
       
  • Circadian rhythm and ischaemia–reperfusion injury
    • Authors: Thomas Bochaton; Michel Ovize
      Pages: 8 - 9
      Abstract: Publication date: 6–12 January 2018
      Source:The Lancet, Volume 391, Issue 10115
      Author(s): Thomas Bochaton, Michel Ovize


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)32177-3
       
  • Renewing the focus on health care for sexually assaulted children and
           adolescents
    • Authors: Rachel Jewkes
      Pages: 9 - 11
      Abstract: Publication date: 6–12 January 2018
      Source:The Lancet, Volume 391, Issue 10115
      Author(s): Rachel Jewkes


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)33362-7
       
  • The polio endgame: securing a world free of all polioviruses
    • Authors: Michel Zaffran; Michael McGovern; Reza Hossaini; Rebecca Martin; Jay Wenger
      Pages: 11 - 13
      Abstract: Publication date: 6–12 January 2018
      Source:The Lancet, Volume 391, Issue 10115
      Author(s): Michel Zaffran, Michael McGovern, Reza Hossaini, Rebecca Martin, Jay Wenger


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)32442-x
       
  • Offline: From 1918 to 2018—the lessons of influenza
    • Authors: Richard Horton
      First page: 14
      Abstract: Publication date: 6–12 January 2018
      Source:The Lancet, Volume 391, Issue 10115
      Author(s): Richard Horton


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30009-6
       
  • Syria: 7 years into a civil war
    • Authors: Sharmila Devi
      Pages: 15 - 16
      Abstract: Publication date: 6–12 January 2018
      Source:The Lancet, Volume 391, Issue 10115
      Author(s): Sharmila Devi


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30006-0
       
  • Zimbabwe post-Mugabe era: reconstructing a health system
    • Authors: Andrew Green
      Pages: 17 - 18
      Abstract: Publication date: 6–12 January 2018
      Source:The Lancet, Volume 391, Issue 10115
      Author(s): Andrew Green


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(18)30007-2
       
  • Using comics to change lives
    • Authors: Petra Boynton
      Pages: 19 - 20
      Abstract: Publication date: 6–12 January 2018
      Source:The Lancet, Volume 391, Issue 10115
      Author(s): Petra Boynton


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)33258-0
       
  • Tony Capon: the world's first professor of planetary health
    • Authors: Tony Kirby
      First page: 21
      Abstract: Publication date: 6–12 January 2018
      Source:The Lancet, Volume 391, Issue 10115
      Author(s): Tony Kirby


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)33251-8
       
  • In search of a teacher
    • Authors: Danielle Ofri
      Pages: 22 - 23
      Abstract: Publication date: 6–12 January 2018
      Source:The Lancet, Volume 391, Issue 10115
      Author(s): Danielle Ofri


      PubDate: 2018-01-15T07:17:22Z
      DOI: 10.1016/s0140-6736(17)33259-2
       
  • Children and social media
    • Authors: Lancet
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): The Lancet


      PubDate: 2018-01-15T07:17:22Z
       
  • A new vaccine for typhoid control
    • Authors: Lancet
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): The Lancet


      PubDate: 2018-01-15T07:17:22Z
       
  • Sanctioning the most vulnerable—a failed foreign policy
    • Authors: Lancet
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): The Lancet


      PubDate: 2018-01-15T07:17:22Z
       
  • Oral fexinidazole for human African trypanosomiasis
    • Authors: Chappuis
      Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116
      Author(s): François Chappuis


      PubDate: 2018-01-15T07:17:22Z
       
  • Department of Error
    • Abstract: Publication date: 13–19 January 2018
      Source:The Lancet, Volume 391, Issue 10116


      PubDate: 2018-01-15T07:17:22Z
       
  • The NHS at 70 and Alma-Ata at 40
    • Authors: Lancet
      Abstract: Publication date: 6–12 January 2018
      Source:The Lancet, Volume 391, Issue 10115
      Author(s): The Lancet


      PubDate: 2018-01-15T07:17:22Z
       
  • Vision quest: gene therapy for inherited vision loss
    • Abstract: Publication date: 6–12 January 2018
      Source:The Lancet, Volume 391, Issue 10115


      PubDate: 2018-01-15T07:17:22Z
       
  • Tuberculosis: criteria for global leadership'
    • Authors: Lancet
      Abstract: Publication date: 6–12 January 2018
      Source:The Lancet, Volume 391, Issue 10115
      Author(s): The Lancet


      PubDate: 2018-01-15T07:17:22Z
       
  • Personalised medicine in the UK
    • Authors: Lancet
      Abstract: Publication date: Available online 21 December 2017
      Source:The Lancet
      Author(s): The Lancet


      PubDate: 2017-12-27T10:51:46Z
       
 
 
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